Tag: pubmed

J Robot Surg. 2022 Oct 21. doi: 10.1007/s11701-022-01462-1. Online ahead of print.

ABSTRACT

Laparoscopic rectal surgery within the confines of a narrow pelvis may be associated with a high rate of open conversion. In the obese and morbidly obese patient, the complexity of laparoscopic surgery increases substantially. Robotic technology is known to reduce the risk of conversion, but it is unclear if it can overcome the technical challenges associated with obesity. The ACS NSQIP database was used to identify obese patients who underwent elective laparoscopic or robotic-assisted rectal resection from 2015 to 2016. Obesity was defined as a body mass index (BMI) greater than or equal to 30 kg/m². Morbid obesity was defined as a BMI greater than or equal to 35 kg/m². The primary outcome was unplanned conversions to open. Other outcomes measures assessed included anastomotic leak, operative time, surgical site infections, length of hospital stay, readmissions and mortality. Statistical analyses were performed using SPSS 22.0 (IBM SPSS, USA). 1490 patients had robotic-assisted and 4967 patients had laparoscopic rectal resections between 2015 and 2016. Of those patients, 561 obese patients had robotic-assisted rectal resections and 1824 patients underwent laparoscopic rectal surgery. In the obese cohort, the rate of unplanned conversion to open in the robotic group was 14% compared to 24% in the laparoscopic group (P < 0.0001). Median operative time was significantly longer in the robotic group (248 min vs. 215 min, P < 0.0001). There was no difference in anastomotic leak or systemic sepsis between the laparoscopic and robotic rectal surgery groups. In morbidly obese patients (BMI ≥ 35 kg/m²), the rate of unplanned conversion to open in the robotic group was 19% compared to 26% in the laparoscopic group (P < 0.027). There was no difference in anastomotic leak, systemic sepsis or surgical site infection rates between robotic and laparoscopic rectal resection. Multivariate analysis showed that robotic-assisted surgery was associated with fewer unplanned conversions to open (OR 0.28, P < 0.0001). Robotic-assisted surgery is associated with a decreased risk of conversion to open in obese and morbidly obese patients when compared to conventional laparoscopic surgery. However, robotic surgery was associated with longer operative time and despite improvement in the rate of conversion to open, there was no difference in complications or length of stay. Our findings are limited by the retrospective non-randomised nature of the study, demographic differences between the two groups, and the likely difference in surgeon experience between the two groups. Large randomised controlled studies are needed to further explore the role of robotic rectal surgery in obese and morbidly obese patients.

PMID:36269488 | DOI:10.1007/s11701-022-01462-1

Clin Oral Investig. 2022 Oct 21. doi: 10.1007/s00784-022-04717-1. Online ahead of print.

ABSTRACT

OBJECTIVES: This study evaluates the impact of systemic medications and polypharmacy on unstimulated (UWS) and chewing-stimulated whole saliva (SWS) flow rates in patients with xerostomia.

MATERIAL AND METHODS: This cross-sectional multicenter study is based on data of patients referred to five oral medicine outpatient practices in Europe and USA from January 2000 and April 2014. Relevant demographic, social, medical history and current medications were collected.

RESULTS: The study included 1144 patients, 972 (85%) females, with a mean (SD) age of 59 (14.1) years. In unmatched patients, the UWS flow rate was lower in patients taking a medication (vs. not taking a medication) from the following drug categories: opioid analgesics, anticonvulsants, antidepressants, antihypertensives, benzodiazepines, corticosteroids, diuretics, disease-modifying antirheumatic drugs (DMARDs) and hormones. There was a greater negative effect on SWS flow rate in patients taking (vs. not taking) anticonvulsants, antidepressants, benzodiazepines, corticosteroids, and DMARDs. In matched patients, both UWS (0.22 vs. 0.19 ml/min; p = 0.03) and SWS (0.97 vs. 0.85 ml/min; p = .017) flow rates were higher in patients on non-opioid analgesics (vs. not taking). The UWS flow rate was lower in patients taking antidepressants (vs. not taking) (0.16 vs. 0.22 ml/min p = .002) and higher (and within normal range) in patients taking sex hormones (vs. not taking) (0.25 vs. 0.16 ml/min; p = .005). On the other hand, SWS was lower in patients taking corticosteroid (vs. not taking) (0.76 vs. 1.07 ml/min; p = .002), and in patients taking DMARDs (vs. not taking) (0.71 vs. 0.98 ml/min; p = .021). Finally, differences in medians of both UWS and SWS were statistically significant in patients taking 1 or more than 1 opioid analgesic (vs. not taking, p ≤ .0001 and p = .031, respectively), 1 or more than 1 anticonvulsants (vs. not taking, p = .008 and p = .007), 1 or more than 1 antidepressants (vs. not taking, p < .0001 for both), 1 or more than 1 DMARDs (vs. not taking, p = .042, and p = .003).

CONCLUSIONS: A greater negative impact on UWS and SWS flow rates was seen in patients taking more than one medication from the same drug class. Intake of antidepressants, corticosteroids and DMARDs is associated with lower whole saliva flow rates.

CLINICAL RELEVANCE: Salivary flow rate can be modified by some specific medications, mostly by polypharmacy.

PMID:36269468 | DOI:10.1007/s00784-022-04717-1

Environ Monit Assess. 2022 Oct 17;194(12):899. doi: 10.1007/s10661-022-10585-9.

ABSTRACT

Total hardness (TH) is an important index representing the water suitability for domestic purpose. TH is represented mainly by Ca²⁺ and Mg²⁺ which are essential elements for human bone development. Between 2000 and 2015, the TH values of groundwater in major cities of the Guanzhong Plain varied significantly. The study was carried out to investigate TH variation over 16 years and to examine how effective the grey Markov model was in predicting TH concentrations in time series datasets. The hydrochemical parameters determining TH concentration and their origins were investigated using statistical analysis and geochemical models. The grey Markov model, which is effective in short time series prediction, was used to forecast the multi-time series of TH. The findings demonstrated a prevalence of HCO₃^– and SO₄^2- in the groundwater types combined with calcite precipitation, gypsum, and dolomite dissolution that increased the concentration of Ca²⁺, Mg²⁺, and HCO₃^–, influencing TH variation. The predicted TH values of the eight monitoring wells for the year 2016 were 1213.66, 124.30, 203.66, 103.01, 349.56, 251.23, 453.31, and 471.81 mg/L, respectively. Datasets with low TH variation were more accurately predicted than datasets with high TH variation. This was especially observed on sample B557 where TH concentration in 2010 was 400.33 mg/L and suddenly dropped to 90.1, 82.6, 85.1, 87.6, and 75.1 mg/L in 2011, 2012, 2013, 2014, and 2015, respectively. The study also shows that the Markov chain model can optimize the GM(1,1) model and improve the prediction accuracy significantly. All samples in Weinan City and one sample in Xi’an City showed a significant decrease in TH concentration. Except one sample in Xi’an City, TH concentrations tended to rise in the other cities (Baoji, Xianyang) of the Guanzhong Plain. This study verified the reliability of the grey Markov model in terms of forecasting time series datasets with high variability, and the results can be referential to similar studies in the world.

PMID:36269437 | DOI:10.1007/s10661-022-10585-9

Environ Monit Assess. 2022 Oct 21;195(1):6. doi: 10.1007/s10661-022-10567-x.

ABSTRACT

Pen shell species such as Pinna bicolor and Pinna deltodes are found in the muddy region associated with intertidal seagrass in the coastal area of Pudupattinam. The pen shell is one of the sources of animal protein-rich, thereby encouraging the community of pen shells and their study worldwide. The water samples were collected for a year between January to December 2016 and analysed. Salinity (30.1-31.5‰), pH (8.1-8.2), EC value (39.79 103-46.09103 mho), turbidity 25-54 NTU, TSS value (5.51-108 mg/l), DO (4.45-5.74 ml/l), BOD (0.175 -1.05 mg/l), chemical oxygen demand (9.6-39.1 mg/l), chloride 14,276.8-16,124.9 mg/l), sulphate (1975.3-25 mg/l), ammonia (0.022-0.112 μm/l), inorganic phosphate (0.754 μm/l and maximum 1.568 μm/l), total nitrogen (10.829-29.509 μm/l), total phosphate (1.76-3.174 μm/l) and silicate (42.264-64.121 μm/l). Minimum and maximum water temperature ranges (26.9-30.6 °C) were recorded. A total of 623 Pinna bicolor and 1341 Pinna deltodes were collected during the same time and consisted of 305 males and 318 females and 558 males and 783 females, respectively. The improvements in the parameters of physico-chemical and statistical analysis have been shown to have a minor effect on the distribution of these two species in the present research, as environmental factors were not sufficient to influence their distribution.

PMID:36269436 | DOI:10.1007/s10661-022-10567-x

Environ Monit Assess. 2022 Oct 21;195(1):5. doi: 10.1007/s10661-022-10648-x.

ABSTRACT

The cationic and anionic composition in groundwater can be better understood by identifying the type of hydrogeochemical processes influencing groundwater chemistry. This research deals with the characterization of groundwater samples by considering the likely role of hydrogeochemical processes and the factors responsible for the weathering process. The study applies statistical methods and supervised machine learning algorithm (i.e., logistic regression model) on the large data set of 1300 water samples from the Lahore district of Punjab, Pakistan. All the water samples were collected by the local authorities from a deep unconfined aquifer (> 350 ft in depth) for the years of 2005 to 2016. The characterization of groundwater quality parameters includes pH, total dissolved solids (TDS), electrical conductivity (EC), total hardness (TH), calcium (Ca²⁺), magnesium (Mg²⁺), sodium (Na⁺), potassium (K⁺), chloride (Cl^–), bicarbonate (HCO₃^–), nitrate (NO₃^–), and sulfate (SO₄^2-). The results show the sequence of the major ion in the following order: Na⁺ > Ca²⁺ > Mg⁺ > K⁺ and HCO₃^2- > SO₄^2- > Cl^– > NO₃^–. The ionic ratios and Gibb’s plot revealed that the prominent hydrogeochemical facies of aquifer water is Ca-HCO₃, Ca-Na-HCO₃, and mixed Ca-Mg-Cl type rock-weathering process, especially carbonate and silicate weathering, as significant process controlling water chemistry. The statistical evaluation of the prepared regression model determined its prediction accuracy as 92.2%, which means the model is highly efficient and satisfies the analysis. The outcomes of this study favor the utilization of such methods for other areas with large data sets.

PMID:36269432 | DOI:10.1007/s10661-022-10648-x

Health Justice. 2022 Oct 21;10(1):31. doi: 10.1186/s40352-022-00194-6.

ABSTRACT

INTRODUCTION: Mass incarceration has mental health consequences on those directly affected; some studies have also shown spillover effects on the physical health of the surrounding population. There is a dearth of research on the spillover mental health consequences of mass incarceration. This study aimed to quantify a consequence of mass incarceration which may adversely affect the population’s health and widen health disparities.

METHODS: Using data from the Vera Institute’s Incarceration Trends 2.2 and the Robert Wood Johnson County Health Rankings, the association between county-level (n = 2823) counts of jail incarceration and reported number of poor mental health days within the past 30 days in the United States in 2018 was examined. To conduct the analysis, a negative binomial regression model was fit, adjusting for State and key demographic covariates.

RESULTS: A change in jail incarceration rate from the first to the second and third tertiles was associated with 10.14% and 14.52% increases, respectively. For every 1% increase in the rate of mass incarceration, there was a statistically significant 15% increase in the average number of reported poor mental health days over the past 30 days.

DISCUSSION: Mass incarceration is a threat to mental health as well as the well-being of the surrounding population. This can be attributed to the spillover effects that extend beyond those who are directly affected by mass incarceration. Interventions to reduce jail incarceration as well as address the mental health needs of those living in high-incarceration rate areas should be prioritized in order to reduce health inequities and augment health outcomes for all residents of the United States.

PMID:36269431 | DOI:10.1186/s40352-022-00194-6

Eur J Orthop Surg Traumatol. 2022 Oct 21. doi: 10.1007/s00590-022-03404-x. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to investigate the amount of saline required to identify a positive traumatic shoulder arthrotomy in a cadaveric model. In addition, intra-articular pressure monitoring was conducted to confirm needle placement and evaluate peak pressure curves prior to capsular failure.

METHODS: We conducted a cadaveric study using thirty fresh-frozen upper extremities with maintained glenohumeral joint. A shoulder arthrotomy was made in the deltopectoral interval using a 4.4-mm trocar. The joint was loaded using an 18-gauge spinal needle inserted posteriorly and attached to a pressure monitoring system. Fluid was introduced at a uniform rate of 1 cc/sec until active extravasation was visualized from the anterior arthrotomy site. Statistical analysis included assessment of distribution, ANOVA and linear regression.

RESULTS: A positive joint challenge was obtained in all specimens (n = 30) within a maximum of 59 ml of fluid (mean 28 ml, STD 15.4). Average intra-articular pressure at visualization (PAV) was 166.8 mmHg (min., 107; max., 268). In twelve specimens, peak pressures (PP) exceeded PAV, showing a corresponding fall in pressure prior to visualization (ΔPP-PAV = 16.5). To reach a sensitivity of 90% and 95% of arthrotomies, 50 and 58 ml of fluid had to be injected.

CONCLUSION: Results demonstrated 58 ml of fluid was required to identify a majority of shoulder arthrotomies. Intra-articular pressure monitoring identified successful needle placement. Pressure curve analysis could identify capsular failure before fluid extravasation visualization which could enhance clinical identification and treatment of traumatic shoulder arthrotomies.

LEVEL OF EVIDENCE: Level IV Diagnostic.

PMID:36269430 | DOI:10.1007/s00590-022-03404-x

Pediatr Nephrol. 2022 Oct 21. doi: 10.1007/s00467-022-05780-2. Online ahead of print.

ABSTRACT

BACKGROUND: Children with chronic kidney disease (CKD) are at risk for neurocognitive deficits while simultaneously being at risk for chronic school absenteeism (≥ 18 school days per school year). Chronic school absenteeism compounds the negative impacts of CKD on academic achievement. In this study, we examined patient- and caregiver-reported factors associated with school absenteeism in children with non-dialysis- or transplant-dependent CKD in order to help identify which factors could be modifiable and ultimately improve school attendance.

METHODS: We utilized a combination of chart review and questionnaires distributed in person to patients and caregivers at a pediatric nephrology clinic between November 2018 and August 2019 to gather data. We used descriptive statistics to illustrate clinical characteristics of the children included in the study, caregiver characteristics, and examined reported reasons for missing school.

RESULTS: Twenty-one percent of participants (10/48) missed 18 full days of school or more, categorizing them as chronically absent. The top three reasons for missing school were doctor appointments, feeling sick, and being bullied. More specific sequelae of CKD were not highly reported as reasons for missing school.

CONCLUSIONS: Chronic absenteeism is a highly reported phenomenon among children with pediatric CKD. Given that missing school for doctor appointments was a top reason for absenteeism, this data suggests alternative appointment hours and virtual appointments may reduce chronic school absenteeism in children, and by extension improve their health, behavioral, and academic outcomes. A higher resolution version of the Graphical abstract is available as Supplementary information.

PMID:36269405 | DOI:10.1007/s00467-022-05780-2

Graefes Arch Clin Exp Ophthalmol. 2022 Oct 21. doi: 10.1007/s00417-022-05849-6. Online ahead of print.

ABSTRACT

PURPOSE: To examine associations between the topographic distribution of geographic atrophy (GA) and vision-related quality of life (VRQoL).

METHODS: This study included 237 eyes from 161 participants in the Age-Related Eye Disease Study (AREDS). GA lesions were manually delineated with color fundus photographs obtained by the AREDS Research Group and atrophic area was measured in an Early Treatment Diabetic Retinopathy Study (ETDRS) grid. VRQoL was measured using the National Eye Institute Visual Function Questionnaire (NEI-VFQ). Area of atrophy in the ETDRS grid subfields was correlated with VRQoL by linear regression modeling.

RESULTS: The average area of atrophy in the better and worse eye was 3.43mm² and 7.15mm² respectively. In multivariable analysis, VRQoL was not associated with total area of atrophy in the better eye (β, – 0.53; 95% confidence interval [CI], – 1.11 to 0.05; P = 0.07) or worse eye (β, 0.12; 95% CI, – 0.32 to 0.55; P = 0.59). However, area of atrophy in the central 1-mm-diameter zone of the better eye was significantly associated with VRQoL when the ETDRS subfields were examined individually (β, – 14.57; 95% CI, – 27.12 to – 2.02; P = 0.023), grouped into quadrants (β, – 18.35; 95% CI, – 30.03 to – 6.67; P = 0.002), inner and outer zones (β, – 17.26; 95% CI, – 29.38 to – 5.14; P = 0.006), or vertical and horizontal zones (β, – 18.97; 95% CI, – 30.18 to – 7.77; P = 0.001).

CONCLUSION: In patients with GA, greater area of atrophy in the central 1-mm-diameter zone of the better eye was independently associated with lower VRQoL, while total area of atrophy in the better or worse eye was not.

PMID:36269402 | DOI:10.1007/s00417-022-05849-6

Arch Orthop Trauma Surg. 2022 Oct 21. doi: 10.1007/s00402-022-04648-2. Online ahead of print.

ABSTRACT

PURPOSE: Conventional instruments for total knee arthroplasty (TKA) have limited accuracy. The occurrence of outliers can negatively influence the clinical outcome and long-term survival of the implant. Orthopaedic robotic systems were developed to increase the accuracy of implant positioning and bone resections. Several systems requiring preoperative imaging have shown a higher degree of precision compared to conventional instrumentation. An imageless system needs less preoperative time and preparation and is more cost effective. Aim of this study was to find out whether this system is as precise, reproduces accurately the surgeon’s planning and reduces the occurrence of outliers.

METHODS: This retrospective study included the first 71 robotic-assisted TKA and 308 conventional TKA in 374 patients. Intraoperatively planned and actual bone resections were compared. Postoperative alignment, measured on full leg weight bearing radiographs, was related to the respective planning and statistically compared between the groups.

RESULTS: Baseline characteristics (age, BMI, ASA, preoperative Knee Society Score and deformity) between both groups were comparable. According to the planned alignment, the postoperative mean difference was – 1.01° in the robotic versus 2.05° in the conventional group. The maximum deviation was – 2/+ 2.5° in the robotic and – 6.6/ + 6.8° in the conventional group. According to the plan, there were no outliers above ± 3° in the robotic versus 24% in the conventional group. The mean difference between planned and measured bone resection was 0.21 mm with a maximum of 2 mm. The 95% confidence interval was at each position 1 mm or below.

CONCLUSIONS: The described imageless robotic system is accurate in terms of coronal alignment and bone resections. In precision, it is superior to conventional instrumentation and could therefore be used to evaluate new alignment concepts.

PMID:36269397 | DOI:10.1007/s00402-022-04648-2