Tag: pubmed

J Foot Ankle Surg. 2022 Oct 4:S1067-2516(22)00272-1. doi: 10.1053/j.jfas.2022.09.007. Online ahead of print.

ABSTRACT

Lateral column deterioration and subsequent loss of function poses a challenge for limb preservation in patients with Charcot neuroarthropathy (CN). Application of “superconstructs” provides stability and clinical improvement to an often-ulcerated lateral foot. This study examines radiodensity in Hounsfield units (HU) to compare bone quality of lateral column fixation targets using computed tomography (CT) scans between patients with and without midfoot CN. A retrospective chart review identified control (nondiabetic, non-CN; n = 29) and midfoot CN (n = 21) groups. Patient demographics and medical history were collected. Two reviewers measured the mean HU of circular regions of interest centered on the fourth and fifth metatarsal heads as well as the anterior, middle, and posterior thirds of the calcaneus. Radiodensity was compared between groups, among calcaneal locations, Eichenholtz stages and Brodsky types. A p value ≤.05 was considered statistically significant. Age and body mass index were not significantly different between groups. The CN group exhibited greater HU than the control group at the metatarsal head and calcaneus (p < .001). The anterior calcaneus exhibited greater HU than the posterior calcaneus in the CN group (p = .02). The difference in HU was not statistically significant between Stages 0-1 and Stages 2-3 or midfoot Brodsky Types. Indirect bone density analysis revealed an increased density in CN compared to control patients with no significant difference between midfoot CN stages or types. The anterior calcaneus was the densest rearfoot bone among the CN patients, a result that may have implications in surgical fixation.

PMID:36335049 | DOI:10.1053/j.jfas.2022.09.007

Eur Urol Focus. 2022 Nov 2:S2405-4569(22)00238-3. doi: 10.1016/j.euf.2022.10.009. Online ahead of print.

ABSTRACT

BACKGROUND: Penile curvature is the most debilitating symptom of Peyronie’s disease (PD); the evaluation of the degree of angulation is essential for planning treatment strategy. However, the most used method of penile at-home autophotography (AHP) is associated with some potential pitfalls and discrepancies compared with different assessment methods.

OBJECTIVE: To compare the degree of penile curvature quantified by AHP and in-office intracavernosal alprostadil injection (ICI) prior to therapy.

DESIGN, SETTING, AND PARTICIPANTS: Data from 55 PD patients of a single tertiary referral center were analyzed. All patients provided standardized AHP of the erect phallus. Clinic-based assessment included ICI with curvature measurement and completion of the International Index of Erectile Function (IIEF-15).

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The Wilcoxon and/or chi-square test was used to compare the degree of curvature obtained using AHP and ICI, and to evaluate whether erectile dysfunction was a predictor of a relevant difference of >10° in curvature assessment between AHP and ICI.

RESULTS AND LIMITATIONS: Our study showed a significant (p < 0.001) difference in the degree of penile curvature between AHP (48° [38°; 55°]) and ICI (50° [40°; 65°]). Patients suffering from erectile dysfunction tend to have a higher difference in the degree of penile curvature between AHP and ICI than patients with good erectile function (p < 0.001). Our study is not devoid of limitations. First, we did not use Peyronie’s Disease Questionnaire, as suggested by the European Association of Urology guidelines. Second, we did not evaluate inter- and intraobserver variations in the measurements.

CONCLUSIONS: AHP tends to underestimate the extent of penile curvature compared to ICI. Erectile dysfunction is an independent predictor of measurement differences of >10° between AHP and ICI.

PATIENT SUMMARY: It is necessary to evaluate the degree of penile curvature in Peyronie’s disease prior to therapy decision. The at-home self-photography underestimates the real degree of penile curvature compared with an erection by in-office penile drug injection. Especially men suffering from erectile dysfunction carry the risk of a high difference in the measured degree of penile curvature, with a potential impact on the further treatment.

PMID:36335039 | DOI:10.1016/j.euf.2022.10.009

Obes Res Clin Pract. 2022 Oct 31:S1871-403X(22)00117-X. doi: 10.1016/j.orcp.2022.10.011. Online ahead of print.

ABSTRACT

OBJECTIVES: We investigated the association between metabolic syndrome (MetS) and mortality among coronavirus disease 2019 (COVID-19) patients in Korea.

METHODS: We analyzed 3876 individuals aged ≥ 20 years who were confirmed with COVID-19 from January 1 to June 4, 2020 based on the Korea National Health Insurance Service (NHIS)-COVID-19 database and had undergone health examination by NHIS between 2015 and 2017. Multivariable Cox proportional hazard regression analyses were performed.

RESULTS: Of total participants, the prevalence of MetS was 21.0% (n = 815). During 58.6 days of mean follow-up, 3.1 % (n = 120) of the participants died. Compared to individuals without MetS, COVID-19 patients with MetS had a significantly increased mortality risk after adjusting for confounders in total participants (hazard ratio [HR]: 1.68, 95 % confidence interval [CI]: 1.14-2.47) and women (HR: 2.41, 95 % CI: 1.17-4.96). A low high-density lipoprotein cholesterol level in total participants (HR: 1.63, 95 % CI: 1.12-2.37) and hyperglycemia in women (HR: 1.97, 95 % CI: 1.01-3.84) was associated with higher mortality risk. The mortality risk increased as the number of MetS components increased among total participants and women (P for trend = 0.009 and 0.016, respectively). In addition, MetS groups had higher mortality risk in aged ≥ 60 years (HR: 1.60, 95 % CI: 1.07-2.39), and never-smokers (2.08, 1.21-3.59).

CONCLUSIONS: The presence of MetS and greater number of its components were associated with increased mortality risks particularly in female patients with COVID-19. Managing MetS may contribute to better outcomes of COVID-19.

PMID:36335025 | DOI:10.1016/j.orcp.2022.10.011

Clin Lymphoma Myeloma Leuk. 2022 Oct 7:S2152-2650(22)01691-3. doi: 10.1016/j.clml.2022.09.007. Online ahead of print.

ABSTRACT

PURPOSE: This study describes the treatment patterns and outcomes of patients with CLL/SLL in a de-identified real-world oncology electronic health records database.

METHODS: Adult patients with CLL/SLL were eligible if they had received cBTKi therapy, both a cBTKi and a BCL2i, or all 4 drug classes (cBTKi, BCL2i, rituximab, and chemotherapy) at any time during the first 5 lines of therapy. Time-to-event outcomes were evaluated using Kaplan Meier method. No statistical comparisons were conducted; all analyses were descriptive and conducted using SAS Enterprise.

RESULTS: A total of 9578 patients were eligible: 52.0% (n = 4983) received at least one cBTKi, 6.1% (n = 581) received both a cBTKi and BCL2i, and 2.3% (n = 218) received all four therapies (cBTKi, BCL2i, rituximab, and chemotherapy). Of those who discontinued these treatments, only 39.5% (n = 1 206/3 577), 59.7% (n = 228/382), and 55.0% (n = 82/149) received subsequent therapy (post-cBTKi, post-cBTKi/post-BCL2i, and post-all 4 therapies, respectively). Median time from treatment discontinuation of these therapies to the discontinuation of subsequent therapy or death was 9.5 months (all patients who discontinued the cBTKi) 5.6 months (those who discontinued both a cBTKi and BCL2i) and 3.9 months (patients who discontinued all four therapies). The median duration of the next treatment among those who received additional therapy was post-cBTKi treatment duration = 4.1 months; post-cBTKi/post-BCL2i treatment duration = 5.5 months; and median duration of the immediate next therapy after discontinuation of all 4 therapies = 5.1 months.

CONCLUSIONS: The poor outcomes observed across cohorts in this study demonstrate the need for effective treatments that can improve outcomes in patients with CLL/SLL.

PMID:36335022 | DOI:10.1016/j.clml.2022.09.007

Z Evid Fortbild Qual Gesundhwes. 2022 Nov 2:S1865-9217(22)00171-4. doi: 10.1016/j.zefq.2022.09.004. Online ahead of print.

ABSTRACT

INTRODUCTION: Germany ranks high concerning the per capita supply of computer tomographs (CT) and positron emission tomographs (PET) which may incentivize supply-induced use. Beyond that, international comparison shows high per capita examinations. However, misuse of diagnostic imaging may cause harm to patients and the health care system. The use of diagnostic imaging in Germany has been insufficiently studied so far. Therefore, the study aimed to determine the extent of regional differences as well as supply and demand side factors of per capita CT and PET examinations in German inpatient care.

METHODS: Cartographic visualizations and a random intercept model controlling for the regional disease burden, ambulatory provided supply and demand, and population deprivation between 2010 and 2017 for CT and between 2016 and 2017 for PET were applied. For this purpose, the Nationwide hospital discharge data (DRG statistics), hospital structured quality reports, the National Association of Statutory Health Insurance Physicians, the Central Research Institute of Ambulatory Health Care in Germany, and the German Index of Socioeconomic Deprivation were used.

RESULTS: We found a substantial regional variation of examination rates (-63 to +108% for CT and from -94 up to +847% for PET). Regarding PET, the supply structures have a significant impact on examinations per 1,000 inhabitants (28.46, p < .000). Both devices were used in correlation with the regional disease burden. Ambulatory and inpatient CT examination rates were positively associated.

DISCUSSION: The regional differences identified are to some extent attributable to the regional burden of disease and thus warranted. Although the inpatient PET supply influences utilization rates, the direction of the effect should be investigated more closely for valid statements. The findings in terms of CT should be treated with caution. The cartographic distribution and examination rates indicate global overuse. The clear separation of inpatient and ambulatory sectors leads to misallocation of scarce resources, medically unnecessary multiple examinations, and capacity utilization problems.

CONCLUSION: The results obtained have great potential for assessing and analyzing the adoption and rapid expansion of imaging technologies. Capacity utilization figures should be the focus of further research to assess utilization rates both economically and medically. Policy makers should address ongoing issues of operational and organizational separation of inpatient and ambulatory sectors in the German health care system.

PMID:36335010 | DOI:10.1016/j.zefq.2022.09.004

Fertil Steril. 2022 Nov 2:S0015-0282(22)01382-6. doi: 10.1016/j.fertnstert.2022.08.860. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate whether cystectomy or ablation for endometrioma has less impact on ovarian reserve as evaluated by antral follicle count (AFC) and antimüllerian hormone (AMH) levels.

DESIGN: Systematic review and meta-analysis.

SETTING: Not applicable.

PATIENT(S): Patients with endometriomas undergoing cystectomy or ablation.

INTERVENTION(S): All prospective studies comparing cystectomy with ablation for endometrioma in the PubMed, EMBASE, MEDLINE and Web of Science until April 3, 2022 were retrieved and reviewed. Medical treatment used as adjuvant therapy for the surgery was excluded. Two authors assessed eligibility and risk of bias independently. The statistical data were pooled using the Review Manager software.

MAIN OUTCOME MEASURE(S): The changes of AMH levels and AFC values in cystectomy group and ablation group, including intergroup comparisons and intragroup comparisons.

RESULT(S): Four randomized clinical trials and 2 prospective cohort studies were eligible for the meta-analysis, with a total of 294 patients. In the intergroup comparisons, preoperative AFC values were similar with low heterogeneity, but postoperative AFC values were significantly lower in cystectomy than ablation (mean differences [MD], -1.33; 95% credible interval, -2.15 to -0.51; I² = 57%). In the intragroup comparisons of AFC values, sensitivity analyses showed a significant decrease in cystectomy (MD, -1.93; 95% credible interval, -2.40 to -1.45; I² = 0%) at 6-month follow-up, compared with no reduction in ablation. The intragroup comparisons of AMH levels supported negative effects on ovarian reserve of both cystectomy (MD, -1.26; 95% credible interval, -1.64 to -0.88; I² = 45%) and ablation (MD, -0.70; 95% credible interval, -1.07 to -0.32; I² = 0%).

CONCLUSION(S): Both ablation and cystectomy have significantly detrimental effects on ovarian reserve as evaluated by AMH, but the ablation causes relatively less damage to ovarian reserve as appraised by AFC.

CLINICAL TRIAL REGISTRATION NUMBER: CRD42020152823;PROSPERO (york.ac.uk).

PMID:36334993 | DOI:10.1016/j.fertnstert.2022.08.860

J Prosthet Dent. 2022 Nov 2:S0022-3913(22)00637-0. doi: 10.1016/j.prosdent.2022.09.018. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: Studies that compared the fracture strength of monolithic lithium disilicate and 5-mol% yttria partially stabilized zirconia multiunit fixed dental prostheses are sparse.

PURPOSE: As the connector is the weakest part of a fixed dental prosthesis, the purpose of this in vitro study was to investigate the effect of connector designs and material on the fracture strength of 3-unit monolithic fixed dental prostheses.

MATERIAL AND METHODS: Resin-ceramic canine and premolar teeth (N=144) were prepared for fixed dental prosthesis abutments. Prostheses with 3 connector designs (width=height, width<height, and width>height) were made from 2 types of lithium disilicate (IPS e.max CAD and Amber Mill) and 5-mol% yttria partially stabilized zirconia (3M Lava Esthetic and Katana Zirconia UTML). Fracture strengths were measured after 200 000 cycles of dynamic loading of 50 N and thermocycling at 5 °C and 55 °C, and the fracture patterns were analyzed. Two-way analysis of variance and the Fisher exact test were used for statistical analysis (α=.05).

RESULTS: The material and connector design affected the fracture strength of fixed dental prostheses (P<.05), and a significant interaction was found between the material and connector design (P<.05). The IPS e.max CAD material had significantly lower fracture strength than Amber Mill, 3M Lava Esthetic, or Katana Zirconia UTML (P<.05). Connector designs with a greater width versus height showed significantly lower fracture strengths than other designs (P<.05).

CONCLUSIONS: The connector design of 3-unit fixed dental prostheses, particularly the connector height, may affect fracture strength depending on the prosthesis material.

PMID:36334990 | DOI:10.1016/j.prosdent.2022.09.018

Drug Alcohol Depend. 2022 Nov 3:109687. doi: 10.1016/j.drugalcdep.2022.109687. Online ahead of print.

NO ABSTRACT

PMID:36334989 | DOI:10.1016/j.drugalcdep.2022.109687

Actas Urol Esp (Engl Ed). 2022 Aug 4:S2173-5786(22)00078-6. doi: 10.1016/j.acuroe.2022.08.003. Online ahead of print.

ABSTRACT

BACKGROUND: The aim was to determine the impact of COVID-19 pandemic on urolithiasis presentation and management.

METHODS: In this retrospective study, we comparatively evaluated urgent and elective procedures due to urolithiasis during the early eight months of the COVID-19 pandemic (March 1, 2020, to October 31, 2020) compared to the same period a year before, and between waves. The student’s t-test, chi-square test, Mann-Whitney U test and Fisher’s exact test were used to compare the patients’ characteristics and outcomes between the two periods and waves.

RESULTS: Five hundred and thirty procedures were included. The overall numbers of surgical procedures due to urolithiasis were similar between pre-pandemic and pandemic periods. Regarding elective surgery, our data draw attention to the increased complication rate in the pandemic times, but no statistically significant differences in terms of types of procedures and need for complementary treatments were observed. We noted that patterns of presentation of complicated renal colic were different during COVID-19 pandemic, with a higher number of days after the onset of symptoms and a higher proportion of patients presenting acute kidney injury. Furthermore, a significant increase of creatinine levels at presentation in first wave was detected, and a growth in the number of urgent procedures after the first wave was noted, owing to the delay in urolithiasis treatment and diagnosis.

CONCLUSION: The COVID-19 pandemic has negatively affected both urgent and elective management of urolithiasis. Lessons about the management of urolithiasis in this context should be learned to avoid fatal complications and improve standards of care.

PMID:36334974 | DOI:10.1016/j.acuroe.2022.08.003

Eur Urol. 2022 Nov 2:S0302-2838(22)02715-4. doi: 10.1016/j.eururo.2022.10.006. Online ahead of print.

ABSTRACT

BACKGROUND: The risk of death from prostate cancer (PC) depends on age, but the age at which to start prostate-specific antigen (PSA) screening remains uncertain.

OBJECTIVE: To study the relationship between risk reduction for PC mortality and age at first PSA screening.

DESIGN, SETTING, AND PARTICIPANTS: The randomized Göteborg-1 trial invited men for biennial PSA screening between the ages of 50 and 70 yr (screening, n = 10 000) or no invitation but exposure to opportunistic PSA testing (control, n = 10 000).

INTERVENTION: Regular versus opportunistic PSA screening or no PSA.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We modeled the nonlinear association between starting age and the absolute risk reduction in PC mortality in three settings: (1) intention-to-screen (randomized arms); (2) historical control (screening group and 1990-1994 registry data); and (3) attendees only (screening attendees and matched controls). We tested whether the effect of screening on PC mortality depends on the age at starting screening by comparing survival models with and without an interaction between trial arm and age (intention-to-screen and attendees only).

RESULTS AND LIMITATIONS: Younger age on starting PSA testing was associated with a greater reduction in PC mortality. Starting screening at age 55 yr approximately halved the risk of PC death compared to first PSA at age 60 yr. The test of association between starting age and the effect of screening on PC mortality was slightly greater than the conventional level of statistical significance (p = 0.052) for the entire cohort, and statistically significant among attendees (p = 0.002). This study is limited by the low number of disease-specific deaths for men starting screening before age 55 yr and the difficulty in discriminating between the effect of starting age and screening duration.

CONCLUSIONS: Given that prior screening trials included men aged up to 70 yr on starting screening, our results suggest that the effect size reported in prior trials underestimates that of currently recommended programs starting at age 50-55 yr.

PATIENT SUMMARY: In this study from the Göteborg-1 trial, we looked at the effect of prostate-specific antigen (PSA) screening in reducing men’s risk of dying from prostate cancer given the age at which they begin testing. Starting at a younger age reduced the risk of prostate cancer death by a greater amount. We recommend that PSA screening should start no later than at age 55 yr.

PMID:36334968 | DOI:10.1016/j.eururo.2022.10.006