Tag: pubmed

J Geriatr Oncol. 2022 Nov 17:S1879-4068(22)00520-3. doi: 10.1016/j.jgo.2022.10.016. Online ahead of print.

ABSTRACT

INTRODUCTION: The GAH (Geriatric Assessment in Hematology) scale is a psychometrically valid tool aimed at identifying older patients with hematological malignancies at higher risk of treatment-related toxicity. Our objective in this study was to determine the weights for each dimension of the GAH scale and the cut-off point to reliably predict treatment tolerability in this population, estimated by a weighted receiver operating characteristic (ROC) analysis and quantified by the area under the curve (AUC).

MATERIAL AND METHODS: The RETROGAH was a retrospective cohort study including 126 patients who had previously participated in the GAH study. Patients were ≥ 65 years old with newly diagnosed myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML), multiple myeloma (MM), or chronic lymphoid leukemia (CLL) and treated with standard front-line therapy within three months after having completed the GAH scale.

RESULTS: The optimal cut-off value of the GAH total score to discriminate patients at higher risk of treatment toxicity was 42, with 68.5% sensitivity and 55.8% specificity. Using this value, 66.1% of patients evaluated were found to develop some type of toxicity. The AUC was 0.6259 (95% CI: 0.512-0.739; p = 0.035).

DISCUSSION: The GAH scale not only would enable clinicians to individualize therapy based on individual risk of toxicity but also discriminate patients that will benefit most from intensive treatments from those requiring an adapted approach. While futures studies in clinical practice may improve the model and overcome its limitations, the GAH scale should not be used alone when making treatment decisions.

PMID:36404260 | DOI:10.1016/j.jgo.2022.10.016

Eur J Surg Oncol. 2022 Nov 8:S0748-7983(22)00736-3. doi: 10.1016/j.ejso.2022.11.008. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to evaluate the prognostic value of lymph node dissection (LND) in node-negative intrahepatic cholangiocarcinoma (ICC) and identify the appropriately total number of lymph nodes examined (TNLE).

METHODS: Data from node-negative ICC patients who underwent curative intent resection in ten Chinese hepatobiliary centers from January 2010 to December 2018 were collected. Overall survival (OS), relapse-free survival (RFS) and postoperative complications were analyzed. Propensity score matching (PSM) was performed to reduce the bias due to confounding variables in LND group and non-lymph node dissection (NLND) group. The optimal TNLE was determined by survival analysis performed by the X-tile program using the enumeration method.

RESULTS: A total of 637 clinically node-negative ICC patients were included in this study, 74 cases were found lymph node (LN) positive after operation. Among the remaining 563 node-negative ICC patients, LND was associated with longer OS but not RFS before PSM (OS: 35.4 vs 26.0 months, p = 0.047; RFS: 15.0 vs 15.4 months, p = 0.992). After PSM, patients in LND group had better prognosis on both OS and RFS (OS: 38.0 vs 23.0 months, p < 0.001; RFS: 15.0 vs 13.0 months, p = 0.029). There were no statistically differences in postoperative complications. When TNLE was greater than 8, OS (48.5 vs 31.1 months, p = 0.025) and RFS (21.0 vs 13.0 months, p = 0.043) were longer in the group with more dissected LNs.

CONCLUSION: Routinely LND for node-negative ICC patients is recommended for it helps accurate tumor staging and associates with better prognosis. The optimal TNLE is more than 8.

PMID:36404249 | DOI:10.1016/j.ejso.2022.11.008

J Voice. 2022 Nov 17:S0892-1997(22)00345-9. doi: 10.1016/j.jvoice.2022.10.017. Online ahead of print.

ABSTRACT

OBJECTIVE: To study the concentration of fibroblasts in the vocal folds of elderly people.

MATERIAL AND METHODS: The vocal folds of 13 cadavers were removed and divided into two age groups: Control group: n-5, 18-40 years; Elderly group: n-8, ≥75 years). The vocal folds were dissected and prepared for immunohistochemical analysis using the SA100 antibody to fibroblasts. The sites analyzed were maculae flavae and medial (or vibrating) portion of the vocal folds. The AVsoft program was used to count the cells.

RESULTS: A higher concentration of fibroblasts was identified in the maculae flavae of the larynx of young adults and in the medial portion of the vocal folds of the elderly. However, these results did not determine statistically significant differences, allowing us to conclude that there was no effect of age on the concentration of fibroblasts in the vocal folds.

CONCLUSION: In the larynx of the elderly, the fibroblast population remains similar to the young adults, both in the maculae flavae and in the body of the vocal folds, possibly being responsible for the constant production of fibrous matrix in the lamina propria. Functional changes in these cells are probably more marked than quantitative ones.

PMID:36404202 | DOI:10.1016/j.jvoice.2022.10.017

J Cardiovasc Electrophysiol. 2022 Nov 20. doi: 10.1111/jce.15752. Online ahead of print.

ABSTRACT

INTRODUCTION: Intramural or epicardial locations of the arrhythmogenic substrate are regarded as one of the main reasons for radiofrequency (RF) catheter ablation failure. This study aims to conduct a comprehensive analysis of various factors including baseline impedance, irrigant and electrode configuration at similar ablation index value.

METHODS: In 12 ex vivo swine hearts, radiofrequency ablation was performed at a target AI value of 500 and a multistep impedance load (100-180Ω) in 4 settings: (1) conventional unipolar configuration with an irrigant of NS; (2) conventional unipolar configuration with an irrigant of HNS; (3) bipolar configuration with an irrigant of NS.; (4) sequential unipolar configuration with an irrigant of NS. The relationships between lesion dimensions and above factors were examined.

RESULTS: Baseline impedance had a strong negative linear correlation with lesion dimensions at a certain AI. The correlation coefficient between baseline impedance and depth, width, and volume were R =-0.890, R =-0.755 and R =-0.813, respectively (P<0.01). There were 10 (total: 10/100, 10%; bipolar: 10/25, 40%) transmural lesions during the whole procedure. Bipolar ablation resulted in significantly deeper lesion than other electrode configurations. Other comparisons in our experiment did not achieve statistical significance.

CONCLUSION: There is a strong negative linear correlation between baseline impedance and lesion dimensions at a certain AI value. Baseline impedance has an influence on the overall lesion dimensions among irrigated fluid and ablation configurations. Over a threshold impedance of 150Ω, the predictive accuracy of AI can be compromised. This article is protected by copyright. All rights reserved.

PMID:36403284 | DOI:10.1111/jce.15752

J Card Surg. 2022 Nov 20. doi: 10.1111/jocs.17047. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the effect of long-term nursing intervention on the quality of life and social support of patients after percutaneous coronary intervention (PCI).

METHODS: A randomised controlled trial was designed. A total of 60 patients with coronary heart disease treated with PCI were randomly divided into the control group and the intervention group. The patients in the control group received routine nursing care, while the patients in the intervention group received long-term nursing intervention. The Simplified Quality of Life Scale-Quality of Life Scale, the Coronary Heart Disease Self-Management Scale, and the Social Support Rating Scale were used to collect and analyse the data.

RESULTS: After the intervention, the scores for quality of life, social support and self-management in the intervention group were higher than those in the control group, and the differences were statistically significant (p < 0.05).

CONCLUSION: Long-term nursing intervention can improve the quality of life and sense of social support of patients with coronary heart disease after PCI.

PMID:36403273 | DOI:10.1111/jocs.17047

Bioelectromagnetics. 2022 Nov 20. doi: 10.1002/bem.22426. Online ahead of print.

ABSTRACT

Numerous studies have been carried out on the potential effects of an extremely low frequency (ELF-0-300 Hz) magnetic field (MF) on human health. However, there is limited data on the effect of a high exposure level to ELF MFs for a prolonged period. Therefore, the objective of this pilot work was to demonstrate the feasibility of a study evaluating the stress hormone concentrations resulting from a 10-min exposure to a 60 Hz MF of several tens of thousands of µT. In this pilot study, human volunteers were thus exposed for the first time to a 60 Hz, 50 mT MF for a duration of 10 min. Stress hormone levels were measured before (once), during (twice) and after (once) this 10-min exposure period. The small sample size (n = 5) did not allow to conduct standard inferential statistical tests and no conclusion regarding the exposure effects can be drawn. However, this study demonstrates the feasibility of using a simple blood testing material in a protocol testing for the effect of a 10-min exposure to a high MF level in healthy human volunteers. © 2022 Bioelectromagnetics Society.

PMID:36403265 | DOI:10.1002/bem.22426

Int Endod J. 2022 Nov 20. doi: 10.1111/iej.13872. Online ahead of print.

ABSTRACT

AIM: To assess and compare the clinical and radiographic outcome of partial pulpotomy and full pulpotomy using Biodentine in cariously exposed mature molar teeth with symptoms indicative of irreversible pulpitis METHODOLOGY: This study is a an unicentric, double-arm, randomised superiority clinical trial with parallel experimental groups, registered under CTRI (CTRI/2019/12/022559). Fifty mature permanent molar teeth with carious exposures with symptoms indicative of irreversible pulpitis were randomly allocated equally into two groups. Partial Pulpotomy (PP) and Full Pulpotomy (FP) was performed in the first and second group respectively following standardised protocols. Exposed pulp tissue was removed up to a depth of 2-3 mm for partial pulpotomy whereas complete coronal pulp tissue was removed up to the level of root orifices for full pulpotomy. Haemostasis was achieved with placement of 2.5% sodium hypochlorite-moistened cotton pellets placed on amputated pulp tissue for a maximum of 10 minutes. Biodentine was used as the pulp capping material. Pain scores were evaluated using 11-point visual analogue scale (VAS) pre-operatively, at 24 hours, 48 hours and 7th day after the intervention(s). Clinical and radiographic evaluation was done at 3 months, 6 months and 1 year. The data was statistically analysed using chi-square test, Mann-Whitney U test, Friedman’s test and Wilcoxon signed-rank test. The significance level was predetermined at p<0.05. Cumulative survival probabilities were assessed at 12 months using Kaplan Meier analysis.

RESULTS: Intra-group analysis of pain scores revealed significant reduction in pain scores pre-operatively and at 24 hours, 48 hours and 7th day in both the groups. However, the difference in the pain score(s) reduction between both the groups was not statistically significant at any time interval (p > 0.05). At 1 year follow up, the success rate was 88% (22/25) and 91.6% (22/24) for PP and FP respectively (p>0.05).

CONCLUSION AND CLINICAL SIGNIFICANCE: Partial pulpotomy showed comparable results to full pulpotomy in terms of clinical/radiographic treatment outcome. If the long-term results remain the same, partial pulpotomy can be proposed as an alternative treatment modality for mature teeth with cariously exposed pulp tissue presenting with signs of symptomatic irreversible pulpitis.

PMID:36403208 | DOI:10.1111/iej.13872

Scand J Med Sci Sports. 2022 Nov 20. doi: 10.1111/sms.14274. Online ahead of print.

ABSTRACT

BACKGROUND: Walking cadence (steps/min) has emerged as a valid proxy of physical activity intensity, with consensus across numerous laboratory-based treadmill studies that ≥100 steps/min approximates absolutely-defined moderate intensity (≥3 metabolic equivalents; METs). We recently reported that this cadence threshold had a classification accuracy of 73.3% for identifying moderate intensity during preferred pace overground walking in young adults. The purpose of this study was to evaluate and compare the performance of a cadence threshold of ≥100 steps/min for correctly classifying moderate intensity during overground walking in middle- and older-aged adults.

METHODS: Participants (N=174, 48.3% female, 41-85 years of age) completed laboratory-based cross-sectional study involving an indoor 5-min overground walking trial at their preferred pace. Steps were manually counted and converted to cadence (total steps/5 min). Intensity was measured using indirect calorimetry and expressed as METs. Classification accuracy (sensitivity, specificity, accuracy) of a cadence threshold of ≥100 steps/min to identify individuals walking at ≥3 METs was calculated.

RESULTS: The ≥100 steps/min threshold demonstrated accuracy of 74.7% for classifying moderate intensity. When comparing middle- vs. older-aged adults, similar accuracy (73.4% vs. 75.8%, respectively) and specificity (33.3% vs. 34.5%) were observed. Sensitivity was high, but was lower for middle- vs. older-aged adults (85.2% vs. 93.9, respectively).

CONCLUSION: A cadence threshold of ≥100 steps/min accurately identified moderate intensity overground walking. Furthermore, accuracy was similar when comparing middle- and older-aged adults. These findings extend our previous analysis in younger adults and confirm the appropriateness of applying this cadence threshold across the adult lifespan.

PMID:36403207 | DOI:10.1111/sms.14274

Breast Cancer Res Treat. 2022 Nov 20. doi: 10.1007/s10549-022-06799-7. Online ahead of print.

ABSTRACT

PURPOSE: Current systemic therapy guidelines for patients with HER2 + breast cancer brain metastases (BCBrM) diverge based on the status of extracranial disease (ECD). An in-depth understanding of the impact of ECD on outcomes in HER2 + BCBrM has never been performed. Our study explores the implications of ECD status on intracranial progression-free survival (iPFS) and overall survival (OS) after first incidence of HER2 + BCBrM and radiation.

METHODS: A retrospective analysis was performed of 151 patients diagnosed with initial HER2 + BCBrM who received radiation therapy to the central nervous system (CNS) at Duke between 2008 and 2021. The primary endpoint was iPFS defined as the time from first CNS radiation treatment to intracranial progression or death. OS was defined as the time from first CNS radiation or first metastatic disease to death. Systemic staging scans within 30 days of initial BCBrM defined ECD status as progressive, stable/responding or none (isolated brain relapse).

RESULTS: In this cohort, > 70% of patients had controlled ECD with either isolated brain relapse (27%) or stable/responding ECD (44%). OS from initial metastatic disease to death was markedly worse for patients with isolated intracranial relapse (median = 28.4 m) compared to those with progressive or stable/responding ECD (48.8 m and 71.5 m, respectively, p = 0.0028). OS from first CNS radiation to death was significantly worse for patients with progressive ECD (16.9 m) versus stable/responding (36.6 m) or isolated intracranial relapse (28.4 m, p = 0.007). iPFS did not differ statistically based on ECD status. Receipt of systemic therapy after first BCBrM significantly improved iPFS (HR 0.45, 95% CI: 0.25-0.81, p = 0.008) and OS (HR: 0.43 (95% CI: 0.23-0.81); p = 0.001).

CONCLUSION: OS in patients with HER2 + isolated BCBrM was inferior to those with concurrent progressive or stable/responding ECD. Studies investigating initiation of brain-penetrable HER2-targeted therapies earlier in the disease course of isolated HER2 + intracranial relapse patients are warranted.

PMID:36403183 | DOI:10.1007/s10549-022-06799-7

Breast Cancer Res Treat. 2022 Nov 20. doi: 10.1007/s10549-022-06811-0. Online ahead of print.

ABSTRACT

PURPOSE: The aim of the study was to analyze the impact of neoadjuvant systemic treatment (NST) on postoperative complications and the beginning of adjuvant treatment.

METHODS: This study includes data from a prospectively maintained database including patients with breast cancer (BC) stage I-IV with or without NST undergoing breast cancer surgery between January 2010 and September 2021.

RESULTS: Out of 517 enrolled patients, 77 received NST, 440 had primary breast surgery. After NST patients underwent surgery after a meantime of 34 days (26.5-40 days). No statistical significance could be found comparing the complication grading according to the Clavien Dindo classification. The complications were most frequently rated as grade 3b. There were no complications with grade 4 or higher. When differentiating into short and long-term, the overall rate of short-term complications was 20.3% with no significant difference between the two groups (20.8% vs. 20.2%). Regarding long-term complications, there was more impairment of shoulder mobility (26.0% vs. 9.5%, p ≤ 0.001) and chronic pain (42.9% vs. 28.6%, p ≤ 0.016) for patients with NST. The beginning of the administration of the adjuvant treatment was comparable in both groups (46.3 days vs. 50.5 days).

CONCLUSION: In our cohort, complications between both groups were comparable according to Clavien Dindo. This study shows that NST has no negative impact on postoperative short-term complications and most importantly did not lead to a delay of the beginning of adjuvant treatment. Therefore, NST can be safely admitted, even when followed by extensive breast reconstruction surgery.

PMID:36403182 | DOI:10.1007/s10549-022-06811-0