Tag: pubmed

Arab J Gastroenterol. 2022 Aug 4:S1687-1979(22)00060-0. doi: 10.1016/j.ajg.2022.06.007. Online ahead of print.

ABSTRACT

BACKGROUND AND STUDY AIMS: Despite its wide availability, we do not have sufficient data aboutthe quality of colonoscopy in Egypt. In this study, we proposed 13 indicators to assess the quality of colonoscopy procedures in the included study centers aiming to attain a representative image of the quality of CS in Egypt.

PATIENTS AND METHODS: A multicenter prospective study was conducted between July and December 2020, which included all patients who underwent colonoscopy in the participating centers. The following were the proposed quality indicators: indications for colonoscopy, preprocedure clinical assessment, obtaining written informed consent, adequate colon preparation, sedation, cecal intubation rate (CIR), withdrawal time, adenoma detection rate (ADR), complication rate, photographic documentation, automated sterilization, regular infection control check, and well-equipped postprocedure recovery room.

RESULT: A total of 1,006 colonoscopy procedures were performed during the study duration in the included centers. Our analysis showed the following four indicators that were fulfilled in all centers: appropriate indications for colonoscopy, preprocedure assessment, written informed consent, and automated sterilization. However, photographic documentation and postprocedure follow-up room were fulfilled only in 57 %. Furthermore, 71 % of the centers performed regular infection control checks. Adequate colon preparation was achieved in 61 % of the procedures, 81 % of the procedures were performed under sedation, 95.4 % CIR, 11-min mean withdrawal time, 15 % ADR, and 0.1 % overall complication rate. Statistically significant factors affecting CIR were age > 40 years, high-definition endoscope, previous colon intervention, and rectal bleeding, whereas those affecting ADR were age > 40 years, the use of image enhancement, previous colon intervention, rectal bleeding, the use of water pump, and a withdrawal time of > 9 min.

CONCLUSION: Our study revealed the bright aspects of colonoscopy practice in Egypt, including high CIRs and low complication rates; conversely, ADR, bowel cleansing quality, and infection control measures should be improved.

PMID:35934640 | DOI:10.1016/j.ajg.2022.06.007

Reprod Biomed Online. 2022 Jun 17:S1472-6483(22)00418-7. doi: 10.1016/j.rbmo.2022.06.008. Online ahead of print.

ABSTRACT

RESEARCH QUESTION: Is the composition of the endometrial or vaginal microbiota associated with recurrent pregnancy loss (RPL)?

DESIGN: Endometrial and vaginal samples were collected from 47 women with two or more consecutive pregnancy losses and 39 healthy control women without a history of pregnancy loss, between March 2018 and December 2020 at Helsinki University Hospital, Helsinki, Finland. The compositions of the endometrial and vaginal microbiota, analysed using 16S rRNA gene amplicon sequencing, were compared between the RPL and control women, and between individual vaginal and endometrial samples. The mycobiota composition was analysed using internal transcribed spacer 1 amplicon sequencing for a descriptive summary. The models were adjusted for body mass index, age and parity. False discovery rate-corrected P-values (q-values) were used to define nominal statistical significance at q < 0.05.

RESULTS: Lactobacillus crispatus was less abundant in the endometrial samples of women with RPL compared with controls (mean relative abundance 17.2% versus 45.6%, q = 0.04). Gardnerella vaginalis was more abundant in the RPL group than in controls in both endometrial (12.4% versus 5.8%, q < 0.001) and vaginal (8.7% versus 5.7%, q = 0.002) samples. The individual vaginal and endometrial microbial compositions correlated strongly (R = 0.85, P < 0.001). Fungi were detected in 22% of the endometrial and 36% of the vaginal samples.

CONCLUSIONS: Dysbiosis of the reproductive tract microbiota is associated with RPL and may represent a novel risk factor for pregnancy losses.

PMID:35934639 | DOI:10.1016/j.rbmo.2022.06.008

Clin Colorectal Cancer. 2022 Jul 8:S1533-0028(22)00069-X. doi: 10.1016/j.clcc.2022.07.001. Online ahead of print.

ABSTRACT

In squamous cell anal canal neoplasms, persistent disease or recurrence after initial chemoradiotherapy are not the rule, yet their occurrence deserves to be analyzed to better identify prognostics factors. The aim of our study was to describe the patterns of failures of the initial treatment, their subsequent evolution and to identify prognostic factors in these relapsed patients. All patients with non-metastatic anal squamous cell carcinoma initially treated with curative intent at the Centre Antoine Lacassagne between 1999 and 2019, and who presented persistent disease or recurrence were analyzed. The median follow-up was 44 months. Univariate and multivariate analyses were performed to identify prognostic factors. From our database of 528 patients, 77 patients were eligible: 25 with persistent disease and 52 with recurrence after complete response. The median overall survival was 39 months (95% CI: 25.5-52.3 months) from the date of treatment failure. In univariate analysis, prognostic factors were gender, initial lymph node status, type of failure, response to treatment’s failure. In multivariate analysis, only female gender remained statistically significant (HR 0.43- P=0.016). 32% of patients with persistent disease had metastatic status. 17.3% and 5.8% of recurrences respectively occurred after three and five years of follow-up. Systematic imaging could be performed after initial treatment because of distant lesions in one third of patients with persistent disease. The follow-up should not be interrupted before five years, given the significant frequency of late recurrences. In multivariate analysis, only female gender was statistically significant. Stratified treatment based on prognostic factors could be envisaged, the details of which remain to be defined.

PMID:35934635 | DOI:10.1016/j.clcc.2022.07.001

J World Fed Orthod. 2022 Aug 4:S2212-4438(22)00039-X. doi: 10.1016/j.ejwf.2022.07.001. Online ahead of print.

ABSTRACT

BACKGROUND: To evaluate the reliability of a new instrument to clinically measure the anteroposterior relationship of the maxillary central incisors to the forehead.

METHODS: An analytical cross-sectional study using a sample of 84 (67% female and 33% male) young adult participants was conducted. Measurements were performed according to Element II of the Andrews’ Six Elements of Orofacial Harmony by assessing the horizontal distance between the facial axis point of the maxillary central incisor and the forehead’s anterior limit line. The instrument tested was a transparent plastic template having a leveling meter, reference lines, and an embedded millimeter ruler. Two orthodontists evaluated the sample twice with a minimum of a two-week interval between evaluations. The reliability was evaluated using the intraclass correlation coefficient. Repeated-measures ANOVA was also performed.

RESULTS: Good to excellent intra- and interexaminer agreement, with intraclass correlation coefficient values of 0.874 (95% confidence interval 0.800-0.921; P < 0.001) and 0.876 (95% confidence interval 0.739-0.948; P < 0.001), respectively, were calculated. There were no statistically significant differences between all the repeated measurements assessed (P = 0.820).

CONCLUSIONS: The instrument showed good to excellent reliability for determining the anteroposterior relationship of the maxillary central incisors to the forehead and could be used to help orthodontists and maxillofacial surgeons indirectly evaluate the anteroposterior position of the maxilla.

PMID:35934619 | DOI:10.1016/j.ejwf.2022.07.001

Am J Orthod Dentofacial Orthop. 2022 Aug 5:S0889-5406(22)00430-9. doi: 10.1016/j.ajodo.2021.07.016. Online ahead of print.

ABSTRACT

INTRODUCTION: Examination is a basic step in the treatment of patients. This study aimed to assess the examination forms of different private and university orthodontic clinics.

METHODS: Examination forms were collected from 21 university and 21 private orthodontic clinics. The 80 questions examined in the study were evaluated under 3 subheadings (demographic questions, systemic disease questions, and dental questions).

RESULTS: In the evaluation among the groups, the number of questions asked in universities was statistically significantly higher in terms of the total number of questions asked. The number of university questions was statistically significantly higher in the evaluation among the groups of dental questions (P <0.05). In all of the subheadings, there were statistically significant differences between groups and parents’ occupation, e-mail, reference, pricing, and personal data protection law questions (P <0.05); breathing pattern question (P <0.05); tongue function, frenulum assessment, transverse problem, jaw deviation, midline, dentition, canine relationship, overjet, overbite, number of teeth, impacted tooth, shape anomaly, dental trauma, profile, and incisal exposure questions (P <0.05).

CONCLUSIONS: There is no consensus on the examination forms used in orthodontics clinics. Although both universities and private clinics aim to treat orthodontic patients, the questions they asked were different in accordance with their dynamics.

PMID:35934627 | DOI:10.1016/j.ajodo.2021.07.016

Eur Urol. 2022 Aug 4:S0302-2838(22)02523-4. doi: 10.1016/j.eururo.2022.07.011. Online ahead of print.

ABSTRACT

CONTEXT: The prognostic importance of local failure after definitive radiotherapy (RT) in National Comprehensive Cancer Network intermediate- and high-risk prostate cancer (PCa) patients remains unclear.

OBJECTIVE: To evaluate the prognostic impact of local failure and the kinetics of distant metastasis following RT.

EVIDENCE ACQUISITION: A pooled analysis was performed on individual patient data of 12 533 PCa (6288 high-risk and 6245 intermediate-risk) patients enrolled in 18 randomized trials (conducted between 1985 and 2015) within the Meta-analysis of Randomized Trials in Cancer of the Prostate Consortium. Multivariable Cox proportional hazard (PH) models were developed to evaluate the relationship between overall survival (OS), PCa-specific survival (PCSS), distant metastasis-free survival (DMFS), and local failure as a time-dependent covariate. Markov PH models were developed to evaluate the impact of specific transition states.

EVIDENCE SYNTHESIS: The median follow-up was 11 yr. There were 795 (13%) local failure events and 1288 (21%) distant metastases for high-risk patients and 449 (7.2%) and 451 (7.2%) for intermediate-risk patients, respectively. For both groups, 81% of distant metastases developed from a clinically relapse-free state (cRF state). Local failure was significantly associated with OS (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.06-1.30), PCSS (HR 2.02, 95% CI 1.75-2.33), and DMFS (HR 1.94, 95% CI 1.75-2.15, p < 0.01 for all) in high-risk patients. Local failure was also significantly associated with DMFS (HR 1.57, 95% CI 1.36-1.81) but not with OS in intermediate-risk patients. Patients without local failure had a significantly lower HR of transitioning to a PCa-specific death state than those who had local failure (HR 0.32, 95% CI 0.21-0.50, p < 0.001). At later time points, more distant metastases emerged after a local failure event for both groups.

CONCLUSIONS: Local failure is an independent prognosticator of OS, PCSS, and DMFS in high-risk and of DMFS in intermediate-risk PCa. Distant metastasis predominantly developed from the cRF state, underscoring the importance of addressing occult microscopic disease. However a “second wave” of distant metastases occurs subsequent to local failure events, and optimization of local control may reduce the risk of distant metastasis.

PATIENT SUMMARY: Among men receiving definitive radiation therapy for high- and intermediate-risk prostate cancer, about 10% experience local recurrence, and they are at significantly increased risks of further disease progression. About 80% of patients who develop distant metastasis do not have a detectable local recurrence preceding it.

PMID:35934601 | DOI:10.1016/j.eururo.2022.07.011

Trends Genet. 2022 Aug 4:S0168-9525(22)00179-2. doi: 10.1016/j.tig.2022.07.002. Online ahead of print.

ABSTRACT

A molecular diagnosis from the analysis of sequencing data in rare Mendelian diseases has a huge impact on the management of patients and their families. Numerous patient phenotype-aware variant prioritisation (VP) tools have been developed to help automate this process, and shorten the diagnostic odyssey, but performance statistics on real patient data are limited. Here we identify, assess, and compare the performance of all up-to-date, freely available, and programmatically accessible tools using a whole-exome, retinal disease dataset from 134 individuals with a molecular diagnosis. All tools were able to identify around two-thirds of the genetic diagnoses as the top-ranked candidate, with LIRICAL performing best overall. Finally, we discuss the challenges to overcome most cases remaining undiagnosed after current, state-of-the-art practices.

PMID:35934592 | DOI:10.1016/j.tig.2022.07.002

Acta Obstet Gynecol Scand. 2022 Aug 7. doi: 10.1111/aogs.14433. Online ahead of print.

ABSTRACT

INTRODUCTION: Primiparity and labor induction, especially when cervical ripening is required, are risk factors for a negative childbirth experience. Our aim was to compare childbirth experience in primiparous women with cervical ripening by balloon catheter or oral misoprostol using the validated Childbirth Experience Questionnaire (CEQ). We also wanted to compare assessment of a negative childbirth experience by visual analogue scale (VAS) and CEQ.

MATERIAL AND METHODS: This is a prospective study of 362 primiparous women undergoing cervical ripening and labor induction by balloon catheter (67.4%) or oral misoprostol (32.6%) at Helsinki University Hospital, Finland, between January 1, 2019 and January 31, 2020. After delivery, the women assessed their childbirth experience using the CEQ, and patient records provided the patient characteristics, delivery outcomes and VAS ratings. We analyzed the results using IBM SPSS Statistics.

RESULTS: Overall, the women experienced their labor and delivery rather positively, with a mean CEQ score of 2.9 (SD 0.6) (scale 1-4), and no differences were detectable when comparing women with cervical ripening by balloon catheter or misoprostol. However, women with balloon catheter were more often satisfied with the method chosen for them and would choose the same method in a future pregnancy. Compared with CEQ, VAS seems mainly to reflect the women’s perception of their own capacity to give birth and the safety of the hospital setting, not the level of professional support or participation in decision-making. According to our results, CEQ and VAS are comparable, but the usability of the CEQ is limited by its inability to distinguish the most negative and the most positive experiences, and the VAS is limited by its simplicity.

CONCLUSIONS: Women with cervical ripening by balloon catheter or oral misoprostol experienced their childbirth rather positively, results being similar in both groups. However, women with cervical ripening by balloon catheter were more content with their labor induction. The CEQ and VAS can both be used to assess the childbirth experience of primiparous women undergoing labor induction, but both methods have limitations.

PMID:35933726 | DOI:10.1111/aogs.14433

Pediatr Pulmonol. 2022 Aug 7. doi: 10.1002/ppul.26103. Online ahead of print.

ABSTRACT

Carriers of the cystic fibrosis transmembrane conductance regulator (CFTR) gene (“carriers”) have been found to have an increased risk of persistent asthma. However, it is unclear at what level of CFTR function this risk exists and whether it is modified by asthmogens, such as air pollution. We conducted a retrospective cohort study of children born in California between July 2007 and December 2013, linking CFTR genotype data from the California newborn screening program to Medicaid claims records through March 17, 2020 to identify asthma cases, and to air pollution data from CalEnviroScreen 3.0 to identify levels of particulate matter with diameter 2.5 microns or smaller (PM_2.5 ). Log-binomial regression models for asthma risk were fitted, adjusting for race/ethnicity and sex. Compared to population controls, carriers had higher risk of asthma (adjusted risk ratio (aRR)=1.29, 95% confidence interval (CI): 0.98, 1.69; p<0.1). Other non-CF-causing variants on the second allele did not appear to further increase risk. Genotypes with the greatest asthma risk were F508del with an intron 10 T7 or (TG)11T5 in trans (aRR=1.52, 95% CI: 1.10, 2.12). This association was higher among children living in areas at or above (aRR=1.80) versus below (aRR=1.37) the current national air quality standard for PM_2.5 , though this difference was not statistically significant (p_interaction >0.2). These results suggest carriers with CFTR functional levels between 25% and 45% of wildtype are at increased risk of asthma. Knowledge of CFTR genotype in asthmatics may be important to open new CFTR-related treatment options for these patients. This article is protected by copyright. All rights reserved.

PMID:35933722 | DOI:10.1002/ppul.26103

J Anat. 2022 Aug 7. doi: 10.1111/joa.13733. Online ahead of print.

ABSTRACT

The cranial casques of modern cassowaries (Casuarius) have long intrigued researchers; however, in-depth studies regarding their morphological variation are scarce. Through visual inspection, it has been recognized that casque variability exists between conspecifics. Understanding casque variation has both evolutionary and ecological importance. Although hypothesized to be targeted by selection, intraspecific casque variation has not been quantified previously. Through a large sample of C. casuarius (n = 103), we compared casque shape (lateral and rostral views) between sexes and between individuals from non-overlapping geographical regions using two-dimensional (2D) geometric morphometrics. We found no statistically significant differences between the casque shape of females and males and few substantial shape differences between individuals from different geographic areas. Much of the intraspecific variation within C. casuarius is due to casque asymmetries (77.5% rightward deviating, 20.7% leftward deviating, and 1.8% non-deviating from the midline; n = 111), which explain the high variability of southern cassowary casque shape, particularly from the rostral aspect. Finally, we discuss how our non-significant findings implicate social selection theory, and we identify the benefits of quantifying such variation for further elucidating casque function(s) and the social biology of cassowaries.

PMID:35933695 | DOI:10.1111/joa.13733