Tag: pubmed

JAMA Netw Open. 2022 Nov 1;5(11):e2242378. doi: 10.1001/jamanetworkopen.2022.42378.

ABSTRACT

IMPORTANCE: Bladder-preserving trimodality therapy can be an effective alternative to radical cystectomy for treatment of muscle-invasive bladder cancer (MIBC), but biomarkers are needed to guide optimal patient selection. The DNA repair protein MRE11 is a candidate response biomarker that has not been validated in prospective cohorts using standardized measurement approaches.

OBJECTIVE: To evaluate MRE11 expression as a prognostic biomarker in MIBC patients receiving trimodality therapy using automated quantitative image analysis.

DESIGN, SETTING, AND PARTICIPANTS: This prognostic study analyzed patients with MIBC pooled from 6 prospective phase I/II, II, or III trials of trimodality therapy (Radiation Therapy Oncology Group [RTOG] 8802, 8903, 9506, 9706, 9906, and 0233) across 37 participating institutions in North America from 1988 to 2007. Eligible patients had nonmetastatic MIBC and were enrolled in 1 of the 6 trimodality therapy clinical trials. Analyses were completed August 2020.

EXPOSURES: Trimodality therapy with transurethral bladder tumor resection and cisplatin-based chemoradiation therapy.

MAIN OUTCOMES AND MEASURES: MRE11 expression and association with disease-specific (bladder cancer) mortality (DSM), defined as death from bladder cancer. Pretreatment tumor tissues were processed for immunofluorescence with anti-MRE11 antibody and analyzed using automated quantitative image analysis to calculate a normalized score for MRE11 based on nuclear-to-cytoplasmic (NC) signal ratio.

RESULTS: Of 465 patients from 6 trials, 168 patients had available tissue, of which 135 were analyzable for MRE11 expression (median age of 65 years [minimum-maximum, 34-90 years]; 111 [82.2%] men). Median (minimum-maximum) follow-up for alive patients was 5.0 (0.6-11.7) years. Median (Q1-Q3) MRE11 NC signal ratio was 2.41 (1.49-3.34). Patients with an MRE11 NC ratio above 1.49 (ie, above first quartile) had a significantly lower DSM (HR, 0.50; 95% CI, 0.26-0.93; P = .03). The 4-year DSM was 41.0% (95% CI, 23.2%-58.0%) for patients with an MRE11 NC signal ratio of 1.49 or lower vs 21.0% (95% CI, 13.4%-29.8%) for a ratio above 1.49. MRE11 NC signal ratio was not significantly associated with overall survival (HR, 0.84; 95% CI, 0.49-1.44).

CONCLUSIONS AND RELEVANCE: Higher MRE11 NC signal ratios were associated with better DSM after trimodality therapy. Lower MRE11 NC signal ratios identified a poor prognosis subgroup that may benefit from intensification of therapy.

PMID:36383379 | DOI:10.1001/jamanetworkopen.2022.42378

Shock. 2022 Nov 17. doi: 10.1097/SHK.0000000000002035. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate and compare the clinical features and prognosis of chronic critical illness (CCI)/ persistent inflammation immunosuppression and catabolism (PICS).

METHODS: This is a prospective observational clinical study. During this study period, we collect ICU patients’ data from Suzhou Municipal Hospital and Suzhou Ninth People’s Hospital. All patients older than 18 years of age were included and according to the corresponding exclusion and diagnostic criteria, they were divided into four groups: PICS group, CCI group, CCI and PICS group (CCI + PICS), nor CCI and nor PICS group (NCCI+NPICS), collected and recorded age, sex, hospital time, hospital diagnosis, acute physiological and chronic health status score II (APACHEII), sequential organ failure detection score(SOFA), c-reactive protein (CRP), absolute value lymphocyte count (L), serum albumin (Alb), white cells count (WBC), absolute value neutrophils count (N), secondary infection and 28-day case fatality rate separately.

RESULTS: A total of 687 patients were admitted to the ICU during the study period. The hospitalization time less than 14 days were excluded, and 168 patients were eventually included. There are 17 in the PICS group, 71 in the CCI group, 50 in the CCI + PICS group, and 30 in the NCCI+NPICS group. Baseline characteristics showed statistically significant differences in SOFA, length of hospital stay, 28-day mortality among four groups. Baseline main indicator, and multiple comparisons showed that the CCI + PICS group had longer hospital stay, worse prognosis and more adverse outcomes. Multivariate analysis showed that final age, CRP on day 14 and 21, serum albumin on day 1 and 21 had an impact on the prognosis (P<0.05).

CONCLUSION: The clinical prognosis of the four groups decreased in order of NCCI+NPICS, CCI, PICS, CCI + PICS. Our finding of clinically isolated PICS may indicate that PICS acts as a inducement or independent factor to worsen the prognosis of CCI.

PMID:36383370 | DOI:10.1097/SHK.0000000000002035

Clin Oral Investig. 2022 Nov 16. doi: 10.1007/s00784-022-04779-1. Online ahead of print.

ABSTRACT

OBJECTIVES: Large part of the tooth is required to be removed during crown preparation. A minimally invasive method for preparing single crowns is required to increase the durability of teeth. The aim of this study was to evaluate the clinical performance of two ceramic systems fabricated with minimally invasive vertical preparation.

MATERIALS AND METHODS: Forty endodontically treated maxillary premolars were prepared with vertical preparation and received temporary crowns for a period of 21 days. Twenty zirconia-reinforced lithium silicate (Celtra Duo HT, Dentsply Sirona, Germany) and 20 monolithic high translucency zirconia (Katana HT, Kuarary Noritake, Japan) crowns were fabricated by CAD/CAM and cemented with dual-polymerizing luting resin. The crowns were evaluated clinically and radiographically for 36 months following modified FDI criteria. Statistical analysis was conducted with t Student test (Cochran Q).

RESULTS: Over the follow-up period, there was no need to replace any of the study’s crowns. The overall survival rate of the 40 crowns was 100% according to the Kaplan-Meier survival method. The clinical quality of all crowns and the patient’s satisfaction were high. No caries was detected and no adverse soft tissue reactions around the crowns were observed. Periodontal probing depth was reported to be increased at mesial and distal sites more than the facial one in the 36-month follow-up with no statistically significant difference between both materials (P = 0.186).

CONCLUSIONS: Zirconia and zirconia-reinforced lithium silicate could be used as a material for restoration of teeth prepared with vertical preparation technique. Both ceramic materials achieved good esthetic results, promotes healthy and stable soft tissues with no mechanical complications after 3 years of clinical evaluation.

CLINICAL RELEVANCE: Monolithic high translucency zirconia and zirconia-reinforced lithium silicate ceramics can be used for the restorations of minimal invasive vertical preparation in premolar area with 0.5 mm margin thickness.

PMID:36383297 | DOI:10.1007/s00784-022-04779-1

Eur J Pediatr. 2022 Nov 16. doi: 10.1007/s00431-022-04710-6. Online ahead of print.

ABSTRACT

The purpose of this study is to compare group B Streptococcus (GBS) infection incidence in HIV-exposed uninfected (HEU) and HIV-unexposed (HU) infants in a Spanish cohort. We conducted a retrospective study in 5 hospitals in Madrid (Spain). Infants ≤ 90 days of life with a GBS infection were included from January 2008 to December 2017. Incidence of GBS infection in HEU and HU children was compared. HEU infants presented a sevenfold greater risk of GBS infection and a 29-fold greater risk of GBS meningitis compared to HU, with statistical significance. Early-onset infection was tenfold more frequent in HEU children, with statistical significance, and late-onset infection was almost fivefold more frequent in the HUE infants’ group, without statistical significance.

CONCLUSION: HEU infants presented an increased risk of GBS sepsis and meningitis. One in each 500 HEU infants of our cohort had a central nervous system infection and 1 in each 200, a GBS infection. Although etiological causes are not well understood, this should be taken into account by physicians when attending this population.

WHAT IS KNOWN: • HIV-exposed uninfected infants are at higher risk of severe infections. • An increased susceptibility of these infants to group B Streptococcus infections has been described in low- and high-income countries, including a higher risk of meningitis in a South African cohort.

WHAT IS NEW: • Group B Streptococcal meningitis is more frequent in HIV-exposed uninfected infants also in high-income countries. • Physicians should be aware of this increased risk when attending these infants.

PMID:36383285 | DOI:10.1007/s00431-022-04710-6

J Robot Surg. 2022 Nov 16. doi: 10.1007/s11701-022-01482-x. Online ahead of print.

ABSTRACT

Robotic-assisted perineal prostatactomy(RAPP) is a new alternative surgical technique, in prostate cancer patients especially with a history of intra-abdominal surgery. The aim of this study is to examine the effects of the challenging patient position and CO₂ insufflation in perineal space during RAPP on both hemodynamic parameters and respiratory mechanics. Hemodynamic and respiratory parameters of 30 patients who underwent RAPP and 31 patients who underwent Robotic-assisted laparoscopic prostatectomy (RALP) for prostate cancer between 2017 and 2019 were retrospectively evaluated. Comparison between RAPP and RALP patients showed that anesthesia, surgery and insufflation times were shorter in RAPP patients (p < 0.05). Blood pCO₂ level was higher, and the pH decrease was more prominent in the RAPP patients 30 and 60 min after perineal CO₂ insufflation (p < 0.05). The mean arterial pressures, driving pressure, Ppeak and Pplato values were statistically higher in the RALP patients and 60 min after insufflation while static and dynamic lung compliance values were found to be lower. Our results showed that blood pCO₂ level may severely increase after perineal CO₂ insufflation. The fact that respiratory mechanics are less affected despite the difficult patient position for lungs in RAPP patients, the presence of higher CO₂ level supports that the perineal CO₂ insufflation plays a more important role in increased CO₂ level. Considering these changes, especially the sudden increase in the risk of CO₂ level, close follow-up and timely intervention by anesthesiology can ensure all changes remain in a clinically safe range.

PMID:36383279 | DOI:10.1007/s11701-022-01482-x

Cardiovasc Drugs Ther. 2022 Nov 16. doi: 10.1007/s10557-022-07399-9. Online ahead of print.

ABSTRACT

BACKGROUND: Mechanical ventilation (MV) is widely used to relieve respiratory failure in patients with congestive heart failure (CHF). Prolonged MV (PMV) is associated with a poor prognosis. We aimed to establish a prediction model based on machine learning (ML) algorithms for the early identification of patients with CHF requiring PMV.

METHODS: Twelve commonly used ML algorithms were used to build the prediction model. The least absolute shrinkage and selection operator (LASSO) regression was employed to select the key features. We examined the area under the curve (AUC) statistics to evaluate the prediction performance. Data from another database were used to conduct external validation.

RESULTS: We screened out 10 key features from the initial 65 variables via LASSO regression to improve the practicability of the model. The CatBoost model showed the best performance for predicting PMV among the 12 commonly used ML algorithms, with favorable discrimination (AUC = 0.790) and calibration (Brier score = 0.154). Moreover, hospital mortality could be accurately predicted using the CatBoost model as well (AUC = 0.844). In the external validation, the CatBoost model also showed satisfactory prediction performance (AUC = 0.780), suggesting certain generalizability of the model. Finally, a nomogram with risk classification of PMV was shown in this study.

CONCLUSION: The present study developed and validated a CatBoost model, which could accurately predict PMV in mechanically ventilated patients with CHF. Moreover, this model has a favorable performance in predicting hospital mortality in these patients.

PMID:36383267 | DOI:10.1007/s10557-022-07399-9

Neurol Sci. 2022 Nov 16. doi: 10.1007/s10072-022-06484-z. Online ahead of print.

ABSTRACT

BACKGROUND: Deep brain stimulation (DBS) is a common treatment for Parkinson’s disease. However, the clinical efficacy of short pulse width DBS (spDBS) compared with conventional DBS (cDBS) is still unknown.

OBJECTIVE: This meta-analysis investigated the effectiveness of spDBS versus cDBS in patients with PD.

METHODS: Four databases (PubMed, Cochrane, Web of Science, and Embase) were independently searched until October 2021 by two reviewers. We utilized the following scales and items: therapeutic windows (TW), efficacy threshold, side effect threshold, Movement Disorder Society-Sponsored Revision Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) part III off-medication score, Speech Intelligence Test (SIT), and Freezing of Gait Questionnaire (FOG-Q).

RESULTS: The analysis included seven studies with a total of 87 patients. The results indicated that spDBS significantly widened the therapeutic windows (0.99, 95% CI = 0.61 to 1.38) while increasing the threshold amplitudes of side effects (2.25, 95% CI = 1.69 to 2.81) and threshold amplitudes of effects (1.60, 95% CI = 0.84 to 2.36). There was no statistically significant difference in UPDRS part III, SIT, and FOG-Q scores between spDBS and cDBS groups, suggesting that treatment with both cDBS and spDBS may result in similar effects of improved dysarthria and gait disorders.

CONCLUSIONS: Compared with cDBS, spDBS is effective in expanding TW. Both types of deep brain stimulation resulted in improved gait disorders and speech intelligibility.

PMID:36383263 | DOI:10.1007/s10072-022-06484-z

Abdom Radiol (NY). 2022 Nov 16. doi: 10.1007/s00261-022-03652-9. Online ahead of print.

ABSTRACT

BACKGROUND: Risk stratification is challenging in the growing population of geriatric patients requiring emergency surgery. Sarcopenia, which assesses muscle bulk, is a surrogate for frailty and predicts 1-year mortality, but does not incorporate potentially valuable additional information about muscle quality.

OBJECTIVE: To describe five different CT methods of measuring sarcopenia and muscle quality and to determine which method has the greatest sensitivity for predicting 1-year mortality following emergency abdominal surgery in elderly patients.

METHODS: This retrospective study includes 297 patients 70 years and older who underwent “urgent” or “emergent” laparotomy or laparoscopy for acute abdominal disease between 2006 and 2011 at a single quaternary academic medical center. All patients received a CT abdomen and pelvis with intravenous contrast within 1 month of surgery. Five different methods were applied to the psoas muscles on CT: method 1 (total psoas index TPI, which is total psoas area TPA normalized by height), method 2 (“pseudoarea” = anterior-posterior × transverse dimensions), method 3 (average HU), method 4 (TPA × HU), and method 5 (“pseudoarea” × HU).

RESULTS: For all five CT measures, mortality was greatest for the lowest quartile by univariate and adjusted Cox proportional hazard analyses at all time points up to 1-year. The C-statistic was highest for Method 4, using a composite index of TPA and Hounsfield Units, indicating the greatest predictive ability to estimate mortality at all time points.

CONCLUSION: Muscle quality and muscle size can be used in tandem to refine risk assessment of older patients undergoing emergency abdominal surgery. Routine calculation of the composite score of psoas cross-sectional area and HU in the emergency room setting may provide surgeons and patients valuable insight on the risk of 1-year mortality to guide preoperative decision-making and counseling.

CLINICAL IMPACT: Muscle quality and size, both strong independent predictors of surgical outcomes in older patients undergoing emergency abdominal surgery, may be used in tandem to refine risk assessment. A composite score of psoas muscle cross-sectional area and Hounsfield units on CT may provide insight on 1-year mortality in this patient population.

PMID:36383241 | DOI:10.1007/s00261-022-03652-9

Ann Work Expo Health. 2022 Nov 16:wxac077. doi: 10.1093/annweh/wxac077. Online ahead of print.

ABSTRACT

OBJECTIVE: Asbestos use has decreased over time but occupational exposure still exists today due to the presence of asbestos in older buildings. The objective of this study was to update CAREX Canada’s prevalence of exposure estimate from 2006 to 2016, and to assess the level of occupational exposure by industry, occupation, province/territory, and sex.

METHODS: Estimates by occupation, industry, province/territory, and sex were calculated using labor force data from the 2016 Census of Population and proportions of workers exposed by occupation and industry, which were previously developed for the 2006 estimates and updated here to reflect new knowledge and changes in exposures. Statistics Canada concordance tables were used to account for changes between the 2006 and 2016 job and industry coding systems. Expert assessment was used to qualitatively assign levels of exposure (low, moderate, or high) for each occupation and industry, with consideration of workers’ proximity and access to asbestos-containing material, and the condition and content of asbestos.

RESULTS: Approximately 235 000 workers are exposed to asbestos on the job in Canada. The majority of Canadian workers exposed to asbestos are male (89%). Only 5% of all exposed workers are in the high-exposure category, while most workers are in the low (49%) or moderate (46%) exposure categories. The construction sector and associated jobs (e.g. carpenters, trades helpers and laborers, electricians) accounted for the majority of exposed workers.

CONCLUSIONS: Occupational exposure to asbestos continues to occur in Canada. Updating the prevalence of exposure estimate and adding exposure levels highlights the shift from high to lower-lever exposures associated with asbestos-containing materials remaining in the built environment.

PMID:36383235 | DOI:10.1093/annweh/wxac077

Eur J Trauma Emerg Surg. 2022 Nov 16. doi: 10.1007/s00068-022-02169-6. Online ahead of print.

ABSTRACT

PURPOSE: There is currently no consensus on nonoperative management in adult patients after a stable type B ankle fracture. The aim of this review is to compare a removable orthosis versus a cast regarding safety and functional outcome in the NOM of stable type B ankle fractures.

METHODS: A systematic review and meta-analysis were performed using randomized clinical trials and observational studies. The methodological quality of the included studies was assessed with the methodological index for non-randomized studies instrument. Nonoperative management was compared using the number of complications and functional outcome measured using the Olerud and Molander Score (OMAS) or the American Academy of Orthopaedic Surgeons Ankle Score.

RESULTS: Five studies were included. Two were randomized clinical trials, and three were observational studies, including a total of 516 patients. A meta-analysis showed statistically significant higher odds of developing complications in the cast group [odds ratio (OR), 4.67 (95% confidence interval (CI) 1.52-14.35)]. Functional outcome in OMAS did not vary significantly at 6 weeks, mean difference (MD) – 6.64 (95% CI – 13.72 to + 0.45), and at 12 weeks, MD – 6.91 (95% CI – 18.73 to + 4.91). The mean difference of functional outcome in OMAS at 26 weeks or longer was significantly better in the removable orthosis group; MD – 2.63 (95% CI – 5.01 to – 0.25).

CONCLUSION: Results of this systematic review and meta-analysis show that a removable orthosis is a safe alternative type of NOM, as complication numbers are significantly lower in the orthosis group. In addition, no statistically significant differences were found in terms of functional outcome between a removable orthosis and a cast at 6 and 12 weeks. The 6-week and the 26-week OMAS results show that in patients with stable type B ankle fractures, a removable orthosis is non-inferior to a cast in terms of functional outcome.

PMID:36383226 | DOI:10.1007/s00068-022-02169-6