Tag: pubmed

J Nutr. 2021 Sep 13:nxab301. doi: 10.1093/jn/nxab301. Online ahead of print.

ABSTRACT

BACKGROUND: Vegetarian-type dietary patterns have been associated with reducing the risk of developing diabetes and may function as an effective strategy for diabetes management.

OBJECTIVES: We aimed to examine the associations between adherence to plant-based diet indices and the risk of developing diabetes in the Boston Puerto Rican Health Study.

METHODS: Puerto Rican adults (n = 646), aged 45-75 y and free of diabetes at baseline, were included. Dietary intake was assessed via a validated FFQ. Three plant-based dietary indices were calculated: an overall plant-based diet index (PDI), a healthful plant-based diet index (hPDI), and an unhealthful plant-based diet index (uPDI). Incident diabetes was defined as fasting plasma glucose ≥ 126 mg/dL (7.0 mmol/L), glycated hemoglobin ≥ 6.5% (48 mmol/mol), or use of hypoglycemic agents during follow-up. Cox proportional hazards were used to evaluate associations between the dietary patterns and incidence of diabetes, adjusting for potential confounders, such as age, sex, socioeconomic status, lifestyle factors, obesity, total energy intake, depressive symptomatology, and plasma concentrations of lipids.

RESULTS: During a mean of 4.2 y of follow-up, we identified 134 diabetes cases. After adjustment for covariates, higher hPDI was associated with lower risk of developing diabetes (adjusted HR for the highest compared with the lowest tertile: 0.54; 95% CI: 0.31, 0.94; P-trend = 0.03). In contrast, the PDI and uPDI were not significantly associated with the risk of diabetes (P-trend > 0.3 for both).

CONCLUSIONS: The healthful plant-based dietary index, but not the total plant-based dietary index, was inversely associated with diabetes risk. These findings suggest that the quality of plant-based diets must be considered when recommending plant-based diets for the prevention of diabetes.This trial was registered at clinicaltrials.gov as NCT01231958.

PMID:34515303 | DOI:10.1093/jn/nxab301

Respiration. 2021 Sep 3:1-8. doi: 10.1159/000518009. Online ahead of print.

ABSTRACT

BACKGROUND: Several advanced bronchoscopy platforms are currently available, but the clinical data supporting their use vary. Electromagnetic navigation bronchoscopy (ENB) remains the dominant technology; it is limited by its reliance on preoperative computed tomography, which only approximates patient anatomy during the procedure. Recently, ENB was enhanced with the (1) addition of digital tomosynthesis-based navigation correction, (2) improvements in planning algorithms, and (3) continuous real-time guidance (Illumisite™; Medtronic, Minneapolis, MN, USA). There are currently no clinical data on the diagnostic yield and safety profile of this system.

OBJECTIVES: The primary objective of this study is to describe the diagnostic yield of the first 100 pulmonary parenchymal lesions sampled using the multimodality navigation bronchoscopy (MNB) platform. The secondary objective is to describe safety.

METHODS: In this single-center prospective observational study, a database was maintained to track patient, procedural, and outcome data for the first 100 consecutive lesions sampled using the MNB platform at an academic quaternary referral center. Descriptive statistics and univariate and multivariate analyses are reported.

RESULTS: The overall diagnostic yield of samples acquired was 79% (79/100). In the cohort where digital tomosynthesis was used, the diagnostic yield was 83% (69/83). Sensitivity for malignancy was 71% (52/73). Overall complication rates were low: pneumothorax (n = 3, 3%) and bleeding requiring intervention (n = 2, 2%). There were no procedural-related hospital admissions.

CONCLUSIONS: The MNB system performed favorably. Platform superiority cannot be established without future prospective and comparative studies.

PMID:34515222 | DOI:10.1159/000518009

Urol Int. 2021 Aug 25:1-10. doi: 10.1159/000518028. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to improve understanding the clinical, pathologic, and prognostic features of urachal carcinoma (UrC), a retrospectively descriptive study was done in 2 clinical centers.

METHODS: After excluding the 2 missed patients, the clinical and pathological data of 59 patients with UrC, who were diagnosed or treated at 2 clinical centers between 1986 and 2019, was retrospectively analyzed. SPSS 22.0 (IBM) and GraphPad Prism 8.0.1 were used for statistics and data visualization. Survival data were analyzed by the Kaplan-Meier method and Log-rank tests. Cox proportional hazards regression were performed for find risk factors on predicting the prognosis.

RESULTS: Of all 59 patients, 47 were male and 12 were female. The median age at diagnosis was 51.6 years (range: 22-84 years). Gross hematuria was the most common symptom (79.66%). The majority of urachal neoplasms were adenocarcinomas (94.92%). Forty-two patients (72.41%) underwent extended partial cystectomy with en bloc resection of the entire urachus. The mean follow-up was 52 months (3-277 months). Median overall survival was 52.8 months (4-93 months). The 3-year cancer-specific survival (CSS) rate and 5-year CSS rate were 69.1% and 61.2%. There was no significant difference among localized T stage, tumor histologic grade and surgical procedures in determining prognosis by survival analyze. While patients with high-risk TNM stage (local abdominal metastasis, lymph node metastasis, or distant metastasis) (p = 0.003) and positive surgical margin (p < 0.001) had significantly worse prognosis.

CONCLUSIONS: The results indicate that high-risk TNM stage and positive surgical margin are risk predictors of prognosis. Localized T stage, histologic grade, and surgical procedure cause no significant effect on patient prognosis. The extended partial cystectomy is the recommended surgical approach for patients with UrC. Active multimodal treatments may improve the survival of patients with recurrent and metastatic disease.

PMID:34515250 | DOI:10.1159/000518028

Int Orthod. 2021 Sep 9:S1761-7227(21)00111-X. doi: 10.1016/j.ortho.2021.08.004. Online ahead of print.

ABSTRACT

OBJECTIVE: In orthodontic treatment, indication of dental extractions is very common and frequently used in adult patients. This situation is a recurrent concern among orthodontists, since age and extraction treatment are factors that may increase periodontal support loss. Therefore, this study aimed to evaluate adolescent and adult patients, orthodontically treated with maxillary premolar extractions, and compare both groups regarding the changes in alveolar bone height loss, retrospectively.

MATERIALS AND METHODS: Fifty-five patients were selected from the files of an Orthodontic Department and divided into 2 groups. The adolescent group comprised 30 patients with a mean age of 12.7 years (SD=1.4) and the adult group comprised 25 patients with a mean age of 25.0 years (SD=1.8). Periapical radiographs obtained at pre-treatment (T1) and posttreatment (T2) were evaluated. Wilcoxon tests were used to analyse intragroup treatment changes. Mann-Whitney tests were used to compare intergroup and inter-sex initial and final statuses and treatment changes. P<0.05 is considered to be statistically significant.

RESULTS: Statistically significant increases in alveolar bone height loss of the maxillary central incisors were observed on the right and left sides of the adolescent (P=0.001 and P=0.002, respectively) and of the adult (P=0.001 and P<0.001, respectively) groups, during treatment. There were no significant differences in alveolar bone height between initial and final state, in treatment effects between adolescent and adult patients, in extraction patterns, and between males and females.

CONCLUSIONS: Significant increase in alveolar bone height loss was found in both adult and adolescent patients orthodontically treated with maxillary premolar extractions. However, no significant differences were found regarding alveolar bone height changes after extraction orthodontic treatment between adolescent and adult patients.

PMID:34511394 | DOI:10.1016/j.ortho.2021.08.004

Pancreatology. 2021 Sep 8:S1424-3903(21)00568-8. doi: 10.1016/j.pan.2021.09.004. Online ahead of print.

ABSTRACT

BACKGROUND: Pancreatic carcinoma carries a devastating prognosis and is the 4th leading cause for cancer related death in the US and most European countries. Apart from imaging and CA 19-9, pancreatic carcinoma is still lacking reliable markers to assess tumor dynamics and to monitor treatment response over time. The aim of this study was to evaluate the feasibility of cell free tumor-DNA (cft-DNA), respectively KRAS mutation in peripheral blood, detection as a prognostic and predictive value for chemotherapy monitoring.

METHODS: Serial plasma samples from 42 patients with KRAS mutated pancreatic cancer were prospectively collected and the ctKRAS Mutation Assay (Idylla™, Biocartis, Mechelen, Belgium) of cft-DNA was performed on 29 patients that did not receive curative surgery and went on to palliative chemotherapy. To monitor cft-DNA KRAS mutation levels during treatment quantitative assessment of cft-DNA was performed at baseline and during follow up at predetermined times.

RESULTS: All 29 patients included in our analyses had a detected KRAS mutation in the tumor biopsy. In almost half (48.2%) of patients a KRAS mutation could also be detected in peripheral plasma. Patients with detectable KRAS mutations before treatment start in plasma had a significantly worse survival (16.8 months vs not reached, p < 0.031 and HR 3.303). Looking for a dynamic assessment of tumor response, we found a statistically significant association between the KRAS mutant ratio from first staging CT scan to basal levels with tumor response or progress (p = 0.014).

CONCLUSION: Performing KRAS testing from peripheral blood for patients, who have no elevated tumor markers, might be a novel option for treatment monitoring complementing routine imaging techniques.

PMID:34511398 | DOI:10.1016/j.pan.2021.09.004

J Plast Reconstr Aesthet Surg. 2021 Aug 17:S1748-6815(21)00377-6. doi: 10.1016/j.bjps.2021.08.002. Online ahead of print.

ABSTRACT

BACKGROUND: There is still no consensus regarding the ideal zoning in abdominal-based autologous breast reconstruction using free DIEP or ms-TRAM flaps. In particular, the perfusion pattern of the flap according to the number of perforators used and their location remains controversial. In this study, the perfusion of free DIEP and ms-TRAM flaps is assessed intraoperatively and analyzed with regard to different perfusion patterns.

METHODS: A retrospective analysis of 100 free flaps for breast reconstruction was performed. Following complete flap harvest, we used indocyanine green angiography for perfusion analysis. By applying two different contour levels, DIEP flaps with lateral or medial perforators and ms-TRAM flaps were assessed for their respective perfusion patterns.

RESULTS: No statistically significant differences were found in the size of the perfusion area between the different flap types when applying the contour level of 20% (p >0.05). For the contour level of 30%, however, statistically significant differences were found between DIEP flaps with medially or laterally located perforators (p = 0.038). Laterally or medially located perforators in DIEP flaps showed no significant differences in their ability to cross the midline (contour level 20%, p = 0.068; contour level 30%, p = 0.058).

CONCLUSION: Considering the variability of the perfusion of the abdominal wall and the high sensitivity of indocyanine green angiography for their detection, the abdominal zonings play a minor role. By using intraoperative indocyanine green angiography, a precise and patient-specific free flap surgery for autologous breast reconstruction is possible independent of perforator location.

PMID:34511387 | DOI:10.1016/j.bjps.2021.08.002

Reprod Biomed Online. 2021 Jul 22:S1472-6483(21)00347-3. doi: 10.1016/j.rbmo.2021.07.007. Online ahead of print.

ABSTRACT

RESEARCH QUESTION: Is there a relationship between body mass index (BMI) and endometriotic lesions, specifically surgical phenotype and lesion location?

DESIGN: An observational retrospective cohort study at the Royal Women’s Hospital, Melbourne, Australia, including 471 histologically confirmed endometriosis patients. Statistical analyses included multivariate logistic regression and multivariate modelling, correcting for multiple testing. Outcomes were the presence or absence of surgically classified lesion phenotypes, as per revised American Society for Reproductive Medicine criteria including superficial or deep, peritoneal or ovarian, and adhesions (Study I); and lesions at specific anatomical locations (including pelvic side wall, uterosacral ligament, pouch of Douglas, ovarian, uterovesical fold, bladder, and pararectal endometriosis) (Study II).

RESULTS: In Study I, patients with higher BMI were more likely to have superficial peritoneal lesions (odds ratio [OR] 1.070, 95% confidence interval [CI] 1.004-1.144; P = 0.044), and less likely to have deep ovarian lesions (OR 0.928, 95% CI 0.864-0.993; P = 0.034). In Study II, patients with higher BMI were less likely to have uterovesical fold lesions (OR 0.927, 95% CI 0.867-0.985; P = 0.021) or anterior compartment lesions (OR 0.940, 95% CI 0.888-0.989; P = 0.023). After correcting for multiple testing, the relationship between BMI and lesion phenotypes did not persist (P > 0.01).

CONCLUSIONS: This analysis does not conclusively support an influence of BMI on endometriotic lesion phenotype based on surgical classification or location. Further investigation of the physiological disturbances underlying BMI and the promotion of endometriotic lesion phenotypes and their location is warranted, but any effect is likely to be small.

PMID:34511393 | DOI:10.1016/j.rbmo.2021.07.007

Oral Surg Oral Med Oral Pathol Oral Radiol. 2021 May 17:4628. doi: 10.1016/j.oooo.2021.05.004. Online ahead of print.

ABSTRACT

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic caused delays in medical and surgical interventions in most health care systems worldwide. Oral and maxillofacial surgeons (OMSs) delayed operations to protect themselves, patients, and staff. This article (1) presents one institution’s experience in the management of pediatric craniomaxillofacial trauma during the COVID-19 pandemic and (2) suggests recommendations to decrease transmission.

METHODS: This was a retrospective review of children aged 18 years or younger who underwent surgery at Children’s Healthcare of Atlanta in Atlanta, GA, between March and August 2020. Patients (1) were aged 18 years old or younger, (2) had one or more maxillofacial fractures, and (3) underwent surgery performed by an OMS, otolaryngologist, or plastic surgeon. Medical records were reviewed regarding (1) fracture location, (2) COVID-19 status, (3) timing, (4) personal protective equipment, and (5) infection status. Descriptive statistics were computed.

RESULTS: Fifty-eight children met the inclusion criteria. The most commonly injured maxillofacial location was the nose. Operations were performed 50.9 hours after admission. Specific prevention perioperative guidelines were used with all patients, with no transmission occurring from a patient to a health care worker.

CONCLUSIONS: With application of our recommendations, there was no transmission to health care workers. We hope that these guidelines will assist OMSs during the COVID-19 pandemic.

PMID:34511346 | DOI:10.1016/j.oooo.2021.05.004

Oral Surg Oral Med Oral Pathol Oral Radiol. 2021 May 18:S2212-4403(21)00431-4. doi: 10.1016/j.oooo.2021.05.003. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the histopathologic outcomes of pericoronal radiolucencies and identify factors predictive of diagnosis.

STUDY DESIGN: A retrospective cohort study of 258 patients with 280 radiolucent pericoronal lesions undergoing treatment at our institution between 2005 and 2019. The primary predictor variable was lesion size (≥2 cm and <2 cm). The primary outcome variable was histopathologic diagnosis (dentigerous cyst vs other pathologic entity). Descriptive, bivariate, and multiple logistic regression statistics were computed to measure the association between clinical and radiographic variables and histopathologic diagnosis.

RESULTS: The study sample was composed of 258 patients with 280 histopathologic specimens. There were 218 dentigerous cysts (77.9%) and 62 other pathologic entities (22.1%). Lesions ≥2 cm were 3.20 times more likely to be diagnosed as a nondentigerous cyst pathologic entity (P ≤ .001). After adjusting for jaw (maxilla vs mandible), pain, history of infection, cortical perforation, expansion, and multiple lesions, younger age (P ≤ .001, odds ratio [OR] = 0.950, 95% confidence interval [CI] = 0.929-0.972) and lesion size as a continuous variable (P = .007, OR = 1.06, 95% CI = 1.02-1.11) were independent predictors of other pathologic entities.

CONCLUSIONS: The majority of pericoronal radiolucent lesions were dentigerous cysts. Younger age and larger lesions were independent predictors of other pathologic entities.

PMID:34511358 | DOI:10.1016/j.oooo.2021.05.003

Oral Surg Oral Med Oral Pathol Oral Radiol. 2021 May 24:S2212-4403(21)00434-X. doi: 10.1016/j.oooo.2021.05.006. Online ahead of print.

ABSTRACT

OBJECTIVE: The present study aimed to comprehensively characterize the epidemiologic characteristics, clinicopathologic characteristics, clinical treatments, and prognoses of pleomorphic adenoma (PA) identified at unusual intraoral sites.

STUDY DESIGN: Patients diagnosed with PA in oral and maxillofacial regions at our institution in the past 16 years (2005-2020) were screened from the inpatient disease registry. All data concerning patients with PA found at unusual intraoral sites (defined as intraoral locations except sublingual gland and palate) were retrieved. Previously published cases with adequate clinicopathologic data were collected from PubMed and Embase. Eligible cases were further reviewed and included for statistical analyses.

RESULTS: Among 1039 cases of PA diagnosed at our institution, 52 lesions were found at unusual intraoral sites. A literature review identified another 63 eligible cases from 32 articles. The upper lip was the most common sites for these lesions (n = 57), followed by buccal mucosa (n = 34), tongue (n = 8), lower lip (n = 8), and retromolar area (n = 2). Recurrence and malignant transformation after surgical resection were extremely rare for these lesions.

CONCLUSIONS: PA might rarely develop at uncommon intraoral sites with atypical presentations, thus complicating its early diagnosis. Surgical resection is the major therapeutic strategy for this rare entity and has a favorable prognosis.

PMID:34511341 | DOI:10.1016/j.oooo.2021.05.006