Tag: pubmed

Eur Urol Focus. 2022 Sep 29:S2405-4569(22)00217-6. doi: 10.1016/j.euf.2022.09.010. Online ahead of print.

ABSTRACT

BACKGROUND: Quantitative Gleason grading appears to be a reliable prognostic parameter and provides broader risk stratification then the traditional Gleason grading in patients with prostate cancer (PCa) treated with radical prostatectomy (RP).

OBJECTIVE: To determine if quantification of Gleason pattern (GP) 4 for targeted and systematic biopsy (TBx + SBx) cores together with further clinical variables can identify the lowest quantitative GP 4 fraction on RP.

DESIGN, SETTING, AND PARTICIPANTS: A total of 548 patients underwent TBx + SBx of the prostate and then RP, with pathology revealing Gleason score 3 + 4, 4 + 3, or 4 + 4 disease.

INTERVENTION: TBx + SBx of the prostate followed by RP.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: GP 4 fraction thresholds of ≤5%, ≤10%, ≤15%, ≤20%, and ≤25% were compared between the TBx + SBx and RP specimens. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy for predicting the GP 4 fraction in the RP specimen were determined. Logistic regression models were used to establish a probabilistic relationship between various combinations of clinical and biopsy variables and the GP 4 fraction in the RP specimen.

RESULTS AND LIMITATIONS: GP 4 fractions of ≤5%, ≤10%, ≤15%, ≤20%, and ≤25% was observed in 33%, 49%, 58%, 65%, and 70% of patients on TBx, and 18%, 41%, 53%, 63%, and 70% of patients on RP, respectively. The sensitivity, specificity, NPV, PPV, and accuracy were 75%, 67%, 91%, 39%, and 74% for a TBx GP 4 fraction of ≤5%, and 65%, 85%, 65%, 85%, and 79% for a TBx GP 4 fraction of ≤25%, respectively. A model combining quantified TBx + SBx GP 4 with clinical parameters demonstrated the highest diagnostic accuracy. Limitations include the retrospective study design.

CONCLUSIONS: Our results demonstrate that the combination of MRI-TBx + SBx and GP 4 quantification allowed precise detection of a low fraction of GP 4 when using RP specimens as the reference standard. Moreover, we found that clinical variables including Prostate Imaging-Reporting and Data System score without biopsy are limited in detection of low GP 4 fractions.

PATIENT SUMMARY: Combination of targeted biopsy alone as well as combined with systematic biopsy and quantitative Gleason grading of biopsy specimen showed high agreement with pathology findings after surgical removal of the prostate. This could help in identifying patients who are suitable for active surveillance.

PMID:36184537 | DOI:10.1016/j.euf.2022.09.010

J Card Surg. 2022 Oct 2. doi: 10.1111/jocs.16988. Online ahead of print.

ABSTRACT

BACKGROUND: While prior data have suggested worse outcomes in women after acute type A aortic dissection (ATAAD) repair when compared to men, results have been inconsistent across studies over time. This study sought to evaluate the impact of sex on short- and long-term outcomes after ATAAD repair.

METHODS: This was a retrospective study utilizing an institutional database of ATAAD repairs from 2007 to 2021. Patients were stratified according to sex. Kaplan-Meier survival estimation and multivariable Cox regression were performed. Supplementary analysis using propensity score matching was also performed.

RESULTS: Of the 601 patients who underwent ATAAD repair, 361 were males (60.1%) and 240 (39.9%) were females. Females were significantly older, more likely to have hypertension, and more likely to have chronic lung disease. Females were also significantly more likely than males to undergo hemiarch replacement, while males were significantly more likely than females to undergo total arch replacement and frozen elephant trunk. Operative mortality was 9.4% among males and 13.8% among females, though this was not a statistically significant difference (p = .098). Postoperative complications were comparable between groups. Kaplan-Meier survival estimates were similar for men and women, and, on multivariable Cox regression, sex was not significantly associated with long-term survival (hazard ratio: 1.00, 95% confidence interval: 0.73, 1.37, p = .986). Outcomes remained comparable after supplementary propensity score matched analysis.

CONCLUSION: ATAAD repair can be performed with comparable short-term and long-term outcomes in both men and women.

PMID:36183385 | DOI:10.1111/jocs.16988

J Card Surg. 2022 Oct 2. doi: 10.1111/jocs.16984. Online ahead of print.

ABSTRACT

BACKGROUND/AIM: A transposition complex with an interrupted aortic arch (IAA) is rare and surgically challenging because of its anatomical diversity and complexity. Herein, we aimed to present our 20-year experience with one-stage arterial switch surgery associated with IAA repair.

METHODS: From January 2000 to April 2017, 11 patients were diagnosed with transposition complex and IAA and underwent one-stage repair at our center. These patients were retrospectively reviewed. Two patients had transposition of the great arteries, while the others had double outlet right ventricles, of whom eight had subpulmonary ventricular septal defects (VSDs; Taussig-Bing anomalies), and one had a noncommitted VSD. In terms of the IAA, three patients underwent repair by extended end-to-end anastomosis, and one 16-mm prosthetic vascular graft was replaced in an elder patient. The remaining patients underwent autologous pericardial patch enlargement. All the variables were summarized and reported with descriptive statistics.

RESULTS: Three early deaths occurred in this study. The median follow-up time was approximately 5 years (range: 3-14 years). No late deaths were reported. Only one patient required percutaneous re-intervention for recurrent coarctation. Moderate aortic regurgitation was observed in three patients. However, there was no requirement for aortic valvuloplasty or valve replacement. One patient had more than moderate tricuspid regurgitation. The other survivors are presently healthy.

CONCLUSIONS: Although one-stage repair for transposition complex and IAA still has non-negligible mortality even in older children, the late outcomes of survivors are acceptable. Owing to the high rate of valve regurgitation, closer follow-up is necessary for these patients.

PMID:36183381 | DOI:10.1111/jocs.16984

Ophthalmic Physiol Opt. 2022 Oct 2. doi: 10.1111/opo.13056. Online ahead of print.

ABSTRACT

PURPOSE: To determine the 3-year changes in anterior and posterior values of corneal asphericity (Q) in 6- to 12-year-old children.

METHODS: The first and second phases of the study were conducted in 2015 and 2018, respectively. The target population in the first phase was 6- to 12-year-old students in Shahroud, Iran. Multistage cluster sampling was performed on urban students. Additionally, all rural students in Shahroud county were invited to participate. Corneal imaging and ocular biometry were performed using the Pentacam-HR and Allegro Biograph, respectively.

RESULTS: A total of 4961 right eyes were analysed in this report. The mean (95% confidence interval) anterior and posterior Q values for an 8-mm chord diameter were -0.38 ± 0.11 (-0.39 to -0.38) and -0.32 ± 0.12 (-0.33 to -0.32) in the first phase of the study, respectively. The mean 3-year changes in anterior and posterior Q values were 0.00 ± 0.08 (95% CI: 0.00-0.00) and -0.01 ± 0.06 (95% CI: -0.01 to -0.01), respectively. Based on a multiple regression model, advancing age (β = -0.002; [-0.003 to -0.001]), 3-year increase in mean keratometry (β = -0.04; [-0.06 to -0.02]), central corneal thickness (β = -0.001; [-0.001 to -0.000]), lens thickness (-0.05; [-0.11 to -0.003]) and anterior chamber depth (-0.09; [-0.15 to -0.03]) showed a statistically significant association with increased anterior Q prolation. Increased axial length was associated with a decrease in Q (β = 0.02; [0.004 to 0.03]). In addition, female gender (β = -0.004; [-0.007 to -0.001]) was significantly associated with a more prolate posterior Q value, while rural residence (β = 0.005; [0.002 to 0.009]) was significantly associated with a more oblate posterior Q value.

CONCLUSION: Three-year changes in anterior and posterior Q values were very small. The cornea tends to become more prolate with increasing age.

PMID:36183360 | DOI:10.1111/opo.13056

Geobiology. 2022 Oct 2. doi: 10.1111/gbi.12529. Online ahead of print.

ABSTRACT

Microbialites provide a record of the interaction of microorganisms with their environment constituting a record of microbial life and environments through geologic time. Our capacity to interpret this record is limited by an incomplete understanding of the microbial, geochemical, and physical processes that influence microbialite formation and morphogenesis. The modern system Laguna Negra in Catamarca Province, Argentina contains microbialites in a zone of carbonate precipitation associated with physico-chemical gradients and variable microbial community structure, making it an ideal location to study how these processes interact to drive microbialite formation. In this study, we investigated the geospatial relationships between carbonate morphology, geochemistry, and microbial community at the macro- (decimeter) to mega- (meter) scale by combining high-resolution imagery with field observations. We mapped the distribution of carbonate morphologies and allochtonously-derived volcaniclasts and correlated these with sedimentary matrices and geochemical parameters. Our work shows that the macroscale distribution of different carbonate morphologies spatially correlates with microbial mat distributions-a result consistent with previous microscale observations. Specifically, microbialitic carbonate morphologies more commonly occur associated with microbial mats while abiotically derived carbonate morphologies were less commonly associated with microbial mats. Spatial variability in the size and abundance of mineralized structures was also observed, however, the processes controlling this variability remains unclear and likely represent a combination of microbial, geochemical, and physical processes. Likewise, the processes controlling the spatial distribution of microbial mats at Laguna Negra are also unresolved. Our results suggest that in addition to the physical drivers observed in other modern environments, variability in the spatial distribution of microbialites and other carbonate morphologies at the macro- to megascale can be controlled by microbial processes. Overall, this study provides insight into the interpretation of microbialite occurrence and distributions in the geologic record and highlights the utility of geospatial statistics to probe the controls of microbialite formation in other environments.

PMID:36183342 | DOI:10.1111/gbi.12529

J Dig Dis. 2022 Oct 2. doi: 10.1111/1751-2980.13134. Online ahead of print.

ABSTRACT

AIM: Clostridioides difficile Infection (CDI) is known for significant morbidity and mortality. Fecal microbiota transplantation (FMT) is an effective therapy for recurrent and resistant CDI. However, its impact on the mortality rate of patients with severe and fulminant CDI has not been rigorously studied yet. We evaluated the effectiveness of FMT on the mortality rate of patients with severe or fulminant CDI in a community hospital system.

METHODS: Our study included 106 inpatients with severe or fulminant CDI. Both standard of care (SOC) and FMT were provided to 14 (13.2%) patients (FMT group). SOC antibiotics alone were provided to 92 (86.8%) patients out of whom we selected 28 controls via propensity score matching (SOC group).

RESULTS: The primary outcome was defined as the composite endpoint of mortality during admission, within 30 and 90 days after discharge, and discharge with comfort measures only. Each component was a secondary endpoint. The primary outcome rate in the FMT group was 7.1% (n=1/14) compared to 25% (n=7/28) in the SOC group. The univariate analysis demonstrated that FMT decreases mortality (odds ratio = 0.08, 95% confidence intervals 0.01 – 0.58, P = 0.01), however multivariate regression did not show statistical significance (odds ratio = 0.15, 95% confidence intervals 0.01 – 2.53, P = 0.19) possibly due to the small sample size.

CONCLUSIONS: FMT may decrease the mortality of patients with severe and fulminant CDI, and larger studies are needed to validate these findings.

PMID:36183340 | DOI:10.1111/1751-2980.13134

Health Econ. 2022 Oct 2. doi: 10.1002/hec.4607. Online ahead of print.

ABSTRACT

We study the health impact of food and beverage price promotion strategies-multi-buy offers and price discounts, typically biased toward unhealthy product categories-in British consumer retail. We are the first to employ econometric models from the marketing literature to analyze the impact of price promotions with a focus on population health. Our dynamic, reduced form demand model incorporates endogenous inventory (stock piling), consumption rates imputed from repeat purchases and allows for unobserved household heterogeneity. We find that removing price discounts is more effective for reducing purchase volume compared to removing multi-buy offers for 10 out of 12 food and drink groups, particularly those products for which price reduction is more common than multibuy. We find that price promotions induce consumption-and waste -through behavioral effects, associated with increased household inventory (stockpiling).

PMID:36183337 | DOI:10.1002/hec.4607

Med J Aust. 2022 Oct 2;217 Suppl 7:S22-S28. doi: 10.5694/mja2.51693.

ABSTRACT

OBJECTIVES: To evaluate the efficacy of peer-facilitated interventions for improving the physical health of people with schizophrenia spectrum disorders.

STUDY DESIGN: Systematic review and random effects meta-analysis of peer-facilitated interventions for people with serious mental illness, including schizophrenia spectrum disorders, in which physical health outcomes were assessed.

DATA SOURCES: MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, Scopus, CENTRAL, and PubMed. In addition, reference lists of reviews were examined for further relevant studies published to 10 November 2021.

DATA SYNTHESIS: We included fourteen publications (thirteen randomised controlled trials of ten peer-facilitated interventions, and one secondary analysis; total of 2099 participants) that assessed physical health outcomes for people with mental health conditions, including schizophrenia spectrum disorders. Intervention duration ranged from three to eighteen months; peers were involved as sole or co-leaders of the programs in group or individual sessions. Meta-analysis identified a statistically significant pooled effect on physical activity and capacity (various measures; six studies; 468 intervention, 461 control participants; standardised mean difference, +0.19 standard deviation [SD]; 95% CI, +0.06-0.32 SD; I² = 0%); overall GRADE certainty of evidence was low. Marked study heterogeneity precluded secure conclusions regarding intervention effects on self-rated physical health, healthy eating, and body mass index.

CONCLUSIONS: Peer-facilitated interventions for improving physical outcomes are feasible for people with schizophrenia spectrum disorders, a group at particular risk of certain physical health conditions. Further research is required to assess the effects of such interventions on other health-related parameters.

PROSPERO REGISTRATION: CRD42021283578 (retrospective).

PMID:36183320 | DOI:10.5694/mja2.51693

Med J Aust. 2022 Oct 2;217 Suppl 7:S7-S21. doi: 10.5694/mja2.51680.

ABSTRACT

OBJECTIVE: To review recent published trials of nutrition and dietary interventions for people with serious mental illness; to assess their effectiveness in improving metabolic syndrome risk factors.

STUDY DESIGN: Systematic review and meta-analysis of randomised and non-randomised controlled trials of interventions with a nutrition/diet-related component delivered to people with serious mental illness, published 1 January 2010 – 6 September 2021. Primary outcomes were weight, body mass index (BMI), and waist circumference. Secondary outcomes were total serum cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, triglyceride, and blood glucose levels.

DATA SOURCES: MEDLINE, EMBASE, PsycINFO, CINAHL, and CENTRAL databases. In addition, reference lists of relevant publications were examined for further additional studies.

DATA SYNTHESIS: Twenty-five studies encompassing 26 intervention arms were included in our analysis. Eight studies were at low or some risk of bias, seventeen were deemed to be at high risk. Eight of seventeen intervention arms found statistically significant intervention effects on weight, ten of 24 on BMI, and seven of seventeen on waist circumference. The pooled effects of nutrition interventions on metabolic syndrome risk factors were statistically non-significant. However, we identified small size effects on weight for interventions delivered by dietitians (five studies; 262 intervention, 258 control participants; standardised mean difference [SMD], -0.28; 95% CI, -0.51 to -0.04) and interventions consisting of individual sessions only (three studies; 141 intervention, 134 control participants; SMD, -0.30; 95% CI, -0.54 to -0.06).

CONCLUSIONS: We found only limited evidence for nutrition interventions improving metabolic syndrome risk factors in people with serious mental illness. However, they may be more effective when delivered on an individual basis or by dietitians.

PROSPERO REGISTRATION: CRD42021235979 (prospective).

PMID:36183316 | DOI:10.5694/mja2.51680

Cancer Causes Control. 2022 Oct 2. doi: 10.1007/s10552-022-01636-0. Online ahead of print.

ABSTRACT

PURPOSE: Little is known about cancer survivors’ needs in Alaska. To address this knowledge gap, the Alaska Cancer Partnership conducted a needs assessment survey; our objectives were to identify unmet needs of Alaska’s cancer survivors; identify survivor sub-populations that might benefit from targeted interventions or programming; and develop recommendations for public health and community organizations and healthcare providers for addressing cancer survivors’ unmet needs.

METHODS: Cancer survivors were identified using data from the Alaska Cancer Registry. A random sample of 2,600 individuals was selected to receive the survey, which assessed unmet needs across the following domains: information needs and medical care issues; quality of life; emotional and relationship issues related to cancer diagnoses; and support services. We calculated descriptive statistics for survey responses and assessed demographic predictors of unmet needs using Poisson regression.

RESULTS: We received 335 survey responses, for a response of 13.7%. Only 29.9% of cancer survivors expressed that all their needs were met. The most highly ranked unmet needs were as follows: help to reduce stress in life; to know doctors were coordinating care; and managing concerns about cancer coming back. After adjustment, men, adults younger than 65 at diagnosis, Alaska Native people, survivors still receiving or who had recently received care, and people who had to travel 50+ miles for most of their care had significantly greater unmet needs than their comparison groups.

CONCLUSION: This assessment provided some of the first information regarding the needs of Alaska’s cancer survivors. These results will be used by Alaska Cancer Partnership members across the state to inform healthcare delivery, programs, and public health messaging to support survivors.

PMID:36183311 | DOI:10.1007/s10552-022-01636-0