Tag: pubmed

J Otolaryngol Head Neck Surg. 2021 Jul 8;50(1):44. doi: 10.1186/s40463-021-00525-x.

ABSTRACT

OBJECTIVE: To evaluate the impact of a high efficiency rapid standardized OR (RAPSTOR) for hemithyroid/parathyroid surgery using standardized equipment sets (SES) and consecutive case scheduling (CCS) on turnover times (TOT), average case volumes, patient outcomes, hospital costs and OR efficiency/stress.

METHODS: Patients requiring hemithyroidectomy (primary or completion) or unilateral parathyroidectomy in a single surgeon’s practice were scheduled consecutively with SES. Retrospective control groups were classified as sequential (CS) or non-sequential (CNS). A survey regarding OR efficiency/stress was administered. Phenomenography and descriptive statistics were conducted for time points, cost and patient outcome variables. Hospital cost minimization analysis was performed.

RESULTS: The mean TOT of RAPSTOR procedures (16 min; n = 27) was not significantly different than CS (14 min, n = 14) or CNS (17 min, n = 6). Mean case number per hour was significantly increased in RAPSTOR (1.2) compared to both CS (0.9; p < 0.05) and CNS (0.7; p < 0.05). Average operative time was significantly reduced in RAPSTOR (32 min; n = 28) compared to CNS (48 min; p < 0.05) but not CS (33 min; p = 0.06). Time to discharge was reduced in RAPSTOR (595 min) compared to CNS (1210 min, p < 0.05). There was no difference in complication rate between all groups (p = 0.27). Survey responses suggested improved efficiency, teamwork and workflow. Furthermore, there is associated decrease in direct operative costs for RAPSTOR vs. CS.

CONCLUSION: A high efficiency standardized OR for hemithyroid and parathyroid surgery using SES and CCS is associated with improved efficiency and, in this study, led to increased capacity at reduced cost without compromising patient safety.

LEVEL OF EVIDENCE: Level 2.

PMID:34238389 | DOI:10.1186/s40463-021-00525-x

J Pediatr Endocrinol Metab. 2021 Jul 9. doi: 10.1515/jpem-2021-0023. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare cardiometabolic risk factors of Brazilian children and adolescents with international reference values. Cardiometabolic risk factors constitute the Metabolic Syndrome, whose evaluation is important to assess pediatric populations’ health and potential to experience metabolic disorders.

METHODS: Cross-sectional study that included 2,250 randomly selected children and adolescents (55.6% girls), aged 6 to 17. Cardiometabolic parameters (body mass index [BMI], waist circumference [WC], systolic and diastolic blood pressures [SBP and DBP], total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], TC:HDL-C ratio, triglycerides [TG], glucose and peak oxygen uptake [VO₂peak]), and clustered risk scores were compared to international age- and sex-specific reference values. A clustered risk score was calculated by summing the WC, glucose, SBP, TG, and the TC:HDL-C ratio Z-scores divided by five. A second clustered was calculated including VO₂peak (inverted) Z-score, but divided by six.

RESULTS: The clustered risk score, considering the all ages sample, was better in the Brazilian boys (-0.20 [-0.41;0.01] and -0.18 [-0.37;0.01], including or not VO₂peak, respectively) but not significantly, and worse in girls (0.24 [0.05;0.43] and 0.28 [0.11;0.44], including or not VO₂peak, respectively) than the international reference. Additionally, Brazilian youth had a statistically better profile in TC, LDL-C, HDL-C, TC:HDL-C ratio, and VO₂peak (only girls) as well as a worse profile in BMI, WC, SBP, DBP, TG (only girls), and VO₂peak (only boys).

CONCLUSIONS: The clustered cardiometabolic risk score (including or not VO₂peak), considering the all ages sample, was better in the Brazilian boys, but not significantly, and worse in girls compared to the international reference.

PMID:34237809 | DOI:10.1515/jpem-2021-0023

Drug Metab Pers Ther. 2021 Jul 8. doi: 10.1515/dmdi-2021-0104. Online ahead of print.

ABSTRACT

OBJECTIVES: To mitigate the incidence of recurrent stroke in patients, dual antiplatelet therapy comprising aspirin and clopidogrel is usually administered. Clopidogrel is a prodrug and its bioactivation is catalyzed by cytochrome P450 (CYP)2C19. The main objective of this work was to determine the prevalence of CYP2C19*2 carriers in Saudi ischemic stroke patients and assess the suitability of using genotyping to guide antiplatelet therapy in a university hospital setup.

METHODS: This prospective (2018-2019) study was conducted on 256 patients (age 61 ± 12.5) clinically diagnosed with ischemic stroke who were genotyped using Spartan RX CYP2C19 assay.

RESULTS: From the total patient group (256), upon admission, 210 patients were prescribed either aspirin, clopidogrel or dual antiplatelet therapy. Of the 27 patients with the CYP2C19*2 allele who were prescribed clopidogrel (18) or dual antiplatelet therapy (9), only 21 patients could be followed up for a period of six months post stroke event, in addition to 21 age- and sex-matched patients with the normal allele. The CYP2C19*2 allele carriers had a statistically significant increased risk of recurrent stroke compared to patients carrying the normal allele.

CONCLUSIONS: This study shows the suitability of using genotyping to guide antiplatelet therapy in ischemic stroke patients in a clinical setting.

PMID:34237806 | DOI:10.1515/dmdi-2021-0104

Drug Metab Pers Ther. 2021 Jul 8. doi: 10.1515/dmdi-2021-0117. Online ahead of print.

ABSTRACT

OBJECTIVES: Majoon-e-Seer Alvi Khan, a compound Unani formulation, has been indicated in disease conditions simulating dyslipidemia. The present study was done to substantiate the efficacy of Majoon-e-Seer Alvi Khan (MSAK) in dyslipidaemia on scientific parameters.

METHODS: A randomized, single-blind, Standard controlled, clinical trial was carried out on 40 patients of dyslipidemia who were randomly allocated into test (n=30) and control (n=10) groups. The test drug, MSAK, and control drug, tablet Atorvastatin was given to the respective group for 60 days along with lifestyle modification.

RESULTS: The test drug significantly alleviated the symptoms of subjective parameters (p<0.05). There was a statistically significant reduction in lipid profile of the patients in the test group (p<0.05) than control drug treatment.

CONCLUSIONS: The study evidenced that Majoon-e-Seer Alvi Khan is potentially effective and safe in the treatment of dyslipidemia. However, a multicentre study with a robust study design is required to generalize the results.

PMID:34237808 | DOI:10.1515/dmdi-2021-0117

Am J Perinatol. 2021 Jul 8. doi: 10.1055/s-0041-1731633. Online ahead of print.

NO ABSTRACT

PMID:34237775 | DOI:10.1055/s-0041-1731633

J Knee Surg. 2021 Jul 8. doi: 10.1055/s-0041-1731722. Online ahead of print.

ABSTRACT

Total knee replacement (TKR) is one of the most common orthopaedic procedures performed, and enhanced recovery after surgery (ERAS) has been developed and incorporated into inpatient surgical pathways to improve patient outcomes. Under ERAS recommendations, multimodal prophylaxis has been used to help manage postoperative nausea and vomiting (PONV) following TKR. Dexamethasone is one of the commonly used for this and the anti-inflammatory properties could depress vagal activity, reducing postural hypotension (PH). The hypothesis of this study is that postoperative dexamethasone use is associated with lower rates of early postoperative PH following TKR surgery. In our institution, patients who undergo elective primary TKR are admitted on the day of surgery and follow a standardized ERAS protocol. Data on patients who underwent elective primary TKR under a single adult reconstruction team from September 2017 to March 2020 were reviewed and analyzed. A review of demographic characteristics, surgical data, postoperative medications, and postoperative notes was performed. Binary logistic regression was used to assess the effect of the use of dexamethasone on PH, with an adjusted odds ratio (OR) calculated after accounting for potential confounders. Of the 149 patients were included in the study, 78 had dexamethasone postoperatively, and 71 did not. Patients who had received dexamethasone were statistically less likely to suffer from PH (OR = 0.31, p = 0.03) and less likely to develop PONV (OR = 0.21, p = 0.006). Patients who had received dexamethasone were more likely able to participate in early physiotherapy (OR = 2.42, p = 0.14), and this result was statistically insignificant. The use of postoperative intravenous dexamethasone is significantly associated with lower rates of postoperative PH after TKR. However, more studies are required to assess the optimal dosing amount and frequency, as well as to assess other factors which can enhance early postoperative patient mobilization as part of our goals for ERAS. This therapeutic study reflects level of evidence III.

PMID:34237779 | DOI:10.1055/s-0041-1731722

Stat Appl Genet Mol Biol. 2021 Jul 8. doi: 10.1515/sagmb-2020-0025. Online ahead of print.

ABSTRACT

The predictive power of machine learning models often exceeds that of mechanistic modeling approaches. However, the interpretability of purely data-driven models, without any mechanistic basis is often complicated, and predictive power by itself can be a poor metric by which we might want to judge different methods. In this work, we focus on the relatively new modeling techniques of neural ordinary differential equations. We discuss how they relate to machine learning and mechanistic models, with the potential to narrow the gulf between these two frameworks: they constitute a class of hybrid model that integrates ideas from data-driven and dynamical systems approaches. Training neural ODEs as representations of dynamical systems data has its own specific demands, and we here propose a collocation scheme as a fast and efficient training strategy. This alleviates the need for costly ODE solvers. We illustrate the advantages that collocation approaches offer, as well as their robustness to qualitative features of a dynamical system, and the quantity and quality of observational data. We focus on systems that exemplify some of the hallmarks of complex dynamical systems encountered in systems biology, and we map out how these methods can be used in the analysis of mathematical models of cellular and physiological processes.

PMID:34237805 | DOI:10.1515/sagmb-2020-0025

Horm Res Paediatr. 2021 Jul 8:1-7. doi: 10.1159/000517341. Online ahead of print.

ABSTRACT

OBJECTIVE: No data are available on advanced glycation end products (AGEs) and their soluble receptor (sRAGE) in pediatric patients with Hashimoto’s thyroiditis (HT). The present study was aimed to simultaneously evaluate serum levels of sRAGE, AGEs, and advanced oxidation protein products (AOPPs) and investigate the relationships between these oxidative stress markers and clinical and biochemical parameters of thyroid function in euthyroid children with HT.

DESIGN: This is a case-control study carried out in a single university hospital center.

METHODS: We enrolled 19 newly diagnosed euthyroid HT pediatric patients (3 M, 16 F; median age 12.44 years, range 6.54-15.81 years) and 16 age-, sex-, and BMI-matched healthy controls (5 M, 11 F; median age 12.83 years, range 5.68-15.07 years). None was on levothyroxine treatment. The exclusion criteria were autoimmune, inflammatory, and infection comorbidities. Patients did not differ significantly from controls with regard to lipid or for anthropometric parameters.

RESULTS: sRAGE levels were significantly lower in HT patients (median 414.30 pg/mL, range 307.30-850.30 pg/mL) than in controls (561.30, 273.20-1121.60 pg/mL; p = 0.034). No differences emerged between patients and controls with regard to serum AGEs (124.25 AU/g prot, 71.98-186.72 vs. 133.90, 94.06-200.78 AU/g prot, p = 0.707) and AOPPs (1.13 nmol/mL, 0.62-1.83 vs. 1.17, 0.76-1.42 nmol/mL, p = 0.545).

CONCLUSIONS: sRAGE levels were decreased in euthyroid children/adolescents at the onset of HT, suggesting that autoimmunity per se seems to play an important role in such a reduction of sRAGE, irrespective of any functional alteration. Children and adolescents suffering from HT may exhibit increased susceptibility to oxidative damage, even when in euthyroid status.

PMID:34237741 | DOI:10.1159/000517341

Obstet Gynecol. 2021 Jul 8. doi: 10.1097/AOG.0000000000004444. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate characteristics associated with treatment failure 1 year after midurethral sling in women with mixed urinary incontinence.

METHODS: Four-hundred three women who participated in a randomized trial that compared midurethral sling and behavioral and pelvic floor muscle therapy (combined group) compared with midurethral sling alone for mixed incontinence with 1-year follow-up data were eligible for this planned secondary analysis. Overall treatment failure was defined as meeting criteria for subjective or objective failure or both. Subjective failure was defined as not meeting the minimal clinical important difference for improvement on the UDI (Urogenital Distress Inventory) total score (26.1 points). Objective failure was defined as not achieving 70% improvement on mean incontinence episodes of any type per day or having undergone any additional treatment for persistent urinary symptoms at 12 months postoperative. Logistic regression models for treatment failure were constructed. Independent variables included site and treatment group, and clinical and demographic variables based on bivariate comparisons (P<.2). Treatment group interaction effects were evaluated.

RESULTS: One hundred twelve of 379 (29.6%) women had overall treatment failure, with 56 of 379 (14.7%) undergoing additional treatment but only two needing intervention for stress incontinence. Previous overactive bladder (OAB) medication (unadjusted odds ratio [OR] 2.19, adjusted odds ratio [aOR] 1.96, 95% CI 1.17-3.31); detrusor overactivity on cystometrogram (OR 2.25, aOR 2.82, 95% CI 1.60-4.97); and higher volume at first urge (OR 1.03, aOR 1.04, 95% CI 1.01-1.07) were associated with overall failure. Worse UDI-urgency scores were associated with failure, with an added interaction effect in the midurethral sling-alone group.

CONCLUSIONS: Certain clinical and urodynamic variables are associated with treatment failure after midurethral sling in women with mixed urinary incontinence. Women with more severe urgency symptoms at baseline may benefit from perioperative behavioral and pelvic floor muscle therapy combined with midurethral sling. Overall, the need for additional urinary treatment was low and primarily for OAB.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT01959347.

PMID:34237755 | DOI:10.1097/AOG.0000000000004444

Aging (Albany NY). 2021 Jul 8;13(undefined). doi: 10.18632/aging.203249. Online ahead of print.

ABSTRACT

Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) are the two most common pathology subtypes of primary liver cancer (PLC). Identifying DNA methylation biomarkers for diagnosis of PLC and further distinguishing HCC from ICC plays a vital role in subsequent treatment options selection. To obtain potential diagnostic DNA methylation sites for PLC, differentially methylated CpG (DMC) sites were first screened by comparing the methylation data between normal liver samples and PLC samples (ICC samples and HCC samples). A random forest algorithm was then used to select specific DMC sites with top Gini value. To avoid overfitting, another cohort was taken as an external validation for evaluating the area under curves (AUCs) of different DMC sites combination. A similar model construction strategy was applied to distinguish HCC from ICC. In addition, we identified DNA Methylation-Driven Genes in HCC and ICC via MethylMix method and performed pathway analysis by utilizing MetaCore. Finally, we not only performed methylator phenotype based on independent prognostic sites but also analyzed the correlations between methylator phenotype and clinical factors in HCC and ICC, respectively. To diagnose PLC, we developed a model based on three PLC-specific methylation sites (cg24035245, cg21072795, and cg00261162), whose sensitivity and specificity achieved 98.8%,94.8% in training set and 97.3%,81% in validation set. Then, to further divide the PLC samples into HCC and ICC, we established another mode through three methylation sites (cg17769836, cg17591574, and cg07823562), HCC accuracy and ICC accuracy achieved 95.8%, 89.8% in the training set and 96.8%,85.4% in the validation set. In HCC, the enrichment pathways were mainly related to protein folding, oxidative stress, and glutathione metabolism. While in ICC, immune response, embryonic hepatocyte maturation were the top pathways. Both in HCC and ICC, methylator phenotype correlated well with overall survival time and clinical factors involved in tumor progression. In summary, our study provides the biomarkers based on methylation sites not only for the diagnosis of PLC but also for distinguishing HCC from ICC.

PMID:34237708 | DOI:10.18632/aging.203249