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Extractions in kidney transplant recipients: A prospective observational pilot study

J Am Dent Assoc. 2021 Nov 15:S0002-8177(21)00513-4. doi: 10.1016/j.adaj.2021.08.004. Online ahead of print.

ABSTRACT

BACKGROUND: The authors undertook a prospective study to determine whether kidney transplant recipients had an increased risk of developing complications, such as local acute infection, alveolitis, increased bleeding, pain, and delayed healing, after tooth extraction.

METHODS: The authors selected patients who underwent kidney transplants more than 6 months ago (study group) and patients who had not (control group) older than 18 years who needed to undergo extraction of erupted teeth. The same oral surgeon performed all tooth extractions while the patients were under local anesthesia. Another blind researcher examined the patients 3, 7, and 21 days after tooth extraction. The first end point was occurrence of complications (local acute infection, alveolitis, increased bleeding), and the second end point was socket reepithelialization on day 21.

RESULTS: Forty-five tooth extractions were performed on 38 study group participants and 61 on 57 control group participants. There was no statistical difference between the groups regarding the incidence of any complication or delayed socket epithelialization.

CONCLUSIONS: The results of this pilot study suggest that there is no difference in postoperative healing after tooth extractions between stable kidney transplant patients and control patients.

PRACTICAL IMPLICATIONS: This is the first prospective study assessing the frequency of postoperative complications after tooth extraction in kidney transplant recipients. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT02547753.

PMID:34794682 | DOI:10.1016/j.adaj.2021.08.004

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The clinical value of further accurate staging of pT2 gastric cancer based on the depth of invasion

Zhonghua Zhong Liu Za Zhi. 2021 Nov 23;43(11):1197-1202. doi: 10.3760/cma.j.cn112152-20200309-00189.

ABSTRACT

Objective: To investigate the clinical value of pT2 gastric cancer staging pT2a and pT2b according to the depth of muscularis propria invasion in evaluating the prognosis of gastric cancer. Methods: According to the 8th edition of TNM staging system for gastric cancer proposed by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC), patients with gastric cancer who underwent radical surgery in the Fourth Hospital of Hebei Medical University from January 1, 2008 to January 1, 2015 were selected and divided into pT2a and pT2b stage group according to the depth of tumor invasion. The 5-year overall survival (OS) and disease-free survival (DFS) were compared between the two groups. Results: The median follow-up time of 1 411 patients with postoperative pathological pT2 stage was 68.8 months, and 1 347 patients (95.46%) received complete follow-up data. The 5-year OS rate was 65.85%, and the 5-year DFS rate was 67.83 %. The 5-year OS rate and 5-year DFS rate of 709 pT2a patients were 72.50% and 73.91%, respectively. The 5-year OS rate and 5-year DFS rate of 638 pT2b patients were 58.46% and 61.13%, respectively, significantly different from those of the pT2a group (P<0.001). Hierarchical analysis was performed according to N staging. The 5-year OS rates of pT2aN0M0 (274 cases), pT2aN1M0 (192 cases), pT2aN2M0 (147 cases), pT2aN3aM0 (59 cases) and pT2aN3bM0 (37 cases) were 83.58 %, 72.40 %, 68.71 %, 54.24 % and 35.12 %, respectively. The 5-year DFS rates were 84.67 %, 77.08 %, 67.35 %, 54.24 % and 35.14 %, respectively. In the pT2b group, the 5-year OS rates of pT2bN0M0 (209 cases), pT2bN1M0 (166 cases), pT2bN2M0 (127 cases), pT2bN3aM0 (78 cases) and pT2bN3bM0 (58 cases) were 76.08%, 62.05%, 56.69%, 37.18% and 17.24%, respectively, and the 5-year DFS rates were 80.86%, 69.28%, 54.33%, 35.90% and 15.52%, respectively. Under the same N stage, the OS rates of patients in the pT2a group were better than those in the pT2b group (P values were 0.023, 0.034, 0.034, 0.043 and 0.018, respectively). When the N stage was N0 and N1, there was no significant difference in the 5-year DFS rate between the pT2a group and the pT2b group (P values were 0.199 and 0.090, respectively). When the N stages were N2, N3a and N3b, the difference between the pT2a stage group and the pT2b stage group was statistically significant (P values were 0.027, 0.022 and 0.025, respectively). Conclusions: In the 8th edition of AJCC/UICC gastric cancer staging system, pT2 stage can be divided into pT2a stage (invasion of superficial muscularis) and pT2b stage (invasion of deep muscularis) according to the infiltration depth of muscularis propria. There are significant differences in prognosis between the two groups. Combined with the number of lymph node metastasis, the prognosis of patients with pT2 gastric cancer can be more accurately evaluated.

PMID:34794224 | DOI:10.3760/cma.j.cn112152-20200309-00189

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Application value of superb microvascular imaging for diagnosis of different size renal solid tumors

Zhonghua Zhong Liu Za Zhi. 2021 Nov 23;43(11):1215-1221. doi: 10.3760/cma.j.cn112152-20191220-00832.

ABSTRACT

Objective: To discuss the diagnostic value of superb microvacular imaging (SMI) in renal solid tumors of different sizes. Methods: A total of 142 patients with 146 renal tumors detected by ultrasound in Tianjin Medical University Cancer Institute and Hospital from September 2017 to March 2019 were retrospectively analyzed. The maximum diameter of lesions was 0.8-7.3 cm, and patients were divided into the maximum diameter ≤3.0 cm group (61 patients, 64 lesions) and the maximum diameter >3.0 cm group (61 patients, 82 lesions). All of the tumors were separately evaluated by SMI and color Doppler flow imaging (CDFI) with Adler grade, vascular morphology and peripheral blood flow. Results: In the group with maximum diameter ≤3.0 cm, 50 lesions were malignant and 14 were benign. In the group with maximum diameter >3.0 cm, 62 lesions were malignant and 20 were benign. In the group with maximum diameter ≤3.0 cm, there were no significant differences in location, boundary, echo, homogeneity and small cystic area between malignant tumors and benign tumors (P>0.05). In the group with maximum diameter >3.0 cm, there were significant differences in echo, homogeneity and small cystic area between malignant tumors and benign tumors (P<0.05). For all of the benign tumors, there were no significant difference between CDFI and SMI in evaluating Adler grade, vascular morphology and peripheral blood flow (P>0.05). For malignant tumors with maximum diameter ≤3.0 cm, 43 lesions with Adler grade 2-3 were detected by SMI, which was higher than CDFI (32, P<0.05). There were 38 lesions with dendritic and irregular vascular morphology detected by SMI, which was higher than CDFI (7, P<0.05). The detected rate of peripheral annular or semi-annular blood flow in lesions was 80.0% (40/50), higher than CDFI (18/50, P<0.05). While in malignant tumors with maximum diameter >3 cm, the lesion with peripheral annular or semi-annular blood flow detected by SMI was 38, higher than 22 of CDFI (P<0.05). The area under the receiver operating characteristic (ROC) curve for CDFI and SMI diagnosis of renal solid tumors with the maximum diameter ≤3.0 cm was 0.627 (sensitivity: 54.0%, specificity: 71.4%) and 0.791 (sensitivity: 94.0%, specificity: 64.3%), respectively, with statistically significant difference (P=0.039). The area under the ROC curve for CDFI and SMI diagnosis of renal solid tumors with the maximum diameter>3.0 cm was 0.852 (sensitivity: 85.5%, specificity: 85.0%) and 0.860 (sensitivity: 91.9%, specificity: 80.0%), respectively, without statistically significance (P=0.858). Conclusions: SMI is superior to CDFI in detecting low-velocity blood flow and microvessels in both malignant and benign renal tumors, and can effectively improve the display rate of peripheral blood flow in malignant tumors. Otherwise, SMI can provide better diagnostic efficiency for renal tumors with the maximum diameter ≤3.0 cm.

PMID:34794227 | DOI:10.3760/cma.j.cn112152-20191220-00832

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Do previous urethral endoscopic procedures and preoperative self-dilatation increase the risk of stricture recurrence after urethroplasty?

Low Urin Tract Symptoms. 2021 Nov 18. doi: 10.1111/luts.12419. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the relation between clinically relevant stricture recurrence after first urethroplasty and prior endoscopic treatments (dilatation and/or direct visual internal urethrotomy) or intermittent self-dilatation (ISD).

METHODS: Patients with bulbar urethral strictures treated with first urethroplasty between 2011 and April 2019 were included in a prospectively gathered database with standardized follow-up. Stricture recurrence was defined as any need for reintervention. Primary outcome was the analysis of recurrence risk after first urethroplasty in relation with the number of prior endoscopic treatments or performance of ISD. Univariate and multivariate statistical analyses were performed.

RESULTS: Overall, 106 patients were included with a median follow-up of 12 months (interquartile range 8-13]. Reintervention was necessary in 16 patients (15%). Recurrence was more prevalent in patients with ≥3 prior endoscopic treatments (28%, P = .009). No increased risk of recurrence was found in patients with 1 or 2 prior endoscopic treatments. The prevalence of prior ISD was twice as high in the stricture recurrence group (56% vs 26%, P = .014), and ISD was performed in 61% of the patients with ≥3 prior endoscopic treatments (P < .001). The number of prior endoscopic interventions and performance of ISD were no independent predictors for recurrence in the multivariable analysis.

CONCLUSIONS: This study shows that the risk of recurrence after first urethroplasty is increased in patients with ≥3 prior endoscopic treatments and in those who performed ISD. Patients performing ISD more often had ≥3 prior endoscopic treatments. Prior endoscopic treatment and performance of ISD were not independent predictors of stricture recurrence.

PMID:34794210 | DOI:10.1111/luts.12419

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The effect of Shendan Sanjie capsule on angiogenesis in mice with colitis associated cancer and mechanism

Zhonghua Zhong Liu Za Zhi. 2021 Nov 23;43(11):1170-1176. doi: 10.3760/cma.j.cn112152-20210318-00240.

ABSTRACT

Objective: To investigate the effects and the mechanism of Shendansanjie capsules on angiogenesis of colitis associated cancer(CAC) mice. Methods: Azoxymethane and dextran sulfact sodium were used to construct a mice model with CAC. Ten mice were divided into the normal group, model group, Shendan Sanjie capsule group, MK-2206 group, and Shendan Sanjie capsule + IGF-1 group, respectively. Immunohistochemistry was used to detect the microvessel density (MVD) in the colon tissue of each group of mice. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) was used to detect the mRNA levels of basic fibroblast growth factor (bFGF) and angiopoietin 2 (Ang2) in colon tissue. Western blot was used to detect the expressions of Akt, p-Akt, vascular endothelial growth factor A (VEGFA), hypoxia-inducible factor-1α (HIF-1α). Results: The number of MVD in the colon tissue of mice in the model group, Shendan Sanjie capsule group, MK-2206 group, Shendan Sanjie capsule + IGF-1 group were 63.3±3.3, 36.6±2.3, 36.6±2.2, 50.3±2.5, significantly higher than 2.0±0.1 in the normal group (P<0.05). The number of MVD in Shendan Sanjie capsule group, MK-2206 group and Shendan Sanjie capsule+ IGF-1 group are lower than that in model group (P<0.05), while Shendan Sanjie capsule+ IGF-1 group is higher than Shendan Sanjie Capsule group (P<0.05). The relative expressions of bFGF mRNA in the colon cancer tissue of mice in the model group, Shendan Sanjie capsule group, MK-2206 group and Shendan Sanjie capsule+ IGF-1 group were 4.55±0.31, 2.46±0.37, 2.49±0.33, 3.34±0.21, respectively, and the relative mRNA expressions of Ang2 were 5.78±0.19, 2.21±0.14, 2.26±0.17 and 3.67±0.32, respectively, which were significantly higher than 1.01±0.05 and 0.99±0.07 in the normal group (P<0.05). The mRNA levels of bFGF and Ang2 in Shendan Sanjie capsule group, MK-2206 group and Shendan Sanjie capsule+ IGF-1 group were lower than those in the model group (P<0.05), while Shendan Sanjie capsule+ IGF-1 group is higher than Shendan Sanjie capsule group (P<0.05). The relative expression levels of p-Akt/Akt, VEGFA and HIF-1α in colon cancer tissues of the model group were 4.75±0.18, 4.64±0.22 and 4.84±0.12, respectively, which were significantly higher than 1.01±0.07, 0.95± 0.08 and 0.98±0.05 in the normal group (P<0.05). The relative expressions of p-Akt/Akt, VEGFA and HIF-1α in colon cancer tissues in the Shendan Sanjie capsule group were 2.24±0.22, 3.15±0.26 and 2.07±0.18, respectively, which were significantly lower than those in the model group (P<0.05). However, compared with the MK-2206 group, the difference was not statistically significant (P>0.05). The relative expression levels p-Akt/Akt, VEGFA and HIF-1α in colon cancer tissue of the Shendan Sanjie capsule+ IGF-1 group were 3.37±0.15, 4.02±0.11, 3.52±0.24, respectively, which were significantly higher than those in the Shendan Sanjie capsule group (P<0.05). Conclusion: Shendan Sanjie capsules may inhibit Akt/HIF-1α/VEGFA signaling pathway, and then reduce the expression of microvascular growth factors bFGF and Ang2, thereby inhibit the tumor angiogenesis of CAC.

PMID:34794219 | DOI:10.3760/cma.j.cn112152-20210318-00240

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A pseudotargeted method based on sequential window acquisition of all theoretical spectra MS acquisition and its application in quality assessment of traditional Chinese medicine preparation-Yuanhu Zhitong Tablet

J Sep Sci. 2021 Nov 18. doi: 10.1002/jssc.202100611. Online ahead of print.

ABSTRACT

Quality control plays a key role in the application of Chinese materia medica, especially in the preparation of traditional Chinese medicine. A pseudotargeted analysis method using an ultra-high-performance liquid chromatography-quadrupole-time-of-flight-mass spectrometry that was operated in the sequential window acquisition of all theoretical spectra mode was proposed to explore the chemical markers of traditional Chinese medicine preparation. Full-scan-based untargeted analysis was applied to extract the target ions. After data preprocessing, 302 target ions were extracted and used for the subsequent sequential window acquisition of all theoretical spectra analyses. The established sequential window acquisition of all theoretical spectra-based pseudotargeted approach exhibited good repeatability and a wide linear range. The established method was successfully applied to discover analytical markers for the Yuanhu Zhitong tablet. After multivariate statistical analysis, 94 potential markers were identified. Ten markers were annotated by matching accurate m/z and product ion information obtained from previous reports. It is clearly indicated that the pseudotargeted analysis could make a great contribution to the quality assessment of traditional Chinese medicine preparation as a newly emerging technique. This article is protected by copyright. All rights reserved.

PMID:34794207 | DOI:10.1002/jssc.202100611

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The Inventory of Physical Activity Barriers for Adults 50 Years and Older: Refinement and Validation

Gerontologist. 2021 Nov 18:gnab165. doi: 10.1093/geront/gnab165. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Due to health consequences associated with insufficient physical activity (PA), particularly among aging adults, healthcare providers should assess and address lack of PA participation. Addressing lack of PA means developing individualized PA prescriptions that incorporate solutions to PA participation barriers. Assessing PA participation barriers can be done through the Social-Ecological Model-based Inventory of Physical Activity Barriers Scale (IPAB). This study aimed to refine the initial 40-item IPAB and determine its reliability and validity.

RESEARCH DESIGN AND METHODS: Five hundred and three community-dwelling adults 50 years and older completed a demographic and health questionnaire, the Physical Activity Vital Sign, the IPAB, and a feedback questionnaire. For scale refinement, half of the data was used for exploratory factor analysis and the other half for confirmatory factor analysis. The refined scale underwent reliability and validity assessment, including internal consistency, test-retest reliability, and construct validity.

RESULTS: The refined scale contains 27 items consisting of seven factors and one stand-alone item: 1) Environmental, 2) Physical Health, 3) PA-Related Motivation, 4) Emotional Health, 5) Time, 6) Skills, 7) Social, and 8) Energy (a stand-alone item). The 27-item IPAB has good internal consistency (alpha= 0.91) and high test-retest reliability (ICC= 0.99). The IPAB’s mean scores were statistically different between those who met the recommended levels of PA and those who did not (p < 0.001).

DISCUSSION AND IMPLICATIONS: The information gathered through the IPAB can guide discussions related to PA participation barriers and develop individualized PA prescriptions that incorporate solutions to the identified barriers.

PMID:34794173 | DOI:10.1093/geront/gnab165

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IDH Wild-type Glioblastoma Presenting with Seizure: Clinical Specificity, and Oncologic and Surgical Outcomes

J Neurol Surg A Cent Eur Neurosurg. 2021 Nov 18. doi: 10.1055/s-0041-1735515. Online ahead of print.

ABSTRACT

BACKGROUND: Glioblastoma (GBM) is the most common and aggressive primary brain neoplasia in adults. Seizure is a common manifestation in GBM. Up to 25 to 60% of patients with GBM have seizures. We aim to summarize all the relevant clinical, surgical, radiologic, and molecular features of a cohort of patients suffering from GBM-related epilepsy and measure the outcome, to understand the possible existence of a clinical/phenotypical specificity of this subgroup of patients.

METHODS: We retrospectively analyzed a cohort of 177 patients affected by isocitrate dehydrogenase wild-type (IDH-WT) GBM; 49 patients presented seizure at onset (SaO) and 128 were seizure free (SF). We investigated the relationship between seizures and other prognostic factors of GBMs.

RESULTS: A statistically significant association between the location of the lesions in the parietal lobe and seizures was observed. The left side was more commonly affected. Interestingly, there was a statistical relationship between tumors involving the subventricular zone (SVZ) and SaO patients. The tumors were also smaller on average at diagnosis, and generalized SaOs were associated with longer overall survival.

CONCLUSIONS: The typical patient with IDH-WT GBM with SaO is a young (<55 year) male without a history of headache. The lesion is typically small to medium in size and located in the temporoparietal dominant lobe, with a high tendency to involve the SVZ.

PMID:34794192 | DOI:10.1055/s-0041-1735515

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Differentiation of aspirated nasal air from room air using analysis with a differential mobility spectrometry-based electronic nose: a proof-of-concept study

J Breath Res. 2021 Nov 18. doi: 10.1088/1752-7163/ac3b39. Online ahead of print.

ABSTRACT

Over the last few decades, breath analysis using electronic nose technology has become a topic of intense research, as it is both non-invasive and painless, and is suitable for point-of-care use. To date, however, only a few studies have examined nasal air. As the air in the oral cavity and the lungs differs from the air in the nasal cavity, it is unknown whether aspirated nasal air could be exploited with electronic nose technology. Compared to traditional electronic noses, differential mobility spectrometry uses an alternating electrical field to discriminate the different molecules of gas mixtures, providing analogous information. This study reports the collection of nasal air by aspiration and the subsequent analysis of the collected air using a differential mobility spectrometer. We collected nasal air from ten volunteers into breath collecting bags and compared them to bags of room air and the air aspirated through the device. Distance and dissimilarity metrics between the sample types were calculated and statistical significance evaluated with Kolmogorov-Smirnov test. After leave-one-day-out cross-validation, a shrinkage linear discriminant classifier was able to correctly classify 100% of the samples. The nasal air differed (p < 0.05) from the other sample types. The results show the feasibility of collecting nasal air by aspiration and subsequent analysis using differential mobility spectrometry, and thus increases the potential of the method to be used in disease detection studies.

PMID:34794137 | DOI:10.1088/1752-7163/ac3b39

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Learning from a Massive Open Online COVID-19 Vaccination Training Experience: A Survey Study

JMIR Public Health Surveill. 2021 Nov 16. doi: 10.2196/33455. Online ahead of print.

ABSTRACT

BACKGROUND: To prepare key stakeholders in countries for the COVID-19 vaccination rollout, WHO and partners have developed online vaccination training packages. The online course launched in December 2020 on the OpenWHO learning platform.

OBJECTIVE: This paper presents findings of an evaluation conducted on these training packages. The evaluation was done to provide insights into user experiences and challenges, measure the impact of the course in terms of knowledge gained, and anticipate potential interest in future online vaccination courses.

METHODS: The primary source of data was the anonymized information on course participants, enrollment, completion, and scores from the OpenWHO platform’s statistical data and metric reporting system. Data from the OpenWHO platform was analyzed from the opening of the courses in mid-December 2020 to mid-April 2021. In addition, a learner feedback survey was sent by email to all course participants to complete within a three-week period (19 March 2021 to 09 April 2021). The survey was designed to determine the perceived strengths and weaknesses of the training packages and to understand barriers to access.

RESULTS: During the study period, 53,593 learners enrolled in the course. Of them, 30,034 (56.0)% completed the course, which is substantially higher than the industry benchmark of 5-10% for a Massive Open Online Course (MOOC). Overall, learners averaged 76.5% on the pre-quiz compared to 85% on the post-quiz, resulting in an increase in average score of 9%. 2,019 learners from the health workers course participated in the survey. Nearly 98% of respondents fully or somewhat agreed that they had more confidence in their ability to support COVID-19 vaccination following completion of this course.

CONCLUSIONS: The online vaccine training was well received by the target audience with a measurable impact on knowledge gained. The key benefits of online training were convenience, self-paced nature, the access to downloadable material, ability to replay material and increased ability to concentrate. Online training was identified as a timely, cost-effective way of delivering essential training to a large number of people to prepare for the COVID-19 vaccination rollout.

PMID:34794116 | DOI:10.2196/33455