Tag: pubmed

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S390. doi: 10.14701/ahbps.EP-191.

ABSTRACT

INTRODUCTION: The oncological effects of adjuvant chemotherapy after surgery for resected ampulla of Vater cancer (AoVCa) remain controversial. This study was conducted to confirm the oncological effects of adjuvant chemotherapy after surgery in patients who underwent radical surgery with AoVCa.

METHODS: For this study, data about clinical pathological characteristics, postoperative chemotherapy, and long-term survival from 306 AoVCa patients who underwent surgical pancreaticoduodenal resection from 2005 to 2019 were retrospectively and reviewed.

RESULTS: Patients were classified into groups that received adjuvant chemotherapy (n = 124, 40.5%) and those who did not (n = 182, 59.5%). There were significant differences in Cancer stage (p < 0.001), lymph node involvement (p < 0.001), PNI (p < 0.001), LVI (p < 0.001), and cancer differentiation (p = 0.010). As a result, relatively low long-term survival (p < 0.001) was found in the group received adjuvant chemotherapy. As a result of multivariate analysis based on univariate analysis of patient’s survival, factors affecting the patient’s prognosis include cancer progression, Lymph node involvement (HR = 3.50 [95% CI: 1.76-6.93], p < 0.001), PNI (HR = 1.90 [95% CI: 1.07-3.40], p = 0.029), LVI (HR = 1.83 [95% CI: 1.00-3.36], p = 0.052), cancer differentiation, but the presence of adjuvant chemotherapy does not have a significantly affect the patient’s long-term survival rate. The regimen of chemotherapy did not show any significant statistics related to patient survival (p = 0.629).

CONCLUSIONS: The oncological effect of adjuvant chemotherapy after surgery in resected AoVCa patients is not clear and will remain controversial in the future. In order to improve the therapeutic outcome of resected AoVCa, it is urgent to develop effective anticancer treatment methods for patients with risk factors.

PMID:34230287 | DOI:10.14701/ahbps.EP-191

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S393. doi: 10.14701/ahbps.EP-194.

ABSTRACT

INTRODUCTION: Surgical site infection (SSI) is an infection occurs after surgery in the part of the body where the surgery took place within 30 days and a significant portion of healthcare-associated infections. Distal pancreatectomy (DP) is a major surgery associated with a relatively high incidence of SSI. The aim of this study is to investigate risk factors of SSI after distal pancreatectomy.

METHODS: In total, 159 patients who underwent DP from January 2002 to December 2019 were identified and included in this study. We retrospectively collected clinical data based on the medical records of the patients. The risk factors were analyzed by logistic regression analysis.

RESULTS: A total of 14 patients (8.8%) developed SSI after DP. Four patient (2.5%) experienced deep incisional SSI and 10 patient (6.3%) had organ space SSI. Male sex was associated with SSI. Hypertension and combined surgery were associated with organ space SSI in univariate analysis. Male sex and hypertension were significant risk factor of organ space SSI in multivariate analysis (p = 0.040, p = 0.032, respectively). Male sex and combined surgery were associated with overall complication (p = 0.039, p = 0.026, respectively). However, age, body mass index, diabetes, diagnosis, type of antibiotics administered, laparoscopic surgery, and spleen preservation were not associated with SSI.

CONCLUSIONS: Male sex, hypertension, and other concomitant organ resections were statistically associated with SSI. The type of prophylactic antibiotics used was not related to SSI. Organ space SSI is associated with significant complications and the effort to reduce SSI is important.

PMID:34230290 | DOI:10.14701/ahbps.EP-194

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S296. doi: 10.14701/ahbps.EP-95.

ABSTRACT

INTRODUCTION: Avicularin is a flavonoidal class chemical basically composed with quercetin-3-α-l-arabino furanoside present in Lindera erythrocarpa, Rhododendron schlipenbachii and Psidium guajava. Avicularin protect hepatocytes against oxidative stress.

METHODS: Various literature databases have been searched to collect the needed information of avicularin for their biological importance against chronic and hepatic complication. All the literature data’s have been evaluated statistically for their protective role in liver disorders through different experimental models. Avicularin has been considered as a potent anti-inflammatory agent, so here in this study scientific literature databases analysis have been performed to know their biological importance on liver complication. Biological importance interleukin (IL-1β, IL-6) and tumor necrosis factor alpha (TNF-alpha) for the development of better drug against liver disorders have been also investigated through literature databases analysis.

RESULTS: Biological importance of avicularin on various model of inflammation were studied and found to be significant against various types of inflammatory disorders through literature databases analysis. Molecular study revealed the biological importance of IL-1β and IL-6 in the medicine for the treatment of liver disorders. Further importance of TNF-alpha in the medicine supports the molecular mechanism for their anti-inflammatory properties. From the literature data analysis, avicularin showed anti-inflammatory and anti-oxidant activities which are the main parameter for the treatment of inflammatory disorders of the liver.

CONCLUSIONS: Present work describes the biological importance of avicularin and their efficacy in chronic inflammatory disorders of Hepatic system. This work also describes mechanistic study of the anti-inflammatory properties of avicularin in biological system.

PMID:34230252 | DOI:10.14701/ahbps.EP-95

ORL J Otorhinolaryngol Relat Spec. 2021 Jul 6:1-11. doi: 10.1159/000516847. Online ahead of print.

ABSTRACT

INTRODUCTION: Chronic inflammation and tissue remodeling always occur together in chronic rhinosinusitis (CRS). Epithelial-mesenchymal transition (EMT) plays a critical role in airway remodeling.

OBJECTIVE: Changes of epithelial cells in sinus mucosa in different subtypes of CRS, especially in eosinophilic chronic rhinosinusitis with nasal polyps, and the role of EMT and eosinophils (EOS) in airway remodeling are still unknown.

METHODS: We included 85 patients in this study. They were divided into 4 groups: a normal control (NC) group, a chronic rhinosinusitis without nasal polyps (CRSsNP) group, an eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) group, and a noneosinophilic chronic rhinosinusitis with nasal polyps (non-ECRSwNP) group. Clinical data were all collected and analyzed. Standard hematoxylin and eosin staining, immunohistochemical staining, and 2-color immunofluorescence staining were performed. Biomarkers of EMT, epithelial cadherin, and vimentin were labeled. The immunohistochemistry results of each group were counted and statistically analyzed.

RESULTS AND CONCLUSION: E-cadherin was downregulated, and vimentin was upregulated in epithelial tissue from the ECRSwNP group, compared with that from the control group and the other groups. The number of vimentin-expressing epithelial cells correlated with sinus CT imaging Lund-Mackay scores (r = 0.560, p < 0.001). Moreover, expression levels of vimentin in the epithelium were associated with numbers of infiltrating EOS in tissues (r = 0.710, p < 0.001) and the peripheral blood EOS ratio (r = 0.594, p < 0.001). EMT occurred in patients with CRSwNP, especially in those with ECRSwNP. Epithelial reprogramming correlates with eosinophil infiltration and disease severity. Eosinophils contributed to impairment of epithelial function and promoted EMT in CRSwNP.

PMID:34229321 | DOI:10.1159/000516847

Int J Urol. 2021 Jul 6. doi: 10.1111/iju.14638. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the association between graft-derived cell-free DNA and pretransplantation clinical variables, and to determine whether the former could be used as a novel biomarker to predict renal function.

METHODS: A total of 87 recipients who underwent primary kidney transplantation were recruited to the study. For each recipient, 10 mL peripheral blood was collected on days 1, 7, 14-20, and 30-45 after transplantation. The fractional abundance of graft-derived cell-free DNA was determined using droplet digital polymerase chain reaction.

RESULTS: For most recipients, graft-derived cell-free DNA fraction values were significantly elevated on the first day after transplantation, followed by a rapid decline, and reaching baseline values of graft-derived cell-free DNA fraction in the range of <1% at 7 days. Statistical analysis showed that longer cold ischemia time was significantly associated with higher graft-derived cell-free DNA fraction values (P = 0.02). Moreover, we also found that graft-derived cell-free DNA fraction values among recipients with delayed graft function were significantly higher than those of recipients without delayed graft function on the first day after transplantation. Kaplan-Meier analysis showed that recipients who had a graft-derived cell-free DNA fraction value of <1% at 7 days had a significantly lower probability of an estimated glomerular filtration rate ≤60 mL/min/1.73 m² at 90 days. Using a random forest regression model, the predicted values of estimated glomerular filtration rate at 90 days were almost the same as the actual values.

CONCLUSIONS: Our findings suggest that graft-derived cell-free DNA might be used as a novel biomarker to predict delayed graft function and renal function.

PMID:34229363 | DOI:10.1111/iju.14638

EBioMedicine. 2021 Jul 3;69:103465. doi: 10.1016/j.ebiom.2021.103465. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) has overwhelmed health systems worldwide and highlighted limitations of diagnostic testing. Several types of diagnostic tests including RT-PCR-based assays and antigen detection by lateral flow assays, each with their own strengths and weaknesses, have been developed and deployed in a short time.

METHODS: Here, we describe an immunoaffinity purification approach followed a by high resolution mass spectrometry-based targeted qualitative assay capable of detecting SARS-CoV-2 viral antigen from nasopharyngeal swab samples. Based on our discovery experiments using purified virus, recombinant viral protein and nasopharyngeal swab samples from COVID-19 positive patients, nucleocapsid protein was selected as a target antigen. We then developed an automated antibody capture-based workflow coupled to targeted high-field asymmetric waveform ion mobility spectrometry (FAIMS) – parallel reaction monitoring (PRM) assay on an Orbitrap Exploris 480 mass spectrometer. An ensemble machine learning-based model for determining COVID-19 positive samples was developed using fragment ion intensities from the PRM data.

FINDINGS: The optimized targeted assay, which was used to analyze 88 positive and 88 negative nasopharyngeal swab samples for validation, resulted in 98% (95% CI = 0.922-0.997) (86/88) sensitivity and 100% (95% CI = 0.958-1.000) (88/88) specificity using RT-PCR-based molecular testing as the reference method.

INTERPRETATION: Our results demonstrate that direct detection of infectious agents from clinical samples by tandem mass spectrometry-based assays have potential to be deployed as diagnostic assays in clinical laboratories, which has hitherto been limited to analysis of pure microbial cultures.

PMID:34229274 | DOI:10.1016/j.ebiom.2021.103465

Gen Hosp Psychiatry. 2021 Jun 25;72:31-35. doi: 10.1016/j.genhosppsych.2021.06.006. Online ahead of print.

ABSTRACT

OBJECTIVE: Two-thirds of United States medical boards require disclosure of mental health treatment or diagnosis during licensure, with negative influence on physician well-being but unknown impact on medical students. This study sought to understand whether medical students perceive mental health treatment to be a threat to their future medical license.

METHOD: Students at an American medical school in a state without disclosure questions completed an anonymous fourteen question survey. Analysis with univariate and multivariate statistics explored knowledge, opinion, and impact of disclosure questions.

RESULTS: Data was obtained from 327 medical students, a 53% response rate. The majority-91% (299)-were unsure or incorrect as to whether their state licensing board requires mental health disclosure. 33% (86) reported disclosure questions substantially discourage them from seeking mental health treatment. Of the 32% (105) who accessed mental health treatment during medical school, half-52% (74)-would not disclose during licensing. Those who believe that disclosure could impact their license were more likely to be discouraged from seeking care (OR, 5.23 [95% CI, 1.97-15.99]; P = 0.002). Most students-75% (245)-opposed mandatory disclosure.

CONCLUSIONS: Concern about mandatory mental health disclosure discourages medical students from seeking care, despite uncertainty about disclosure questions.

PMID:34229281 | DOI:10.1016/j.genhosppsych.2021.06.006

J Pediatr Nurs. 2021 Jun 23;60:198-206. doi: 10.1016/j.pedn.2021.06.015. Online ahead of print.

ABSTRACT

PURPOSE: During the COVID-19 pandemic, pediatric nurses at one medical center in New York assumed care of COVID-19 adult patients. The purpose of this study was to understand pediatric nurses’ experiences during the peak of the COVID-19 pandemic, when they were caring for patients outside of their usual practice.

DESIGN AND METHODS: A qualitative descriptive study was implemented, and a descriptive survey was sent to all pediatric nurses who worked during the peak of the pandemic, from March 2020 – May 2020. Categorical responses were analyzed using descriptive statistics and free texts were coded to develop central themes.

RESULTS: Four themes emerged from the data: concerns for safety, unprepared to care, nurses’ emotional responses, and persevering together.

CONCLUSIONS: As pediatric nurses adjusted to caring for a new disease and a new population of patients, concerns of safety and preparedness emanated. The need for teamwork and support was emphasized by nurses. The impact that nurses’ experiences had on their emotional wellbeing was also highlighted.

PRACTICE IMPLICATIONS: Exploring pediatric nurses’ experiences during a pandemic is important, as it furthers understanding and guides efforts to enhance preparedness for a future pandemic or public health emergency. Findings from this study illustrate the need to provide nurses with support for both their physical and emotional health.

PMID:34229296 | DOI:10.1016/j.pedn.2021.06.015

Clin Nutr. 2021 Jun 17;40(7):4616-4623. doi: 10.1016/j.clnu.2021.06.012. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: Mixed oil intravenous lipid emulsion (MO ILE) that contains 30% soybean oil (SO), 30% medium chain triglycerides, 25% olive oil and 15% fish oil can benefit hospitalized patients receiving parenteral nutrition (PN) but there are very few studies on its long-term use. Our goal was to evaluate the clinical outcomes of adults receiving home PN (HPN) with MO versus those receiving SO ILE over a 2-year period.

METHOD: This is a retrospective analysis of data collected prospectively from a cohort of patients recorded in the Canadian HPN Registry over a 2-year period. HPN patients from academic programs across Canada were entered in the Registry according to a validated protocol. For this study, demographic, nutritional, laboratory and clinical data were extracted from January 1st 2015, when MO lipid emulsion became available in Canada, to July 24th 2019. Clinical data for each patient included: number of hospitalizations, number of hospitalizations related to HPN and number of hospitalization days related to HPN, over a year; incidence of line sepsis per 1000 catheter days and mortality. Data are presented as median (1st, 3rd quartile) for continuous variables and frequency (percentage) for categorical variables. Comparisons between groups were performed using two sample t-test or Wilcoxon Rank Sum tests for continuous variables and Chi-square tests or Fisher’s exact tests for categorical variables. Univariate and multiple linear regressions were also carried out. Statistical significance is set at a p-value <0.05.

RESULTS: A total of 120 patients were included (MO n = 68, SO n = 52). Significant differences at baseline between the two groups were a higher use of Hickman line (62.12% vs 42%, p = 0.038) and more western Canada based hospital care with MO (75% vs 42.31%, p = 0.0002). The MO group had significantly more hospitalizations (p = 0.001), more hospitalizations related to HPN (p = 0.012) and more hospitalization days related to HPN (p = 0.016) per patient per year compared to SO patients. There was no significant difference between groups for line sepsis per 1000 catheter days (MO: 0.05 (0.0, 1.0) vs SO: 0.0 (0.0, 0.22), p = 0.053) or mortality. All other variables, including biochemical variables, were similar between groups. In a multiple regression analysis, the following factors were significantly associated with a greater number of hospitalizations per patient per year: use of MO, high blood glucose from the last recorded value and having died by the end of the study period.

CONCLUSION: This 2-year prospective cohort study suggests an increased risk of hospitalization in HPN patients receiving MO lipid emulsion. The long-term effect of using MO lipid emulsion in HPN patients should be further evaluated using a large randomized controlled trial. THE STUDY WAS REGISTERED IN CLINICALTRIALS.GOV: (NCT02299466).

PMID:34229267 | DOI:10.1016/j.clnu.2021.06.012

Clin Nutr. 2021 Jun 21;40(7):4633-4641. doi: 10.1016/j.clnu.2021.06.009. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: Sarcopenic obesity (SO), which refers to the coexistence of sarcopenia and obesity. It can lead to physical disability, morbidity, and even mortality. This systematic review and meta-analysis aimed to estimate the global prevalence of SO in older adults.

METHODS: We searched PubMed, Embase, and Web of Science for studies reporting the prevalence of SO from inception to December 2020. Two researchers independently screened the literature, evaluated study quality, and extracted data. A random-effects model was used to pool the estimates for the prevalence of SO. Subgroup analysis, sensitivity analysis, and meta-regression analysis were conducted. Publication bias was assessed using a funnel plot and the Egger test. All statistical analyses were performed using Stata 15.0 software.

RESULTS: This review included 50 studies, we found that the global prevalence of SO in older adults was 11%. Subgroup analyses showed that the prevalence of SO was higher among studies using diagnostic criteria of muscle mass alone (15%) to diagnose sarcopenia, using dual-energy X-ray absorptiometry (15%) to assess muscle mass, and those focused on age ≥ 75 years old (23%), hospitalized (16%), South Americans (21%) and North Americans (19%). There were no significant differences in the prevalence of SO among studies using body fat percentage (10%), body mass index (13%), waist circumference (16%) to diagnose obesity and in female (14%), male (10%) patients. Sensitivity analysis showed that none of the studies affected the overall pooled results. Meta-regression analysis found that publication year, geographical region, study setting, and the diagnostic criteria of sarcopenia were sources of heterogeneity.

CONCLUSION: This meta-analysis indicated SO affects more than one in ten older adults globally. Therefore, we should attach importance to the screening and early diagnosis of SO in older adults, then selecting appropriate interventions to reduce the occurrence of it and various adverse outcomes in this demographic.

PMID:34229269 | DOI:10.1016/j.clnu.2021.06.009