Tag: pubmed

Ann Surg Oncol. 2022 Mar 22. doi: 10.1245/s10434-022-11480-w. Online ahead of print.

ABSTRACT

BACKGROUND: Knowledge on the optimal extent of lymphadenectomy among elderly patients with advanced gastric cancer is limited. This study was designed to compare standard D2 and limited lymphadenectomy for evaluating the appropriate extent of lymphadenectomy.

PATIENTS AND METHODS: We retrospectively reviewed patient’s data based on a prospectively collected gastric cancer registry. The inclusion criteria were age above 75 years and histologically confirmed stage II or more advanced gastric cancer. In this study, 103 patients who underwent limited lymph node dissection and 134 patients who underwent standard D2 lymph node dissection were included to evaluate surgical and oncological outcomes using propensity score matching (PSM) analysis.

RESULTS: The mean age after PSM was approximately 78 years in both groups. The Charlson Comorbidity Index was 5.81 ± 0.87 and 5.75 ± 0.76, respectively, and 12.5% of the patients in both groups had American Society of Anesthesiologists scores of more than 3. The limited lymphadenectomy group showed a shorter operation time and fewer retrieved lymph. However, other surgical outcomes and pathological data were not significantly different between the groups. No postoperative mortality within 30 days was observed. There were no significant differences in overall complications between the groups. The 3-year overall survival rates of the limited and standard lymphadenectomy groups were 58.3% and 73.6%, respectively. The 3-year recurrence-free survival rate of the limited lymphadenectomy group was lower than that of the standard lymphadenectomy group; however, the difference was not statistically significant.

CONCLUSIONS: Standard D2 lymphadenectomy has better oncological outcomes in elderly patients with advanced gastric cancer.

PMID:35316435 | DOI:10.1245/s10434-022-11480-w

Prev Sci. 2022 Mar 22. doi: 10.1007/s11121-021-01330-8. Online ahead of print.

ABSTRACT

Driven by the movement of evidence-based practices, Bayesian statistical methods have become increasingly popular. This paper introduces a Bayesian approach to meta-regression, focusing on the use and implementation in prevention science research. We first compare Bayesian meta-analysis and meta-regression to a frequentist approach. Thereafter, we illustrate Bayesian methods in meta-regression, highlighting advantages, providing detailed interpretation, and presenting results. The example is completed using several R packages. We also provide annotated R code for readers as a foundation for their own research.

PMID:35316455 | DOI:10.1007/s11121-021-01330-8

Insights Imaging. 2022 Mar 22;13(1):50. doi: 10.1186/s13244-022-01192-w.

ABSTRACT

OBJECTIVES: Accurate prenatal diagnosis of placenta accrete spectrum disorder (PAS) remains a challenge, and the reported diagnostic value of ultrasonography (US) and magnetic resonance imaging (MRI) varies widely. This study aims to systematically evaluate the diagnostic accuracy of US as compared with MRI in the detection of PAS within the identical patient population.

METHODS: Medline, EMBASE, Google scholar and Cochrane library were searched. Pooled sensitivity, specificity, diagnostic odds ratio (DOR) and the area under the summary receiver operating characteristic (SROC) curve were calculated. Subgroup analysis was also performed to elucidate the heterogeneity of results.

RESULTS: A total of 18 articles comprising 861 pregnancies were included in the study. The overall diagnostic accuracy of US for identification of PAS was as follows: sensitivity [0.90 (0.86-0.93)], specificity [0.83 (0.79-0.86)], DOR [39.5 (19.6-79.7)]. The overall diagnostic accuracy of MRI for identification of PAS was as follows: sensitivity [0.89 (0.85-0.92)], specificity [0.87 (0.83-0.89)], DOR [37.4 (17.0-82.3)]. The pooled sensitivity (p = 0.808) and specificity (p = 0.413) between US and MRI are not significantly different. SROC analysis revealed that there was no statistical difference (p = 0.552) in US and MRI for the overall predictive accuracy of PAS. Furthermore, in the subgroup analysis of between retrospective and prospective studies, between earlier and most recent studies, there was no statistical difference (p > 0.05) in diagnostic accuracy of US and MRI for the detection of PAS.

CONCLUSIONS: Both ultrasonography (US) and magnetic resonance imaging (MRI) showed comparable accuracy in the prenatal diagnosis of placenta accrete spectrum disorder (PAS). Routine employment of MRI with relatively high expense in the prenatal identification of PAS should not be recommended.

PMID:35316430 | DOI:10.1186/s13244-022-01192-w

Bull Math Biol. 2022 Mar 22;84(5):54. doi: 10.1007/s11538-022-01006-6.

ABSTRACT

As antibiotic resistance grows more frequent for common bacterial infections, alternative treatment strategies such as phage therapy have become more widely studied in the medical field. While many studies have explored the efficacy of antibiotics, phage therapy, or synergistic combinations of phages and antibiotics, the impact of virus competition on the efficacy of antibiotic treatment has not yet been considered. Here, we model the synergy between antibiotics and two viral types, temperate and chronic, in controlling bacterial infections. We demonstrate that while combinations of antibiotic and temperate viruses exhibit synergy, competition between temperate and chronic viruses inhibits bacterial control with antibiotics. In fact, our model reveals that antibiotic treatment may counterintuitively increase the bacterial load when a large fraction of the bacteria are antibiotic resistant, and both chronic and temperate phages are present.

PMID:35316421 | DOI:10.1007/s11538-022-01006-6

Pediatr Cardiol. 2022 Mar 22. doi: 10.1007/s00246-022-02860-w. Online ahead of print.

ABSTRACT

Leftward posterior deviation of the atrial septum primum (LDSP) has been reported in up to 64% of patients with hypoplastic left heart syndrome (HLHS) but there are no published data on its impact on neonatal outcomes. We reviewed the prevalence of LDSP and its correlation with neonatal outcomes in our institution. This was a single-center retrospective study of neonates with HLHS from 2001 to 2019. Echocardiograms were reviewed and the presence or absence of LDSP was noted. To quantify the degree of deviation in patients with LDSP, a new measurement, the deviation index (DI) was calculated using both the subcostal long and short-axis views. Of ninety-four patients with HLHS, fifty-seven (61%) patients were noted to have LDSP. There was no statistically significant difference in gestational age (GA), birth weight (BW), or mortality between patients with and without LDSP. Patients with LDSP had an increased incidence of unplanned reoperation (p < 0.01), post-operative cardiac catheterization (p < 0.05), and post-operative infection (p < 0.05). After correction for GA, BW, HLHS subtype, and type of surgery, LDSP predicted reoperation (OR = 3.6, p < 0.01), catheterization (OR = 2.7, p = 0.05), and infection (OR = 3.4, p < 0.05). Higher degree of deviation predicted reoperation (DI > 0.17), catheterization (DI > 0.07), and infection (DI > 0.12). There was excellent inter-observer reproducibility of the DI (ICCabsolute-agreement = 0.82, ICCconsistency = 0.90). Patients with LDSP have a higher prevalence of post-operative morbidity. The degree of deviation was found to be predictive of post-operative complications. Pre-operative echocardiographic evaluation of LDSP in patients with HLHS may be helpful in risk stratification and counseling.

PMID:35316357 | DOI:10.1007/s00246-022-02860-w

Eur Radiol. 2022 Mar 22. doi: 10.1007/s00330-022-08624-7. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate if baseline [¹⁸F]FDG PET/CT can predict the outcome of follicular lymphoma (FL) in patients managed with an initial “watch-and-wait” approach.

METHODS: Thirty-eight newly diagnosed FL patients who were managed with an initial “watch-and-wait” approach and undergone baseline [¹⁸F]FDG PET/CT were retrospectively enrolled. The standard uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of FL lesions were measured on PET/CT. Patients were followed up for at least 24 months or until initiation of FL therapy. The endpoint was the time to initiation of lymphoma treatment (TLT).

RESULTS: After a median follow-up of 28 months (range 3-94 months), lymphoma treatment was initiated in 21/38 (55.3%) patients (median 15 months, range 3-51 months). Patients with TLT < 24 months showed SUVmax and TLG values significantly higher than those with TLT ≥ 24 months (p < 0.05). Receiver operating characteristic analysis demonstrated cutoff values of SUVmax > 9.5, MTV > 90.62 ml, and TLG > 144.96 SUVbw*ml were optimal for predicting TLT < 24 months. Kaplan-Meier analysis showed SUVmax > 9.5, MTV > 90.62 ml, and TLG > 144.96 SUVbw*ml had statistically significant correlations with shorter TLT (p < 0.01). Lymph node regions ≥ 3 and lymph nodes > 3 cm had almost significance (p < 0.1). In multivariate analysis, SUVmax > 9.5 (HR 3.2 [95% CI 1.1-9.2], p = 0.033) and TLG > 144.96 SUVbw*ml (HR 9.3 [95% CI 1.8-47.7], p = 0.008) were demonstrated to be independent predictive factors for shorter TLT.

CONCLUSIONS: Metabolic indices (SUVmax and TLG) of baseline [¹⁸F]FDG PET/CT could predict the outcome independently in FL patients under an initial “watch-and-wait” approach.

KEY POINTS: • “Watch-and-wait” approach is part of the overall treatment plan in asymptomatic patients with low tumor burden FL. However, the time to initiation of active treatment varies from months to years. • In our retrospective study of 38 patients with FL managed with an initial “watch-and-wait” approach, the SUVmax and TLG were demonstrated to be independent predictive factors for time to initiation of FL treatment. • Baseline [¹⁸F]FDG PET/CT may help to better select patients with FL who are most likely to benefit from “watch-and-wait” management.

PMID:35316362 | DOI:10.1007/s00330-022-08624-7

Exp Brain Res. 2022 Mar 22. doi: 10.1007/s00221-022-06345-3. Online ahead of print.

ABSTRACT

Humans and other animals live in dynamic environments. To reliably manipulate the environment and attain their goals they would benefit from a constant modification of motor-responding based on responses’ current effect on the current environment. It is argued that this is exactly what is achieved by a mechanism that reinforces responses which have led to accurate sensorimotor predictions. We further show that evaluations of a response’s effectiveness can occur simultaneously, driven by at least two different processes, each relying on different statistical properties of the feedback and affecting a different level of responding. Specifically, we show the continuous effect of (a) a sensorimotor process sensitive only to the conditional probability of effects given that the agent acted on the environment (i.e., action-effects) and of (b) a more abstract judgement or inference that is also sensitive to the conditional probabilities of occurrence of feedback given no action by the agent (i.e., inaction-effects). The latter process seems to guide action selection (e.g., should I act?) while the former the manner of the action’s execution. This study is the first to show that different evaluation processes of a response’s effectiveness influence different levels of responding.

PMID:35316354 | DOI:10.1007/s00221-022-06345-3

PLoS One. 2022 Mar 22;17(3):e0265741. doi: 10.1371/journal.pone.0265741. eCollection 2022.

ABSTRACT

Psoriasis is a chronic disease with high impact on patients’ health and their quality of life. Psoriasis often occurs along with other comorbidities, but it is not yet clear what role the comorbidities play in regional psoriasis prevalence. This study investigates the temporal and regional variation of the psoriasis comorbidities diabetes mellitus type II, obesity, hypertension, affective disorders in Germany and their association with psoriasis prevalence. This analysis based on the population set of ambulatory claims data (2010-2017) of the statutory health insurance (SHI) in Germany (approx. 70.3 million people in 2017). Psoriasis comorbidities rates were determined on county level. We performed descriptive spatiotemporal analyses of psoriasis comorbidity prevalence rates. In addition, we identified and compared spatial clusters and examined regional variations using spatial statistical methods. The results show strong regional variations (northeast to south gradient) and an increasing psoriasis prevalence (max. 28.8%) within the observation period. Considering the comorbidities, results indicate comparable spatial prevalence patterns for diabetes mellitus type II, obesity and hypertension. This means that the highest prevalence of comorbidities tends to be found where the psoriasis prevalence is highest. The spatiotemporal cluster analyses could once again confirm the results. An exception to this is to be found in the case of affective disorders with different spatial patterns. The results of the studies show the first spatiotemporal association between psoriasis prevalence and comorbidities in Germany. The causalities must be investigated in more detail in order to be able to derive measures for improved care.

PMID:35316303 | DOI:10.1371/journal.pone.0265741

PLoS One. 2022 Mar 22;17(3):e0265570. doi: 10.1371/journal.pone.0265570. eCollection 2022.

ABSTRACT

INTRODUCTION: Mental, neurological and substance use conditions lead to tremendous suffering, yet globally access to effective care is limited. In line with the 13th General Programme of Work (GPW 13), in 2019 the World Health Organization (WHO) launched the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health to advance mental health policies, advocacy, and human rights and to scale up access to quality and affordable care for people living with mental health conditions. Six countries were selected as ‘early-adopter’ countries for the WHO Special Initiative for Mental Health in the initial phase. Our objective was to rapidly and comprehensively assess the strength of mental health systems in each country with the goal of informing national priority-setting at the outset of the Initiative.

METHODS: We used a modified version of the Program for Improving Mental Health Care (PRIME) situational analysis tool. We used a participatory process to document national demographic and population health characteristics; environmental, sociopolitical, and health-related threats; the status of mental health policies and plans; the prevalence of mental disorders and treatment coverage; and the availability of resources for mental health.

RESULTS: Each country had distinct needs, though several common themes emerged. Most were dealing with crises with serious implications for population mental health. None had sufficient mental health services to meet their needs. All aimed to decentralize and deinstitutionalize mental health services, to integrate mental health care into primary health care, and to devote more financial and human resources to mental health systems. All cited insufficient and inequitably distributed specialist human resources for mental health as a major impediment.

CONCLUSIONS: This rapid assessment facilitated priority-setting for mental health system strengthening by national stakeholders. Next steps include convening design workshops in each country and initiating monitoring and evaluation procedures.

PMID:35316294 | DOI:10.1371/journal.pone.0265570

PLoS One. 2022 Mar 22;17(3):e0265575. doi: 10.1371/journal.pone.0265575. eCollection 2022.

ABSTRACT

BACKGROUND AND OBJECTIVES: Professional pianists tend to develop playing-related musculoskeletal disorders mostly in the forearm. These injuries are often due to overuse, suggesting the existence of a common forearm region where muscles are often excited during piano playing across subjects. Here we use a grid of electrodes to test this hypothesis, assessing where EMGs with greatest amplitude are more likely to be detected when expert pianists perform different excerpts.

METHODS: Tasks were separated into two groups: classical excerpts and octaves, performed by eight, healthy, professional pianists. Monopolar electromyograms (EMGs) were sampled with a grid of 96 electrodes, covering the forearm region where hand and wrist muscles reside. Regions providing consistently high EMG amplitude across subjects were assessed with a non-parametric permutation test, designed for the statistical analysis of neuroimaging experiments. Spatial consistency across trials was assessed with the Binomial test.

RESULTS: Spatial consistency of muscle excitation was found across subjects but not across tasks, confining at most 20% of the electrodes in the grid. These local groups of electrodes providing high EMG amplitude were found at the ventral forearm region during classical excerpts and at the dorsal region during octaves, when performed both at preferred and at high, playing speeds.

DISCUSSION: Our results revealed that professional pianists consistently load a specific forearm region, depending on whether performing octaves or classical excerpts. This spatial consistency may help furthering our understanding on the incidence of playing-related muscular disorders and provide an anatomical reference for the study of active muscle loading in piano players using surface EMG.

PMID:35316295 | DOI:10.1371/journal.pone.0265575