Tag: pubmed

Am J Clin Nutr. 2021 May 8:nqab061. doi: 10.1093/ajcn/nqab061. Online ahead of print.

ABSTRACT

BACKGROUND: Plant-rich diets are associated with lower cardiometabolic risks and longer survival in the general population, but their association with mortality in cancer survivors is still unclear.

OBJECTIVES: We aimed to examine the associations of 3 postdiagnostic plant-based diet indices with all-cause mortality in omnivorous long-term colorectal cancer (CRC) survivors.

METHODS: Diet was assessed with FFQs at a median of 6 years after diagnosis in 1404 CRC survivors (56% male; median age, 69 years) in a Northern German prospective cohort study. An overall, a healthful plant-based, and an unhealthful plant-based diet index were derived by scoring intakes of animal foods reversely and intakes of healthy (whole grains, vegetables, fruits, legumes, nuts, oils, tea/coffee) and less healthy plant foods (refined grains, fruit juices, sugar-sweetened beverages, potatoes, sweets/desserts) positively or reversely, depending on the index. Vital status follow-up was conducted via population registries. Cox proportional hazards regression was applied to estimate HRs for all-cause mortality according to plant-based diet adherence.

RESULTS: Within 7 years (median) after diet assessment, 204 deaths occurred. The overall plant-based diet index displayed a significant, inverse association with all-cause mortality (HR per 10-point increase in diet index, 0.72; 95% CI, 0.57-0.91). Although not statistically significant, higher healthful plant-based diet scores showed a strong tendency towards lower mortality (HR, 0.82; 95% CI, 0.67-1.01). The unhealthful plant-based diet index was associated with higher mortality, but lost statistical significance after multivariable adjustment (HR, 1.19; 95% CI, 0.96-1.48). A subgroup analysis revealed that the tendency towards a positive association of the unhealthful plant-based diet with mortality was restricted to less physically active individuals (<95 metabolic equivalent of task hours/week).

CONCLUSIONS: An overall plant-based diet was inversely associated with all-cause mortality in long-term CRC survivors. However, more research is needed to further disentangle the impacts of different qualities of plant-based diets on cancer survivors’ health.

PMID:33964858 | DOI:10.1093/ajcn/nqab061

Respir Med. 2021 Apr 30;183:106440. doi: 10.1016/j.rmed.2021.106440. Online ahead of print.

ABSTRACT

The clinical manifestations of COVID-19 are heterogeneous: 46.4% of patients admitted into hospital reported to have at least one comorbidity. Comorbidities such as COPD, diabetes, hypertension and malignancy predispose patients with Covid-19 to adverse clinical outcomes. Alpha 1-antitrypsin deficiency (AATD) is a genetic disorder caused by pathological mutation(s) in the SERPINA1 gene resulting in an imbalance in proteinase activity which may lead to premature emphysema and COPD. Our aim was to investigate whether people with severe AAT deficiency (AATD) have an increased risk of (severe) COVID-19 infection. We collected data on COVID-19 symptoms, laboratory-confirmed infection, hospitalization and treatment by means of a telephone survey, directly administered to Italian severe AATD subjects in May 2020. We then compared our findings with data collected by the Istituto Superiore di Sanità on the total population in Italy during the same period. We found an higher frequency of SARS-CoV-2 infection in our cohort (3.8%) compared to national data regarding infection, thus giving severe AATD a relative risk of 8. 8 (95%CI 5.1-20,0; p<0.0001) for symptomatic SARS-CoV-2 infection. Moreover, the relative risk (RR) was higher in AATD patients with pre-existing lung diseases (RR 13.9; 95%CI 8.0-33.6; p<0.001), but with a similar death rate (1 in 8, 12.5%) compared to the general population (13.9%; RR 0.9). These preliminary findings highlight the importance of close surveillance in the spread of COVID-19 in patients with severe AATD and underlines the need for further studies into the role of the antiprotease shield in preventing SARS-Cov-2 infection.

PMID:33964815 | DOI:10.1016/j.rmed.2021.106440

Georgian Med News. 2021 Mar;(312):36-42.

ABSTRACT

Goal – to determine efficacy of the Ileosigmo-pouch (ISP) as a method of transrectal urinary diversion in invasive bladder cancer (BC) treatment. Retrospective analysis of clinical data of patients that undergone radical cystectomy (RC), followed by ISP method of urinary diversion. Study compared two groups of patients: the first group of 22 (23.6%) patients with ISP and the control group included 71 (76.4%) patients with Mainz pouch II (MP II) diversion. The groups were statistically comparable by major clinical parameters. Complication rates were evaluated with Clavien-Dindo classification. There were no significant differences in the duration of surgery procedure, – ISP 210 – 562 (380.4±38.4) minutes vs. 190 – 557 (311.3±49.5) minutes for MP II. Levels of intraoperative blood loss in both groups were comparable: 110 – 2850 (707.42±97.2) ml vs. 170 – 3000 (788.51±141.3) ml. Peroiperative complications after ISP and MP II (1 (4.5%) vs. 6 (4.8%)) did not exceed 3 grade according to Clavien-Dindo. The frequency of postoperative chronic pyelonephritis (CP) was higher in MP II 26 (24.3%) vs. ISP 3 (15.7%). Gas reflux into the kidneys was observed only in MP II 18 (16.8%). Metabolic acidosis was revealed in 27 (25.2%) after MP II and in 2 (10.5%) after ISP. During the ISP formation comparing to MP II, the pouch volume increased in average up to 1000 ml vs. 750 ml., the pressure in a sigmoid colon decreases to 18 cm of water column against 35 cm wc. Urination/defecation frequency was improved in patients after ISP – every 3-4 hours during the day and 5-6 hours at night vs. MP II every 2-3 hours during the day and 3-4 hours at night. The ISP method of urinary diversion in our study showed improvements of urodynamic parameters and eliminated the body metabolic disorders when compared to transrectal diversion with MP2. This viable option of diversion in patients with invasive bladder cancer who are not candidates for neobladder, but strongly afraid of cutaneous urinary stoma.

PMID:33964823

Georgian Med News. 2021 Mar;(312):52-56.

ABSTRACT

The new cardiovascular events development remains the main factors limiting its long-term effectiveness despite technological progress and the widespread use of percutaneous coronary intervention (PCI). Objective – to assess the effect of clinical and genetic factors on the development of complication after percutaneous coronary intervention with double antiplatelet therapy (DAT). Case-control. The main group included 34 (46.57%) patients with ischemic heart disease after the procedure of percutaneous coronary intervention with bleeding, the control group included 39 (53.43%) patients with verified ischemic heart disease after the procedure of percutaneous coronary intervention without bleeding signs. The average age of the patients in the main group was 63.25±8.7, this group included 65% men and 35% women. The average age of the patients in the control group was 63.82±8.9, this group included 87% men and 13% women, respectively. It was found on the base of the clinical and laboratory characteristics of the bleeding risk in patients after percutaneous coronary intervention that the bleeding predictors after PCI against a background of DAT were: female gender (OR=3.405, p=0.027), the presence of diabetes mellitus (OR=2.399, p=0.046), body mass index (BMI) (OR=1.200, p=0.038), coronary artery stenting (OR=1.045, p=0.030), erythrocytes level (OR=2.292, p=0.049), platelet count (OR=3.964, p=0.048), hemoglobin (Hb) (OR=1.333, p=0.042), erythrocyte sedimentation rate (ESR) (OR=1.008, p=0.009), ejection fraction (OR=1.248, p=0.043), glomerular filtration rate (OR=1.227, p=0.002). According to a genetic study, CYP2C19*17 C/T gene polymorphism was detected in 9% of patients with double antiplatelet therapy. There was no statistically significant difference in genotypes of the 17th allele CYP2C19 in accordance with the results of the analysis of genotypes in the first and second groups. The Odds Ratio values (OR=0.658), 95% confidence interval [0.145-2.984] were obtained for all the studied polymorphisms, which indicates the absence of polymorphism association of СYP2C19*17 gene with a risk of bleeding.

PMID:33964826

Sci Total Environ. 2021 Apr 27;786:147360. doi: 10.1016/j.scitotenv.2021.147360. Online ahead of print.

ABSTRACT

The study objective was to derive a susceptibility model for shallow landslides that could include process-related non-stationary variables, to be adaptable to climate changes. We selected the territory of the Mont-Emilius and Mont-Cervin Mountain Communities (northern Italy) as the study area. To define summary variables related to landslide predisposing and triggering processes, we investigated the relationships between landslide occurrences and intense rainfall and snowmelt events (period 1991-2020). For landslide susceptibility mapping, we set up a Generalized Additive Model. We defined a reference model through variable penalization (relief, NDVI, land cover and geology predictors). Similarly, we optimized a model including the climate variables, checking their smooth functions to ensure physical plausibility. Finally, we validated the optimized model through a k-fold cross-validation and performed an evaluation based on contingency tables, area under the receiver operating characteristic curve (AUROC) and variable importance (decrease in explained variance). The climate variables that resulted as being statistically and physically significant are the effective annual number of rainfall events with intensity-duration characteristics above a defined threshold (EAT_ean) and the average number of melting events occurring in a hydrological year (ME_n). In the optimized model, EAT_ean and ME_n accounted for 5% of the explained deviance. Compared to the reference model, their introduction led to an increase in true positive rate and AUROC of 2.4% and 0.8%, respectively. Also, their inclusion caused a transition of the vulnerability class in 11.0% of the study area. The k-fold validation confirmed the statistical significance and physical plausibility of the meteorological variables in 74% (EAT_ean) and 93% (ME_n) of the fitted models. Our results demonstrate the validity of the proposed approach to introduce process-related, non-stationary, physically-plausible climate variables within a shallow landslide susceptibility analysis. Not only do the variables improve the model performance, but they make it adaptable to map the future evolution of landslide susceptibility including climate changes.

PMID:33964775 | DOI:10.1016/j.scitotenv.2021.147360

Comput Med Imaging Graph. 2021 Mar 26;90:101904. doi: 10.1016/j.compmedimag.2021.101904. Online ahead of print.

ABSTRACT

Medical image registration is a critical process for automated image computing, and ideally, the deformation field from one image to another should be smooth and inverse-consistent in order to bidirectionally align anatomical structures and to preserve their topology. Consistent registration can reduce bias caused by the order of input images, increase robustness, and improve reliability of subsequent quantitative analysis. Rigorous differential geometry constraints have been used in traditional methods to enforce the topological consistency but require comprehensive optimization and are time consuming. Recent studies show that deep learning-based registration methods can achieve comparable accuracy and are much faster than traditional registration. However, the estimated deformation fields do not necessarily possess inverse consistency when the order of two input images is swapped. To tackle this problem, we propose a new deep registration algorithm by employing the inverse consistency training strategy, so the forward and backward deformations of a pair of images can consistently align anatomical structures. In addition, since fine-tuned deformations among the training images reflect variability of shapes and appearances in a high-dimensional space, we formulate a group prior data modeling framework so that such statistics can be used to improve accuracy and consistency for registering new input image pairs. Specifically, we implement the wavelet principle component analysis (w-PCA) model of deformation fields and incorporate such prior constraints into the inverse-consistent deep registration network. We refer the proposed algorithm as consistent deep registration with group data modeling. Experiments on 3D brain magnetic resonance (MR) images showed that the unsupervised consistent deep registration and data modeling strategy yield consistent deformations after switching the input images and tolerated image variations well.

PMID:33964791 | DOI:10.1016/j.compmedimag.2021.101904

Sci Total Environ. 2021 Apr 28;786:147375. doi: 10.1016/j.scitotenv.2021.147375. Online ahead of print.

ABSTRACT

The introduction of non-indigenous species (NIS) is a major driver for global change in species biogeography, often associated with significant consequences for recipient ecosystems and services they provide for humans. Despite mandated by several high-level international legislative instruments, comprehensive quantitative evaluation on ecosystem impacts of marine NIS is scarce and lack a robust and data-driven assessment framework. The current study is aiming at fulfilling this gap, through quantitative assessment on the effects of the widespread NIS of the Baltic Sea on multiple ecosystem features and components including direct food-web effects. The outcomes of this study allowed identifying the most impacting widespread NIS, together with defining the processes underlying the most significant changes and outlined major sources of uncertainty. Lack and/or bias in the availability of evidence of impacts was recorded for several (both recent and early) introductions. Realizing a sophisticated, data and information-hungry framework for the evaluation of ecosystem impacts of NIS is not pragmatic for management purposes in the foreseeable future. Instead, simple approaches, such as application of common statistical parameters like absolute effect size, are more likely to result in tangible outcomes. As bearing no unit, effect sizes can be later easily aggregated across taxa, affected ecosystem features or spatial scales. The proposed approach enables performing systematic comparisons on the severity of impacts of different NIS along different study disciplines and ecosystems.

PMID:33964771 | DOI:10.1016/j.scitotenv.2021.147375

Am J Emerg Med. 2021 Apr 30;48:183-190. doi: 10.1016/j.ajem.2021.04.076. Online ahead of print.

ABSTRACT

BACKGROUND: One of the proposed benefits of expanding insurance coverage under the Affordable Care Act (ACA) was a reduction in emergency department (ED) utilization for non-urgent visits related to lack of health insurance coverage and access to primary care providers. The objective of this study was to estimate the effect of the 2014 ACA implementation on ED use in New York.

METHODS: We used the Healthcare Cost and Utilization Project State Emergency Department and State Inpatient Databases for all outpatient and all inpatient visits for patients admitted through an ED from 2011 to 2016. We focused on in-state residents aged 18 to 64, who were covered under Medicaid, private insurance, or were uninsured prior to the 2014 expansion. We estimated the effect of the expanded insurance coverage on average monthly ED visits volumes and visits per 1000 residents (rates) using interrupted time-series regression analyses.

RESULTS: After ACA implementation, overall average monthly ED visits increased by around 3.0%, both in volume (9362; 95% Confidence Intervals [CI]: 1681-17,522) and in rates (0.80, 95% CI:0.12-1.49). Medicaid covered ED visits volume increased by 23,972 visits (95% CI: 16,240 -31,704) while ED visits by the uninsured declined by 13,297 (95% CI:-15,856 – -10,737), and by 1453 (95% CI:-4027-1121) for the privately insured. Medicaid ED visits rates per 1000 residents increased by 0.77 (95% CI:-1.96-3.51) and by 2.18 (95% CI:-0.55-4.92) for those remaining uninsured, while private insurance visits rates decreased by 0.48 (95% CI:-0.79 – -0.18). We observed increases in primary-care treatable ED visits and in visits related to mental health and alcohol disorders, substance use, diabetes, and hypertension. All estimated changes in monthly ED visits after the expansion were statistically significant, except for ED visit rates among Medicaid beneficiaries.

CONCLUSION: Net ED visits by adults 18 to 64 years of age increased in New York after the implementation of the ACA. Large increases in ED use by Medicaid beneficiaries were partially offset by reductions among the uninsured and those with private coverage. Our results suggest that efforts to expand health insurance coverage only will be unlikely to reverse the increase in ED use.

PMID:33964693 | DOI:10.1016/j.ajem.2021.04.076

Int J Med Inform. 2021 Apr 24;151:104471. doi: 10.1016/j.ijmedinf.2021.104471. Online ahead of print.

ABSTRACT

AIM: The implementation of electronic health records (EHRs) in the aged care sector has been shown to improve efficiency and quality of care, administrative and funding processes. The aim of this study was to examine whether implementing EHRs and/or interventions leveraging EHRs in residential aged care facilities has any impact on health outcomes for residents and to review and summarise any published evidence.

METHODS: Using the Joanna Briggs Institute guidelines for conducting scoping reviews, we searched PubMed, CINAHL, Embase, Cochrane and Scopus databases for articles describing the impact of EHRs and/or EHR-based interventions on health outcomes for residents in residential aged care. We included journal articles published in English between 2009 and 2019. After identifying articles meeting the inclusion criteria, we extracted individual findings and produced a narrative summary.

RESULTS: Out of 6576 articles identified through database searches, seven met our inclusion criteria. The articles varied in study design, experimental methods, sample sizes and health outcomes assessed but there were no randomised controlled trials: four articles employed quantitative methods and three employed both quantitative and qualitative methods. The implementation of EHR-based interventions had positive impact on outcomes related to excessive weight loss, malnutrition, mobility, weighing of residents and use of antipsychotic medicines but had mixed impact (i.e., positive impact in some studies but non-significant or negative impact in others) on pressure ulcers, activities of daily living, behavioural symptoms, use of physical restraints and signs of depression. We also found that these interventions had no statistically significant impact on medication discrepancies, adverse drug events, falls or mortality.

CONCLUSION: In conclusion, research in this area is not yet comprehensive enough to reach a definitive conclusion on the impact of EHR-based interventions on health outcomes in residential aged care. As provider organisations increasingly implement EHRs, more research is needed to study their impact on resident health outcomes and examine how this impact eventuates.

PMID:33964704 | DOI:10.1016/j.ijmedinf.2021.104471

Int J Pediatr Otorhinolaryngol. 2021 Apr 28;146:110741. doi: 10.1016/j.ijporl.2021.110741. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate and identify the concerns and opinions expressed in both parental and provider posts on social media about ankyloglossia.

METHODS: In this study, posts on Twitter between 1/1/2008 and 12/31/2018 were collected using search terms and hashtags specific to pediatric ankyloglossia. The search terms included a primary phrase to indicate ankyloglossia along with a pediatric identifier. Tweets that met inclusion criteria were analyzed qualitatively via conventional content analysis. After all tweets were categorized, descriptive statistics were completed to determine frequency of each theme.

RESULTS: In total, 5951 tweets were retrieved. Parents authored 982 (16.5%) of tweets, and 782 (13.1%) were by providers. The remaining 4187 tweets did not fit criteria for either the parent or provider groups. Amongst parents, the most common themes mentioned were feeding problems (309 tweets [32.4%]), followed by lip tie (215 [22.5%]), anxiety or emotion (207 [21.7%]), and maternal breastfeeding complications (127 [13.3%]). The number of tweets about ankyloglossia and frenotomy in 2018 had increased by 2395% since 2009. Amongst providers, 215 tweets were judged by the coders to provide an opinion on ankyloglossia, of which 94.4% had a pro-frenotomy sentiment. When a specialty was identified, tweets were most often by dentists (250 [31.9%]), followed by lactation consultants and International Board Certified Lactation Consultants (IBCLCs) (157 [29.7%]) and non-otolaryngologist physicians (79 [10.1%]). Otolaryngologists accounted for 8.7% (68 tweets) of posts about ankyloglossia.

CONCLUSION: Our findings demonstrate the spectrum of opinions that exist among both parents and providers about ankyloglossia. This can aid in shared-decision making by enabling the counseling provider to guide recommendations based on medical evidence with the understanding that there is a large amount of non-scientific information and opinions disseminated that may be shaping decisions.

PMID:33964675 | DOI:10.1016/j.ijporl.2021.110741