Tag: pubmed

Exp Clin Transplant. 2021 Sep;19(9):910-913. doi: 10.6002/ect.2021.0231.

ABSTRACT

OBJECTIVES: Tacrolimus has a narrow therapeutic window, and lack of adherence to the therapeutic regimen is a main risk factor for acute graft rejection; hence, the prolonged-release formulation was created. A high intrapatient variability for tacrolimus trough levels has been associated with worse graft outcomes; therefore, we investigated the correlation between the tacrolimus variation coefficient and the development of biopsy-proven acute graft rejection in kidney transplant patients with typical maintenance immunosuppression versus the prolonged-release formulation.

MATERIALS AND METHODS: This was a single-center observational retrospective study that included all adult kidney transplants from deceased donors between January 2011 and December 2014 for which the transplant recipients were given maintenance therapy with tacrolimus prolonged-release formulation (Advagraf). The overall tacrolimus variation coefficient was calculated for the follow-up period from transplant until December 2019. Biopsy-proven acute graft rejection results were collected throughout follow-up. Statistical analysis was performed with SPSS software.

RESULTS: The study was composed of 147 patients with a mean follow-up time of 60.4 ± 15 months. The mean age of the patients was 47.5 ± 11.9 years and 67.3% were men. Of these 147 patients, 29 had at least 1 episode of acute graft rejection during follow-up. There was a significant correlation between patients with a higher tacrolimus variation coefficient and the presence of biopsy-proven acute graft rejection. Receiver operating characteristic curves were used to determine an intrapatient variability cutoff point of 28.3% for tacrolimus. Younger patients were also more likely than older patients to develop acute graft rejection in our sample.

CONCLUSIONS: High intrapatient variability of tacrolimus trough levels is a risk factor for acute graft rejection in kidney transplant patients.

PMID:34545776 | DOI:10.6002/ect.2021.0231

J Craniofac Surg. 2021 Sep 20. doi: 10.1097/SCS.0000000000008180. Online ahead of print.

ABSTRACT

Various recent developments, including legislation in 2014 banning healthcare discrimination against gender minorities, have contributed to expanding insurance coverage for gender-affirming care, which includes facial gender confirmation surgery (FGCS). Increasing evidence suggests FGCS improves quality-of-life outcomes, but literature evaluating FGCS patient demographics, surgical risk factors, procedures, and complications is limited. Therefore, the authors conducted a study of a national surgical database from 2005 to 2019 attempting to fill in these literature gaps. Statistics were used to assess temporal trends after 2014. A total of 203 FGCS cases were identified, with the earliest occurring in 2013. Case volume increased annually from 2015-2019. The average patient age was 34.0 years and racial demographics largely mirrored national estimates for the transgender/non-binary population. Obesity (20.7%) and hypertension (3.9%) were the only patient co-morbidities, although a relatively high proportion were underweight (5.4%). The majority of cases were outpatient procedures (66.5%) conducted by either plastic surgery (38.9%) or otolaryngology (61.1%). Comparing FGCSs by anatomic site, the proportion of tracheal procedures decreased between 2015-17 and 2018-19 (25.6% vs. 10.7%, P = 0.0002) whereas the proportion of brow/forehead reconstructions increased (32.6% versus 63.1%, P = 0.0005). These changes coincided with an increase in mean operative time (168.6 minutes versus 260.0, P = 0.0002). Complications were rare (3.9%), and the most common was surgical site infection (3.4%), a previously unreported outcome in the FGCS literature. Overall, FGCS patients are mostly young healthy individuals from diverse racial/ethnic backgrounds, and they have few surgical complications. The increasing volume and complexity of FGCSs may be a result of expanding insurance coverage for previously unaffordable procedures.

PMID:34545054 | DOI:10.1097/SCS.0000000000008180

Med Sci Monit. 2021 Sep 21;27:e932674. doi: 10.12659/MSM.932674.

ABSTRACT

BACKGROUND The aim of this study was to compare the clinical efficacy and postoperative recovery between uterine artery embolization (UAE) and infrarenal aortic balloon occlusion (IABO) in planned cesarean sections for placenta accreta spectrum disorders. MATERIAL AND METHODS A retrospective analysis using the clinical data of 62 patients with placenta previa combined with placenta accreta for planned cesarean between January 2014 and December 2019 was performed at the First People’s Hospital in Lianyungang. Thirty-five cases undergoing UAE during cesarean section were defined as group A, while the other 27 cases undergoing IABO were defined as group B. Intraoperative and postoperative parameters including intraoperative blood loss, blood transfusion volume, radiation duration, radiation dose, hysterectomy rate, operation duration, Intensive Care Unit hospitalization, complications, and neonatal outcomes as well as the maternal recovery during follow-up were compared between the 2 groups. RESULTS Intraoperative blood loss, transfusion volume, radiation time, radiation dose, hysterectomy rate, duration of surgery, Intensive Care Unit admission, and complications were higher in group A than group B, with differences being statistically significant (P<0.05). There were no significant differences in birth weight, 1-min Apgar score, neonatal asphyxia rate, admission to Neonatal Intensive Care Unit, breastfeeding time, duration of postpartum lochia, and data related to menstruation between the 2 groups (P>0.05). CONCLUSIONS IABO, which was more effective than UAE in cesarean section of patients with placenta accreta spectrum, could be further applied in treatment.

PMID:34545059 | DOI:10.12659/MSM.932674

J Craniofac Surg. 2021 Sep 20. doi: 10.1097/SCS.0000000000008188. Online ahead of print.

ABSTRACT

BACKGROUND: Craniosynostosis, a malformation caused by premature closure of one or more cranial sutures, is a rare congenital disability usually of unknown cause; however, it is often associated with assisted reproductive technology. Given the increasing prevalence of craniosynostosis and the use of the in vitro fertilization (IVF) method, the authors evaluated the association between IVF and the prevalence of craniosynostosis.

METHODS: This retrospective study reviewed records of patients with nonsyndromic craniosynostosis who underwent surgery in Mofid Hospital, a tertiary children’s hospital affiliated to Shahid Beheshti University of Medical Sciences, between 2010 and 2019.

RESULTS: A total of 200 patients aged one month to 7 years old, were evaluated. Out of 200 patients, 43% were plagiocephalic, 39% trigonocephalic, 8.5% scaphocephalic, 8% brachiocephalic, and 1.5% were mixed. Nine (4.5%) patients had received clomiphene citrate. Eight (4%) mothers had become pregnant under IVF, and they all had used clomiphene citrate for ovulation stimulation. No use of artificial insemination was reported. Of the eight patients whose mother had become pregnant through IVF, three were trigonocephalic, and five were plagiocephalic.

CONCLUSIONS: Without a control group, we are not able report the statistical results confirming or denying a link between craniosynostosis and infertility treatment. However, 4% prevalence of IVF use among craniosynostosis patients is significant. Further studies with a broader statistical community are suggested in this regard.

PMID:34545049 | DOI:10.1097/SCS.0000000000008188

J Craniofac Surg. 2021 Sep 20. doi: 10.1097/SCS.0000000000008182. Online ahead of print.

ABSTRACT

BACKGROUND: Cone beam computerized computed tomography (CBCT) has been widely indicated in dental implant procedure. The first step that the doctors should perform in local hospitals is to use orthopantomography for surgical planning to avoid and limit the risk of complications. As a result, determining the magnification amount of orthopantomography to achieve a precise diagnosis is clinically important. This study investigated the difference in measurement of the mental foramen (MF) position before dental surgery using 2 views of CBCT.

MATERIALS AND METHODS: Cone beam computed tomography scan was performed for 100 patients who required implant placement. In the panoramic and three-dimensional views of CBCT, the vertical distance between the margin of the mandible and the lower border of MF, and the horizontal distance between the mandibular symphysis and the mesial anterior border of MF were calculated. The differences between the 2 views were compared using Wilcoxon-rank U test with P value ≤ 0.05 considered statistically significant.

RESULTS: The findings of this study showed a substantial statistical difference in the horizontal distance for the dentate patients in panoramic and three-dimensional views (22.7 ± 3.04 versus 21.1 ± 1.6), (22.5 ± 2.4 versus 20.9 ± 1.5) and left side (22.4 ± 2.8 versus 21.2 ± 1.6), (22.4 ± 2.8 versus 20.6 ± 1.4) of both genders. Concerning the vertical distance, a significant difference was also observed in the dentate (12.1 ± 2.1 versus 11.1 ± 1.4), (10.6 ± 1.4 versus 9.6 ± 1.3) and left side of the jaw (11.6 ± 1.95 versus 10.9 ± 1.2), (10.5 ± 1.2 versus 9.96 ± 1.4) for both genders in both views. In the edentulous and right side of the jaw, however no statistical difference was observed between male and female patients in terms of horizontal and vertical measurements.

PMID:34545052 | DOI:10.1097/SCS.0000000000008182

Eur J Cancer Prev. 2021 Sep 17. doi: 10.1097/CEJ.0000000000000716. Online ahead of print.

ABSTRACT

BACKGROUND: The incidence of cutaneous melanoma has risen faster than almost any other type of cancer in the last 50 years. Ultraviolet (UV) radiation and genetic susceptibility are the most important risk factors.

OBJECTIVE: We aimed to determine the epidemiologic indicators of melanoma in Hungary, a country with an estimated population of 9.8 million and an area of 93 030 km2.

METHODS: Anonymized patient records from the National Health Insurance Fund Management covering the entire population were used to determine the incidence and prevalence of melanoma in the counties of Hungary from 2013 to 2017. Altogether 20 030 melanoma cases were identified for inclusion in this study.

RESULTS: The prevalence of melanoma increased over the investigated period and was significantly higher among women than men. The incidence of melanoma stagnated during this period and the incidence rate was the highest among the elderly. Interestingly, the incidence was higher in males in the elderly population, while the incidence was higher in females in the younger (<60 years) population. Geographical variations in ambient UV radiation did not show statistically significant correlation with the regional variability of epidemiologic indicators, probably due to small differences in the number of bright sunshine hours per year between regions. Although Hungary is a relatively small country, we observed regional heterogeneity in socioeconomic factors. Notably, a significant and strong negative correlation was found between single-person household rates and melanoma prevalence.

CONCLUSION: In addition to ambient UV radiation, melanoma incidence and prevalence appear to be related to age, gender and socioeconomic factors.

PMID:34545023 | DOI:10.1097/CEJ.0000000000000716

Eur J Cancer Prev. 2021 Sep 17. doi: 10.1097/CEJ.0000000000000715. Online ahead of print.

ABSTRACT

BACKGROUND: Models estimating risk for advanced proximal colorectal neoplasia (APN) may be used to select colorectal cancer (CRC) screening test, either prior to knowing distal colorectal findings or afterward. Current models have only fair discrimination and nearly all require knowing distal findings.

OBJECTIVE: Derive and test risk prediction models for APN with and without distal findings.

SETTING: Selected endoscopy centers within central Indiana, USA.

PARTICIPANTS: Average-risk persons undergoing first-time screening colonoscopy.

INTERVENTIONS: Demographics, personal and family medical history, lifestyle factors and physical measures were linked to the most advanced finding in proximal and distal colorectal segments. For both models, logistic regression identified factors independently associated with APN on a derivation set. Based on equation coefficients, points were assigned to each factor, and risk for APN was examined for each score. Scores with comparable risks were collapsed into risk categories. Both models and their scoring systems were tested on the validation set.

MAIN OUTCOME: APN, defined as any adenoma or sessile serrated lesion ≥1 cm, one with villous histology or high-grade dysplasia, or CRC proximal to the descending colon.

RESULTS: Among 3025 subjects in the derivation set (mean age 57.3 ± 6.5 years; 52% women), APN prevalence was 4.5%; 2859 (94.5%) had complete data on risk factors. Independently associated with APN were age, sex, cigarette smoking, cohabitation status, metabolic syndrome, non-steroidal anti-inflammatory drug use and physical activity. This model (without distal findings) was well-calibrated (P = 0.62) and had good discrimination (c-statistic = 0.73). In low-, intermediate- and high-risk groups that comprised 21, 58 and 21% of the sample, respectively, APN risks were 1.47% (95% CI, 0.67-2.77%), 3.09% (CI, 2.31-4.04%) and 11.6% (CI, 9.10-14.4%), respectively (P < 0.0001), with no proximal CRCs in the low-risk group and 2 in the intermediate-risk group. When tested in the validation set of 1455, the model retained good metrics (calibration P = 0.85; c-statistic = 0.83), with APN risks in low- (22%), intermediate- (56%) and high-risk (22%) subgroups of 0.62% (CI, 0.08-2.23%) 2.20% (CI, 1.31-3.46%) and 13.0% (CI, 9.50-17.2%), respectively (P < 0.0001). There were no proximal CRCs in the low-risk group, and two in the intermediate-risk group. The model with distal findings performed comparably, with validation set metrics of 0.18 for calibration, 0.76 for discrimination and APN risk (% sample) in low-, intermediate-, and high-risk groups of 1.1 (69%), 8.3 (22%) and 22.3% (9%).

CONCLUSION: These models stratify large proportions of average-risk persons into clinically meaningful risk groups, and could improve screening efficiency, particularly for noncolonoscopy-based programs.

PMID:34545024 | DOI:10.1097/CEJ.0000000000000715

Eur J Cancer Prev. 2021 Sep 17. doi: 10.1097/CEJ.0000000000000588. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: The overall evidence on the association between gallbladder conditions (GBC: gallstones and cholecystectomy) and pancreatic cancer (PC) is inconsistent. To our knowledge, no previous investigations considered the role of tumour characteristics on this association. Thus, we aimed to assess the association between self-reported GBC and PC risk, by focussing on timing to PC diagnosis and tumour features (stage, location, and resection).

METHODS: Data derived from a European case-control study conducted between 2009 and 2014 including 1431 PC cases and 1090 controls. We used unconditional logistic regression models to estimate odds ratios (ORs) and corresponding 95% confidence intervals (CIs) adjusted for recognized confounders.

RESULTS: Overall, 298 (20.8%) cases and 127 (11.6%) controls reported to have had GBC, corresponding to an OR of 1.70 (95% CI 1.33-2.16). The ORs were 4.84 (95% CI 2.96-7.89) for GBC diagnosed <3 years before PC and 1.06 (95% CI 0.79-1.41) for ≥3 years. The risk was slightly higher for stage I/II (OR = 1.71, 95% CI 1.15-2.55) vs. stage III/IV tumours (OR = 1.23, 95% CI 0.87-1.76); for tumours sited in the head of the pancreas (OR = 1.59, 95% CI 1.13-2.24) vs. tumours located at the body/tail (OR = 1.02, 95% CI 0.62-1.68); and for tumours surgically resected (OR = 1.69, 95% CI 1.14-2.51) vs. non-resected tumours (OR = 1.25, 95% CI 0.88-1.78). The corresponding ORs for GBC diagnosed ≥3 years prior PC were close to unity.

CONCLUSION: Our study supports the association between GBC and PC. Given the time-risk pattern observed, however, this relationship may be non-causal and, partly or largely, due to diagnostic attention and/or reverse causation.

PMID:34545020 | DOI:10.1097/CEJ.0000000000000588

Eur J Cancer Prev. 2021 Sep 17. doi: 10.1097/CEJ.0000000000000680. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate and quantify the relationship between coffee and gastric cancer using a uniquely large dataset from an international consortium of observational studies on gastric cancer, including data from 18 studies, for a total of 8198 cases and 21 419 controls.

METHODS: A two-stage approach was used to obtain the pooled odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) for coffee drinkers versus never or rare drinkers. A one-stage logistic mixed-effects model with a random intercept for each study was used to estimate the dose-response relationship. Estimates were adjusted for sex, age and the main recognized risk factors for gastric cancer.

RESULTS: Compared to never or rare coffee drinkers, the estimated pooled OR for coffee drinkers was 1.03 (95% CI, 0.94-1.13). When the amount of coffee intake was considered, the pooled ORs were 0.91 (95% CI, 0.81-1.03) for drinkers of 1-2 cups per day, 0.95 (95% CI, 0.82-1.10) for 3-4 cups, and 0.95 (95% CI, 0.79-1.15) for five or more cups. An OR of 1.20 (95% CI, 0.91-1.58) was found for heavy coffee drinkers (seven or more cups of caffeinated coffee per day). A positive association emerged for high coffee intake (five or more cups per day) for gastric cardia cancer only.

CONCLUSIONS: These findings better quantify the previously available evidence of the absence of a relevant association between coffee consumption and gastric cancer.

PMID:34545022 | DOI:10.1097/CEJ.0000000000000680

Intern Med. 2021 Sep 18. doi: 10.2169/internalmedicine.8020-21. Online ahead of print.

ABSTRACT

Objective Mapping the long-term prognosis of Budd-Chiari syndrome (BCS) is difficult, as the prognosis is associated with changes in the liver function. The present study evaluated the time course changes in the liver function in a treatment group with percutaneous old balloon angioplasty (POBA) and a non-treatment group using the albumin-bilirubin score (ALBI) and Child-Pugh score during long-term follow-up. Methods In this retrospective study, 13 consecutive patients diagnosed with BCS at our hospital between 2007 and 2020 were categorized into a treatment group (n=8), which received POBA, and a non-treatment group (n=5). Differences in the liver function in the ALBI and Child-Pugh scores between the initial visit and one- and three-year follow-up were calculated and statistically evaluated. We investigated the changes in the liver function during the long-term follow-up, including events such as re-stenosis and re-treatment. Results While the Child-Pugh scores in the treatment group did not differ significantly between the initial visit and 1- or 3-year follow-up, the ALBI scores in this group improved significantly between the initial visit and the 1- or 3-year follow-up visit (p=0.0078 and 0.0156, respectively). The liver function according to the ALBI score in the treatment group showed gradual improvement from the initial value but gradual worsening in the non-treatment group. The ALBI scores also revealed that the liver function varies according to re-stenosis and re-POBA in BCS patients. Conclusion Unlike the Child-Pugh score, the ALBI score was able to capture changes in the liver function of BCS patients during the long-term course of BCS.

PMID:34544949 | DOI:10.2169/internalmedicine.8020-21