Tag: pubmed

Oncologist. 2021 Jun 7. doi: 10.1002/onco.13851. Online ahead of print.

ABSTRACT

BACKGROUND: To reduce the overall exposure to dexamethasone (DEX) in patients receiving cisplatin-based chemotherapy, we evaluated the non-inferiority of DEX on day 1, with or without low-dose DEX on days 2 and 3, combined with oral NEPA, a fixed-dose combination of netupitant and palonosetron, compared with the guideline-consistent use of 4-day DEX.

PATIENTS AND METHODS: In this open-label, multicenter study, chemo-naïve patients undergoing high-dose cisplatin (≥70 mg/m² ), were given NEPA and DEX (12 mg) on day 1 and randomized (1:1:1 ratio) to receive either 1) no further DEX (DEX1), 2) oral DEX (4 mg daily) on days 2-3 (DEX3), or 3) DEX (4 mg twice daily) on days 2-4 (DEX4). The primary efficacy endpoint was complete response (CR: no emesis and no rescue medication) during the 5-day overall phase. The non-inferiority margin was set at -15% difference (DEX1 or DEX3 minus DEX4). Secondary efficacy endpoints included complete protection (CP: CR and none or mild nausea).

RESULTS: Two-hundred twenty-eight patients, 76 in each arm, were assessable. Non-inferiority was met for both DEX-sparing regimens and the reference arm, with overall phase CR rates of 76.3% in each of the DEX1 and DEX3 arms and 75.0% in the DEX4 arm (95% CI, -12.3% to 15% for each comparison). During the overall phase, CP rates were similar between groups.

CONCLUSIONS: A simplified regimen of NEPA plus single-dose DEX offers comparable CINV prevention throughout 5 days post-chemotherapy with the advantage of sparing patients additional doses of DEX in the high emetic risk setting of cisplatin-based chemotherapy.

IMPLICATIONS FOR PRACTICE: Dexamethasone (DEX) has traditionally played an integral role in the management of chemotherapy-induced nausea and vomiting (CINV). While generally considered safe, even short-term DEX use is associated with various side effects, and some evidence suggests that steroids may reduce the efficacy of immunotherapies and cellular therapies, if used concurrently. Our study demonstrates, for the first time, comparable antiemetic control during the 5-days post-chemotherapy with a simplified three-drug regimen of NEPA (netupitant/palonosetron) plus single-dose DEX versus the standard 4-day DEX reference treatment in patients undergoing high-dose cisplatin. This represents a clinically relevant achievement as it not only simplifies antiemetic prophylaxis but also offers an opportunity to minimize DEX-related side effects and appropriately use in patients where caution with corticosteroid use is advised.

PMID:34101934 | DOI:10.1002/onco.13851

Histopathology. 2021 Jun 8. doi: 10.1111/his.14428. Online ahead of print.

ABSTRACT

AIM: To compare the fibroinflammatory diseases Kimura’s disease (KD) and IgG4-related disease (IgG4RD) and to explore their possible relationship.

METHODS AND RESULTS: 46 cases of KD and 29 IgG4RD of our institution diagnosed from 2011 to 2020 were studied. They were compared with each other on clinical, pathological and immunohistological features. There were similar clinical features, except that IgG4RD affected older patient population, with more frequent salivary gland involvement; and KD affected head and neck lymph nodes and showed blood eosinophilia more frequently than IgG4RD. IgG4RD exhibited frequent storiform fibrosis and obliterative phlebitis while KD more frequent tissue eosinophilia, eosinophilic abscess, germinal centre eosinophilic deposit and vascularization. Twenty to 30% of KD had more than 50 IgG4+ plasma cell (PC) per high power field (HPF) and IgG4/IgG+PC ratio exceeding 40%. These parameters, however, occurred in 100% of IgG4RD. Significantly more KD had >10 IgE+PC / HPF and lymphoid germinal centre IgE reticular staining as compared to IgG4RD. All these histological and immunohistological features are overlapping in the two diseases, though differed with statistical significance.

CONCLUSION: Our study confirmed that there is significant overlap in clinical, pathological and immuohistological features between KD and IgG4RD. It is important to recognize these overlapping features and correlation with clinicopathological picture is required in differential diagnosis. The overlapping features also suggest a possible close relationship between KD and IgG4RD, which could represent different facets of a continuous fibroinflammatory disease spectrum.

PMID:34101896 | DOI:10.1111/his.14428

Clin Transplant. 2021 Jun 8. doi: 10.1111/ctr.14382. Online ahead of print.

ABSTRACT

PURPOSE: The risks and benefits of remote corticosteroid weaning in heart transplant recipients more than two years post-transplant are unknown. We compared outcomes in patients undergoing early and remote steroid weaning after heart transplantation.

METHODS: We performed a retrospective study (range 09/1991- 04/2017). Primary outcomes included short-term and long-term mortality, allograft dysfunction and burden of rejection. Secondary outcomes included impact on hemoglobin A1c, lipid panel, bone scan Tscore, and body mass index.

RESULTS: 63 patients underwent corticosteroid weaning between 2012 and 2017. Outcomes of patients weaned early (n = 34; median time from transplant = 1.1 years) were compared with those weaned late (n = 29; median time from transplant = 4.4 years). 52 (82.5%) patients were successfully weaned off corticosteroids. No statistically significant difference in outcomes was found between the early and late weaning groups (p = 0.20). There were no differences in allograft function (p-value = 0.16), incidence of rejection (p = 0.46) or mortality (p = 0.15). Improvement in metabolic profile was seen in both groups but was not statistically significant.

CONCLUSIONS: In heart transplant recipients remote vs early weaning of corticosteroids is not associated with significant differences in graft function or the incidence of rejection after one-year follow-up. Moreover, there were no significant differences in survival up to three years between the two groups. This article is protected by copyright. All rights reserved.

PMID:34101911 | DOI:10.1111/ctr.14382

Chemistry. 2021 Jun 8. doi: 10.1002/chem.202100268. Online ahead of print.

ABSTRACT

Scientists and students with disabilities have been severely affected by the COVID-19 pandemic, and this must be urgently addressed to avoid further entrenching existing inequalities. The need for rapid decision-making, often by senior colleagues without lived experience of disabilities, can lead to policies which discriminate against scientists with disabilities. This article reflects on disability declaration statistics and research in critical disability studies and social science to explore the challenges experienced by disabled scientists before and during the COVID-19 pandemic and highlights recommendations and examples of good practice to adopt in order to challenge ableism in STEM communities and workplaces. It is vital that disabled staff and students are fully involved in decision making. This is particularly important as we continue to respond to the challenges and opportunities associated with the ongoing COVID-19 pandemic and plan for a post-COVID-19 future. This time of great change can be used as an opportunity to listen, learn, and improve working conditions and access for scientists with disabilities, and by doing so, for everyone.

PMID:34101912 | DOI:10.1002/chem.202100268

Clin Cardiol. 2021 Jun 8. doi: 10.1002/clc.23663. Online ahead of print.

ABSTRACT

BACKGROUND: Atrial fibrillation (AF) recurrence is common in the 3-month blanking-period after catheter ablation, during which electrical cardioversion (ECV) is usually performed to restore sinus rhythm. Whether ECV can affect the clinical outcome of post-ablation AF patients is inconsistent, however. We aimed to explore the 1-year effect of ECV on AF recurrence and rehospitalization in patients experienced recurrence within 3-month after AF catheter ablation.

METHODS: Patients who experienced recurrence within 3-month after AF catheter ablation procedure were enrolled from the China Atrial Fibrillation Registry (China-AF). A 1:3 Propensity score matching (PSM) method was applying to adjust the confounders between patients who had been treated by ECV or not. Logistic regression models were conducted to evaluate the association of ECV with 1-year AF recurrence and rehospitalization.

RESULTS: In this study, 2961 patients experienced AF recurrence within 3-month after the procedure, and 282 of them underwent successful ECV, 2155 patients did not undergo ECV. One-year AF recurrence rates were 56.4% in ECV group versus 65.4% in non-ECV group (p = .003), and were 55.9% versus 65.9%, respectively, after PSM (adjusted odds ratio [OR] 0.66; 95% confidence interval (CI): 0.49-0.88, p = .005). However, the difference of 1-year rehospitalization rates between two groups were not statistically significant before (ECV group: 23.7% vs. non-ECV group: 22.3%, p = .595) and after PSM (ECV group: 24.4% vs. non-ECV group: 21.6%, adjusted OR1.14; 95% CI 0.81-1.62, p = .451).

CONCLUSIONS: Successful ECV was associated with lower rate of one-year recurrence in patients with early recurrent AF after catheter ablation.

PMID:34101841 | DOI:10.1002/clc.23663

J Orthop Res. 2021 Jun 8. doi: 10.1002/jor.25117. Online ahead of print.

ABSTRACT

Previous research suggests more biomechanically demanding tasks (e.g., stair descent, hopping) magnify biomechanical asymmetries compared with walking after anterior cruciate ligament (ACL) reconstruction. However, it is unclear if modifying task-specific constraints, like walking speed also elicits greater biomechanical asymmetries in this population. We examined the effects of manipulating walking speed on ground reaction force (GRF) asymmetries in individuals with ACL reconstruction and uninjured controls. Thirty individuals with ACL reconstruction (Age= 20.6 ± 5.4 yr., body mass index [BMI]= 23.9 ± 3.3 kg/m² ) and fifteen controls (Age= 23.1 ± 4.5 yr., BMI= 23.6 ± 2.7 kg/m² ) were tested on an instrumented treadmill at three speeds (100%, 120%, and 80% self-selected speed). Bilateral vertical and posterior-anterior GRFs were recorded at each speed. GRF asymmetries were calculated by subtracting the uninjured from the injured limb at each percent of stance. Statistical parametric mapping was used to evaluate the effects of speed on GRF asymmetries across stance. We found vertical and posterior GRF asymmetries were exacerbated at faster speeds and reduced at slower speeds in ACL individuals but not controls (p < 0.05). No differences in anterior GRF asymmetries were observed between speeds in either group (p > 0.05). Our results suggest increasing walking speed magnifies GRF asymmetries in individuals with ACL reconstruction. This article is protected by copyright. All rights reserved.

PMID:34101887 | DOI:10.1002/jor.25117

Trans R Soc Trop Med Hyg. 2021 Jun 8:trab085. doi: 10.1093/trstmh/trab085. Online ahead of print.

ABSTRACT

BACKGROUND: Snakebite statistics are lacking in Sudan despite the high estimated burden. In this study we aimed to describe the incidence of snakebite envenomation and death in Sudan and to show the state-wise distribution of snakebite episode.

METHODS: We retrospectively analyzed hospital-based data on snakebite for 2014-2018. Data were obtained from the annual health statistical reports of the Ministry of Health. Descriptive statistics were used to illustrate the results.

RESULTS: A total of 63 160 people were envenomed during 2014-2018 with an average of 12 632 cases/year. The death rate between inpatient cases was 2.5%. The annual incidence was 18- 47 cases/100 000 population. Gadarif state recorded the highest incidence (132/100 000 population) of snakebite envenomation in Sudan whereas Northern state had the least incidence (5/100 000 population). The 15-24 y age group experienced the highest risk of snakebite and males were more exposed to snakebites than females.

CONCLUSIONS: Although hospital-based records underestimate the burden of snakebite, they can still provide an insight regarding the actual numbers. Here, we highlight the at-risk states in Sudan to be targeted for further questionnaire-based epidemiological studies and to guide health authorities to reduce the burden of snakebite envenomation by insuring proper antivenom distribution to the highly affected areas.

PMID:34101816 | DOI:10.1093/trstmh/trab085

J Travel Med. 2021 Jun 9:taab071. doi: 10.1093/jtm/taab071. Online ahead of print.

ABSTRACT

BACKGROUND: In recent years, multiple outbreaks of measles associated with vaccine hesitancy occurred in high-income countries, where measles incidence had previously been low. Most safety data about the measles, mumps and rubella (MMR) vaccine are derived from studies conducted among children, whereas evidence regarding the safety profile of the vaccine in adults is scarce.

METHODS: In 2017, during an outbreak of measles in Europe, Israeli travellers to high-risk locations who were incompletely vaccinated, were urged to complete the two MMR vaccination schedule before their travel. In this prospective cohort study, we analysed adverse events (AEs) of MMR and MMRV (measles, mumps, rubella and varicella) vaccines among these travellers. All participants were followed up using structured questionnaires 2-4 weeks after vaccination.

RESULTS: Seven hundred and eighty-five adult travellers whose median age was 49.2 years were vaccinated and followed up. Any AEs were reported by 25.2% of all participants; 11.6% reported local AEs, and 18.6% reported systemic AEs, none of which were severe. In general, AEs were much more common among female travellers (19.4% of males vs 30.1% of females (P < 0.001)). Local AEs, overall systemic AEs, headache and arthralgia were much more common among females, whereas rates of general malaise and fever were not statistically different between genders. We did not observe any significant differences in the rates of total, local or systemic AEs between the MMR and MMRV vaccines. Higher rates of systemic AEs were observed among participants who were younger and probably immunized once with MMR compared to older vaccines immunized once to measles only and to those who were never immunized.

CONCLUSIONS: The current study demonstrated low rates of systemic AEs and no serious AEs following either MMR or MMRV administration. More AEs were reported among females, and rates of AEs were similar after either MMR or MMRV.

PMID:34101817 | DOI:10.1093/jtm/taab071

Cancer. 2021 Jun 8. doi: 10.1002/cncr.33503. Online ahead of print.

ABSTRACT

BACKGROUND: Defining workup beyond usual clinical practice that may improve treatment outcomes in men with a prostate-specific antigen (PSA) level of ≤4 ng/mL (vs >4 ng/mL) and Gleason score (GS) 9 to 10 prostate cancer (PC) remains to be determined.

METHODS: Between February 25, 1992, and February 25, 2016, 17,632 men with clinical T1-4 PC with a biopsy GS of 6 to 10 underwent radical prostatectomy at a single academic center. Multivariable Fine and Gray regressions were used to evaluate the risk of prostate cancer-specific mortality (PCSM) with an interaction model evaluating the prognostic significance of PSA ≤ 4 ng/mL versus PSA > 4 ng/mL among men with PC with a biopsy GS of 9 to 10 versus ≤8, with adjustments made for the time-dependent use of adjuvant and/or salvage radiation therapy and androgen deprivation therapy (ADT) in addition to known PC prognostic factors.

RESULTS: There was a significant interaction in men with a biopsy GS of 9 to 10 versus ≤8 and a PSA level of ≤4 ng/mL versus >4 ng/mL (adjusted hazard ratio [AHR], 2.87; 95% confidence interval [CI], 1.02-8.08; P = .046). Specifically, among men with a biopsy GS of 9 to 10 and a PSA level of ≤4 ng/mL versus >4 ng/mL, there was a significantly higher rate of PCSM (AHR, 2.59; 95% CI, 1.19-5.67; P = .017); however, there was no significant difference in the risk of PCSM in men with a biopsy GS ≤ 8 and a PSA level of ≤4 ng/mL versus >4 ng/mL (AHR, 0.90; 95% CI, 0.46-1.78; P = .771). Moreover, the time-dependent use of postoperative ADT was also associated with an increased risk of PCSM (AHR, 10.76; 95% CI, 6.88-16.81; P < .0001).

CONCLUSIONS: Some men with PSA ≤ 4 ng/mL and a biopsy GS of 9 to 10 may have pathologic or genetic variants that make them less amenable to a cure with current standards of care. Additional workup assessing for small cell, neuroendocrine, and genetic variants should be considered.

PMID:34101827 | DOI:10.1002/cncr.33503

J Gerontol B Psychol Sci Soc Sci. 2021 Jun 8;76(Supplement_1):S86-S96. doi: 10.1093/geronb/gbab004.

ABSTRACT

OBJECTIVE: To study the role of gender and marital status as risk factors for nursing home entry in the United States.

METHOD: The paper uses data from the Health and Retirement Study, a nationally representative survey of the older population in the United States. Multivariate logit models of the risk of nursing home entry over a 2-year follow-up period were estimated for noninstitutionalized individuals over the age of 65. A multiple imputation procedure was used to explore the sensitivity of the results to alternative assumptions about the data-generating process of missing outcome values.

RESULTS: In an analysis based on complete observations, women exhibited the same risk of nursing home entry as men (risk ratio [RR] = 1.01; CI: 0.90, 1.13). However, after expanding the sample to include information on nursing home use for individuals who died during the follow-up period, women were found to have a statistically lower risk of nursing home entry (RR = 0.85; CI: 0.79, 0.92). The latter result was robust to alternative assumptions about the nature of missing data. The type of sample used in the analysis did not affect the conclusions regarding the role of marital status. Divorced and widowed individuals were found to be at higher risk of nursing home admissions than married individuals in all specifications.

DISCUSSION: The findings clarify the role of gender as a predictor of nursing home admissions and may provide useful prognostic information for clinicians and caregivers regarding nursing home entry risk. The study also sheds light on how conclusions about predictors of nursing home risk obtained from prospective studies with long follow-up periods can be affected by the treatment of missing outcomes due to death or attritions.

PMID:34101810 | DOI:10.1093/geronb/gbab004