Tag: pubmed

J Cataract Refract Surg. 2021 Jun 1. doi: 10.1097/j.jcrs.0000000000000708. Online ahead of print.

ABSTRACT

PURPOSE: To analyze the incidence and risk factors of posterior capsule rupture (PCR) in cataract surgery.

SETTING: European clinics affiliated with the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO).

DESIGN: Retrospective cross-sectional register-based study.

METHODS: Data was obtained from the EUREQUO. The database contains data on demographics, comorbidities, and intraoperative complications, including PCR for the study period from January 1, 2008, to December 31, 2018. Univariable and multivariable logistic regression analyses were performed to estimate the (adjusted) odds ratio (OR) and 95% confidence intervals (CI).

RESULTS: Data was available of 2,853,376 patients and 31,749 (1.1%) cataract surgeries were complicated by a PCR. The PCR rate ranged from 0.60 to 1.65 percent throughout the years, with a decreasing trend (p <0.001). The mean age of the PCR cohort was 74.8 ± 10.5 years and 17,629 (55.5%) patients were female. Risk factors most significantly associated with PCR were corneal opacities (OR 3.21, 95% CI 3.02 – 3.41, p <0.001), diabetic retinopathy (OR 2.74, 95% CI 2.59 – 2.90, p <0.001), poor preoperative visual acuity (OR 1.98, 95% CI 1.88 – 2.07, p <0.001), and white cataract (OR 1.87, 95% CI 1.72 – 2.03, p <0.001).

CONCLUSION: Risk factors for PCR were identified based on the EUREQUO and the incidence of this complication is decreasing over time.

PMID:34074994 | DOI:10.1097/j.jcrs.0000000000000708

Nucl Med Commun. 2021 Jun 1. doi: 10.1097/MNM.0000000000001449. Online ahead of print.

ABSTRACT

AIM: To assess the prognostic role of metabolic parameters on 18F-FDG PET/CT & correlation with molecular markers in IDH-1 wild-type GBM.

METHODS: A total of 129 patients with brain lesions showing equivocal findings on baseline MRI who were referred for fluoro-deoxy-glucose PET/CT were analyzed. Of these, 50 underwent surgery/biopsy and postoperative histopathological diagnosis of IDH-1 wild-type GBM. SUVmax, metabolic tumor volume (MTV), total lesion glycolysis (TLG) & T/w ratio was calculated. Median metabolic parameters were used for stratification. Overall survival was calculated using Kaplan-Meier method and was compared using log rank test. P value < 0.05 was considered significant. Multivariate analysis was done using Cox proportional hazard model. Correlation between metabolic parameters and molecular markers was done using Mann-Whitney U test.

RESULTS: Median of SUVmax, T/w ratio, MTV, TLG, 18.3, 2.09, 61, 409. Average overall survival (OS) for T/w ratio >2.08 was 5 months, <2.08 was 18 months (P value 0.001). For MTV >61 was 4 months, <61 was 18 months (P value 0.001). Similarly, for TLG >409 was 5 months while for <409 was 19 months (P value 0.001). SUVmax was not significant for OS. In multivariate analysis, age was the statistically significant independent prognostic factor.

CONCLUSION: Metabolic parameters of fluoro-deoxy-glucose PET/CT help in prognosticating IDH-1 wild-type GBM. Higher MiB-1 index correlates with higher T/w ratio and is associated with poor overall survival.

PMID:34075008 | DOI:10.1097/MNM.0000000000001449

Spine (Phila Pa 1976). 2021 Jun 2. doi: 10.1097/BRS.0000000000004135. Online ahead of print.

ABSTRACT

STUDY DESIGN: Multicenter, retrospective cohort study.

OBJECTIVE: The aim of this study was to investigate the occurrence and surgical predictors of postoperative shoulder imbalance (PSI) in Lenke type 2A adolescent idiopathic scoliosis (AIS).

SUMMARY OF BACKGROUND DATA: Although several studies have investigated the factors influencing PSI in Lenke type 2 curves, no studies have analyzed PSI-related factors considering upper instrumented vertebra (UIV) and lumbar modifier type simultaneously.

METHODS: Patients with Lenke Type 2A AIS treated by spinal fusion were retrospectively identified and their data were extracted from six spine centers in Japan. Inclusion criteria were age between 10 and 20 years at surgery, UIV = T2, major curve 40° to 90°, and follow-up for 24 to 30 months after surgery. We analyzed patient characteristics, surgical characteristics, and preoperative and immediate-postoperative radiographic parameters. We defined patients with lower instrumented vertebra (LIV) equal or proximal to the last touching vertebra (LTV) as selective thoracic fusion (STF-LTV) and patients with LIV distal to the LTV as non-STF-LTV. t Tests, Mann-Whitney U test, χ2 tests, Fisher exact tests, and multivariate logistic regression were used for statistical analyses.

RESULTS: Among the 99 consecutive patients with a mean follow-up of 25.6 months, PSI was seen in 27 (27.3%) patients immediately after and in 17 (17.2%) patients at 24 to 30 months. The univariate analysis revealed that the significant risk factors of PSI were preoperative radiographical shoulder height, non-STF-LTV, and high main thoracic curve (MTC) correction (immediate-postoperative MTC correction rate: ≥70%), with PSI incidence of 40.0%. The multivariate logistic regression analysis indicated that interaction term of non-STF-LTV and high MTC correction was an independent risk factor for PSI (non-STF-LTV and high MTC correction, odds ratio: 5.167, 95% confidence interval: 1.470-18.159, P = 0.010).

CONCLUSION: To prevent PSI in Lenke Type 2A AIS patients, surgeons should avoid the combination of non-STF-LTV and high MTC correction in those surgeries with UIV as T2.Level of Evidence: 4.

PMID:34075011 | DOI:10.1097/BRS.0000000000004135

Eur J Gastroenterol Hepatol. 2021 May 31. doi: 10.1097/MEG.0000000000002207. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Acute-on-chronic liver failure (ACLF) is associated with bacterial infection and poor outcome. Neutrophil-to-lymphocyte ratio (NLR) is used to assess bacterial infection and immune dysfunction in numerous diseases. We aimed to evaluate NLR as a prognostic biomarker and to explore its combination with accepted prognostic models in ACLF patients.

METHODS: This retrospective study included patients with ACLF or severe liver injury from chronic HBV infection admitted to three tertiary academic hospitals in China from 2013 to 2019. Baseline NLR was correlated with ACLF grade, bacterial infection, survival and accepted ACLF scores.

RESULTS: NLR values were significantly increased in nonsurvivors and patients with bacterial infection at or after admission and were unaffected by cirrhotic status in 412 transplant-free patients included in three cohorts. Compared with accepted scores, NLR showed moderate accuracy in predicting 28-day mortality and high accuracy in predicting 90-day mortality. Three levels of mortality risk were graded on the basis of NLR values (<3.10, 3.10-4.79 and >4.79), and NLR >4.79 was associated with 53.2-60.0% 28-day and 75.0-80.0% 90-day mortality in these cohorts. Multivariate analyses indicated that NLR retained statistical significance independently of CLIF consortium organ failure score (CLIF-C OFs). NLR-based CLIF-C ACLF score was primarily developed and showed excellent performance in predicting 28/90-day mortality.

CONCLUSIONS: NLR is a dependable biomarker for bacterial infection assessment and short-term mortality prediction in ACLF patients and can be used jointly with CLIF-C OFs to improve the accuracy of mortality prediction in patients with the disease. NLR-based CLIF-C ACLF model needs further validation.

PMID:34074984 | DOI:10.1097/MEG.0000000000002207

Eur J Gastroenterol Hepatol. 2021 May 31. doi: 10.1097/MEG.0000000000002216. Online ahead of print.

ABSTRACT

OBJECTIVES: To develop a prognostic score evaluating treatment response at 6 months after ursodeoxycholic acid (UDCA) initiation in primary biliary cholangitis (PBC) patients.

METHODS: Adult PBC patients who were newly prescribed UDCA at our institution (n = 292) were included. Significant determinants of liver-related adverse events in the multivariable Cox model were used for score development, weighted by β-coefficients. Discrimination ability was assessed using Harrell’s C-statistic. The performance of our model was compared to the previous models.

RESULTS: Our model included the following variables evaluated at 6 months: (1) alkaline phosphatase decline of less than 50% from baseline and >upper limit normal (ULN) (2 points); (2) bilirubin >ULN (2 points); (3) albumin <lower limit normal (1 point). The score ranged from 0 to 5 points. C-statistic estimates were 0.87 (overall cohort), 0.87 (no cirrhosis) and 0.77 (cirrhosis), indicating good discrimination of treatment response. Patients with scores ≥3 points had significant shorter transplant-free survival (TFS) than scores <3 points (P < 0.001). The TFS rates for patients with score ≥3 points at 5, 10 and 15 years were 52, 26 and 7%, and for patients with scores <3 points were 96, 92 and 82%, respectively. There was no significant difference between the performance of our 6-month model and the previous models (Paris I, Paris II, Barcelona, Rotterdam and GLOBE scores evaluated at 12 months) in predicting liver-related outcomes (all P = NS).

CONCLUSION: This novel 6-month prognostic model showed good prognostic performance. Utilization of this score would identify patients with suboptimal responses to UDCA earlier.

PMID:34074987 | DOI:10.1097/MEG.0000000000002216

J Cataract Refract Surg. 2021 May 10. doi: 10.1097/j.jcrs.0000000000000688. Online ahead of print.

ABSTRACT

PURPOSE: To compare the time spent on toric intraocular lens (IOL) implantation during cataract surgery using a manual-marking versus a digital image-guided system (the Verion) for toric IOL alignment.

SETTINGS: All procedures were performed at the Instituto Oftalmológico Quirónsalud ophthalmology clinic (A Coruña, Spain).

DESIGN: We designed an experimental and longitudinal (1-month follow-up) study.

METHODS: A total of 98 eyes of 65 participants (68.2 ± 12.2 years) were divided into two groups: 49 eyes operated with toric IOL alignment using a manual-marking technique (manual group) and another 49 eyes operated using image-guided marking (Verion group). The primary variable for comparison between both groups was cataract surgery time. Other outcomes such as toric IOL misalignment, spherical equivalent (SE), astigmatism, uncorrected distance visual acuity (UDVA), and corrected distance visual acuity (CDVA) were also measured.

RESULTS: The total cataract surgery time was 2:09 minutes shorter (p < 0.001) with the Verion system (12:12 ± 2:20) compared to the surgical procedure performed using manual marking (15:27 ± 3:04). One month after surgery, there were no statistical differences in terms of toric IOL misalignment between the Verion (3.38° ± 2.95°) and the manual group (4.66° ± 3.95°). No statistical differences were observed between groups for refractive and visual outcomes either (p ≥ 0.05).

CONCLUSIONS: The cataract surgery time was reduced when the procedure was assisted using the Verion system to align the IOL compared to manual marking, maintaining the same efficacy in terms of toric IOL misalignment, residual refraction, and visual acuity.

PMID:34074992 | DOI:10.1097/j.jcrs.0000000000000688

J Occup Environ Med. 2021 Jun 1. doi: 10.1097/JOM.0000000000002251. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine if repeat annual health risk assessments (RAHRAs) with intervention reduce 10-year cardiovascular disease (CVD) risk in financial sector employees.

METHODS: Retrospective analysis from RAHRAs in 13737 employees over 4-years. We report changes in 10-year Framingham risk score (FRS) for CVD (%) and risk factors after 1 (GR1), 2 (GR2) and 3 (GR 3) RAHRAs.

RESULTS: Mean FRS increased with RAHRAs (GR1: +0.4%; GR2: +0.7%; GR3: +0.8%) (p < 0.001) and was higher for GR3 vs. GR1 (p < 0.001) and GR2 (pairwise: p < 0.0355). RAHRAs were associated with increased inadequate fruit/vegetable intake (GR1: +5.4%; GR2: +9.8%; GR3: +15.8%) (all pairwise: p < 0.001) and overweight (GR1: +5.4% vs. GR2: +9.8%) (p < 0.001) and only hypercholesterolaemia decreased (GR1; -4.4% vs. GR3; -9.6%) (p < 0.001).

CONCLUSION: RAHRAs did not reduce 10-year CVD risk in financial sector employees. Role of RAHRAs in chronic disease management requires further study.

PMID:34074955 | DOI:10.1097/JOM.0000000000002251

J Hypertens. 2021 Jul 1;39(7):1274-1281. doi: 10.1097/HJH.0000000000002799.

ABSTRACT

OBJECTIVES: Antihypertensives and cancer have a complex relationship. Among the antihypertensives, renin–angiotensin system inhibitors have strong immune modulatory activities that may affect immune check point inhibitors-related outcomes in cancer patients. We evaluated the association between concomitant use of renin–angiotensin system inhibitors and other antihypertensive agents with survival/toxicity outcomes from atezolizumab.

METHODS: A post hoc analysis of individual patient data from seven clinical trials of lung, renal or urothelial cancers was performed. Users and nonusers of antihypertensive classes were compared for overall survival, progression-free survival and immune adverse events. Cox proportional hazards were calculated between the groups and reported as hazards ratio and 95% confidence interval (95% CI).

RESULTS: Of the 3695 patients, 2539 were treated with atezolizumab and the rest with chemotherapy. Twenty-four percent of patients were on a renin–angiotensin system inhibitor at trial commencement. No statistically significant difference in overall survival (hazard ratio 0.92, 95% CI 0.79-1.07, P = 0.29), progression-free survival (hazard ratio 0.95, 95% CI 0.84-1.08, P = 0.42) or immune adverse events (odds ratio 0.94, 95% CI 0.76-1.15, P = 0.55) between renin–angiotensin system inhibitor users and nonusers were identified in the atezolizumab-treated cohort. Other classes of antihypertensives were also not associated with survival.

CONCLUSION: Concomitant use of antihypertensives including RASi was not associated with survival and immune-related safety outcomes during atezolizumab therapy for solid cancers. Future studies should evaluate the association between antihypertensives and other ICI as well as ICI combination interventions in clinical trials and real-world settings.

PMID:34074965 | DOI:10.1097/HJH.0000000000002799

J Chin Med Assoc. 2021 Jun 1. doi: 10.1097/JCMA.0000000000000561. Online ahead of print.

ABSTRACT

BACKGROUND: It is controversial that the association of hepatitis C virus (HCV) infection and chronic kidney disease (CKD). We wanted to investigate whether HCV really affect to renal function, also to analyze the association between clinical effects of CHC and decreased kidney function assessed by estimated glomerular filtration rate (eGFR) level.

METHODS: The 3360 patients with hepatitis C virus infection and 3360 age and sex matched community based control individuals without HCV were enrolled (1:1, case and control ratio) in this study between 2004 and 2016. We used the Modification of Diet in Renal Diseases (MRDR) for calculate eGFR. Demographic and laboratory parameters were assessed and appropriate statistical methods were performed for the analysis.

RESULTS: Multivariate logistic regression analysis revealed that serum alanine aminotransferase (ALT) (OR-0.998; 95% CI – 0.997-0.999; p=0.001) level, platelet (OR-0.997; 95% CI – 0.995-0.999; p=0.002) count and hypertension (OR-1.31; 95% CI – 1.03-1.66; p=0.027) were significantly associated with HCV infection and serum triglycerides (OR-1.001; 95% CI -1.00-1.002; p=0.005) level, platelet (OR-0.996; 95% CI – 0.995-0.997; p<0.001) count, BMI>25 (OR-1.43; 95% CI- 1.23-1.67; p<0.001), hypertension (OR-1.69; 95% CI – 1.42-1.99; p<0.001), hyperlipidemia (OR- 1.32; 95% CI – 1.02-1.71; p=0.035) and diabetes (OR-1.33; 95% CI-1.03-1.71; p=0.032) were significantly associated with low eGFR (<90ml/min/m3) in control subjects. The BMI >25kg/m2, hypertension, and diabetes were associated with low eGFR interaction with the HCV infection by multivariate analysis.

CONCLUSION: Our study indicated that the patients with HCV infection are associated with low eGFR compared with non HCV infected patients. This association is consistent in obese, diabetic and hypertensive patients.

PMID:34074934 | DOI:10.1097/JCMA.0000000000000561

JBI Evid Implement. 2021 Jun 1. doi: 10.1097/XEB.0000000000000286. Online ahead of print.

ABSTRACT

AIM: Integrated knowledge translation (IKT) is an increasingly recommended collaborative approach to minimize knowledge translation gap. Still, few studies have documented the impact of IKT to optimize knowledge uptake in healthcare settings. An IKT-based clinical algorithm (Algo) was deployed in Quebec (Canada) homecare services to support skill mix for selecting bathing equipment for community-dwelling adults. The objective of this study was to document the characteristics related to Algo’s IKT process.

METHODS: A multiple-case study with a nested concurrent mixed design was conducted in provincial homecare services. Based on Knott and Wildavsky’s seven-stage classification and the integrated-Promoting Action on Research Implementation in Health Services model, Innovation, Recipients, and Context, characteristics related to Algo’s levels of utilization were documented. Quantitative (electronic questionnaire) and qualitative (semistructured interviews and focus groups) data were collected for each case (i.e., homecare service). Descriptive statistics and thematic analysis were performed to describe each case through a mixed methods matrix, for intra/intercase analyses.

RESULTS: Knowledge translation characteristics of five Algo’s levels of utilization were documented: reception, cognition, reference, effort, and impact. Innovation characteristics (e.g., underlying knowledge) were found to facilitate its dissemination and its use. However, the Recipients (e.g., unclear mechanisms to implement change) and Context (e.g., organizational mandates nonaligned with skill mix) characteristics hampered its application through intermediate and advanced levels of utilization.

CONCLUSION: The knowledge translation analysis of Algo allowed for documenting the IKT-based benefits in terms of utilization in healthcare settings. Although an IKT approach appears to be a strong facilitator for initiating the implementation process, additional characteristics should be considered for promoting and sustaining its use on local, organizational, and external levels of context. Facilitation strategies should document the administrative benefits related to Algo’s utilization and contextualize it according to homecare services’ characteristics.

PMID:34074950 | DOI:10.1097/XEB.0000000000000286