Tag: pubmed

J Magn Reson Imaging. 2021 Nov 13. doi: 10.1002/jmri.27993. Online ahead of print.

ABSTRACT

BACKGROUND: Breast tumor heterogeneity is associated with histological characteristics. However, pharmacokinetic (PK) heterogeneity within tumor might merit further exploration.

PURPOSE: To enhance the predictive power of molecular subtypes, Ki-67, and tumor grade by analyzing PK heterogeneity within tumor based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).

STUDY TYPE: Retrospective.

POPULATION: Two hundred and eight biopsy-proven breast cancer patients, randomly divided into a training cohort (N = 144) and a testing cohort (N = 64).

FIELD STRENGTH/SEQUENCE: T₁ -weighted DCE-MRI at 3.0 T.

ASSESSMENT: A convex analysis of mixtures-compartmental modeling decomposition method was used to estimate the PK parameter (i.e., the volume transfer constant K^trans ) in tumor subregions with distinct physiological kinetic patterns, including fast-flow kinetics, slow-flow kinetics, and plasma input. Radiomic features based on the PK parameter were calculated from each tumor subregion.

STATISTICAL TESTS: The training cohort was used to build random forest classifiers based on the optimal features determined by the 5-fold cross-validation method. The performance was assessed on the testing cohort using the area under the receiver operating characteristic curve (AUC). The AUCs derived from the tumor subregion-based PK parameter were compared with those of the original images of the entire tumor using the DeLong test. A P-value of <0.05 was considered statistically significant.

RESULTS: The tumor subregion-based PK parameter, which yielded the highest AUCs of 0.8782, 0.7568, 0.7019, 0.7963, 0.8080, and 0.7375 for luminal A, luminal B, basal-like, human epidermal growth factor receptor 2, Ki-67, and tumor grade, respectively, obtained better diagnostic performance than the original images in the entire tumor (highest AUCs = 0.8612, 0.6191, 0.5593, 0.7704, 0.7494, and 0.6261, respectively). In particular, statistically significant improvement in the diagnostic performance was obtained for luminal B.

DATA CONCLUSION: Radiomic analysis of PK heterogeneity within tumor can enhance the predictive performance of radiomic models compared with that of the entire tumor.

LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY STAGE: 3.

PMID:34773446 | DOI:10.1002/jmri.27993

Dermatol Ther. 2021 Nov 13:e15202. doi: 10.1111/dth.15202. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Psoriasis is a chronic inflammatory dermatosis affecting 2-3% of the general population. The link between psoriasis and renal dysfunction has been investigated, demonstrating a common pro-inflammatory pathogenesis. This study is aimed at evaluating renal function in patients with moderate-to-severe chronic plaque psoriasis treated with biological therapy.

PATIENTS AND METHODS: We analyzed 92 patients, correlating PASI and serum creatinine levels at baseline, after 6 months and after 1 year of continuous treatment with biological therapy. Data were analyzed using paired t-test and the linear mixed model for PASI and serum creatinine levels correlation, whereas the analysis of variances (ANOVA) was used for creatinine levels assessment between the baseline, the 6-months and, 1-year later evaluation.

RESULTS: We observed a significant mean decrease in comparing serum creatinine levels after 1 year of biological therapy (p<0.001). Interestingly, PASI reduction is correlated with creatinine decrease, and the renal function improvement is greater when complete psoriasis remission is attained.

CONCLUSION: Our data suggest that a drop in systemic inflammation, secondary to biological therapy administration, might improve renal function. Future research is needed to confirm and expand our findings. This article is protected by copyright. All rights reserved.

PMID:34773435 | DOI:10.1111/dth.15202

Pediatr Infect Dis J. 2021 Nov 9. doi: 10.1097/INF.0000000000003399. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to determine the overall incidence and reinfection rates of sexually transmitted infections (STIs) and the discrepancy between self-reported exposure history and anatomic site positivity of STIs among adolescents and young adults (AYAs) with HIV in Atlanta, GA.

METHODS: Retrospective chart review was conducted on all patients 13-24 years of age at the Grady Ponce and Family Youth Clinic from January 1, 2009 to December 31, 2018. Data were collected on patient demographics, self-reported sexual history and STI events. First STI incidence and incidence of reinfections were calculated by dividing new cases over corresponding person follow-up time.

RESULTS: A total of 626 sexually active AYAs with HIV were included in analysis. The mean age at first observation was 18.9 (SD: ±2.8) years; 72% were male, 92% were Black and 80% were horizontally infected. The cumulative first STI incidence rate was 45.49 cases per 100 person-years, and the recurrent STI incidence rate was 119.86 cases per 100 person-years. Among all Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) cases, the most common site of infection was the rectum (48.6% and 49.6%, respectively). Disagreement between exposure history and presence of GC or CT infection was statistically significant for nearly all anatomic sites and types of intercourse.

CONCLUSIONS: AYAs with HIV in Atlanta have disproportionately high first and recurrent incidence rates of STIs, with many patients not reporting exposure at their site of infection. There is considerable need to increase screening for STIs, including routine extragenital testing for GC and CT, among AYAs with HIV regardless of self-reported exposure history.

PMID:34773398 | DOI:10.1097/INF.0000000000003399

Pacing Clin Electrophysiol. 2021 Nov 13. doi: 10.1111/pace.14408. Online ahead of print.

ABSTRACT

INTRODUCTION: Pulmonary vein (PV) isolation is an established treatment for paroxysmal drug-refractory atrial fibrillation (AF). High parasympathetic tone and reconnection of PVs have demonstrated to be possible culprits of AF recurrence after ablation. Our aim was to investigate the association between parasympathetic tone and reconnected PVs in patients with paroxysmal AF.

METHODS: Consecutive patients who underwent a repeated catheter ablation procedure for atrial tachyarrhythmia recurrence by means of 3D electroanatomic mapping with documentation of presence or absence of PVs reconnection following an initial procedure of cryoballoon ablation with for symptomatic drug-refractory paroxysmal AF were screened for the study.

RESULTS: A total of 92 patients were included, of whom 50(54.35%) were males. Reconnected PVs were found in 64 (69%) patients. PVs reconnection could be predicted by DC(C-statistic = .770), by SDNNI(C-statistic = .714) and by absolute VLF power(C-statistic = .722), while right-sided PVs reconnection could be better predicted by DC(C-statistic = .848) and by SDNNI(C-statistic = .761). In multivariate binary logistic regression analysis, a DC value ≥6.45 ms and an absolute VLF power value ≥160ms² associated with 3 times and 5 times higher odds of PVs reconnection, respectively. On a vein-per-vein analysis, absolute VLF power ≥160ms² associated with 3 times higher odds, while reaching of -40°C within 60 seconds associated with 3 times lower odds of PVs reconnection.

CONCLUSION: High parasympathetic tonus accurately predicts PVs reconnection. On a vein-per-vein analysis, parasympathetic markers along with biophysical parameters predicted PVs reconnection. On a case-by-case analysis, parasympathetic markers were the only predictors of PVs reconnection, thus being a robust PVs reconnection prediction tool. This article is protected by copyright. All rights reserved.

PMID:34773413 | DOI:10.1111/pace.14408

J Nurs Scholarsh. 2021 Nov 12. doi: 10.1111/jnu.12734. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to understand the mediating effect of workplace incivility on the relationship between nursing organizational culture and turnover intention among nurses.

DESIGN: A descriptive survey was used to collect data. The participants were 170 nurses with more than six months of clinical experience at university hospitals or hospitals with over 500 beds in South Korea.

METHODS: Data were collected using self-report questionnaires. Collected data were analyzed using descriptive statistics, t-test, ANOVA, Scheffé test, and Pearson’s correlation. Baron and Kenny’s three-step hierarchical regression analysis and the Sobel test were used to determine the mediating effect of workplace incivility on the relationship between nursing organizational culture and nurses’ turnover intention.

RESULTS: This study found a full mediating effect of workplace incivility on the association between relationship-oriented culture and turnover intention (Z = -3.02, p = 0.003) and a partial mediating effect of workplace incivility on the association between hierarchy-oriented culture and turnover intention (Z = 2.36, p = 0.018).

CONCLUSION: This study empirically confirmed that nursing organizational culture and workplace incivility directly or indirectly influenced turnover intention, which highlights the seriousness of workplace incivility.

CLINICAL RELEVANCE: This study suggests that there is a need to establish a concrete strategy to avoid a hierarchy-oriented culture and create a relationship-oriented culture. It is important to develop a variety of intervention programs to reduce workplace incivility in order to prevent nurses’ turnover.

PMID:34773356 | DOI:10.1111/jnu.12734

Cancer Med. 2021 Nov 12. doi: 10.1002/cam4.4368. Online ahead of print.

ABSTRACT

BACKGROUND: There is currently no recognized first-line treatment strategy for ovarian neuroendocrine tumors (NETs). Furthermore, because of the low incidence of ovarian NETs, no studies have reported prognostic statistics derived from large samples. This retrospective study aimed to investigate the clinical behavior of ovarian NETs.

METHODS: The Surveillance, Epidemiology, and End Results database was used to identify women diagnosed with ovarian NETs from 2004 to 2015. Overall survival (OS), cancer-specific survival (CSS), and independent prognostic factors for ovarian NETs were evaluated. The effects of different treatments on prognosis were also compared, as were OS and CSS rates for histological subtypes.

RESULTS: The 5-year OS rates were 83.3%, 30.0%, 20.3%, and 9.8% for patients in stages I (n = 159), II (n = 23), III (n = 101), and IV (n = 148), respectively. The 5-year CSS rates were 85.6%, 41.7%, 21.2%, and 9.8% for patients in stages I-IV, respectively. Age, American Joint Committee on Cancer (AJCC) stage, lymph node metastasis, treatment, and histological type were related to poor OS and CSS. In the early stage, the 5-year OS and CSS rates were 97.03% and 96.90%, respectively. For patients in the advanced stage receiving comprehensive treatment (surgery + chemotherapy + radiotherapy), the 5-year OS and CSS rates were 72.9% and 70.00%, respectively. When comparing low- and high-grade neuroendocrine carcinoma, 5-year OS rates were 93.96% and 7.01%, 5-year CSS rates were 97.44% and 7.31%, 10-year OS rates were 93.56% and 2.34%, and 10-year CSS rates were 97.44% and 4.88%, respectively.

CONCLUSION: Age, AJCC stage, treatment, and histological type are independent prognostic factors of ovarian NETs. OS and CSS are relatively good for early-stage cases treated with surgery alone, whereas more comprehensive treatment is required to improve OS and CSS in the advanced stage.

PMID:34773393 | DOI:10.1002/cam4.4368

BJOG. 2021 Nov 12. doi: 10.1111/1471-0528.17005. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the impact of uterine contractile activity on the outcome of trial of labour after caesarean section (TOLAC).

DESIGN: Secondary, blinded analyses of a prospective TOLAC cohort.

SETTING: Two labour wards, in a university tertiary hospital and a central hospital.

POPULATION: 194 TOLAC parturients with intrauterine tocodynamometry during labour.

METHODS: Analysis of intrauterine pressure, frequency of contractions and baseline tonus of uterine muscle in 30-minute periods for four hours prior to birth.

MAIN OUTCOME MEASURES: Primary Outcome: uterine contractile activity during TOLAC. Secondary aims: contributors associated with failed TOLAC and uterine rupture.

RESULTS: TOLAC succeeded in 74% of cases. Uterine contractile activity, expressed as intrauterine pressure, was significantly higher in successful compared with failed TOLAC (210 vs 170 MVU). The statistically significant risk factors of failed TOLAC, after multivariate regression analysis, were prolonged gestational age, reduced cervical dilatation at admission, and lower mean intrauterine pressure. In cases of uterine rupture contractile activity did not differ from that in failed TOLAC. Cervical ripening with a Foley catheter appeared to be a risk factor of uterine rupture, as well as cervical dilatation < 3 cm at admission. The incidence of total uterine rupture was 2.6% (n=5).

CONCLUSIONS: Parturients with successful vaginal birth had higher uterine contractile activity than those experiencing failed TOLAC or uterine rupture despite similar use of oxytocin. Induction of labour with a Foley catheter turned out to be a risk factor of uterine rupture during TOLAC among parturients with no previous vaginal delivery.

PMID:34773355 | DOI:10.1111/1471-0528.17005

Oral Dis. 2021 Nov 13. doi: 10.1111/odi.14080. Online ahead of print.

ABSTRACT

OBJECTIVE: The present study aimed to characterize and differentiate the ultrasonography (US) and computed tomography (CT) features of mammary analogue secretory carcinoma (MASC) and acinic cell carcinoma (AciCC).

METHODS AND PATIENTS: A total of 83 patients with clinically proven MASC and AciCC were analyzed. The following characteristics were assessed on US, CT, and magnetic resonance imaging: lesion size, shape, margin, echogenicity, echotexture, cystic components, posterior echo, vascularity, density, degree of enhancement, enhancement pattern, signal intensity (SI) on T1 and T2 weighted images (WI), hemorrhages, and lymph node enlargement.

RESULTS: Similarities were observed between the imaging performance of MASC and AciCC. Differences between the two characteristics of shape on US and cystic components on CT were statistically significant. The proportion of MASC to regular shape on US (P = 0.006) and cystic components on CT (P = 0.027) was significantly higher than that of AciCC. Regular shape on US had the highest sensitivity in the identification of MASC and AciCC, while regular shape on US + cystic component on CT had the highest specificity.

CONCLUSIONS: The shape on US and cystic components on CT are key characteristics for distinguishing MASC and AciCC.

PMID:34773340 | DOI:10.1111/odi.14080

Int J Ment Health Nurs. 2021 Nov 12. doi: 10.1111/inm.12950. Online ahead of print.

ABSTRACT

Safewards is an internationally adopted framework that provides interventions to reduce conflict and containment in healthcare settings. This systematic review evaluated the effect of Safewards on conflict and containment events in inpatient units and the perceptions of staff and consumers. Quantitative, qualitative, and mixed-methods studies were considered for inclusion. Following the Joanna Briggs Institute methodology, two reviewers independently screened, appraised, and extracted data. Qualitative data were synthesized using inductive-thematic analysis. Quantitative and qualitative data were integrated with a convergent-segregated approach and presented in tabular and narrative format. A search of 13 databases and grey literature yielded 14 studies of variable methodological quality. Four studies reported reduced rates of conflict and one study reported reductions that were not statistically significant. Six studies reported reductions in rates of containment, three studies found no statistical significance and one study reported statistically significant reductions at follow-up. Staff and consumers in four studies reported an improved experience of safety. Three themes were developed as follows: (i) therapeutic hold, cohesion, support and the environment, (ii) conflict, containment and the experience of safety, and (iii) the complexities of adapting and embedding change. This review found most staff and consumers reported Safewards improved therapeutic relationships, cohesion, and ward atmosphere. Staff and consumers reported improved ward atmosphere, leading to consumer-centred, recovery-oriented care. Safewards improved the experience of safety from the perspective of staff and consumers when combined with ongoing training, leadership and time for consolidation. While results are promising they should be used cautiously until more robust evidence is established.

PMID:34773348 | DOI:10.1111/inm.12950

J Sleep Res. 2021 Nov 13:e13516. doi: 10.1111/jsr.13516. Online ahead of print.

ABSTRACT

Unemployed people could be at risk of developing inefficient sleep habits by spending excessive time in bed, as they lack a structuring activity. This could impact their mental health and reintegration into labour. This study aims to analyse possible associations between employment status and sleep parameters using actigraphy. Subjects (148 employed and 50 unemployed) were drawn from a German population-based cohort. Sleep parameters were measured with the SenseWear Bodymedia Pro 3 armband. Comparison of means concerning sleep duration, sleep efficiency, time of sleep and sleep fragmentation was performed separately for week days and weekends. Multiple linear regression analysis was performed to analyse group differences controlling for covariates. Finally, we defined cut-off scores for each sleep variable, and analysed the distribution of subjects above and below these values. Unemployed people did not sleep significantly longer than employed people. However, on week days, they displayed night sleep efficiency reduced by on average > 5% points, they lay down for 28 min longer, had later mid sleep time (38 min) and sleep offset (55 min), as well as more frequent awakenings after sleep onset accounting for being awake 28 min longer (all p ≤ 0.005). Sleep in unemployed subjects compared with employed subjects aged 41-64 years was less efficient, more fragmented and shifted to a later point of the night. Results support prior findings that unemployment has a negative influence on sleep quality. Unemployed individuals could benefit from intervention programmes aiming at the adoption of healthier sleep habits.

PMID:34773314 | DOI:10.1111/jsr.13516