Tag: pubmed

Spine (Phila Pa 1976). 2021 Aug 31. doi: 10.1097/BRS.0000000000004214. Online ahead of print.

ABSTRACT

STUDY DESIGN: A retrospective cross-sectional study.

OBJECTIVE: This study aims to evaluate the effect size of postoperative glycemic variability on surgical outcomes among patients who have undergone one- to three-level lumbar fusion.

SUMMARY OF BACKGROUND DATA: While numerous patient characteristics have been associated with surgical outcomes after lumbar fusion, recent studies have described the measuring of postoperative glycemic variability as another promising marker.

METHODS: A total of 850 patients were stratified into tertiles (low, moderate, high) based on degree of postoperative glycemic variability defined by coefficient of variation (CV). Surgical site infections were determined via chart review based on the CDC definition. Demographic factors, surgical characteristics, inpatient complications, readmissions, and reoperations were determined by chart review and telephone encounters.

RESULTS: Overall, a statistically significant difference in 90-day adverse outcomes was observed when stratified by postoperative glycemic variability. In particular, patients with high CV had higher odds of readmission (OR = 2.19 [1.17, 4.09]; P = 0.01), experiencing a surgical site infection (OR = 3.22 [1.39, 7.45]; P = 0.01), and undergoing reoperations (OR = 2.65 [1.34, 5.23]; P = 0.01) compared with patients with low CV. No significant association was seen between low and moderate CV groups. Higher CV patients were more likely to experience longer hospital stays (β: 1.03; P = 0.01). Among the three groups, high CV group experienced the highest proportion of complications.

CONCLUSION: Our study establishes a significant relationship between postoperative glycemic variability and inpatient complications, length of stay, and 90-day adverse outcomes. While HbA1c has classically been used as the principal marker to assess blood glucose control, our results show CV to be a strong predictor of postoperative adverse outcomes. Future high-quality, prospective studies are necessary to explore the true effect of CV, as well as its practicality in clinical practice. Nevertheless, fluctuations in blood glucose levels during the inpatient stay should be limited to improve patient results.Level of Evidence: 4.

PMID:34474452 | DOI:10.1097/BRS.0000000000004214

J Glaucoma. 2021 Sep 2. doi: 10.1097/IJG.0000000000001934. Online ahead of print.

ABSTRACT

PRECIS: Bruch membrane opening minimum rim width (BMO-MRW) is overall a useful parameter for diagnosing early glaucoma in myopic eyes.

PURPOSE: The aim of this study was to determine the diagnostic value of BMO-MRW compared with peripapillary retinal nerve fiber layer (pRNFL) thickness for detecting early glaucoma in patients with moderate to severe myopia.

METHODS: One eye was randomly selected from each of the 253 subjects (127 normal controls, 82 with glaucoma suspect, and 44 with early glaucoma). All patients underwent visual acuity testing, refractive error assessment, slit-lamp inspection, intraocular pressure measurement, fundus photography, perimetry. BMO-MRW and pRNFL thickness data were obtained using spectral-domain optical coherence tomography. Area under the receiver operating characteristic curves (AUC) for global and sectoral thickness parameters were calculated.

RESULTS: Global analyses for the discrimination of early glaucoma in all myopic subjects showed comparable AUCs between BMO-MRW and pRNFL thickness [AUC 0.952 (95% confidence interval, 0.918-0.975) and 0.934 (95% confidence interval, 0.896-0.961), respectively, P=0.345]. However, in sectoral analysis, BMO-MRW showed significantly better diagnostic performance than pRNFL thickness except for the superotemporal sector. The AUC for discriminating early glaucoma from glaucoma suspect, BMO-MRW showed statistically better diagnostic performance in the inferotemporal, inferonasal, superonasal, and nasal sectors. When dividing the subject based on a threshold Bruch membrane opening (BMO) area of 2.5 mm2, the diagnostic power of BMO-MRW was generally lower except for the inferonasal sector in the subgroup with a large BMO area.

CONCLUSIONS: BMO-MRW was overall a useful parameter for diagnosing early glaucoma in myopic eyes. However, its diagnostic performance was decreased in myopic eyes with large BMO and there were no significant differences from pRNFL thickness.

PMID:34474421 | DOI:10.1097/IJG.0000000000001934

J Mech Behav Biomed Mater. 2021 Aug 25;124:104733. doi: 10.1016/j.jmbbm.2021.104733. Online ahead of print.

ABSTRACT

The contribution of the proteoglycan to the strain-rate-dependent mechanical behaviour of cartilage tissues has been suggested to decrease with an increase in the strain-rate. On the other hand, the contribution from the collagen network has been suggested to increase as the strain-rate increases. These conclusions are drawn mainly based on numerical studies conducted on high-load-bearing knee cartilage tissues, while experimental evidence of these behaviours have not been demonstrated previously. Further, in contrast to the reported findings on high-load bearing knee cartilage, our previous study on the low-load-bearing kangaroo shoulder cartilage indicated that proteoglycan and collagen contribution remained steady as the strain-rate increases. Therefore, in the present study, we experimentally investigate the contribution of proteoglycan and collagen network to the strain-rate-dependent behaviour of the kangaroo knee cartilage, and plausible reasons for the differences observed in relation to the kangaroo shoulder cartilage. Firstly, in order to quantify the contribution of proteoglycans and collagen network, the indentation testings on normal, proteoglycan, and collagen-degraded kangaroo knee cartilage were conducted at different strain-rates. Then, structural and compositional differences between the kangaroo knee and shoulder cartilage were assessed qualitatively through polarised light microscopy (PLM) imaging and histological staining. Identified differences in the collagen architecture and proteoglycan composition were incorporated in a fibril-reinforced porohyperelastic Finite Element (FE) model with the objective of explaining the mechanisms underlying differences observed between the two tissues. Experimental results on knee cartilage indicated that when the strain-rate increases, proteoglycan contribution decreases while collagen contribution increases, where statistically significant differences were identified at each strain-rate (p < 0.05). PLM images revealed a sizable deep zone in the kangaroo knee cartilage where collagen fibrils were oriented perpendicular to the subchondral bone. On the other hand, no such apparent deep zone was observed in the shoulder cartilage. FE model confirmed that the biomechanical differences observed in the knee and shoulder cartilage are due to the differences in the collagen fibril arrangement in the deep zone. From these results, it can be concluded that in high-load-bearing cartilage tissues, the collagen network in the deep zone assists in increasing the stiffness of tissue with strain-rate and plays a significant role in supporting transient loads. This, in turn, helps protect the solid matrix against large distortions and strains at the subchondral junction, pointing to the importance of the collagen network in deep zone in assisting high-load-bearing cartilage tissues.

PMID:34474320 | DOI:10.1016/j.jmbbm.2021.104733

Forensic Sci Int Genet. 2021 Aug 14;55:102570. doi: 10.1016/j.fsigen.2021.102570. Online ahead of print.

ABSTRACT

Latest innovations indicate that continuous tools are promising DNA trace assessment methods. In this study, we present the continuous software solution Statistefix 4.0. The software supports DNA experts in deducing DNA profiles for database queries and can help to preselect DNA samples suitable for further processing using advanced probabilistic search engines. The novel tool weights genotype contributions and deduces major contributors from high- and low-quality DNA traces. Peak height, degradation, stutter as well as allelic drop-in/-out events are incorporated in the statistical model. We analyzed reference and casework samples as well as artificially generated mixture samples for software evaluation. The tool offers the completely automated assessment of reference and mixture samples. Deconvolution outcomes of mixtures are compared with EuroForMix, GenoProof Mixture 3 and STRmix™. Data show that Statistefix 4.0 is as successful as analogously tested and implemented software. Deduced DNA profiles from casework samples highlight the potential benefit in routine casework. Statistefix 4.0 is freely available, works with replicates of different autosomal kits and enables bulk sample processing. This inter-laboratory study includes a variety of sample types and indicates a timesaving, robust and easily implemented software that supports DNA analysts in evaluating DNA traces.

PMID:34474323 | DOI:10.1016/j.fsigen.2021.102570

J Hazard Mater. 2021 Aug 18;423(Pt A):126954. doi: 10.1016/j.jhazmat.2021.126954. Online ahead of print.

ABSTRACT

4-Aminobiphenyl (4-ABP) is a human bladder cancer carcinogen found in the manufacture of azo dyes and the composition of cigarette smoke in the environment. To determine whether low concentrations of 4-ABP induced or promote liver carcinogenesis and investigate the underlying mechanism, we have established the liver cell carcinogenesis model in human liver cell lines and zebrafish to evaluate liver cancer development associated with long-term exposure to low concentrations of 4-ABP. Results show that repeated 4-ABP exposure promoted cellular proliferation and migration via the involvement of ROS in Ras/MEK/ERK pathway in vitro. Also, 4-ABP (1, 10, and 100 nM) induces hepatocellular carcinoma (HCC) formation in HBx, Src (p53^-/-) transgenic zebrafish at four months of age and in wild-type zebrafish at seven months of age. In addition, we observed a correlation between the Ras-ERK pathway and 4-ABP-induced HCC in vitro and in vivo. Our finding suggests low concentrations of 4-ABP repeated exposure is a potential risk factor for liver cancer. To our knowledge, this is the first report on the promotion of liver carcinogenesis in human liver cells and zebrafish following 4-ABP exposure.

PMID:34474361 | DOI:10.1016/j.jhazmat.2021.126954

J Electrocardiol. 2021 Aug 30;69:6-14. doi: 10.1016/j.jelectrocard.2021.08.019. Online ahead of print.

ABSTRACT

This paper proposes a two-dimensional (2D) bidirectional long short-term memory generative adversarial network (GAN) to produce synthetic standard 12-lead ECGs corresponding to four types of signals-left ventricular hypertrophy (LVH), left branch bundle block (LBBB), acute myocardial infarction (ACUTMI), and Normal. It uses a fully automatic end-to-end process to generate and verify the synthetic ECGs that does not require any visual inspection. The proposed model is able to produce synthetic standard 12-lead ECG signals with success rates of 98% for LVH, 93% for LBBB, 79% for ACUTMI, and 59% for Normal. Statistical evaluation of the data confirms that the synthetic ECGs are not biased towards or overfitted to the training ECGs, and span a wide range of morphological features. This study demonstrates that it is feasible to use a 2D GAN to produce standard 12-lead ECGs suitable to augment artificially a diverse database of real ECGs, thus providing a possible solution to the demand for extensive ECG datasets.

PMID:34474312 | DOI:10.1016/j.jelectrocard.2021.08.019

Transplant Cell Ther. 2021 Aug 30:S2666-6367(21)01169-6. doi: 10.1016/j.jtct.2021.08.020. Online ahead of print.

ABSTRACT

INTRODUCTION: Each year more than 8,000 allogeneic stem cell transplantations (allo-SCT) are performed in the United States and approximately 30% of these patients are ≥60 years old. Allo-SCT cases have increased risk to develop human papillomavirus (HPV)-related precancer or second malignancy. It is important to evaluate HPV-related precancer or second malignancy among allo-SCT cases to develop or enhance screening and preventive practice guidelines to improve patients’ survival and quality of life.

OBJECTIVE: We estimated the cumulative incidence of HPV-related precancer or second malignancy in both male and female Medicare beneficiaries who received allo-SCT and compared it with non-SCT controls and non-cancer controls.

MATERIALS AND METHODS: This is a retrospective matched case control study. Hematologic cancer patients aged ≥18 years who received allo-SCT between 2002 and 2011 were matched 1:5 to non-SCT controls and to non-cancer controls by age, sex, race/ethnicity, and follow-up time. Proportions of HPV-related precancer or second malignancy were estimated and compared between cases and controls using Chi-square test and logistic regression. Kaplan-Meier cumulative incidences were estimated and compared using log rank tests.

RESULTS: We identified 700 allo-SCT cases (median age of 64 years and median follow-up time post-transplant of 4.3 years) matched with 3159 non-SCT controls and 3302 non-cancer controls. About 3.7% of allo-SCT cases developed HPV-related precancer or second malignancy post-transplant, compared with 1.9% in the non-SCT controls and 1.1% in the non-cancer controls. The odds ratio of developing HPV-related precancer or second malignancy of allo-SCT cases compared with non-SCT controls and non-cancer controls was 2.0 (95% confidence interval [CI]: 1.25-3.18) and 3.5 (95% CI: 2.1-5.8), respectively. Both allo-SCT cases and non-SCT controls had significantly higher proportions and odds in developing HPV-related precancer or second malignancy than non-cancer controls. The 5-year cumulative incidence in allo-SCT cases was 5% compared with 2.1% in non-SCT controls and 1.2% in non-cancer controls. The cumulative incidence of HPV-related precancer or second malignancy in the allo-SCT was statistically significantly higher than either of the two matched control groups, and non-SCT controls had a higher cumulative incidence of HPV-related precancer or second malignancy than that in non-cancer controls.

DISCUSSION: Allo-SCT cases were at increased risk of developing HPV-related precancer or second malignancy compared with non-SCT controls and non-cancer controls. Routine screening of HPV-related precancer or second malignancy in allo-SCT cases is needed to prevent HPV-related precancer or second malignancy.

PMID:34474166 | DOI:10.1016/j.jtct.2021.08.020

J Obstet Gynaecol Can. 2021 Aug 30:S1701-2163(21)00611-3. doi: 10.1016/j.jogc.2021.07.021. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare surgical and oncological outcomes in the treatment of endometrial cancer between laparotomy and minimally invasive surgery. The secondary objective was to determine which MIS approach was the most beneficial.

METHODS: This was a single-centre retrospective review of all endometrial cancer surgeries performed between November 1, 2012 and October 31, 2017 in a gynaecologic oncology unit of a university hospital. Descriptive statistics were used to compare histopathologic results and oncological outcomes, and Kaplan-Meier estimates were used to compare survival.

RESULTS: A total of 735 cases were reviewed. The majority of patients (77%) underwent either laparotomy (35%) or robotic-assisted hysterectomy (42%); the remaining patients underwent total laparoscopic hysterectomy (12%) or a laparoscopic-assisted vaginal hysterectomy (8.7%). There was a statistically significant overall survival benefit (P = 0.02), a shorter hospital stay (P < 0.0001), and fewer early surgical complications (<30 d; P = 0.0002), as well as a survival benefit in elderly patients (>70 y) in the robotic-assisted hysterectomy group (P = 0.043) than the laparotomy group. Operating time was shorter in the laparotomy group (P < 0.0001). Recurrence rates in stage 1 low-risk disease were similar between groups.

CONCLUSION: Minimally invasive surgical approaches, particularly robotic surgery, do not compromise oncologic outcomes, especially for early-stage low-risk disease. In addition, these approaches are associated with fewer early surgical complications and shorter hospital stay, with significantly more same-day discharges. Overall survival and survival in a subgroup of elderly patients were significantly better in the robotic-assisted hysterectomy group.

PMID:34474173 | DOI:10.1016/j.jogc.2021.07.021

Sex Med. 2021 Aug 30;9(5):100424. doi: 10.1016/j.esxm.2021.100424. Online ahead of print.

ABSTRACT

INTRODUCTION: The consequences of stroke on sexual life in stroke patients in need of specialized cognitive rehabilitation have been limited explored. A biopsychosocial perspective in post-stroke sexuality studies is warranted to capture the complex picture of stroke consequences and sexual life after stroke and sexual satisfaction is an important outcome measure when exploring such multifactorial associations.

AIM: To explore sexual satisfaction and associated biopsychosocial factors in stroke patients admitted to specialized cognitive rehabilitation.

METHODS: A cross-sectional study was performed including 91 consecutive stroke patients admitted to specialized cognitive rehabilitation. Data were collected from medical records and by face-to-face interviews using a structured interview guide and questionnaires. Descriptive and inferential statistics were applied.

MAIN OUTCOME MEASURES: A wide range of biopsychosocial variables including medical and sociodemographic characteristics, social support, sexual complaints, aspects of sexual life, psychological distress and life satisfaction were analyzed in relation to the main outcome “Satisfaction with sexual life.”

RESULTS: Only 33 % were satisfied with sexual life. Prevalence of sexual complaints was high, more frequent in women (84%) than in men (64%). Three-quarters were less sexually active than before stroke. Multivariable analyses showed that anxiety, sleep problems, manifested sexual complaint, decrease in sexual activity and fear of partner rejection were significantly associated with low odds of sexual satisfaction, while affectionate support and partnership satisfaction were significant for sexual satisfaction. When combined in a biopsychosocial multivariable model only fear of partner rejection (OR 0.07; 95 % CI: 0.01-0.42) and decrease in sexual activity (OR 0.11; 95 % CI: 0.02-0.58) showed significant contribution to sexual satisfaction.

CONCLUSION: The variety of predictors for sexual satisfaction indicates that therapeutic actions need to be individualized and points towards a broad assessment and interventional approach to meet the sexual rehabilitation needs of stroke patients with cognitive impairments in need of specialized rehabilitation. Vikan JK, Snekkevik H, Nilsson MI, et al. Sexual Satisfaction and Associated Biopsychosocial Factors in Stroke Patients Admitted to Specialized Cognitive Rehabilitation. Sex Med 2021;XX:XXXXXX.

PMID:34474266 | DOI:10.1016/j.esxm.2021.100424

Transplant Cell Ther. 2021 Aug 30:S2666-6367(21)01170-2. doi: 10.1016/j.jtct.2021.08.021. Online ahead of print.

ABSTRACT

BACKGROUND: Acute graft-versus-host disease (GVHD) is a major cause of mortality in patients receiving hematopoietic cell transplantation (HCT) for hematologic malignancies. The skin is the most commonly involved organ in GVHD. Elafin, a protease inhibitor overexpressed in inflamed epidermis, was previously identified as a diagnostic biomarker of skin GVHD. However, this finding was restricted to a subset of patients with isolated skin GVHD. The main driver of nonrelapse mortality (NRM) in HCT patients is GI GVHD. Two biomarkers, Regenerating islet-derived 3a (REG3a) and Suppressor of tumorigenesis 2 (ST2), have been validated as biomarkers of GI GVHD that predict long-term outcomes in patients treated for GVHD. We undertook this study to determine the utility of elafin as a prognostic biomarker in the general population of acute GVHD patients in whom GVHD may develop in multiple organs.

OBJECTIVE: To analyze serum elafin concentrations as a predictive biomarker of acute GVHD outcomes and to compare it to ST2 and REG3a in a large group of patients treated at multiple centers.

STUDY DESIGN: 526 patients who received corticosteroid treatment for skin GVHD and who had not been previously studied were analyzed from the Mount Sinai Acute GVHD International Consortium (MAGIC). Serum concentrations of elafin, ST2 and REG3a were measured for all patients using ELISA. Patients were divided randomly into equal training and validation sets and a competing risk regression model was developed to model 6-month NRM using elafin concentration in the training set. Additional models were developed using concentrations of ST2 and REG3a, or the combination of all three biomarkers as predictors. ROC curves were constructed using the validation set to evaluate the predictive accuracy of each model and to stratify patients into high- and low-risk biomarker groups. The cumulative incidence of 6-month NRM, overall survival, and four-week treatment response were compared between risk groups.

RESULTS: Patients in the low-risk elafin group unexpectedly demonstrated a higher incidence of 6-month NRM, although this difference was not statistically significant (17% vs. 11%, P=0.19). Overall survival at 6 months (68% vs. 68%, P>0.99) and four-week response (78% vs. 78%, P=0.98) were similar in the low- and high-risk elafin groups. The area under the receiver operating curve (AUROC) for elafin was 0.55 whereas it was 0.75 for the combination of ST2 and REG3a. The addition of elafin to the other two biomarkers did not improve the AUROC.

CONCLUSION: Serum elafin concentrations measured at the initiation of systemic treatment for acute GVHD do not predict 6-month NRM, overall survival, or treatment response in a multicenter population of patients treated systemically for acute GVHD. As seen in previous studies, serum concentrations of the GI GVHD biomarkers ST2 and REG3a were significant predictors of NRM and the addition of elafin levels did not improve their accuracy. These results underscore the importance of GI disease in driving NRM in patients who develop acute GVHD.

PMID:34474163 | DOI:10.1016/j.jtct.2021.08.021