Tag: pubmed

Ann Coloproctol. 2021 Aug 11. doi: 10.3393/ac.2020.01060.0151. Online ahead of print.

ABSTRACT

PURPOSE: This study was aimed to assess the feasibility of laparoscopic rectal surgery, comparing quality of surgical specimen, morbidity, and mortality.

METHODS: Prospectively acquired data from consecutive patients undergoing laparoscopic surgery for rectal cancer, at 2 minimally invasive colorectal units, operated by the same team was included. Locally advanced rectal tumors were identified as T3B or T4 with preoperative magnetic resonance imaging scans. All the patients were operated on by the same team. The 1:1 propensity score matching was performed to create a perfect match in terms of tumor height.

RESULTS: Total of 418 laparoscopic resections were performed, out of which 109 patients had locally advanced rectal cancer (LARC) and were propensity score matched with non-LARC (NLARC) patients. Median operation time was higher for the LARC group (270 minutes vs. 250 minutes, P=0.011). However, conversion to open surgery was done in 5 vs. 2 patients (P=0.445), reoperation in 8 vs. 7 (P=0.789), clinical anastomotic leak was found in 3 vs. 2 (P=0.670), and 30-day mortality rates was 2 vs. 1 (P>0.999) between LARC and NLARC, respectively. Readmission rate was higher in the NLARC group (33 patients vs. 19 patients, P=0.026), due to stoma-related issues. There was no statistically significant difference in the R0 resection between the 2 groups (99 patients in LARC vs. 104 patients in NLARC, P=0.284).

CONCLUSION: This study demonstrates that standardized approach to laparoscopy is safe and feasible in LARC. Comparable postoperative short-term clinical and pathological outcomes were seen between LARC and NLARC groups.

PMID:34399445 | DOI:10.3393/ac.2020.01060.0151

Thromb Haemost. 2021 Aug 16. doi: 10.1055/a-1588-8867. Online ahead of print.

ABSTRACT

OBJECTIVE: We evaluated stroke risk in patients with single timepoint screen-detected atrial fibrillation (AF) and the effect of oral anticoagulants (OAC).

METHODS: Consecutive patients aged ≥65 years attending medical outpatient clinics were prospectively enrolled for AF-screening using handheld single-lead ECG (AliveCor) from 12/2014 to 12/2017 (NCT02409654). Repeated screening was performed in patients with >1 visit during this period. Three cohorts were formed, screen-detected AF, clinically-diagnosed AF and no AF. Ischemic stroke risk was estimated using adjusted sub-distribution hazard ratios (aSHR) from multivariate regression and no AF as reference, and stratified according to OAC use.

RESULTS: Of 11,972 subjects enrolled, 2,238 (18.7%) had clinically-diagnosed AF at study enrollment. The yield of screen-detected AF on initial screening was 2.3% (n=223/9,734). AF was clinically-diagnosed during follow-up in 2.3% (n=216/9,440) and during subsequent screening in 71 initially screen-negative patients. Compared to no AF, patients with screen-detected AF without OAC treatment had the highest stroke risk (aSHR 2.63; 95% confidence interval 1.46-4.72), while aSHR for clinically-diagnosed AF without OAC use was 2.01 (1.54-2.62). Among screen-detected AF the risk of stroke was significantly less with OAC (no strokes in 196 person-years) compared with those not given OAC (12 strokes in 429 person-years), p=0.01.

CONCLUSION: The prognosis of single timepoint ECG screen-detected AF is not benign. The risk of stroke is high enough to warrant OAC use, and reduced by OAC.

PMID:34399432 | DOI:10.1055/a-1588-8867

Nutrition. 2021 Jun 24;91-92:111393. doi: 10.1016/j.nut.2021.111393. Online ahead of print.

ABSTRACT

OBJECTIVE: The aims of this study were to assess the effectiveness of a low-carbohydrate high-fat (LCHF) diet with and without a time-restricted feeding (TRF) protocol on weight loss and participating in three sequential dietary interventions (standard calorie-deficit diet, LCHF, and LCHF + TRF) on weight loss outcomes.

METHODS: Data from 227 adults from the Wharton Medical Clinic (WMC) were analyzed using a unidirectional case crossover design. Data was imputed for 154 patients to create a pseudo-sample in which everyone participated in three dietary interventions: standard calorie restriction, LCHF, and LCHF + TRF.

RESULTS: Patients lost an average of 11.1 ± 1.3 kg (9.8 ± 1.1%) after three sequential dietary interventions (P < 0.0001). Patients lost a statistically significant amount of weight from the standard WMC, LCHF, and LCHF+TRF diets (P < 0.05). With and without adjustment for age, sex, body mass index at the start of the dietary protocol, and treatment time, patients lost a similar amount of weight regardless of the dietary intervention (P > 0.05). Approximately 78.6% of patients achieved ≥5% weight loss with at least one of the diets.

CONCLUSION: Patients can lose a similar amount of weight regardless of the diet they are following. Approximately 78.9% of patients achieved 5% weight loss with at least one of the diets and lost an average 11.1 kg (or 9.8%). This is nearly double what has been previously reported for one dietary intervention. Thus, participating in sequential diets may be associated with greater absolute weight loss, and likelihood of achieving a clinically significant weight loss.

PMID:34399399 | DOI:10.1016/j.nut.2021.111393

J Neural Eng. 2021 Aug 16. doi: 10.1088/1741-2552/ac1deb. Online ahead of print.

ABSTRACT

Phase-amplitude coupling (PAC) is the association of the amplitude of a high-frequency oscillation with the phase of a low-frequency oscillation. In neuroscience, this relationship provides a mechanism by which neural activity might be coordinated between distant regions. The dangers and pitfalls of assessing phase-amplitude coupling with commonly used statistical measures have been well-documented. The limitations of these measures include: (i) response to non-oscillatory, high-frequency, broad-band activity, (ii) response to high-frequency components of the low-frequency oscillation, (iii) adhoc selection of analysis frequency-intervals, and (iv) reliance upon data shuffling to assess statistical significance.

OBJECTIVE: To address issues (i)-(iv) by introducing a nonparametric multitaper estimator of phase-amplitude coupling.

APPROACH: In this work, a multitaper phase-amplitude coupling estimator is proposed that addresses these issues. Specifically, issue (i) is addressed by replacing the analytic signal envelope estimator computed using the Hilbert transform with a multitaper estimator that down-weights non-sinusoidal activity using a classical, multitaper super-resolution technique. Issue (ii) is addressed by replacing coherence between the low-frequency and high-frequency components in a standard PAC estimator with multitaper partial coherence, while issue (iii) is addressed with a physical argument regarding meaningful neural oscillation. Finally, asymptotic statistical assessment of the multitaper estimator is introduced to address issue (iv).

MAIN RESULTS: Multitaper estimates of phase-amplitude coupling are introduced. Their efficacy is demonstrated in simulation and on human intracranial recordings obtained from epileptic patients.

SIGNIFICANCE: This work facilitates a more informative statistical assessment of phase-amplitude coupling, a phenomena exhibited by many neural systems, and provides a basis upon which further nonparametric multitaper-related methods can be developed.

PMID:34399415 | DOI:10.1088/1741-2552/ac1deb

Theriogenology. 2021 Aug 8;173:202-210. doi: 10.1016/j.theriogenology.2021.07.026. Online ahead of print.

ABSTRACT

Most old, intact male dogs usually have prostate disorders, especially benign prostatic hypertrophy and prostatitis with or without abscesses, and concurrent cystitis. The successful treatment of dogs with prostatitis concurrent with cystitis has relied on choosing an appropriate antimicrobial drug based on a bacterial culture and drug sensitivity testing. The objective of the study was to compare the prevalence of bacterial species and results of drug susceptibility testing of bacteria that were isolated from the prostatic fluids and urine samples that were collected from dogs with both prostatitis and cystitis. One hundred and sixty intact male dogs, who presented with both diseases, were recruited for the study. The disease diagnoses were based on clinical history notes, physical examinations, abdominal ultrasonography, prostatic fluid cytology, urinalysis and bacterial cultures from both prostatic fluid and urine samples. The bacterial culture results demonstrated that the major species that were detected in either the prostatic fluid or urine samples were Staphylococcus spp., Escherichia coli, Pseudomonas spp., Streptococcus spp., Proteus mirabilis and Klebsiella pneumoniae. Staphylococcus spp. (26.5 %, 43/162) and Escherichia coli (26.1 %, 12/46) were the most prevalent species from the prostatic fluid and urine samples, respectively. Statistical tests revealed that there were no significantly different prevalence levels among the isolated bacteria between the prostatic fluid and urine samples. Imipenem and gentamicin were the most potent antimicrobial drugs tested against the bacterial isolates in the present study. However, the administration of imipenem to treat prostatitis and cystitis in dogs was of concern. Interestingly, there were no significant differences in the antimicrobial drug susceptibility trends between the prostatic fluid and urine samples. Based on these results, a urine sample might be considered as an optional sample for bacterial cultures and antimicrobial drug susceptibility testing when it is not possible to collect a prostatic fluid sample.

PMID:34399384 | DOI:10.1016/j.theriogenology.2021.07.026

Sleep Med. 2021 Jul 30;85:313-316. doi: 10.1016/j.sleep.2021.07.036. Online ahead of print.

ABSTRACT

BACKGROUND: There is a critical gap in identifying effective interventions for children with obstructive sleep apnea (OSA) who do not tolerate continuous positive airway pressure therapy. Positional OSA (POSA) is a common clinical phenotype whereby OSA occurs predominantly while sleeping in supine position. POSA may be amenable to treatment with a positional device, a belt worn around the chest with cushions on the back to prevent supine positioning, but no data exists in children. The primary aim of this study was to evaluate the efficacy of positional device therapy for the treatment of POSA in children.

METHODS: This observational study included children aged 4-18 years with POSA and an obstructive apnea-hypopnea index (OAHI) ≥ 5 events/hour on baseline polysomnogram (PSG) who underwent a second PSG to evaluate the efficacy of a positional device. The primary outcome was the change in OAHI.

RESULTS: Ten children were included (8 male, median age 11.2 years, median body mass index z-score 1.6). Compared to the baseline PSG, PSG data obtained while using a positional device showed a reduced median (interquartile range) OAHI (15.2 [8.3-25.6] versus 6.7 [1.0-13.7] events/hour respectively; p = 0.004) and percentage of total sleep time in supine position (54.4 [35.0-80.6]% versus 4.2 [1.1-25.2]% respectively; p = 0.04). Despite observed improvements in the oxygen desaturation index, these results were not statistically significant.

SIGNIFICANCE AND CONCLUSIONS: In this novel pilot study, positional device therapy was effective for the treatment of POSA. Positional device therapy may potentially change clinical practice as a cost-efficient and non-invasive treatment option for POSA.

PMID:34399395 | DOI:10.1016/j.sleep.2021.07.036

J Surg Res. 2021 Aug 13;268:337-346. doi: 10.1016/j.jss.2021.06.075. Online ahead of print.

ABSTRACT

BACKGROUND: Ventral hernia repair (VHR) has been shown to improve overall quality of life (QOL) by the validated 12-question Hernia-Related Quality-of-Life survey (HerQLes). However, which specific aspects of quality of life are most affected by VHR have not been formally investigated.

METHODS: Through retrospective analysis of the Abdominal Core Health Quality Collaborative national database, we measured the change in each individual component of the HerQLes questionnaire from a pre-operative baseline assessment to one-year postoperatively in VHR patients.

RESULTS: In total, 1,875 VHR patients had completed both pre- and post-operative questionnaires from 2014-2018. They were predominately Caucasian (92.3%), 57.9 ± 12.4 Y old, and evenly gender split (50.5% male, 49.5% female, P = 0.31). Most operations were performed open (80.5%) with fewer laparoscopic (7.5%) or robotic cases (12.1%). For each of the 12 individual categories, improvement in QOL from baseline to 1-Y was found to be statistically significant (P < 0.0001). This held true with subgroup analysis of small (<2 cm), medium (2-6 cm), and large (>6 cm) hernias (P < 0.0001), though a larger improvement was seen in 8 of 12 components in hernias >6 cm (P < 0.001). Operative approach did not carry a significant effect except in medium hernias (2-6 cm), where an open approach saw a greater improvement in the “accomplish less at work” item (P = 0.02).

CONCLUSIONS: VHR is associated with improvement in each of the 12 components of QOL measured in the HerQLes questionnaire, regardless of the size of their hernia. The amount of improvement, however, may be dependent on hernia size and approach.

PMID:34399356 | DOI:10.1016/j.jss.2021.06.075

J Surg Res. 2021 Aug 13;268:363-370. doi: 10.1016/j.jss.2021.06.073. Online ahead of print.

ABSTRACT

OBJECTIVE: Laparoscopic appendectomy is a common operation that is frequently performed by junior surgical residents. We investigated the effect of a structured training program on the proficiency of junior residents in acquiring skills necessary in this operation.

DESIGN AND PARTICIPANTS: This is a randomized pilot trial. Between December 2014 and July 2018, twenty junior residents were recruited for this study. 11 were randomized to receive a structured training program of supervised, task-specific training. Each resident subsequently performed ten cases of laparoscopic appendectomy with their performance assessed for the last 5. The GOALS scale was used as the primary endpoint. Secondary endpoints were perioperative outcomes. The effect of intervention on these outcomes were evaluated assuming a linear mixed effect multi-level model. The study was single-blinded as the assessors did not know which group each resident belonged to.

RESULTS: There were no statistically significant differences in the total GOALS score or any of its individual domains. After adjusting for the number of operations done within the trial, the mean difference between the total GOALS score was 0.07 (95% CI -0.76 to 0.90, P=0.866). Blood loss, hospital stay and postoperative complication rates were similar. There was suggestion of a shorter operative time (effect estimate -9.03, 95% CI -19.56 to 1.50) in the intervention arm although statistical significance was not achieved. No avoidable adverse events due to this study were recorded.

CONCLUSION: Structured training program did not significantly improve surgical performance and outcomes in laparoscopic appendectomy in this pilot trial. Despite these findings, residents can still potentially mount their learning curves in laparoscopy earlier in a safe environment with such a program which is especially important in the era of minimally invasive surgery.

PMID:34399358 | DOI:10.1016/j.jss.2021.06.073

Sci Total Environ. 2021 Aug 8;800:149404. doi: 10.1016/j.scitotenv.2021.149404. Online ahead of print.

ABSTRACT

The altitudinal distribution of biodiversity in alpine ecosystems has captured academic attention, especially in streams because of their sensitivity to climate change. In the past years, research mainly focused on understanding the role played by alpine streams’ internal factors such as aquatic environmental variables, as well as physical and hydrological conditions, on the shaping of benthic macroinvertebrate communities. More recently, external factors such as terrestrial environments were included in analyses worldwide. In particular, the inherent properties constituting the ecological niche of specific species were considered as factors regulating dispersal and influencing community construction. The objective of this study was to reveal the distribution pattern and the driving factors regulating aquatic biodiversity in alpine streams. We hypothesized that the altitudinal distribution of aquatic macroinvertebrates could be explained by the interaction of the aquatic environment with both species’ ecological niche and the terrestrial environment surrounding their habitat, and that rare species display a more pronounced pattern than widespread dominant species. To test these hypotheses, samples were collected from two alpine streams situated on opposite slopes of Biluo Snow Mountain in Yunnan Province, China. Results of statistical analyses showed poor explanatory power from aquatic environmental factors, while the differences in vegetation type and the ecological niche of the species played an important role in determining the distribution pattern of aquatic biodiversity. Furthermore, we found that the altitudinal distribution pattern of aquatic biodiversity exhibits a bimodal type, with rare species fitting the bimodal peaks. These findings call for a better inclusion and further investigation on the effects of the terrestrial environment on aquatic ecosystems.

PMID:34399334 | DOI:10.1016/j.scitotenv.2021.149404

Sci Total Environ. 2021 Aug 3;800:149340. doi: 10.1016/j.scitotenv.2021.149340. Online ahead of print.

ABSTRACT

Pharmaceutically active compounds (PhACs) present in the environment are a great threat to human well-being and the ecosystem. Eventhough recognized as the pharmacy of the world”, studies addressing the distribution of PhACs in the Indian environment are scarce. Hence, in the current study, selected PhACs, heavy metals (HMs), and physicochemical parameters (PCPs) were measured from the surface waters of the River Cauvery during the pre- and post-monsoon. PhACs such as caffeine, carbamazepine, and diclofenac were detected in most samples, whereas topiramate, ibuprofen, and verapamil were found only in few stations. In contrast, the distribution of ciprofloxacin, atenolol, and isoprenaline was strongly influenced by the seasonal pattern (p < 0.05). PhACs such as loperamide, glafenine, erythromycin, and gemfibrozil were not detected during the study. Distribution of PhACs based on average concentration (ng/L) are, CBZ (205.62) > CAF (114.09) > DCF (28.51) > CIP (25.23) > ATL (18.86) > IPL (13.91) > PPL (11.26) > TCS (10.39) > IBF (7.34) > TPT (3.09) > VPL (1.16). Bivariate and multivariate statistical analyses have revealed a positive correlation expressed by the majority of the PhACs with PCPs (COD, TOC), nutrients (TN, TP), and HMs (Pb, Mn, Ni) in the range from 0.540** to 0.961**(p < 0.01). Whereas, DO revealed negative correlation with most of the parameters in the range from -0.559** to -0.831** (p < 0.01). A high average concentration of PhACs was recorded in the upstream (52.08 ng/L) and wastewater discharge points (55.60 ng/L). Further, the environmental risk assessment study has identified the higher risk exhibited by TCS (RQ: 3.29) and CAF (RQ: 38.82) on algae and Daphnia respectively. The study portrays the distribution of emerging contaminants in the River Cauvery and its tributaries and also delivers preliminary data about the distribution of isoprenaline, topiramate, verapamil, and perindopril in the Indian freshwater system.

PMID:34399341 | DOI:10.1016/j.scitotenv.2021.149340