Tag: pubmed

Eur J Surg Oncol. 2021 Jun 8:S0748-7983(21)00568-0. doi: 10.1016/j.ejso.2021.06.006. Online ahead of print.

ABSTRACT

BACKGROUND: Despite multiple studies evaluating the effectiveness of Robot-Assisted Radical Prostatectomy (RARP), there is no definitive conclusion about the added value of RARP. A retrospective cluster study was conducted to evaluate long-term sexual and urinary functioning after RARP and Laparoscopic Radical Prostatectomy (LRP) based on real-world data from 12 Dutch hospitals.

METHODS: Data was collected from patients who underwent surgery between 2010 and 2012. A mixed effect model was used to evaluate differences between groups on urinary and sexual functioning (EPIC-26). Additionally, a regression analysis was conducted to evaluate the relationship between these functional outcomes and, among others, hospital volume.

RESULTS: 1370 (65.1%) patients participated, 907 underwent RARP and 463 LRP, with a median follow-up time of 7.08 years (SD = 0.98). The RARP group showed a statistically and clinically significant better urinary functioning compared to the LRP group (p = 0.002). RARP showed also a shorter procedure time (p=<0.001), reduced blood loss (p=<0.001), and a higher chance of neurovascular bundle preservation (39.8% vs 29.1%; p=<0.01).

CONCLUSION: RARP resulted in better long-term urinary function compared to LRP. Based on the results from this study, guidelines concerning the preferred surgery type and the position on reimbursement may change, especially when RARP proves to be cost-effective.

PMID:34140189 | DOI:10.1016/j.ejso.2021.06.006

Patient Educ Couns. 2021 Jun 11:S0738-3991(21)00413-4. doi: 10.1016/j.pec.2021.06.014. Online ahead of print.

ABSTRACT

OBJECTIVE: This review aimed to: (i) inventory the definitions and measurements of patient empowerment in healthcare literature; (ii) appraise the conceptual and methodological rigor of included studies; and (iii) identify correlates of patient empowerment in persons with chronic conditions.

METHODS: Four databases were searched to identify articles measuring patient empowerment in persons with chronic conditions, used a quantitative design and provided evidence on correlates of patient empowerment. Seventy-six articles were included and analyzed by descriptive statistics and summative content analysis.

RESULTS: The articles used a range of definitions (n = 35) and instruments (n = 38), evaluating a range of correlates in four categories: sociodemographic characteristics, clinical outcomes, patient-reported outcomes and patient-reported experiences. The most frequent associations were between patient empowerment and age (n = 21), sex (n = 15), educational level (n = 15) and quality of life (n = 18). However, they were not always significant.

CONCLUSION: The broad variation of definitions and instruments highlights the lack of consensus on how to interpret and measure patient empowerment. Although several covariates have been evaluated, there are few studies assess the same relationships.

PRACTICE IMPLICATIONS: Consensus on a definition and measurement of patient empowerment is needed to improve the quality of future research and to provide a more cohesive body of knowledge.

PMID:34140196 | DOI:10.1016/j.pec.2021.06.014

Ann Plast Surg. 2021 Jun 16. doi: 10.1097/SAP.0000000000002943. Online ahead of print.

ABSTRACT

Medical students pursuing plastic surgery training must overcome multiple challenges to successfully match in such a highly coveted subspecialty. This adversity is amplified in applicants from medical schools without a home plastic surgery residency program and academic division. There is a paucity of data on the advantage of medical students applying from an institution with a home residency program. Applicant data from the past 5 years were accessed from the Association of American Medical Colleges Electronic Residency Application Services statistics form. Individual home programs of successfully matched applicants were collected from plastic surgery residency websites. A survey was distributed to 32 students pursuing specialty residencies from home medical schools without a plastic surgery residency. Evaluation of a subset of incoming plastic surgery interns revealed that 72% of matched applicants attended home medical institutions with plastic surgery residency programs. Seventy-seven percent of survey respondents felt strongly that students at institutions with home residency programs had a significant advantage. The current COVID pandemic is changing the landscape of subinternships and bringing to light the disadvantage students face without home residency programs. The development of virtual subinternships, online mentorship, and selection of students for subinternships from geographic areas without home programs may help address some disparities in educational opportunities. Continuing these virtual programs and offering preferential help to disadvantaged medical students permanently is an avenue for the field of plastic surgery to be a leader in diversity and inclusion.

PMID:34139740 | DOI:10.1097/SAP.0000000000002943

Stat Med. 2021 Jun 17. doi: 10.1002/sim.9106. Online ahead of print.

ABSTRACT

Joint mean-covariance modeling of multivariate longitudinal data helps to understand the relative changes among multiple longitudinally measured and correlated outcomes. A key challenge in the analysis of multivariate longitudinal data is the complex covariance structure. This is due to the contemporaneous and cross-temporal associations between multiple longitudinal outcomes. Graphical and data-driven tools that can aid in visualizing the dependence patterns among multiple longitudinal outcomes are not readily available. In this work, we show the role of graphical techniques: profile plots, and multivariate regressograms, in developing mean and covariance models for multivariate longitudinal data. We introduce an R package MLGM (Multivariate Longitudinal Graphical Models) to facilitate visualization and modeling mean and covariance patterns. Through two real studies, microarray data from the T-cell activation study and Mayo Clinic’s primary biliary cirrhosis of the liver study, we show the key features of MLGM. We evaluate the finite sample performance of the proposed mean-covariance estimation approach through simulations.

PMID:34139788 | DOI:10.1002/sim.9106

Gerontology. 2021 Jun 17:1-7. doi: 10.1159/000516627. Online ahead of print.

ABSTRACT

INTRODUCTION: The prevalence of malnutrition among inpatient older adults is as high as 20∼50%. Masticatory performance is known to affect the nutritional status of individuals. However, an objective measurement to reflect the real status of masticatory muscle performance is lacking at the bedside.

METHODS: This pilot study analyzed the masticatory performance using surface electromyography (sEMG) of masticatory muscles that measures both muscle strength and muscle tone at the bedside. The nutritional status was measured using the Mini Nutritional Assessment tool. The handgrip strength was measured using a hand dynamometer. The statistical data were analyzed using SPSS 25 software.

RESULTS: The data revealed that female inpatient older adults more frequently had substandard handgrip strength (p = 0.028), an at-risk and poor nutritional status (p = 0.005), and a higher masseter muscle tone (p = 0.024). Inpatient older adults with an at-risk and poor nutritional status had an older age (p = 0.016), lower handgrip strength (p = 0.001), and higher average masseter muscle tone (p = 0.01). A high masseter muscle tone predicted the risk of having an at-risk and poor nutritional status. The at-risk or poor nutritional status predicted having a substandard handgrip strength by 5-fold.

CONCLUSIONS: A high masticatory muscle tone predicts malnutrition and frailty. Medical professionals should combat masticatory dysfunction-induced malnutrition by detecting masticatory muscle performance using sEMG and referring patients to dental professionals. Additionally, encouraging inpatient older adults to perform oral motor exercise is recommended.

PMID:34139690 | DOI:10.1159/000516627

Blood Purif. 2021 Jun 17:1-8. doi: 10.1159/000515825. Online ahead of print.

ABSTRACT

INTRODUCTION: Liver failure is associated with hepatic and extrahepatic organ failure leading to a high short-term mortality rate. Extracorporeal albumin dialysis (ECAD) aims to reduce albumin-bound toxins accumulated during liver failure. ECAD detoxifies blood using albumin dialysis through an artificial semipermeable membrane with recirculation (molecular adsorbent recirculating system, MARS) or without (single-pass albumin dialysis, SPAD).

METHODS: We performed a randomized crossover open trial in a surgical intensive care unit. The primary outcome of the study was total bilirubin reduction during MARS and during SPAD therapies. The secondary outcomes were conjugated bilirubin and bile acid level reduction during MARS and SPAD sessions and tolerance of dialysis system devices. Inclusion criteria were adult patients presenting liver failure with factor V activity <50% associated with bilirubin ≥250 μmol/L and a complication (either hepatic encephalopathy, severe pruritus, or hepatorenal syndrome). For MARS and SPAD, the dialysis flow rate was equal to 1,000 mL/h.

RESULTS: Twenty crossovers have been performed. Baseline biochemical characteristics (bilirubin, ammonia, bile acids, creatinine, and urea) were not statistically different between MARS and SPAD. Both ECAD have led to a significant reduction in total bilirubin (-83 ± 67 μmol/L after MARS; -122 ± 118 μmol/L after SPAD session), conjugated bilirubin (-82 ± 61 μmol/L after MARS; -105 ± 96 μmol/L after SPAD session), and bile acid levels (-64 ± 75 μmol/L after MARS; -56 ± 56 μmol/L after SPAD session), all nondifferent comparing MARS to SPAD.

CONCLUSION: A simple-to-perform SPAD therapy with equal to MARS dialysate flow parameters provides the same efficacy in bilirubin and bile acid removal. However, clinically relevant endpoints have to be evaluated in randomized trials to compare MARS and SPAD therapies and to define the place of SPAD in the liver failure care program.

PMID:34139706 | DOI:10.1159/000515825

Lifestyle Genom. 2021 Jun 17:1-10. doi: 10.1159/000514338. Online ahead of print.

ABSTRACT

BACKGROUND/AIM: An alarming increase in vitamin D deficiency even in sunny regions highlights the need for a better understanding of the genetic background of the vitamin D endocrine system and the molecular mechanisms of gene polymorphisms of the vitamin D receptor (VDR). In this study, the serum levels of 25(OH)D3 were correlated with common VDR polymorphisms (ApaI, BsmI, FokI, and TaqI) in 98 subjects of a Greek homogeneous rural population.

METHODS: 25(OH)D3 concentration was measured by ultra-HPLC, and the VDR gene polymorphisms were identified by quantitative real-time PCR followed by amplicon high-resolution melting analysis.

RESULTS: Subjects carrying either the B BsmI (OR: 0.52, 95% CI: 0.27-0.99) or t TaqI (OR: 2.06, 95%: 1.06-3.99) allele presented twice the risk for developing vitamin D deficiency compared to the reference allele. Moreover, subjects carrying 1, 2, or all 3 of these genotypes (BB/Bb, Tt/tt, and FF) demonstrated 2-fold (OR: 2.04, 95% CI: 0.42-9.92), 3.6-fold (OR: 3.62, 95% CI: 1.07-12.2), and 7-fold (OR: 6.92, 95% CI: 1.68-28.5) increased risk for low 25(OH)D3 levels, respectively.

CONCLUSIONS: Our findings reveal a cumulative effect of specific VDR gene polymorphisms that may regulate vitamin D concentrations explaining, in part, the paradox of vitamin D deficiency in sunny regions, with important implications for precision medicine.

PMID:34139712 | DOI:10.1159/000514338

J Phys Condens Matter. 2021 Jun 17. doi: 10.1088/1361-648X/ac0c3c. Online ahead of print.

ABSTRACT

We present a comprehensive study of the linear response of interacting underdamped Brownian particles to simple shear flow. We collect six different routes for computing the response, two of which are based on the symmetry of the considered system and observable with respect to the shear axes. We include the extension of the Green-Kubo relation to underdamped cases, which shows two unexpected additional terms. These six computational methods are applied to investigate the relaxation of the response towards the steady state for different observables, where interesting effects due to interactions and a finite particle mass are observed. Moreover, we compare the different response relations in terms of their statistical efficiency, identifying their relative demand on experimental measurement time or computational resources in computer simulations. Finally, several measures of breakdown of linear response theory for larger shear rates are discussed.

PMID:34139676 | DOI:10.1088/1361-648X/ac0c3c

Cerebrovasc Dis. 2021 Jun 17:1-7. doi: 10.1159/000515707. Online ahead of print.

ABSTRACT

BACKGROUND: Acute infarction patterns have been described in cardioembolic stroke, mainly with atrial fibrillation (AF) or patent foramen ovale. We aimed to analyse acute infarction magnetic resonance imaging (MRI) characteristics in stroke patients with intracardiac thrombus (ICT) compared with stroke patients with AF.

METHODS: We performed a retrospective study analysing brain MRI scans of consecutive acute symptomatic cardioembolic infarction patients associated with ICT or AF who were recruited and registered in the stroke database between June 2018 and November 2019. Diffusion-weighted imaging performed within 1 week after symptom onset, intra-/extracranial vessel imaging, echocardiography, and ≥24-h ECG monitoring were required for inclusion. Baseline, biological, and echocardiography characteristics were assessed. Analysed MRI characteristics were infarction location (anterior/middle/posterior cerebral artery territory; anterior/posterior/mixed anterior-posterior circulation; multiterritorial infarction; brainstem; cerebellum; small cortical cerebellar infarctions [SCCIs] or non-SCCI; cortical/subcortical/cortico-subcortical), lesion number, subcortical lesion size (> or <15 mm), and total infarction volume.

RESULTS: We included 28 ICT and 94 AF patients presenting with acute stroke. ICT patients were younger (median age 66 vs. 81 years, p < 0.001), more frequently male (79 vs. 47%, p = 0.003), and smokers (39 vs. 17%, p = 0.013), had more frequent history of diabetes (36 vs. 18%, p = 0.049) and ischaemic heart disease (57 vs. 21%, p < 0.001), and had lower HDL cholesterol levels (0.39 vs. 0.53 g/L, p < 0.001). On MRI, SCCI was more frequent in the ICT group (25 vs. 5%, p = 0.006) in the absence of other differences in infarction localisation, number, size, or volume on MRI. On multivariate analysis, younger age (p < 0.001), history of ischaemic heart disease (p < 0.001), and low HDL cholesterol levels (p = 0.01) were significantly associated with ICT. Results approaching statistical significance were observed for SCCI (more frequent in the ICT group, p = 0.053) and non-SCCI (more frequent in the AF group, p = 0.053) on MRI.

CONCLUSIONS: ICT-related stroke is associated with acute SCCI presence on MRI. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT04456309.

PMID:34139688 | DOI:10.1159/000515707

Int J Hyg Environ Health. 2021 Jun 14;236:113790. doi: 10.1016/j.ijheh.2021.113790. Online ahead of print.

ABSTRACT

BACKGROUND: Ankle-brachial index (ABI) and cardio-ankle vascular index (CAVI) are surrogate measures of atherosclerosis based on the functional performance of vessels, and are highly related to cardiovascular events. However, only a few longitudinal studies have been conducted on their associations with long-term air pollution exposure.

OBJECTIVE: This study aimed to examine whether long-term air pollution exposure is associated with ABI and CAVI in workers of the Electricity Generating Authority of Thailand (EGAT) in the Bangkok Metropolitan Region (BMR).

METHODS: This longitudinal study included 1261 participants (age range, 57-76 years as of 2007) of the EGAT study (2007-2017). ABI and CAVI were measured in 2007, 2012, and 2017. Annual mean concentrations of particulate matter ≤10 μm in diameter (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃), and carbon monoxide (CO) were estimated by ordinary kriging using data from 22 background and 7 traffic monitoring stations in BMR between 2002 and 2017. Linear mixed-effects models were used to assess associations between air pollution (expressed as 1-year, 3-year, and 5-year average concentration) and ABI and CAVI (expressed as percent changes per interquartile range (IQR) increase in PM₁₀, O₃, NO₂, SO_2, and CO). We also applied the mixed-effect ordinal logistic models to calculate odds ratios (ORs) of having high or moderate CAVI per an IQR increase in air pollution.

RESULTS: After controlling for potential confounders, 1-year average CO was negatively associated with ABI, but not significantly (-0.48%, 95% CI: -1.03, 0.07). Three-year average NO₂ was positively associated with CAVI (6.67%, 95% CI: 0.21, 13.1). In contrast, 1-year average PM₁₀ was inversely associated with CAVI although the association was not significant. Although not significantly, 1-year average NO₂ and CO were positively associated with prevalence of high or moderate CAVI.

CONCLUSIONS: Although not statistically significant, long-term NO₂ and CO exposure was associated with ABI and CAVI in the participants of the EGAT study.

PMID:34139634 | DOI:10.1016/j.ijheh.2021.113790