Tag: pubmed

Am J Sports Med. 2021 Jun 7:3635465211016840. doi: 10.1177/03635465211016840. Online ahead of print.

ABSTRACT

BACKGROUND: The use of cannabis is common among athletes and the US population at large. Cannabinoids are currently being evaluated as alternatives to opioid medications for chronic pain management. However, the effects of recreational and/or medical use of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) on musculoskeletal injury and healing remain largely unknown.

HYPOTHESIS/PURPOSE: The purpose of this study was to evaluate the biomechanical effects of CBD and THC on tendon-to-tendon healing in a rat Achilles tendon repair model. The hypothesis was that rats administered CBD would demonstrate decreased tensile load to failure of surgically repaired Achilles tendons compared with the THC and control groups.

STUDY DESIGN: Controlled laboratory study.

METHODS: A total of 33 Sprague Dawley rats underwent Achilles tendon surgical transection and repair and were randomized to receive subcutaneous injection of THC, CBD, or vehicle once daily starting on the day of surgery and for 5 total days. After sacrifice, biomechanical tensile load-displacement testing was performed to determine Achilles tendon load to failure and stiffness. Data were analyzed by 1-way analysis of variance.

RESULTS: The THC group demonstrated the highest median load to failure, 18.7 N (95% CI, 15.3-19.2 N); the CBD group had the second highest at 16.9 N (95% CI, 15.1-19.8 N), and the control group had the lowest at 14.4 N (95% CI, 12.1-18.3 N). Stiffness was highest in the THC group at 4.1 N/mm (95% CI, 2.7-5.1 N/mm) compared with 3.6 N/mm (95% CI, 2.9-4.1 N/mm) for the CBD group and 3.6 N/mm (95% CI, 2.8-4.3 N/mm) for the control group. No statistically significant differences for strength and stiffness were observed between the groups.

CONCLUSION: In this pilot study using an animal tendon-to-tendon repair model, neither THC nor CBD resulted in altered biomechanical characteristics compared to control.

CLINICAL RELEVANCE: Cannabinoids do not appear to adversely affect Achilles tendon healing.

PMID:34097540 | DOI:10.1177/03635465211016840

Health Aff (Millwood). 2021 Jun;40(6):896-903. doi: 10.1377/hlthaff.2020.02464.

ABSTRACT

Prior studies suggest that the COVID-19 pandemic was associated with decreases in emergency department (ED) volumes, but it is not known whether these decreases varied by visit acuity or by demographic and socioeconomic risk factors. In this study of more than one million non-COVID-19 visits to thirteen EDs in a large St. Louis, Missouri, health system, we observed an overall 35 percent decline in ED visits. The decrease in medical and surgical visits ranged from 40 percent to 52 percent across acuity levels, with no statistically significant differences between higher- and lower-acuity visits after correction for multiple comparisons. Mental health visits saw a smaller decrease (-32 percent), and there was no decrease for visits due to substance use. Medicare patients had the smallest decrease in visits (-31 percent) of the insurance groups; privately insured (-46 percent) and Medicaid (-44 percent) patients saw larger drops. There were no observable differences in ED visit decreases by race. These findings can help inform interventions to ensure that people requiring timely ED care continue to seek it and to improve access to lower-risk alternative settings of care where appropriate.

PMID:34097513 | DOI:10.1377/hlthaff.2020.02464

Multivariate Behav Res. 2021 Jun 7:1-16. doi: 10.1080/00273171.2021.1935202. Online ahead of print.

ABSTRACT

Bayesian methods are often suggested as a solution for issues encountered in small sample research, however, Bayesian methods often require informative priors to outperform classical methods in these settings. Specifying accurate priors with respect to the true value of the parameter of interest is challenging and inaccurate informative priors can have detrimental effects on conclusions from the statistical analysis. This paper proposes an objective procedure for creating informative priors for mediation analysis based on a historical data set; the only requirements for implementing the procedure are that the data from the current study constitute a representative sample from the population of interest, and that the historical and current data sets contain measures of the same covariates and independent variable, mediator, and outcome. The simulation study findings show that the proposed method leads to appropriate amount of borrowing from the historical data set, which leads to increases in precision and power when the historical data and current data are exchangeable, and does not induce bias when the historical and current studies are not exchangeable. The proposed method is illustrated using data from the project PROsetta Stone, and we provide rstan code for implementing the proposed method.

PMID:34097538 | DOI:10.1080/00273171.2021.1935202

Neoplasma. 2021 Jun 7:210115N67. doi: 10.4149/neo_2021_210115N67. Online ahead of print.

ABSTRACT

Due to tumor heterogeneity, the consistency of programmed cell death-ligand 1 (PD-L1) expression between circulating tumor cells (CTCs) and tissue is controversial. This study aimed to establish a method for detecting CTC PD-L1 expression and exploring the impact of the same on the prognosis of lung cancer. In 32 patients with non-small cell lung cancer, lung cancer cells in the blood were enriched using CD326 immunomagnetic beads. Goat anti-mouse polyclonal CD326 antibody stained the epithelial lung cancer cells and anti-PD-L1 antibody was used to detect the expression of CTC PD-L1. The DAKO Link 48 automatic staining device detected the expression in lung cancer tissue. The consistency of PD-L1 expression was analyzed in lung cancer tissue and CTCs. The effect of plasma interferon gamma, tumor necrosis factor alpha, and interleukin-2 on PD-L1 expression and prognosis was analyzed. The number of CTCs detected in patients was 1-36, with a median of 2. There was no significant difference in PD-L1 expression fractions between CTCs and paired tumor tissue (p > 0.05). The correlation coefficient was 0.20. Regardless of lung cancer tissue or CTCs, there was no statistically significant difference in the blood cytokine levels between the two groups with positive or negative PD-L1 expression (p > 0.05). There was no correlation between CTCs and PD-L1 in 23 untreated patients. The expression of PD-L1 in CTCs and lung cancer tissue is heterogeneous and unaffected by the peripheral cytokines’ levels. PD-L1 expression has no correlation between CTCs and tissues and is not related to prognosis.

PMID:34097427 | DOI:10.4149/neo_2021_210115N67

JCO Clin Cancer Inform. 2021 Jun;5:631-640. doi: 10.1200/CCI.20.00191.

ABSTRACT

PURPOSE: Oral chemotherapy challenges providers’ abilities to safely monitor patients’ symptoms, adherence, and financial toxicity. COVID-19 has increased the urgency of caring for patients remotely. Collection of electronic patient-reported outcomes (ePROs) has demonstrated efficacy for patients on intravenous chemotherapy, but limited data support their use in oral chemotherapy. We undertook a pilot project to assess the feasibility of implementing an ePRO system for patients starting oral chemotherapy at our cancer center, which includes both an academic site and a community site.

METHODS: Patients initiating oral chemotherapy were asked to participate. A five-question tool was built in REDCap. Concerning responses triggered outreach within one business day. The primary outcome was time to first symptom assessment. For comparison, we used a historical cohort of patients who had been prescribed oral chemotherapies by providers in the same disease groups at the cancer center.

RESULTS: Twenty-five of 62 (40%) patients completed ePRO assessments. Fifty historical charts were reviewed. Time to first symptom assessment was 7 days (IQR, 4-14 days) in the historical group compared with 3 days (IQR, 2-4 days) in the ePRO group. Time to clinical action was 14 days (7-35 days) in the historical group compared with 8 days (4-19 days) in the ePRO group. No statistically significant differences were detected in 30-day emergency department visit or hospitalization (12% for both groups) or 90-day emergency department visit or hospitalization rates (historical 28% and ePRO 20%).

CONCLUSION: An ePRO tool monitoring patient concerns about adherence, cost, and toxicities for patients with new oral chemotherapy regimens is feasible and improves time to symptom assessment. Further investigation is needed to improve patient engagement with ePROs and evaluate the long-term impacts for patients on oral chemotherapy.

PMID:34097439 | DOI:10.1200/CCI.20.00191

Aust Endod J. 2021 Jun 7. doi: 10.1111/aej.12534. Online ahead of print.

ABSTRACT

The aim of this study was to compare the efficacy of UAI with ESI, sonic activation with Eddy^® and syringe irrigation in removing debris, and dentin removal during canal irrigation. Twenty-four mandibular molars containing isthmus type V and with a mean curvature of 32.5º were instrumented and divided into three groups for final irrigation: UAI with ESI, sonic activation with Eddy and syringe irrigation. The samples were scanned in a SkyScan 1172 micro-CT device for pre-, post-instrumentation and post-irrigation images and analysis of dentin removal. Statistical analysis was performed using Wilcoxon, Kruskal-Wallis and Dunn tests. UAI and sonic activation significantly improved debris removal (P < 0.05). No significant difference was observed regarding dentin removal between the groups (P > 0.05), although higher values were found for UAI. Sonic activation with Eddy^® showed to be an effective and safe device since it was able to remove debris without causing damage to the canal walls.

PMID:34097337 | DOI:10.1111/aej.12534

Aust Endod J. 2021 Jun 7. doi: 10.1111/aej.12537. Online ahead of print.

ABSTRACT

The aim of this study was to evaluate the biocompatibility of epoxy-resin-based AHPlus, salicylate-based MTA-Fillapex and calcium silicate-based iRootSP root canal sealers. Cytotoxicity was assessed by XTT test. The extracts from sealers of different setting times were serially diluted. Cell viability was calculated as the percentage of the control group (100%). The optimal concentration of each sealer was used at genotoxicity test, and micronuclei formations were detected. Statistical analyses were done by using Kruskal-Wallis and Dunn post hoc test with Bonferroni correction. AHPlus and MTA-Fillapex showed the lowest percentage of cell viability at higher concentrations (1:1, 1:2, 1:4), especially at first 12 h. iRootSP showed higher viability at all concentrations and times than AHPlus and MTA-Fillapex. At genotoxicity assay, AHPlus increased the number of micronuclei. MTA-Fillapex slightly induced micronucleus formation (not significant) and iRootSP was not increased. In conclusion, calcium silicate-based iRootSP had lowest cytotoxic and genotoxic potential and can be considered as a highly biocompatible material.

PMID:34097343 | DOI:10.1111/aej.12537

Aust N Z J Public Health. 2021 Jun 7. doi: 10.1111/1753-6405.13122. Online ahead of print.

ABSTRACT

BACKGROUND: The acute effects of alcohol consumption are a major risk factor for suicide. Positive blood alcohol concentrations are present in almost one-third of all suicides at time of death. These suicides are defined as alcohol-related suicides. This cross-sectional study examines the geospatial distribution/clustering of high proportions of alcohol-related suicides and reports on socioeconomic and demographic risk factors.

METHODS: National Coronial Information System (NCIS) data were used to calculate proportions of suicides with alcohol present at the time of death for each level 3 statistical areas (SA3) in Australia. A density analysis and hotspot cluster analysis were used to visualise and establish statistically significant clustering of areas with higher (hotspots) and lower (coldspots) proportions. Subsequently, socioeconomic and demographic risk factors for alcohol use and suicide were reported on for hot and cold spots.

RESULTS: Significant clustering of areas with higher proportions of alcohol-related suicide occurred in northern Western Australia, the Northern Territory and Queensland, as well as inland New South Wales and inland Queensland. Clustering of SA3s with significantly lower proportions occurred in major city and inner regional Sydney and Melbourne. Conclusion and implications for public health: Results from this study identify areas in which prevention strategies should target alcohol use and can be used to inform prevention strategy design. Additionally, hotspots and coldspots identified in this study can be used for further analysis to better understand contextual risk factors for alcohol-related suicide.

PMID:34097331 | DOI:10.1111/1753-6405.13122

Ultrasound Obstet Gynecol. 2021 Jun 7. doi: 10.1002/uog.23706. Online ahead of print.

ABSTRACT

OBJECTIVE: Monochorionic pregnancies complicated by twin-twin transfusion syndrome (TTTS) and treated with fetoscopic laser photocoagulation (FLP) can be associated with neurodevelopmental impairment (NDI). This meta-analysis aimed to identify the prevalence and risk factors of NDI among TTTS survivors after FLP.

METHODS: We searched PubMed, Embase, Scopus and Web of Science, from the inception of the database until 13^th February 2021. Data regarding the severity of TTTS at the time of diagnosis (by Quintero staging), FLP procedure related complications and perinatal outcomes were compared between the survivors with and without NDI (defined as performance on a cognitive or developmental assessment tool > 2 SD below than the mean or a defined neurological disability). The random-effect model was used to pool the mean differences or odds ratios (OR) and the corresponding 95% confidence intervals (CIs). Heterogeneity was assessed using the I² value.

RESULTS: Nine studies with a total of 1499 TTTS survivors were included. The overall incidence of NDI was 14.0% (95% CI, 9.0-18.0%). Occurrence of NDI in TTTS survivors was associated with higher gestational age (GA) at FLP (weeks) (mean difference 0.94, 95% CI 0.50, 1.38, P <0.001; I² 0%), lower GA at delivery (weeks) (mean difference -1.44, 95% CI -2.28, -0.61, P <0.001; I² 49%) and lower birth weight (grams) (mean difference -343.26, 95% CI -470.59, -215.92, P <0.001; I² 27%). Using different GA cut-off values, preterm birth < 32 weeks was associated with risk of NDI later in childhood (OR 2.25, 95% CI 1.02, 4.94, P 0.04; I2 35%). No statistical difference was found between NDI vs non-NDI survivors in terms of Quintero staging, being recipient or donor status, development of post-laser TAPS, recurrence of TTTS, rates of small for gestational age (SGA) and co-twin fetal demise.

CONCLUSION: TTTS survivors with advanced GA at the time of FLP, lower GA at delivery and lower birth weight are at the higher risk of developing NDI. No significant association was found between Quintero staging and risk of NDI. Together, our findings may be helpful for parental counseling and highlighting the need for future studies to better understand the risk factors of NDI among TTTS survivors. This article is protected by copyright. All rights reserved.

PMID:34097320 | DOI:10.1002/uog.23706

J Am Geriatr Soc. 2021 Jun 7. doi: 10.1111/jgs.17286. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVES: Homecare staff often take over activities instead of “doing activities with” clients, thereby hampering clients from remaining active in daily life. Training and supporting staff to integrate reablement into their working practices may reduce clients’ sedentary behavior and improve their independence. This study evaluated the effectiveness of the “Stay Active at Home” (SAaH) reablement training program for homecare staff on older homecare clients’ sedentary behavior.

DESIGN: Cluster randomized controlled trial (c-RCT).

SETTING: Dutch homecare (10 nursing teams comprising a total of 313 staff members).

PARTICIPANTS: 264 clients (aged ≥65 years).

INTERVENTION: SAaH seeks to equip staff with knowledge, attitude, and skills on reablement, and to provide social and organizational support to implement reablement in homecare practice. SAaH consists of program meetings, practical assignments, and weekly newsletters over a 9-month period. The control group received no additional training and delivered care as usual.

MEASUREMENTS: Sedentary behavior (primary outcome) was measured using tri-axial wrist-worn accelerometers. Secondary outcomes included daily functioning (GARS), physical functioning (SPPB), psychological functioning (PHQ-9), and falls. Data were collected at baseline and at 12 months; data on falls were also collected at 6 months. Intention-to-treat analyses using mixed-effects linear and logistic regression were performed.

RESULTS: We found no statistically significant differences between the study groups for sedentary time expressed as daily minutes (adjusted mean difference: β 18.5 (95% confidence interval [CI] -22.4, 59.3), p = 0.374) and as proportion of wake/wear time (β 0.6 [95% CI -1.5, 2.6], p = 0.589) or for most secondary outcomes.

CONCLUSION: Our c-RCT showed no evidence for the effectiveness of SAaH for all client outcomes. Refining SAaH, by adding components that intervene directly on homecare clients, may optimize the program and require further research. Additional research should explore the effectiveness of SAaH on behavioral determinants of clients and staff and cost-effectiveness.

PMID:34097301 | DOI:10.1111/jgs.17286