Δευτέρα 25 Απριλίου 2022

Epicardial adipose tissue in coronary microvascular dysfunction

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International Journal of Obesity, Published online: 25 April 2022; doi:10.1038/s41366-022-01125-z

Epicardial adipose tissue in coronary microvascular dysfunction
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Molecular Biomarker-Defined Brain Tumors: Epidemiology, Validity, and Completeness in the United States

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Abstract
Background
Selected molecular biomarkers were incorporated into U.S. cancer registry reporting for patients with brain tumors beginning in 2018. We investigated the completeness and validity of these variables, and described the epidemiology of molecularly-defined brain tumor types.
Methods
Brain tumor patients with histopathologically-confirmed diagnosis in 2018 were identified within the Central Brain Tumor Registry of the United States and NCI's Surveillance, Epidemiology, and End Results Incidence databases. The brain molecular markers (BMM) site-specific data item was assessed for coding completeness and validity. 1p/19q status, MGMT promoter methylation, and WHO grade data items, and new ICD-O-3 codes were additionally evaluated. These data were used to profile the characteristics and age-adjusted incidence rates per 100,000 population of molecularly-defined brain tumors with 95% confidence intervals (95%CI).
Results
BMM completeness across the applicable tumor types was 75-92% and demonstrated favorable coding validity. IDH-wildtype glioblastomas' incidence rate was 1.74 (95%CI: 1.69-1.78), as compared to 0.14 for WHO grade 2 (95%CI: 0.12-0.15), 0.15 for grade 3 (95%CI: 0.14-0.16), and 0.07 for grade 4 (95%CI: 0.06-0.08) IDH-mutant astrocytomas. Irrespective of WHO grade, IDH mutation prevalence was highest in adolescent & young adult patients and IDH-mutant astrocytomas were more frequently MGMT promoter methylated. Among pediatric-type tumors, the incidence rate was 0.06 for H3K27M-mutant diffuse midline gliomas (95%CI: 0.05-0.07), 0.03 for SHH-activated/TP53-wildtype medulloblastomas (95%CI: 0.02-0.03), and <0.01 for both C19MC-altered ETMRs and RELA-fusion ependymomas.
Conclusions
Our findings illustrate the success of developing a dedicated, integrated-diagnosis variable, which provides critical molecular information about brain tumors related to accurate diagnosis.
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ONC201 and ONC206: metabolically ClipPing the wings of diffuse midline glioma

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Infant Growth Trajectories and Lipid Levels in Adolescence: Evidence from a Chilean Infancy Cohort

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Abstract
Growth in early infancy is hypothesized to affect chronic disease risk factors later in life. To date, most reports draw on European ancestry cohorts with few repeated observations in early infancy. We investigated the association between infant growth before six months and lipid levels in adolescents in a Hispanic/Latino cohort. We characterized infant growth from birth to five months in males (n=311) and females (n=285) from the Santiago Longitudinal Study (1991-1996) using three metrics: weight (kg), length (cm) and weight-for-length (WFL) (g/cm). SuperImposition by Translation and Rotation (SITAR) and latent growth mixture models (LGMM) were used to estimate the association between infant growth characteristics and lipid levels at 17 years. We found a positive relationship between the SITAR length velocity parameter before six months of age and high-density lipoprotein cholesterol levels in adolescence (11.5, standard error=4.1) indicating hi gher high-density lipoprotein cholesterol levels occurring with faster length growth. The strongest associations from the LGMM models were between higher low-density lipoprotein cholesterol and slower WFL growth, following a pattern of associations between slower growth and adverse lipid profiles. Further research in this window of time can confirm the association between early infant growth as an exposure and adolescent cardiovascular disease risk factors.
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Effect of vitamin E supplementation in rheumatoid arthritis: a systematic review and meta-analysis

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European Journal of Clinical Nutrition, Published online: 25 April 2022; doi:10.1038/s41430-022-01148-9

Effect of vitamin E supplementation in rheumatoid arthritis: a systematic review and meta-analysis
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Management der Ohrmuschelteilamputationen

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Laryngorhinootologie
DOI: 10.1055/a-1792-2194

Ohrmuschelverletzungen zählen zu den selteneren Traumata im Kopf-Hals-Bereich. Aufgrund der komplexen Anatomie des Knorpels und der begrenzten Blutversorgung bedürfen sie einer raschen und strukturierten Behandlung. Für die Behandlung sowohl von leichten Verletzungen als auch von (sub-)totalen Abrissen der Ohrmuschel stehen unterschiedliche Therapieoptionen zur Verfügung. Eine direkte Readaptation einer (sub-)total abgerissenen Ohrmuschel ohne mikrovaskulare Anastomose ist aufgrund des hohen Risikos von Haut- und Knorpelnekrosen nur selten erfolgreich. Mehrzeitige Rekonstruktionen mit Pocket-Methoden sind dagegen gut etabliert. Die vorliegende Arbeit beschreibt einige dieser Ansä tze und demonstriert eine 2-stufige OP-Technik eines Ohrmuschelteilabrisses aus dem eigenen Patientengut.
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Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Barriers to Adoption of Electronic Health Record Systems from the Perspective of Nurses: A Cross-sectional Study

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imageThis study report aimed to investigate the barriers to implementation of electronic health record systems from the perspective of nurses. The research data comprised responses from nurses working in a university hospital. Our data collection instruments were the Participant Information Form and EHR Nurse Opinion Questionnaire, which were developed by the researchers. Data analysis was presented as summary statistics, including mean values of variables, standard deviation, frequency, and percentages. A total of 160 nurses participated in the study. The mean age of participants was 30.94 ± 0.59 years, and 77.5% were university graduates. Barriers to adoption of the electronic health record system included high number of patients (82.8%), limited time (79%), lack of knowledge and skills for effective use of the system (22.9%), lack of user-friendly interface and inability to create a common language within the team (17.8%), and attachment to the traditional method (17.2%). Although most nurses thought that the electronic health record system offered some advantages, they reported that factors such as large numbers of patients, limited time, and lack of user-friendly interface hindered its adoption. Innovative strategies should be explored to develop user-friendly designs for electronic health records and to produce solutions for nursing shortages to increase the time allocated for patient care.
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Prediction of Bedridden Duration of Hospitalized Patients by Machine Learning Based on EMRs at Admission

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imageBeing bedridden is a frequent comorbid condition that leads to a series of complications in clinical practice. The present study aimed to predict bedridden duration of hospitalized patients based on EMR at admission by machine learning. The medical data of 4345 hospitalized patients who were bedridden for at least 24 hours after admission were retrospectively collected. After preprocessing of the data, features for modeling were selected by support vector machine recursive feature elimination. Thereafter, logistic regression, support vector machine, and extreme gradient boosting algorithms were adopted to predict th e bedridden duration. The feasibility and efficacy of above models were evaluated by performance indicators. Our results demonstrated that the most important features related to bedridden duration were Charlson Comorbidity Index, age, bedridden duration before admission, mobility capability, and perceptual ability. The extreme gradient boosting algorithm showed the best performance (accuracy, 0.797; area under the curve, 0.841) when compared with support vector machine (accuracy, 0.771; area under the curve, 0.803) and logistic regression (accuracy, 0.765; area under the curve, 0.809) algorithms. Meanwhile, the extreme gradient boosting algorithm had a higher sensitivity (0.856), specificity (0.650), and F1 score (0.858) than that of support vector machine algorithm (0.843, 0.589, and 0.841) and logistic regression (0.852, 0.545, and 0.839), respectively. These findings indicate that machine learning based on EMRs at admission is a feasible avenue to predict the bedridden duration. The extreme gradient boosting algorithm shows great potential for further clinical application.
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Higher Moments Matter for Optimal Balance Weighting in Causal Estimation

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We expand upon a simulation study that compared three promising methods for estimating weights for assessing the average treatment effect on the treated for binary treatments: generalized boosted models, covariate-balancing propensity scores, and entropy balance. The original study showed that generalized boosted models can outperfo rm covariate-balancing propensity scores, and entropy balance when there are likely to be non-linear associations in both the treatment assignment and outcome models and when the other two models are fine-tuned to obtain balance only on first-order moments. We explore the potential benefit of using higher-order moments in the balancing conditions for covariate-balancing propensity scores and entry balance. Our findings showcase that these two models should, by default, include higher order moments and focusing only on first moments can result in substantial bias in estimated treatment effect estimates from both models that could be avoided using higher moments. We expand upon a simulation study that compared three promising methods for estimating weights for assessing the average treatment effect on the treated for binary treatments: generalized boosted models, covariate-balancing propensity scores, and entropy balance. The original study showed that generalized boosted models can outperform covariate-balancing propensity scores, and entropy balance when there are likely to be non-linear associations in both the treatment assignment and outcome models and when the other two models are fine-tuned to obtain balance only on first-order moments. We explore the potential benefit of using higher-order moments in the balancing conditions for covariate-balancing propensity scores and entry balance. Our findings showcase that these two models should, by default, include higher order moments and focusing only on first moments can result in substantial bias in estimated treatment effect estimates from both models that could be avoided using higher mom ents. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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Prospective Study of PET/MRI Tumor Response During Chemoradiotherapy for Patients With Low-risk and Intermediate-risk p16-positive Oropharynx Cancer

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imageObjective: The objective of this study was to examine tumor response with positron emission tomography (PET)/magnetic resonance imaging (MRI) during chemoradiotherapy as a predictor of outcome in patients with p16-positive oropharynx cancer. Materials and Methods: Patients with p16-positive oropharynx cancer were treated with chemoradiotherapy. Low-risk (LR) disease was defined as T1-T3 and N0-2b and ≤10 pack-years and intermediate-risk (IR) disease as T4 or N2c-3 or >10 pack-years. Patients underwent a PET/MRI scan pretreatment and at fraction 10. Change in value of imaging means were analyzed by analysis of variance. K-means clustering with Euclidean distance functions were used for patient clustering. Silhouette width was used to determine the optimal number of clusters. Linear regression was performed on all radiographic metrics using patient and disease characteristics. Results: Twenty-four patients were enrolled with 7 LR and 11 IR patients available for analysis. Pretreatment imaging characteristics between LR and IR patients were similar. Patients with LR disease exhibited a larger reduction in maximum standardized uptake value (SUV) compared with IR patients (P
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A Proposal to Modify the 8th IASLC System: Is it Suitable for T4N2M0 Lung Adenocarcinoma to Be Placed in Stage IIIB?

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imagePurpose: The International Association for the Study of Lung Cancer (IASLC) of TNM staging system has been well accepted as a precise model. However, the latest American Joint Committee on Cancer (AJCC) staging system to solve the different survival and prognosis of lung adenocarcinoma in the same period is still controversial. Therefore, it is necessary to thoroughly explore the applicability between the new system and survival prediction in terms of lung adenocarcinoma. Methods: We recruited 52,517 patients with lung adenocarcinoma from the Surveillence, Epidemiology, and End Results database. Cox regression analysis was performed to determine survival related factors. The mortality rate per 1000 persons per year of the T4N2M0 lung adenocarcinoma stage and other stages were compared. Survival curves were obtained using the Kaplan-Meier analysis and log-rank test. Results: The results of Cox proportional hazards regression analysis showed that age at diagnosis, race, T stage, distant metastasis, extrathoracic extension, radiotherapy, chemotherapy, and surgery are independent factors related to cancer-specific survival (CSS) and all-cause survival. Furthermore, patients with stage IIIA disease (P0.05). Conclusion: The survival rate of patients with T4N2M0 stage was significantly lower than that of patients with IIIA and IIIB stages excluding T4N2M0, there was no significant difference between T4N2M0 and IIIC. It was suggested that this group of patients with stage T4N2M0 were upgraded in the 8th IASLC system.
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Short-term ADT and Dose-escalated IMRT in Patients With Intermediate-risk Prostate Cancer: Benefit or Caution?

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imageObjectives: In the era of dose-escalated prostate radiation therapy (RT), the use of androgen deprivation therapy (ADT) is undefined for intermediate-risk (IR) prostate cancer. There is growing concern of the risk of ADT to be detrimental to quality of life. This single-institution retrospective analysis aimed to evaluate outcomes of IR patients treated with dose-escalated intensity modulated radiation therapy (IMRT) with or without concurrent/adjuvant short-term ADT. Materials and Methods: Data was collected from 260 consecutive patients treated with dose-escalated IMRT with daily image-guided RT for newly diagnosed IR prostate cancer. Biochemical recurrence-free survival (BCRFS), distant metastasis-free survival, prostate cancer-specific survival, and overall survival (OS) were calculated using Kaplan-Meier methodology. Results: Median follow-up was 93 months. A total of 181 patients had unfavorable IR disease, and 36.2% (N=94) received ADT, with median ADT duration of 6 months. Seven-year BCRFS was 94.1% vs. 86.2% (P=0.067), for ADT and no ADT, respectively, and no difference in distant metastasis-free survival or prostate cancer-specific survival was observed. ADT was associated with significantly worse 7-year OS (80.0% vs. 91.3%, P=0.010). Analysis of the unfavorable IR cohort alone, showed similar results; 7-year BCRFS and 7-year OS in patients who received ADT versus no ADT were 93.7% vs. 85.9% (P=0.093), and 79.0% vs. 90.6% (P=0.019), respectively. Conclusions: In our 15-year experience treating IR prostate cancer with dose-escalated IMRT with daily image-guided RT, short-term concurrent ADT was associated with a statistically significant worse OS. Additional studies are needed to determine if ADT is beneficial or detrimental for patients with IR prostate cancer treated with dose-escalated radiation.
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