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Multivisceral Transplant Prognosis and Complications In Patients With Metastatic Neuroendocrine Tumor
Get PDFNeuroendocrine tumors (NETs) are a rare subset of cancers that most commonly arise in the gastrointestinal tract, but can also arise in the pancreas, lungs, ovaries, thyroid, pituitary gland, and adrenal gland. When patients present with metastatic NETs, physicians have a variety of therapeutic options. Considering these options, transplant specialists are often involved due to the profound therapeutic effects of multi-organ transplantation. However, little information is available on prognosis/complications for patients that receive multi-organ transplants due to severe metastatic NETs.
With the incidence of NETs in the United States trending in an upward direction, researchers and physicians must understand the prognosis and complications of these complex clinical cases. Therefore, the goal of this study is to analyze the health outcomes of four Henry Ford patients that received multi-organ transplants due to metastatic NETs. This will provide physicians with valuable information, not only regarding therapeutic decision-making, but also for educating patients on their current condition and what he/she can expect for their future
High Variability Exists in Reporting Clinical and Patient-Reported Outcome Measures Following Meniscal Surgery
Get PDFPurpose: To evaluate the variability in outcomes following surgical meniscal repair and compare responsiveness between patient reported outcome measures (PROMs).
Methods: A systematic search of the PubMed/MEDLINE and Web of Science databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A total of 257 unique studies met inclusion criteria. Patient and study attributes were extracted, including pre- and postoperative means for PROMs. Of the studies that met inclusion criteria for responsiveness analysis (2+ PROMs reported, 1-year minimum follow-up; n=172), we compared the responsiveness between PROM instruments using effect size and relative efficiency (RE) if a PROM could be compared to another in at least 10 articles.
Results: A total of 18,612 patients (18,690 menisci, mean age = 38.6 years, mean body mass index = 26.3 kg/m2) were included in this study. Thirty-five different PROM instruments were identified, and the mean number of PROMs in each article was 3.6. The most cited PROMs were Lysholm (74.5%) and International Knee Documentation Committee (IKDC) (51.0%). IKDC was found to be more responsive than other PROMs, which include Lysholm (RE=2.29), Tegner (RE=3.90), and Knee Injury and Osteoarthritis Outcome Score (KOOS) Activities of Daily Living (ADL) (RE=1.08). KOOS Quality of Life (QoL) was also more responsive than other PROMs, such as IKDC (RE=1.42) and KOOS ADL (RE=1.43). Lysholm was more responsive compared to KOOS QoL (RE=1.14), KOOS ADL (RE=1.96), and Tegner (RE=3.53).
Conclusion: Our study found that IKDC, KOOS QoL, and Lysholm were the most responsive PROMs
Preoperative PROMIS Depression Scores Can Predict Failure to Improve after Trapeziectomy and LRTI
Get PDFINTRODUCTION: Patient-Reported Outcomes Measurement Information System (PROMIS) scores have been utilized in setting realistic post-intervention expectations. Having a model to stratify likelihood of improvement based on pre-operative variables may allow for better decision making and patient counseling. We hypothesized that preoperative PROMIS scores correlate with patients’ subjective level of improvement after trapeziectomy and ligament reconstruction with tendon interposition (LRTI)
METHODS: Retrospective chart review was performed to identify patients who underwent trapeziectomy and LRTI. Demographic data along with preoperative PROMIS Upper Extremity (UE), Pain Interference (PI), Depression (DP), and QuickDASH (QD) scores were collected. At their follow-up appointment, patients were asked a follow-up anchor question: “Since your treatment, how would you rate your overall function?”. Possible responses represent a 7-point Likert scale from “Much Worse” to “Much Improved”. Significance between preoperative scores and subjective improvement were modeled using univariable logistic regression. Correlation between preoperative scores and patient anchor question response was calculated using Receiver Operating Characteristic (ROC) Curves and reported as area under the curve (AUC) (values 0.6 - 0.69; moderate predictive ability, 0.7 - 0.79; strong, and \u3e 0.8; excellent).
RESULTS: There were 69 patients included in this study. The mean age was 62 years and 78% of patients were female. The median follow-up time was 40 days (interquartile range 13-86 days). Forty-two patients (61%) reported “somewhat improved” or better and 27 patients (39%) reported “no change” or worse. Univariate logistic regression revealed that preoperative PROMIS Depression scores were significantly correlated with achieving subjective improvement (Table 1), with patients with higher pre-operative depression scores demonstrating a lower likelihood of reporting improvement. ROC curves an AUC of 0.76 for preoperative PROMIS Depression scores indicating a strong predictive ability (Table 2). Preoperative PROMIS UE, PI, and QD scores were not significantly correlated with subjective improvement.
DISCUSSION: Patients with higher preoperative PROMIS Depression scores are significantly less likely to report improvement after trapeziectomy with LRTI; this had overall strong predictive ability. Development of a predictive model through utilization of preoperative PROMIS Depression scores will allow for providers to elucidate improved decision making and more realistic patient expectations after intervention which may improve patient satisfaction overall. Lack of significant correlation between PROMIS UE, PI, and QD scores and subjective improvement indicates a limitation of this study in utilizing these scores within the predictive model.
SIGNIFICANCE/CLINICAL RELEVANCE: This study is significant because use of preoperative PROMIS Depression scores to predict patients’ likelihood to improve after trapziectomy and LRTI may improve patient selection and pre-operative counseling in the future.
FIGURES:
Table 1. Univariable Logistic Regression. Odds ratio are reported relative to achieving subjective improvement.
Non-Improved
[Mean (SD)]
Improved
[Mean (SD)]
Odds Ratio
(1-point increase)
95% Confidence Interval
P-value
Preop UE
31.5 (5.6)
32.1 (5.6)
1.03
0.94-1.12
P = 0.56
Preop PI
63 (7.9)
61.4 (5.1)
0.95
0.87-1.04
P = 0.30
Preop DP
52.6 (4.6)
45.8 (9.7)
0.88
0.77-1.00
P = 0.03
Preop QD
55.1 (18.4)
51.0 (17.0)
0.98
0.96-1.01
P= 0.37
Preop, Preoperative; UE, PROMIS Upper Extremity; PI, PROMIS Pain Interference; DP, PROMIS Depression; QD QuickDASH
Table 2. ROC Curve illustrating diagnostic abilities of the preoperative PROMIS and QD scores to predict subjective patient outcome (AUC values of 0.6 to 0.69 - moderate predictive ability, 0.7 to 0.79 - strong, and \u3e 0.8 - excellent).
Variable
AUC
UE
0.55
PI
0.65
DP
0.76
QD
0.60
AUC, Area Under the Curve; UE, Preoperative PROMIS UE Score; PI, Preoperative PROMIS PI Score; DP, Preoperative PROMIS Depression Score; QD, Preoperative QuickDASH Scor
Gender Disparities in the Diagnosis of Sleep Disordered Breathing
Get PDFIntroduction: Current diagnostic guidelines for sleep disordered breathing (SDB) require that apneas and hypopneas be accompanied by a 4% desaturation for it to constitute a respiratory event (AHI-Accepted). However, the American Academy of Sleep Medicine recommends expanding the diagnostic criteria to include apneas and hypopneas accompanied by a 3% desaturation or a cortical arousal for diagnosis (AHI-Recommended). We hypothesized that a clinical sample of both men and women would demonstrate that women are more likely to be misdiagnosed using the accepted criteria compared to the recommended criteria.
Methods: The clinical sample consisted of all patients receiving a PSG at the Detroit Medical Center Sleep Clinic in 2019. We used t-test calculations to analyze gender, BMI, AHI-R, and AHI-A.
Results: 286 Women and 158 Men were analyzed. For Women, the average AHI-R was 27.0 events/hr (±27.4), and AHI-A was 15.1 events/hr (±21.4). For Men, the average AHI-R was 47.1 events/hr (±35.1), and AHI-A was 32.5 events/hr (±31.9). 19.8% of women had an AHI-A greater than 15 compared to 35.3% of women when using AHI-R (15.5% increase). For men, 20.5% had an AHI-A greater than 15 compared to 27.4% when using AHI-R (6.9% increase).
Discussion: There was a significant difference between men and women when comparing AHI-A to AHI-R. Using the AHI-R criteria resulted in a greater increase in women being diagnosed with severe SDB compared to men. This indicates that using the recommended criteria benefits women to a greater extent than men
Thymic Stromal Lymphopoietin Participates in the Host Response to Intra-Amniotic Inflammation Leading to Preterm Labor and Birth
Get PDFObjective: To determine if bacteria (Ureaplasma parvum and Sneathia spp.) associated with intra-amniotic infection can trigger the induction of cytokine Thymic stromal lymphopoietin (TSLP) in human amnion epithelial cells (hAECs) in vitro.
Material or subjects: Amniotic fluid and chorioamniotic membrane (CAM) were collected from women with sPTL who delivered at term (n=30) or preterm without intra-amniotic inflammation (n=34), with sterile intra-amniotic inflammation (SIAI, n=27), or with intra-amniotic infection (IAI, n=17). Amnion epithelial cells (AECs), Ureaplasma parvum, and Sneathia spp. were also utilized.
Methods: The expression of TSLP, TSLPR, and IL-7Rα was evaluated in amniotic fluid or CAM by RT-qPCR and/or immunoassays. AECs co-cultured with Ureaplasma parvum or Sneathia spp. were evaluated for TSLP expression by immunofluorescence and/or RT-qPCR.
Results: TSLP was elevated in amniotic fluid of women with SIAI or IAI and expressed by the CAM. TSLPR and IL-7Rα had detectable gene and protein expression in the CAM; yet, CRLF2 was specifically elevated with IAI. While TSLP localized to all layers of the CAM and increased with SIAI or IAI, TSLPR and IL-7Rα were minimal and became most apparent with IAI. Co-culture experiments indicated that Ureaplasma parvum and Sneathia amnii upregulated TSLP expression in AECs.
Conclusions: Ureaplasma parvum and Sneathia spp. triggers induction of TSLP, a central component of the intra-amniotic host response during sPTL
Demographic and Psychosocial Factors Associated with Suicide Mortality Among Childbearing-Aged Individuals: A Case-Control Study
Get PDFObjective: Examine pregnancy-related, demographic, psychosocial and healthcare utilization factors associated with suicide mortality among childbearing-aged women. Methods: Data from nine health care systems in the Mental Health Research Network were included. A case-control study design was used in which 290 childbearing-age women who died by suicide (cases) from 2000-2015 were matched with 2,900 childbearing-age women from the same healthcare system and enrolled during the same time period who did not die by suicide. Conditional logistic regression was used to analyze associations between patient characteristics and suicide. Results: Women who died by suicide were more likely to have mental health or substance use disorders (aOR = 2.36, 95%CI: 1.46, 3.82) and to have visited the emergency department in the year prior to index date (aOR = 3.35, 95%CI: 2.39, 4.68). Pregnancy (aOR = 0.17, 95% CI: 0.04, 0.78) and delivery of a liveborn baby (aOR = 0.39, 95% CI: 0.16, 0.92) within a year before index date were associated with lower risk of suicide mortality. Women who experienced pregnancy loss were more likely to die by suicide (aOR = 1.41, 95% CI: 0.49, 4.06), but this was not statistically significant potentially due to small sample size (n = 6 cases; n = 21 control). Conclusions: Childbearing-aged women with mental health and/or substance use disorders, prior emergency department encounters may benefit from routine screening and monitoring for suicide risk. Future research should further examine the relationship between pregnancy loss and suicide mortality
