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Analysis of Endoscope-Assisted Retrosigmoid Approach versus Modified Transjugular Approach for Microvascular Decompression of the Facial Nerve: A Comparative Cadaveric Study.
No full textOBJECTIVE: Two main approaches for microvascular decompression for hemifacial spasm include the retrosigmoid approach (RA) and the modified transjugular-tubercular approach (MTA). This anatomical study compares both and evaluates the value of neuroendoscopy.
METHODS: Dissections were performed on 4 cadaveric human heads, performing RA on one side and MTA on the other. Anatomical landmarks were determined beforehand, and the accessibility to each was evaluated by determining visibility with a microscope and 0°, 30°, and 45° endoscopes. The degree of freedom at each landmark, representing the working area afforded by each approach, was measured using vectors from the boundaries of the craniotomy to the points of interest.
RESULTS: MTA yielded 90.1% greater degree of freedom (P \u3c 0.00001) at the internal acoustic canal and 118.3% greater access (P \u3c 0.001) to the facial nerve root exit zone than RA. For landmarks with sub-100% microscopic visualization, the 0° endoscope improved visualization for 15/16 (94%) landmarks with RA and 9/9 (100%) with MTA. Introducing 30° and 45° angled endoscopes improved visualization in every instance. Although MTA provided a higher visualization for some landmarks with the microscope and 0° endoscope, all discrepancies were eliminated with the 30° endoscope, while the 45° endoscope showed identical visualization.
CONCLUSIONS: Despite the greater degree of freedom with MTA, visualizing and manipulating the facial nerve at the root exit zone was comparable between both approaches, with the use of angled endoscopy further improving visualization and accessibility. As such, the endoscope-assisted RA, with its smaller exposure and soft-tissue disruption, is a viable approach for microvascular decompression for hemifacial spasm
Impact of weight change on kidney transplantation outcomes: A systematic review and meta-analysis.
No full textBACKGROUND AND AIM: Kidney transplant recipients frequently experience a wide range of metabolic complications, including weight changes, which significantly impact patient outcomes and graft function, yet the relationship between weight gain and transplant outcomes remains poorly understood. This systematic review and meta-analysis aimed to synthesise existing evidence on the influence of weight gain on patient and graft outcomes following kidney transplantation to enhance clinical practice and optimise post-transplant care strategies.
MATERIALS AND METHODS: A literature search was conducted across databases such as PubMed and Scopus for peer-reviewed studies published up to 8 August 2024. We included adult kidney transplant recipients (ages 18 years and older) with substantial and clinically relevant post-transplant weight gain and a control group without such changes, focusing on outcomes including all-cause mortality, graft survival, cardiovascular events and acute rejection.
RESULTS: The pooled analysis, which included data from 11 studies, indicated no significant association between post-transplant weight gain and the risk of all-cause mortality (hazard ratio [HR] 1.21, 95% confidence interval [CI] 0.69 to 2.10, p = 0.51; I
CONCLUSION: Substantial and clinically relevant weight gain after kidney transplant was associated with a higher risk of graft failure. Within the timeframes of study observation, risks of all-cause mortality, cardiovascular events or acute rejection were not increased by weight gain in kidney transplant recipients
Design and baseline characteristics of the Finerenone, in addition to standard of care, on the progression of kidney disease in patients with Non-Diabetic Chronic Kidney Disease (FIND-CKD) randomized trial.
No full textBACKGROUND: Finerenone, a non-steroidal mineralocorticoid receptor antagonist, improved kidney and cardiovascular outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes in two phase 3 outcome trials. The Finerenone, in addition to standard of care, on the progression of kidney disease in patients with Non-Diabetic Chronic Kidney Disease (FIND-CKD) study investigates the effect of finerenone in adults with CKD without diabetes.
METHODS: FIND-CKD (NCT05047263 and EU CT 2023-506897-11-00) is a randomized, double-blind, placebo-controlled phase 3 trial in patients with CKD of non-diabetic aetiology. Adults with a urinary albumin:creatinine ratio (UACR) ≥200-≤3500 mg/g and an estimated glomerular filtration rate (eGFR) ≥25-/min/1.73 m2 receiving a maximum tolerated dose of a renin-angiotensin system inhibitor were randomized 1:1 to once-daily placebo or finerenone 10 or 20 mg depending on eGFR \u3e60 or/min/1.73 m2. The primary efficacy outcome is total eGFR slope, defined as the mean annual rate of change in eGFR from baseline to month 32. Secondary efficacy outcomes include a combined cardiorenal composite outcome comprising time to kidney failure, sustained ≥57% decrease in eGFR, hospitalization for heart failure or cardiovascular death, as well as separate kidney and cardiovascular composite outcomes. Adverse events are recorded to assess tolerability and safety.
RESULTS: Across 24 countries, 3231 patients were screened and 1584 were randomized to study treatment. The most common causes of CKD were chronic glomerulonephritis (57.0%) and hypertensive/ischaemic nephropathy (29.0%). Immunoglobulin A nephropathy was the most common glomerulonephritis (26.3% of the total population). At baseline, mean eGFR and median UACR were 46.7 ml/min/1.73 m2 and 818.9 mg/g, respectively. Diuretics were used by 282 participants (17.8%), statins by 851 (53.7%) and calcium channel blockers by 794 (50.1%). Sodium-glucose co-transporter 2 (SGLT2) inhibitors were used in 16.9% of patients; these individuals had a similar mean eGFR (45.6 versus 46.8 ml/min/1.73 m2) and a slightly higher median UACR (871.9 versus 808.3 mg/g) compared with those not using SGLT2 inhibitors at baseline.
CONCLUSIONS: FIND-CKD is the first phase 3 trial of finerenone in patients with CKD of non-diabetic aetiology
Social determinants of health and variability in treatment for patients with early-stage non-small cell lung cancer.
No full textBACKGROUND: In non-small cell lung cancer, social determinants of health (SDOH) influence treatment, but SDOH with geographic precision are infrequently used in real-world research because of privacy considerations. This research aims to characterize the influence of census tract-level SDOH on treatment for stage I and IIa non-small cell lung cancer.
METHODS: Patients diagnosed between January 1, 2017, and September 30, 2022, with stage I or IIa non-small cell lung cancer in the Syapse Learning Health Network had their addresses geocoded and linked to 6 census tract-level indicators of SDOH (the Centers for Disease Control and Prevention and Agency for Toxic Substances and Disease Registry Social Vulnerability Index, percentage housing burden, percentage broadband internet access, primary care shortage area, and rurality). Clinical and demographic characteristics were ascertained from medical records. Nested multinomial logistic regression models estimated associations between SDOH and initial treatment using 2-sided Wald tests. The collective statistical significance of SDOH was assessed using a likelihood ratio test comparing nested models. Descriptive statistics described time to treatment initiation.
RESULTS: Among 3595 patients, 58% were initially treated with surgery, 29% with radiation, and 12% with other. Two SDOH variables were associated with increased relative risk for radiation therapy compared with surgery: living in primary care shortage areas (relative risk = 1.61, 95% CI = 1.23 to 2.10) and living in nonmetropolitan areas (relative risk = 1.45, 95% CI = 1.02 to 2.07). The likelihood ratio test suggested that the 5 SDOH variables collectively improved the treatment model. Further, patients in areas with high Social Vulnerability Index, low internet access, and high housing burden initiated treatment later.
CONCLUSION: When using precise estimates of geospatial SDOH, these measures were associated with treatment and should be considered in analyses of cancer outcomes
Mindfulness Bundle Toolkit\u27s Impact on Nurse Burnout.
No full textBACKGROUND: Nurse burnout is a widespread problem affecting nurses\u27 physical and mental health and patients\u27 satisfaction. Nurses in intensive care units designated for patients with COVID-19 during the pandemic reported experiencing higher levels of emotional exhaustion, depersonalization, and stress and exhaustion and lower levels of personal accomplishment. The current literature does not have a solution to combat burnout.
OBJECTIVE: To test the effectiveness of a mindfulness bundle toolkit on burnout for nurses caring for patients with COVID-19.
METHODS: A quantitative quasi-experimental design was used. Participants were 52 frontline registered nurses caring for patients with COVID-19. A mindfulness bundle toolkit was provided with the goal of decreasing burnout in a 6-week period. Data were collected before intervention, immediately after intervention, and 6 weeks after intervention using the Maslach Burnout Inventory-Human Services Survey for Medical Personnel, the Nursing Work Index-Revised, and the Stress/Arousal Adjective Checklist. Results The analysis indicated a statistically significant effect from the mindfulness bundle toolkit in 3 areas pertaining to burnout: emotional exhaustion (Wilks Λ = .66; F1,41 = 19.02; P = .001; η2 = .31), depersonalization (Wilks Λ = .70; F1,41 = 7.93; P = .007; η2 = .16), and stress (Wilks Λ = .81; F1,41 = 8.81; P = .005; η2 = .17).
CONCLUSIONS: The results suggest that the use of a 6-week mindfulness bundle toolkit is an effective intervention to mitigate emotional exhaustion, depersonalization, and stress associated with burnout in critical care nurses caring for patients with COVID-19
Reoperative Pulmonary Metastasectomy: Outcomes and Indications.
No full textRecurrent pulmonary metastasis after initial pulmonary metastasectomy is common and poses a clinical dilemma. Reoperative pulmonary metastasectomy is an option that in select patients has been shown to be safe and technically feasible resulting in encouraging survival results from non-randomized retrospective studies. As with metastasectomy in general, there is ongoing debate if observed benefit of repeat pulmonary resection is a result of surgery or a reflection of selection bias. This review summarizes available evidence regarding reoperative pulmonary metastasectomy, discusses selection bias, and outlines future directions in the context of our evolving understanding of the oligometastatic state
Altered huntingtin-chromatin interactions predict transcriptional and epigenetic changes in Huntington\u27s disease.
No full textWhile progressive striatal gene expression changes and epigenetic alterations are a prominent feature of Huntington\u27s disease (HD), the mechanistic basis remains poorly understood. Using chromatin immunoprecipitation and sequencing (ChIP-seq), we show that the huntingtin protein (HTT) reproducibly occupies specific locations in the mouse genome. Striatal HTT ChIP-seq peaks were enriched in coding regions of spiny projection neuron identity genes that were found to have reduced expression in HD patients and mouse models, and had reduced occupancy in expanded polyglutamine HTT knock-in mice (HttQ111/Q111). By contrast, HTT occupancy was depleted near genes that are upregulated in HD. ChIP-seq of striatal histone modifications revealed genotype-specific colocalization of HTT with active chromatin marks and enhancer of zeste homolog 2 (EZH2), a key enzymatic component of the PRC2 complex. In the vicinity of genes that are differentially regulated in HD, greater HTT occupancy in HttQ111/Q111 vs wild-type mice was associated with increased EZH2 occupancy, increased H3K4me3 levels and decreased H3K27me3 levels. Our study suggests that HTT-chromatin interactions may play a role in organizing chromatin and promoting cell type-specific gene expression, with HTT occupancy predicting transcriptional dysregulation in HD