Publications by authors named "Matthew Lee"

415 Publications

AUTHOR REPLY.

Urology 2021 Jun;152:165-166

Lewis Katz School of Medicine at Temple Univiersity, Philadelphia, PA.

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http://dx.doi.org/10.1016/j.urology.2021.01.060DOI Listing
June 2021

Correction to: Tumor volume improves preoperative differentiation of prolactinomas and nonfunctioning pituitary adenomas.

Endocrine 2021 Jun 7. Epub 2021 Jun 7.

Division of Endocrinology, Diabetes and Metabolism, NYU Langone Medical Center/ Bellevue Hospital Center, 550 1st Avenue, New York, NY, 10016, USA.

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http://dx.doi.org/10.1007/s12020-021-02777-zDOI Listing
June 2021

The role of financial conditions for physical and mental health. Evidence from a longitudinal survey and insurance claims data.

Soc Sci Med 2021 May 21;281:114041. Epub 2021 May 21.

Sustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.

Background: Both theory and empirical evidence suggest that financial conditions are influential for mental health and might contribute to physical health outcomes.

Methods: Using longitudinal survey data and health insurance claims data from 1209 employees in a large U.S. health insurance company, we examined temporal associations between measures of financial safety, financial capability, financial distress, their summary index (financial security) and six subsequently measured mental and physical health outcomes.

Results: We found that financial safety and financial capability were positively associated, while financial distress was negatively associated, with subsequent self-reported measures of physical and mental health, even after controlling for these health measures at baseline and other confounders. Additionally, financial conditions were associated with reduced risk of depression based on health insurance claims data. Financial safety was also associated with anxiety.

Conclusions: Policy-makers might consider the introduction of more effective measures for ensuring favorable financial conditions as an important contributor to better population health. Furthermore, policy could encourage teaching adequate financial management techniques and the importance of understanding of long-term consequences of financial decisions, as those might be pivotal for health outcomes.
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http://dx.doi.org/10.1016/j.socscimed.2021.114041DOI Listing
May 2021

The CT scout view: complementary value added to abdominal CT interpretation.

Abdom Radiol (NY) 2021 Jun 1. Epub 2021 Jun 1.

Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave, Madison, WI, 53792, USA.

Computed tomography (CT) scout images, also known as CT localizer radiographs, topograms, or scanograms, are an important, albeit often overlooked part of the CT examination. Scout images may contain important findings outside of the scanned field of view on CT examinations of the abdomen and pelvis, such as unsuspected lung cancer at the lung bases. Alternatively, scout images can provide complementary information to findings within the scanned field of view, such as characterization of retained surgical foreign bodies. Assessment of scout images adds value and provides a complementary "opportunistic" review for interpretation of abdominopelvic CT examinations. Scout image review is a useful modern application of conventional abdominal radiograph interpretation that can help establish a diagnosis or narrow a differential diagnosis. This review discusses the primary purpose and intent of the CT scout images, addresses standard of care and bias related to scout image review, and presents a general systematic approach to assessing scout images with multiple illustrative examples, including potential pitfalls in interpreting scout images.
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http://dx.doi.org/10.1007/s00261-021-03135-3DOI Listing
June 2021

Fab-dimerized glycan-reactive antibodies are a structural category of natural antibodies.

Cell 2021 05 20;184(11):2955-2972.e25. Epub 2021 May 20.

Duke Human Vaccine Institute, Durham, NC 27710, USA.

Natural antibodies (Abs) can target host glycans on the surface of pathogens. We studied the evolution of glycan-reactive B cells of rhesus macaques and humans using glycosylated HIV-1 envelope (Env) as a model antigen. 2G12 is a broadly neutralizing Ab (bnAb) that targets a conserved glycan patch on Env of geographically diverse HIV-1 strains using a unique heavy-chain (V) domain-swapped architecture that results in fragment antigen-binding (Fab) dimerization. Here, we describe HIV-1 Env Fab-dimerized glycan (FDG)-reactive bnAbs without V-swapped domains from simian-human immunodeficiency virus (SHIV)-infected macaques. FDG Abs also recognized cell-surface glycans on diverse pathogens, including yeast and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike. FDG precursors were expanded by glycan-bearing immunogens in macaques and were abundant in HIV-1-naive humans. Moreover, FDG precursors were predominately mutated IgMIgDCD27, thus suggesting that they originated from a pool of antigen-experienced IgM or marginal zone B cells.
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http://dx.doi.org/10.1016/j.cell.2021.04.042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8135257PMC
May 2021

The Effect of Neprilysin Inhibition on Left Ventricular Remodeling in Patients with Asymptomatic Left Ventricular Systolic Dysfunction Late After Myocardial Infarction.

Circulation 2021 May 13. Epub 2021 May 13.

Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.

Patients with left ventricular systolic dysfunction (LVSD) following myocardial infarction (MI) are at high risk of developing heart failure. The addition of neprilysin inhibition to renin angiotensin system (RAS) inhibition may result in greater attenuation of adverse LV remodeling due to increased levels of substrates for neprilysin with vasodilatory, anti-hypertrophic, anti-fibrotic and sympatholytic effects. We performed a prospective, multi-center, randomized, double-blind, active-comparator trial comparing sacubitril/valsartan 97/103mg twice daily with valsartan 160mg twice daily in patients ≥3 months following MI with a LV ejection fraction (LVEF) ≤40% who were taking a RAS inhibitor (equivalent dose of ramipril ≥2.5mg twice daily), and a beta-blocker unless contraindicated or intolerant. Patients in New York Heart Association functional classification ≥II or with signs and symptoms of HF were excluded. The primary outcome was change from baseline to 52-weeks in LV end-systolic volume index (LVESVI) measured using cardiac magnetic resonance imaging (MRI). Secondary outcomes included other MRI measurements of LV remodeling, change in N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I (hs-TnI), and a patient global assessment of change questionnaire. From July 2018 to June 2019, 93 patients were randomized: mean age 60.7±10.4 years, median time from MI 3.6 years (IQR 1.2-7.2), mean LVEF 36.8%±7.1, median NT-proBNP 230pg/mL (124-404). Sacubitril/valsartan, compared with valsartan, did not significantly reduce LVESVI; adjusted between-group difference -1.9mL/m (95%CI -4.9, 1.0); p=0.19. There were no significant between-group differences in NT-proBNP, hs-TnI, LV end-diastolic volume index, left atrial volume index, LVEF, LV mass index, or patient global assessment of change. In patients with asymptomatic LVSD following MI, treatment with sacubitril/valsartan did not have a significant reverse remodeling effect compared with valsartan. URL: https://www.clinicaltrials.gov Unique identifier: NCT03552575.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.121.054892DOI Listing
May 2021

Psychometric Properties of Flourishing Scales From a Comprehensive Well-Being Assessment.

Front Psychol 2021 21;12:652209. Epub 2021 Apr 21.

Sustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, United States.

In this article, we develop a measure of complete well-being. The framework is derived from the theoretical model of human flourishing understood as a state in which all aspects of a human life are favorable. The approach extends beyond psychological well-being and reflects the World Health Organization definition of health that not only considers the health of body and mind but also embraces the wholeness of the person. The Well-Being Assessment (WBA) is a comprehensive instrument designed to assess holistic well-being in six domains: emotional health, physical health, meaning and purpose, character strengths, social connectedness, and financial security. Although each of these domains is distinct, all of them are nearly universally desired, and all but financial security constitute ends in themselves. Data were collected from a representative sample of working adults. A sample of 276 employees participated in the pilot, 2,370 participated in the first wave and 1,209 in the second wave of the survey. The WBA showed a good fitting (40 items, six factors), satisfactory reliability, test-retest correlation, and convergent/discriminant validity in relation to stability over time and relevant health measures, as well as a good fit to the data that were invariant over time, gender, age, education, and marital status. The instrument can be of use for scientists, practitioners, clinicians, public health officials, and patients. Adoption of more holistic measures of well-being that go beyond psychological well-being may help to shift the focus from health deficiencies to health and well-being promotion.
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http://dx.doi.org/10.3389/fpsyg.2021.652209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8097094PMC
April 2021

Tumor volume improves preoperative differentiation of prolactinomas and nonfunctioning pituitary adenomas.

Endocrine 2021 May 8. Epub 2021 May 8.

Division of Endocrinology, Diabetes and Metabolism, NYU Langone Medical Center/ Bellevue Hospital Center, 550 1st Avenue, New York, NY, 10016, USA.

Purpose: Both prolactinomas and nonfunctioning adenomas (NFAs) can present with hyperprolactinemia. Distinguishing them is critical because prolactinomas are effectively managed with dopamine agonists, whereas compressive NFAs are treated surgically. Current guidelines rely only on serum prolactin (PRL) levels, which are neither sensitive nor specific enough. Recent studies suggest that accounting for tumor volume may improve diagnosis. The objective of this study is to investigate the diagnostic utility of PRL, tumor volume, and imaging features in differentiating prolactinoma and NFA.

Methods: Adult patients with pathologically confirmed prolactinoma (n = 21) or NFA with hyperprolactinemia (n = 58) between 2013 and 2020 were retrospectively identified. Diagnostic performance of clinical and imaging variables was analyzed using receiver-operating characteristic curves to calculate area under the curve (AUC).

Results: Tumor volume and PRL positively correlated for prolactinoma (r = 0.4839, p = 0.0263) but not for NFA (r = 0.0421, p = 0.7536). PRL distinguished prolactinomas from NFAs with an AUC of 0.8892 (p < 0.0001) and optimal cut-off value of 62.45 ng/ml, yielding a sensitivity of 85.71% and specificity of 94.83%. The ratio of PRL to tumor volume had an AUC of 0.9647 (p < 0.0001) and optimal cut-off value of 21.62 (ng/ml)/cm with sensitivity of 100% and specificity of 82.76%. Binary logistic regression found that PRL was a significant positive predictor of prolactinoma diagnosis, whereas tumor volume, presence of CSI not previously defined, and T2 hyperintensity were significant negative predictors. The regression model had an AUC of 0.9915 (p < 0.0001).

Conclusions: Consideration of tumor volume improves differentiation between prolactinomas and NFAs, which in turn leads to effective management.
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http://dx.doi.org/10.1007/s12020-021-02744-8DOI Listing
May 2021

Not all symptoms of alcohol dependence are developmentally equivalent: Implications for the false-positives problem.

Psychol Addict Behav 2021 Jun 6;35(4):444-457. Epub 2021 May 6.

Department of Psychological Sciences.

Objective: Recent studies have examined the extent to which alcohol dependence (AD) criteria prospectively predict the course of AD. Critically, these studies have lacked a developmental perspective. However, the differential performance of criteria by age might indicate overendorsement in younger individuals. The current study examined AD criteria in terms of persistence and prediction of AD course and alcohol use by age in order to identify criteria that are likely to be overly endorsed by younger individuals.

Method: The current study used longitudinal data from the National Epidemiologic Survey on Alcohol and Related Conditions to depict age differences in rates of new onset, recurrence, and persistence for each AD criterion, thereby showing how these three factors contribute to the overall age-prevalence curve of each criterion. Additionally, we tested age moderation of the predictive association between each criterion at baseline and new onset, recurrence, and persistence of syndromal AD.

Results: Some criteria (particularly, persistent desire or unsuccessful efforts to cut down or control drinking, and drinking despite physical/psychological problems) are both less persistent and less predictive of AD course among younger adults compared to older adults.

Conclusions: These findings raise the possibility of elevated rates of false-positive AD among younger adults and suggest ways to improve the assessment of AD criteria. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/adb0000723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184633PMC
June 2021

MET alterations and their impact on the future of non-small cell lung cancer (NSCLC) targeted therapies.

Expert Opin Ther Targets 2021 Apr 13;25(4):249-268. Epub 2021 Jun 13.

Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.

: The gene and its pathway normally plays a crucial role in cell homeostasis, motility, and apoptosis. However, when the gene is altered, there is an imbalance toward cell proliferation and invasion commonly seen in numerous different types of cancers. The heterogeneous group of alterations that includes amplification, exon 14 skipping mutation, and fusions has been difficult to diagnose and treat. Currently, treatments are focused on tyrosine kinase inhibitors but now there is emerging data on novel MET-targeted therapies including monoclonal antibodies and antibody-drug conjugates that have emerged.: We introduce new emerging data on alterations in non-small cell lung cancer (NSCLC) that has contributed to advances in MET targeted therapeutics. We offer our perspective and examine new information on the mechanisms of the alterations in this review.: Given the trends currently involving the targeting of MET altered malignancies, there will most likely be a continued rapid expansion of testing, novel tyrosine kinase inhibitors and potent antibody approaches. Combination treatments will be necessary to optimize management of advanced and early disease.
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http://dx.doi.org/10.1080/14728222.2021.1925648DOI Listing
April 2021

Dietary Policies and Programs: Moving Beyond Efficacy and Into "Real-World" Settings.

Health Equity 2021 19;5(1):194-202. Epub 2021 Apr 19.

Department of Population Health, NYU School of Medicine, New York, New York, USA.

Dietary behaviors are key modifiable risk factors in averting cardiovascular disease (CVD), the leading cause of morbidity, mortality, and disability in the United States. Before investing in adoption and implementation, community-based organizations, public health practitioners, and policymakers-often working with limited resources-need to compare the population health impacts of different food policies and programs to determine priorities, build capacity, and maximize resources. Numerous reports, reviews, and policy briefs have synthesized across evidence-based policies and programs to make recommendations, but few have made a deep acknowledgment that dietary policies and programs are not implemented in a vacuum, and that "real-world" settings are complex, multifaceted and dynamic. A narrative review was conducted of currently recommended evidence-based approaches to improving dietary behaviors, to describe and characterize applied and practical factors for consideration when adopting and implementing these dietary policies and programs across diverse settings. From the narrative review, six key considerations emerged to guide community-based organizations, public health practitioners, and policymakers on moving from the evidence base, toward implementation in local and community settings. Considerations of "real-world" contextual factors are necessary and important when adopting and selecting evidence-based policies and programs to improve dietary behaviors and ultimately improve CVD outcomes. Promising approaches include those that apply community-partnered research and systems science to examine the equitable implementation of evidence-based dietary policies and programs.
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http://dx.doi.org/10.1089/heq.2020.0050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8080927PMC
April 2021

Kidney cancer management 3.0: can artificial intelligence make us better?

Curr Opin Urol 2021 Jul;31(4):409-415

Division of Urologic Oncology.

Purpose Of Review: Artificial intelligence holds tremendous potential for disrupting clinical medicine. Here we review the current role of artificial intelligence in the kidney cancer space.

Recent Findings: Machine learning and deep learning algorithms have been developed using information extracted from radiomic, histopathologic, and genomic datasets of patients with renal masses.

Summary: Although artificial intelligence applications in medicine are still in their infancy, they already hold immediate promise to improve accuracy of renal mass characterization, grade, and prognostication. As algorithms become more robust and generalizable, artificial intelligence is poised to significantly disrupt kidney cancer care.
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http://dx.doi.org/10.1097/MOU.0000000000000881DOI Listing
July 2021

Parenteral nutrition in emergency surgery: A multicentre cross-sectional study.

J Hum Nutr Diet 2021 Apr 8. Epub 2021 Apr 8.

Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK.

Background: Emergency general surgical patients are inherently at high risk of malnutrition. Early decision-making with implementation is fundamental to patient recovery. For many patients, parenteral nutrition (PN) is the only feeding option available. The present study assessed the timing and outcomes of this decision-making process.

Methods: A sample of at least 10 consecutive adult patients admitted as a general surgical emergency to eight UK hospitals over 1 year who had received PN was identified. Patient demographics, basic descriptors and nutritional data were captured. Process measures regarding dates decisions were made or activities completed were extracted from records, as were outcome measures including PN complications. Six time frames examining the process of PN delivery were analysed. Associations between categorical and binary variables were investigated with a chi-squared test with significance determined as p < 0.05.

Results: In total, 125 patients were included. Intestinal obstruction was the most common diagnosis with 59% of all patients deemed high risk on nutritional assessment at admission. Median time to decision for PN was 5 days following admission (n = 122, interquartile range = 7). Patients received PN for a mean of 11 days. Eighty-five percent of patients developed a complication, with a phosphate abnormality being the most commonly reported (54%). Only altered blood glucose levels appeared to correlate with a delay in starting PN (p < 0.01).

Conclusions: The present study shows there are delays in the decision to use PN in the acutely ill surgical patient. Once initiated, the pathway is relatively short. There are high rates of electrolyte abnormalities in this population.
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http://dx.doi.org/10.1111/jhn.12902DOI Listing
April 2021

A Multi-institutional Experience with Robotic Vesicovaginal and Ureterovaginal Fistula Repair After Iatrogenic Injury.

J Endourol 2021 Mar 31. Epub 2021 Mar 31.

Lewis Katz School of Medicine at Temple University, 12314, Urology, Philadelphia, Pennsylvania, United States;

Objectives: To describe our multi-institutional experience with robotic repair of iatrogenic urogynecologic fistulae (UGF), including vesicovaginal fistulae (VVF) and ureterovaginal fistulae (UVF).

Methods: We performed a retrospective review identifying patients who underwent robotic repair of vesicovaginal and ureterovaginal fistulae between January 2010 and May 2019. All patients failed conservative management with foley catheter or upper tract drainage (ureteral stent and/or nephrostomy tube), respectively. Patient demographics and perioperative outcomes were analyzed. Success was defined as no vaginal leakage of urine postoperatively, in the absence of drains, catheters or stents.

Results: Of 34 patients, 22/34 (65%) had VVF and 12/34 (35%) had UVF repair. VVF etiology included radiation (1/22, 4.5%) and surgery (21/22, 95.5%). 4/22 (18%) had undergone prior repair attempt. Median console time was 187 minutes (interquartile range (IQR): 151-219), estimated blood loss (EBL) was 50 milliliters (mL) (IQR: 50-93), and median length of stay (LOS) was 1 day (IQR: 1-2). 2/22 (9%) patients had a postoperative complication. At mean follow-up of 28.9 months, 20/22 (91%) VVF cases were clinically successful. UVF etiology was gynecologic surgery in all cases; 8/12 (67%) were left-sided, 4/12 (33%) were right-sided. None were repeat repairs. 2/12 (17%) underwent ureteroureterostomy, 10/12 (83%) had reimplant. Median console time was 160 minutes (IQR: 133-196), EBL was 50 mL (IQR: 50-112) and LOS was 1 day (IQR: 1-1). No complications were encountered. At mean follow-up of 29.3 months, 100% of UVF repairs were successful.

Conclusions: Robotic repair of iatrogenic UGF may be successfully performed with low complication rates by experienced urologic surgeons.
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http://dx.doi.org/10.1089/end.2020.0993DOI Listing
March 2021

Opioid Free Ureteroscopy: What is the True Failure Rate?

Urology 2021 Mar 26. Epub 2021 Mar 26.

Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.

Objective: To determine the true failure rate of opioid free ureteroscopy (OF-URS) and rates of new-persistent opioid use utilizing a national prescription drug monitoring program.

Material And Methods: We identified 239 patients utilizing our retrospective stone database who underwent OF-URS from Februrary 2018-March 2020. In Feb 2018, we initiated a OF-URS pathway (diclofenac, tamsulosin, acetaminophen, pyridium and oxybutynin). Patients who had a contraindication to NSAIDs were excluded from primary analyses. A prescription drug monitoring program was then utilized to determine the number of patients who failed OF-URS (defined as receipt of an opioid within 31 days of surgery) as well as rates of new-persistent opioid use (defined as receipt of opioid 91-180 days after surgery). All statistical analyses were performed using SAS 9.4. Tests were 2-sided and statistical significance was set at P<0.05.

Results: We found a OF-URS failure rate of 16.6% and 14.0% in the total and opioid naïve cohorts, respectively. Rates of new-persistent opioid use were 0.9% and 1.2%, respectively (lower than published expected rate of ~6% after URS with postoperative opioids). 91% of patients obtained opioid from alternative sources. Uni/multivariate analyses were performed for both cohorts. In the total cohort, benzodiazepine users had a lower risk of OF-URS failure on multivariate analysis. No variables were associated with OF-URS failure in the opioid naïve cohort.

Conclusion: The true failure rate of OF-URS is higher than previously thought at 16.6% and 14.0%. However, efforts to reduce opioid prescriptions with OF-URS pathways have successfully reduced new-persistent opioid use.
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http://dx.doi.org/10.1016/j.urology.2021.03.011DOI Listing
March 2021

Investigating the relationships between unfavourable habitual sleep and metabolomic traits: evidence from multi-cohort multivariable regression and Mendelian randomization analyses.

BMC Med 2021 Mar 18;19(1):69. Epub 2021 Mar 18.

Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands.

Background: Sleep traits are associated with cardiometabolic disease risk, with evidence from Mendelian randomization (MR) suggesting that insomnia symptoms and shorter sleep duration increase coronary artery disease risk. We combined adjusted multivariable regression (AMV) and MR analyses of phenotypes of unfavourable sleep on 113 metabolomic traits to investigate possible biochemical mechanisms linking sleep to cardiovascular disease.

Methods: We used AMV (N = 17,368) combined with two-sample MR (N = 38,618) to examine effects of self-reported insomnia symptoms, total habitual sleep duration, and chronotype on 113 metabolomic traits. The AMV analyses were conducted on data from 10 cohorts of mostly Europeans, adjusted for age, sex, and body mass index. For the MR analyses, we used summary results from published European-ancestry genome-wide association studies of self-reported sleep traits and of nuclear magnetic resonance (NMR) serum metabolites. We used the inverse-variance weighted (IVW) method and complemented this with sensitivity analyses to assess MR assumptions.

Results: We found consistent evidence from AMV and MR analyses for associations of usual vs. sometimes/rare/never insomnia symptoms with lower citrate (- 0.08 standard deviation (SD)[95% confidence interval (CI) - 0.12, - 0.03] in AMV and - 0.03SD [- 0.07, - 0.003] in MR), higher glycoprotein acetyls (0.08SD [95% CI 0.03, 0.12] in AMV and 0.06SD [0.03, 0.10) in MR]), lower total very large HDL particles (- 0.04SD [- 0.08, 0.00] in AMV and - 0.05SD [- 0.09, - 0.02] in MR), and lower phospholipids in very large HDL particles (- 0.04SD [- 0.08, 0.002] in AMV and - 0.05SD [- 0.08, - 0.02] in MR). Longer total sleep duration associated with higher creatinine concentrations using both methods (0.02SD per 1 h [0.01, 0.03] in AMV and 0.15SD [0.02, 0.29] in MR) and with isoleucine in MR analyses (0.22SD [0.08, 0.35]). No consistent evidence was observed for effects of chronotype on metabolomic measures.

Conclusions: Whilst our results suggested that unfavourable sleep traits may not cause widespread metabolic disruption, some notable effects were observed. The evidence for possible effects of insomnia symptoms on glycoprotein acetyls and citrate and longer total sleep duration on creatinine and isoleucine might explain some of the effects, found in MR analyses of these sleep traits on coronary heart disease, which warrant further investigation.
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http://dx.doi.org/10.1186/s12916-021-01939-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7971964PMC
March 2021

Investing in the Future: A Role for Professional Societies to Prepare the Next Generation of Healthcare Leaders through Curriculum Development and Dissemination.

Clin Infect Dis 2021 Mar 17. Epub 2021 Mar 17.

Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, United States.

Professional societies serve many functions that benefit constituents, however, few professional societies have undertaken the development and dissemination of formal, national curricula to in order to train the future workforce while simultaneously addressing significant healthcare needs. The Infectious Diseases Society of America (IDSA) has developed two curricula for the specific purpose of training the next generation of clinicians in order to ensure the future infectious diseases (ID) workforce is optimally trained to lead antimicrobial stewardship programs; and equipped to meet the challenges of multidrug resistance, patient safety, and healthcare quality improvement. A core curriculum was developed to provide a foundation in antimicrobial stewardship for all ID fellows, regardless of career path. An advanced curriculum was developed for ID fellows specifically pursuing a career in antimicrobial stewardship. Both curricula will be broadly available in the summer of 2021 through the IDSA website.
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http://dx.doi.org/10.1093/cid/ciab244DOI Listing
March 2021

Sex differences in congestive markers in patients hospitalized for acute heart failure.

ESC Heart Fail 2021 Jun 11;8(3):1784-1795. Epub 2021 Mar 11.

Cardiovascular Division/Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Aims: We sought to examine sex differences in congestion in patients hospitalized for acute heart failure (AHF). Understanding congestive patterns in women and men with AHF may provide insights into sex differences in the presentation and prognosis of AHF patients.

Methods And Results: In a prospective, two-site study in adults hospitalized for AHF, four-zone lung ultrasound (LUS) was performed at the time of echocardiography at baseline (LUS1) and, in a subset, pre-discharge (LUS2). B-lines on LUS and echocardiographic images were analysed offline, blinded to clinical information and outcomes. Among 349 patients with LUS1 data (median age 74, 59% male, and 87% White), women had higher left ventricular ejection fraction (mean 43% vs. 36%, P < 0.001), higher tricuspid annular plane systolic excursion (mean 17 vs. 15 mm, P = 0.021), and higher measures of filling pressures (median E/e' 20 vs. 16, P < 0.001). B-line number on LUS1 (median 6 vs. 6, P = 0.69) and admission N-terminal pro-B-type natriuretic peptide levels (median 3932 vs. 3483 pg/mL, P = 0.77) were similar in women and men. In 121 patients with both LUS1 and LUS2 data, there was a similar and significant decrease in B-lines from baseline to discharge in both women and men. The risk of the composite 90 day outcome increased with higher B-line number on four-zone LUS2: unadjusted hazard ratio for each B-line tertile was 1.86 (95% confidence interval 1.08-3.20, P = 0.025) in women and 1.65 (95% confidence interval 1.03-2.64, P = 0.037) in men (interaction P = 0.72).

Conclusions: Among patients with AHF, echocardiographic markers differed between women and men at baseline, whereas B-line number on LUS did not. The dynamic changes in B-lines during a hospitalization for AHF were similar in women and men.
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http://dx.doi.org/10.1002/ehf2.13300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120385PMC
June 2021

Meta-analyses of Results From Randomized Outcome Trials Comparing Cardiovascular Effects of SGLT2is and GLP-1RAs in Asian Versus White Patients With and Without Type 2 Diabetes.

Diabetes Care 2021 May 11;44(5):1236-1241. Epub 2021 Mar 11.

Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K.

Background: Results of cardiovascular outcome trials (CVOTs) suggest Asians may derive greater benefit than Whites from newer classes of antihyperglycemic medications.

Purpose: To provide summary hazard ratio (HR) estimates for cardiovascular efficacy of sodium-glucose cotransporter 2 inhibitors (SGLT2is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) stratified by race (Asian vs. White).

Data Sources: A systematic review performed in PubMed from 1 January 2015 to 8 December 2020.

Study Selection: Randomized placebo-controlled CVOTs of SGLT2is and GLP-1RAs that reported HRs (95% CIs) for ) major adverse cardiovascular event (MACE) in patients with diabetes and ) cardiovascular (CV) death/hospitalization for heart failure (HHF) in patients with HF and reduced ejection fraction (HFrEF).

Data Extraction And Synthesis: HRs (95% CIs) for selected outcomes in Asians and Whites were extracted from each trial, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random-effects meta-analyses were performed to examine differences between the selected outcomes in Asians versus Whites.

Results: In four SGLT2i trials in type 2 diabetes, the MACE outcome HR (95% CI) in 3,298 Asians versus 20,258 Whites was 0.81 (0.57, 1.04) vs. 0.90 (0.80, 1.00), respectively ( = 0.46). In two SGLT2i trials in patients with HFrEF, the CV death/HHF outcome HR in 1,788 Asians versus 5,962 Whites was 0.60 (0.47, 0.74) vs. 0.82 (0.73, 0.92), respectively ( = 0.01). In six GLP-1RA trials, the MACE outcome HR in 4,195 Asians versus 37,530 Whites was 0.68 (0.53, 0.84) vs. 0.87 (0.81, 0.94), respectively ( = 0.03).

Limitations: Lack of individual patient-level data, relatively short duration of trial observation, and lack of granular categorization of race within broadly defined Asian subgroups.

Conclusions: Compared with Whites, Asians may derive greater CV death/HHF benefit from SGLT2is in patients with HFrEF, and MACE benefit from GLP-1RAs in patients with type 2 diabetes.
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http://dx.doi.org/10.2337/dc20-3007DOI Listing
May 2021

Cecal endometriosis presenting as a term intrauterine fetal demise and gastrointestinal hemorrhage: A case report.

Case Rep Womens Health 2021 Apr 20;30:e00301. Epub 2021 Feb 20.

Kaiser Permanente Fresno, USA.

Background: Of women diagnosed with endometriosis, 3.8-37% have bowel endometriosis. The cecum is the least common site for endometriotic implants affecting the bowel, accounting for only 3.6-6% of cases. We present a case of intrauterine fetal demise at term in which the patient was found to have gastrointestinal bleeding caused by endometriosis of the cecum.

Case: A 35-year-old woman, gravida 4, para 1, at 37 weeks and 3 days of gestation, without a known history of endometriosis but with two prior miscarriages, presented with severe anemia and intrauterine fetal demise. During delivery, melanotic stool was noted. Colonoscopic biopsy noted the source of bleeding to be a 2 cm endometriotic implant in the patient's cecum. Suppression therapy was started. Postpartum, the patient underwent laparoscopic cecectomy and pathology confirmed the diagnosis of endometriosis.

Conclusion: Hemorrhage from endometriotic implants may occur during pregnancy due to changes in the hormonal milieu. Bowel endometriosis may increase the risk of maternal hemorrhage during pregnancy, thereby increasing the risk of unfavorable pregnancy outcomes, including intrauterine fetal demise.
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http://dx.doi.org/10.1016/j.crwh.2021.e00301DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930353PMC
April 2021

Pharmacological-assisted Psychotherapy for Post-Traumatic Stress Disorder: a systematic review and meta-analysis.

Eur J Psychotraumatol 2021 Jan 15;12(1):1853379. Epub 2021 Jan 15.

Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, Wales, UK.

: Pharmacological-assisted psychotherapies, using conventional and novel drug agents, are increasingly being used both in clinical and experimental research settings, respectively. : To determine the efficacy of conventional and novel pharmacological-assisted psychotherapies in reducing PTSD symptom severity. : A systematic review and meta-analysis of randomised-controlled trials were undertaken; 21 studies were included. : MDMA-assisted therapy was found to statistically superior to active and inactive placebo-assisted therapy in reduction of PTSD symptoms (standardised mean difference -1.09, 95% CI -1.60 to -0.58). There was no evidence of superiority over placebo for any other intervention. : MDMA-assisted therapy demonstrated an impressive effect size; however, it is difficult to have confidence at this stage in this intervention due to the small numbers of participants included, and more research in this area is needed. There was no evidence to support the efficacy of any other drug-assisted interventions.
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http://dx.doi.org/10.1080/20008198.2020.1853379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7874936PMC
January 2021

Improving the LGBTQ2S+ cultural competency of healthcare trainees: advancing health professional education.

Can Med Educ J 2021 Feb 26;12(1):e7-e20. Epub 2021 Feb 26.

Gender and Health Promotion Studies Unit, School of Health and Human Performance, Dalhousie University, Nova Scotia, Canada.

Background: Lesbian, Gay, Bisexual, Trans, Queer, and Two-spirit (LGBTQ2S+) populations experience worse health outcomes compared to age-matched heterosexual and cisgender peers. Health professionals' deficient knowledge and negative attitudes can contribute to these inequities. Healthcare trainees report insufficient LGBTQS2+ cultural competence training.

Methods: In this prospective, mixed-methods pre-post design, Atlantic Canadian health students were tested on knowledge, attitudes and self-reported behaviours towards LGBTQ2S+ populations in healthcare settings. Assessment included psychometric measurements and clinical cases involving normative and non-normative fictional patients. Participants were randomised to intervention or control groups. The intervention consisted of three training sessions lead by LGBTQ2S+ experts and elders from the community. The control group continued with usual training. Full assessment was repeated after training. We also held focus group discussions with students and faculty.

Results: The intervention group significantly improved attitudes toward and knowledge of LGBTQ2S+ populations and changed relevant aspects of their performance in the simulated clinical situations. Focus groups identified key gaps in current local training.

Conclusions: Integrating specific training related to LGBTQ2S+ health within health professions programs is an important step toward improving these populations' accessibility to a competent, exhaustive and nurturing healthcare. Additional research on innovative means to expand and broaden the scope of our training is warranted.
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http://dx.doi.org/10.36834/cmej.67870DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7931472PMC
February 2021

Recommendations for the Rising Otolaryngology Residency Programs' Social Media Presence.

Laryngoscope 2021 06 4;131(6):E1816. Epub 2021 Mar 4.

Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A.

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http://dx.doi.org/10.1002/lary.29496DOI Listing
June 2021

Specificity of International Classification of Diseases codes for bronchopulmonary dysplasia: an investigation using electronic health record data and a large insurance database.

J Perinatol 2021 Apr 1;41(4):764-771. Epub 2021 Mar 1.

Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA.

Objective: International Classification of Diseases (ICD) codes in electronic health records (EHRs) are increasingly used for health services research, in spite of unknown diagnostic accuracy. The accuracy of ICD codes to identify bronchopulmonary dysplasia (BPD) is unknown.

Study Design: Retrospective cohort study in a single-center NICU (n = 166) to evaluate sensitivity and specificity of ICD-10 codes for the diagnosis of BPD. Analysis of large insurance claims database (n = 7887) to determine date of assignment of the code.

Results: The sensitivity of any BPD-related ICD codes ranged from 0.82 to 0.95, while the specificity ranged from 0.25 to 0.36. In a large national insurance database, the most common date of ICD-9 or ICD-10 code assignment was the day of birth, which is inconsistent with the clinical definition.

Conclusions: ICD codes registered for BPD are unlikely to accurately reflect the current clinical definition and should be interpreted with caution.
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http://dx.doi.org/10.1038/s41372-021-00965-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7917960PMC
April 2021

Patient decision-making and regret in pilonidal sinus surgery: a mixed-methods study.

Colorectal Dis 2021 Jun 29;23(6):1487-1498. Epub 2021 Mar 29.

Clinical Trials Research Unit, University of Sheffield, Sheffield, UK.

Aim: Little is known about optimal management strategies for pilonidal sinus disease (PSD). We conducted a mixed-methods study to understand why patients make, and sometimes regret, treatment decisions.

Method: We conducted longitudinal semi-structured interviews at the time of surgery and 6 months later with 20 patients from 13 UK hospitals. Framework analysis was performed, and themes were mapped to (1) the coping in deliberation framework and (2) an acceptability framework. Results were triangulated with those from structured survey instruments evaluating shared decision-making (SDM, best = 9) at baseline and decision regret (DR, most regret = 100) at 6 months.

Results: Nine of 20 patients were not offered a choice of treatment, but this was not necessarily seen as negative (SDM median 4; range 2-4). Factors that influenced decision-making included previous experience and anticipated recovery time. Median (range) DR was 5 (0-50). Those with the highest DR (scores 40-50) were, paradoxically, also amongst the highest scores on SDM (scores 4). Burden of wound care and the disparity between anticipated and actual recovery time were the main reasons for decision regret.

Conclusion: To minimize regret about surgical decisions, people with PSD need better information about the burden of wound care and the risks of recurrence associated with different surgical approaches.
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http://dx.doi.org/10.1111/codi.15606DOI Listing
June 2021

Supporting patients whose first language is not English.

Authors:
Matthew Lee

Br J Nurs 2021 Feb;30(4):208

Lecturer in Nursing and Clinical Link Tutor, Faculty of Health Sciences and Wellbeing, University of Sunderland.

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http://dx.doi.org/10.12968/bjon.2021.30.4.208DOI Listing
February 2021

Ureteral Rest is Associated With Improved Outcomes in Patients Undergoing Robotic Ureteral Reconstruction of Proximal and Middle Ureteral Strictures.

Urology 2021 Jun 25;152:160-166. Epub 2021 Feb 25.

Lewis Katz School of Medicine at Temple University, Philadelphia, PA.

Objectives: To evaluate the effect of ureteral rest on outcomes of robotic ureteral reconstruction.

Methods: We retrospectively reviewed all patients who underwent robotic ureteral reconstruction of proximal and/or middle ureteral strictures in our multi-institutional database between 2/2012-03/2019 with ≥12 months follow-up. All patients were recommended to undergo ureteral rest, which we defined as the absence of hardware (ie. double-J stent or percutaneous nephroureteral tube) across a ureteral stricture ≥4 weeks prior to reconstruction. However, patients who refused percutaneous nephrostomy tube placement did not undergo ureteral rest. Perioperative outcomes were compared after grouping patients according to whether or not they underwent ureteral rest. Continuous and categorical variables were compared using Mann-Whitney U and 2-tailed chi-squared tests, respectively; P <.05 was considered significant.

Results: Of 234 total patients, 194 (82.9%) underwent ureteral rest and 40 (17.1%) did not undergo ureteral rest prior to ureteral reconstruction. Patients undergoing ureteral rest were associated with a higher success rate compared to those not undergoing ureteral rest (90.7% versus 77.5%, respectively; P = .027). Also, patients undergoing ureteral rest were associated with lower estimated blood loss (50 versus 75 milliliters, respectively; p<0.001) and less likely to undergo buccal mucosa graft ureteroplasty (20.1% versus 37.5%, respectively; p=0.023).

Conclusions: Implementing ureteral rest prior to ureteral reconstruction may allow for stricture maturation and is associated higher surgical success rates, lower estimated blood loss, and decreased utilization of buccal mucosa graft ureteroplasty.
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http://dx.doi.org/10.1016/j.urology.2021.01.058DOI Listing
June 2021

Protocol for a multi-centre observational and mixed methods pilot study to identify factors predictive of poor functional recovery after major gastrointestinal surgery and strategies to enhance uptake of perioperative optimization: Optimizing the care and treatment pathways for older patients facing major gastrointestinal surgery (OCTAGON).

Colorectal Dis 2021 Jun 22;23(6):1552-1561. Epub 2021 Mar 22.

University of Sheffield, Sheffield, UK.

Introduction: National datasets report large variations in outcomes from older people (≥65 years) between different UK surgical units. This implies that not all patients receive the same level of care or access to resources, such as rehabilitation or allied health professional input. This might impact functional decline.

Aims: Our aim is to evaluate the baseline status of older patients facing major gastrointestinal surgery and the impact of variation in perioperative assessment and provision of perioperative support on functional outcomes. Patients' experiences and views of assessment and optimization will be explored via integrated qualitative semi-structured interviews.

Methods And Analysis: This multi-centre, pilot cohort study will include patients ≥65 years presenting via both elective and emergency pathways at three to five South Yorkshire NHS hospitals (Clinical Trials registration NCT04545125). The primary outcome is functional recovery measured using the World Health Organization Disability Assessment Schedule 2.0 at 6 weeks post-operation. Secondary outcomes include feasibility, quality of life, length of stay and complication rate. An opportunistic sample size of 120 has been estimated and will inform the design of a future, adequately powered study. For the qualitative study, 20-30 semi-structured patient interviews will be undertaken with patients from the cohort study to explore experiences of assessment and optimization. Interviews will be digitally recorded, transcribed verbatim and analysed according to the framework approach.

Ethics And Dissemination: This study has been approved by the National Health Service Research Ethics Committee and is registered centrally with Health Research Authority. It has been adopted by the National Institute for Health Research Portfolio scheme. Dissemination will be via international and national surgical and geriatric conferences.
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http://dx.doi.org/10.1111/codi.15603DOI Listing
June 2021

Invasive versus medically managed acute coronary syndromes with prior bypass (CABG-ACS): insights into the registry versus randomised trial populations.

Open Heart 2021 02;8(1)

Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK

Background: Coronary artery bypass graft (CABG) patients are under-represented in acute coronary syndrome (ACS) trials. We compared characteristics and outcomes for patients who did and did not participate in a randomised trial of invasive versus non-invasive management (CABG-ACS).

Methods: ACS patients with prior CABG in four hospitals were randomised to invasive or non-invasive management. Non-randomised patients entered a registry. Primary efficacy (composite of all-cause mortality, rehospitalisation for refractory ischaemia/angina, myocardial infarction (MI), heart failure) and safety outcomes (composite of bleeding, stroke, procedure-related MI, worsening renal function) were independently adjudicated.

Results: Of 217 patients screened, 84 (39%) screenfailed, of whom 24 (29%) did not consent and 60 (71%) were ineligible. Of 133 (61%) eligible, 60 (mean±SD age, 71±9 years, 72% male) entered the trial and 73 (age, 72±10 years, 73% male) entered a registry (preferences: physician (79%), patient (38%), both (21%)).Compared with trial participants, registry patients had more valve disease, lower haemoglobin, worse New York Heart Association class and higher frailty.At baseline, invasive management was performed in 52% and 49% trial and registry patients, respectively, of whom 32% and 36% had percutaneous coronary intervention at baseline, respectively (p=0.800). After 2 years follow-up (694 (median, IQR 558-841) days), primary efficacy (43% trial vs 49% registry (HR 1.14, 95% CI 0.69 to 1.89)) and safety outcomes (28% trial vs 22% registry (HR 0.74, 95% CI 0.37 to 1.46)) were similar. EuroQol was lower in registry patients at 1 year.

Conclusions: Compared with trial participants, registry participants had excess morbidity, but longer-term outcomes were similar.

Trial Registration Number: NCT01895751.
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http://dx.doi.org/10.1136/openhrt-2020-001453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7919592PMC
February 2021

Evaluating the Cool Versus Not Cool Procedure via Telehealth.

Behav Anal Pract 2021 Feb 12:1-9. Epub 2021 Feb 12.

Autism Partnership Foundation, 200 Marina Dr., Seal Beach, CA 90740 USA.

Autistics/individuals diagnosed with autism spectrum disorder (ASD) commonly display qualitative impairments in social behavior that commonly result in the use of interventions directly targeting the development of social skills. The COVID-19 pandemic has highlighted the need for effective social skills interventions that can be delivered directly via telehealth. The Cool Versus Not Cool procedure has continually been documented as effective within the literature. However, its reported use has been limited to in-person delivery. The purpose of this study was to evaluate the effectiveness of the Cool Versus Not Cool procedure conducted via telehealth to teach three children diagnosed with ASD to change the conversation when someone is bored. The results of a nonconcurrent multiple-baseline across-participants design demonstrated that all three participants reached the mastery criterion in four to eight sessions. Responding generalized to another adult for two of the three participants, and all three participants maintained correct responding. Social validity measures indicated the skill was important to teach, the intervention was acceptable and effective, and the telehealth format was an acceptable replacement for in-person intervention for these three participants.
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http://dx.doi.org/10.1007/s40617-021-00553-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880643PMC
February 2021