Search

Many types of cancer have been found to be associated with being overweight or obese. Literature has demonstrated a reduction in cancer risk in patients who have undergone bariatric surgery. To compare the incidence and types of new cancer diagnoses, cumulative cancer incidence, cancer risk, and overall survival in patients with obesity who underwent bariatric surgery with that of those who did not. Community-based academic medical center. We retrospectively compared the rates and types of new incident cancers in a bariatric surgery cohort (Bariatric group) with those of a non-surgical cohort (Comparison group). The Comparison group was chosen from patients who had a clinic visit in our health system within 30 days of each bariatric surgical operation and matched on age, sex, and body mass index. Patients who had a cancer diagnosis prior to having bariatric surgery were excluded from the Bariatric group and patients who had a cancer diagnosis prior to the clinic visit on which they were matched were excluded from the Comparison group. Relative risk of cancer by type was calculated. Chi-square and Fisher exact tests were used for categorical data analysis, and Wilcoxon rank-sum for continuous data. The Kaplan Meier estimator with the log-rank test was used to compare overall survival between groups, while competing risks survival analysis with the Gray test for equality was used to compare cancer incidence in the Surgery group with that in the Comparison group. After matching, the Bariatric group had 1593 patients and the Comparison group had 2156. The Bariatric and Comparison groups had 82 and 222 new incident cancer cases, respectively (P <.001). The 10-year incidence of any new cancer in the Bariatric group was 6.5%, compared with an incidence of 12.1% in the Comparison group (P <.001). Relative risk of cancer in the Bariatric group was lower than that of the Comparison group, with the greatest differences in endometrial (88.8%), kidney (77.4%), thyroid (72.9%), and ductal carcinoma in situ (71.2%) cancers. The 10-year overall survival rate was higher in the Bariatric group than in the Comparison group, 93.3% versus 80.6%, respectively (P <.001). Bariatric surgery reduces the risk for developing cancer and offers survival advantage when compared with similar patients who do not undergo bariatric surgery. [ABSTRACT FROM AUTHOR]

The following position statement is issued by the American Society for Metabolic and Bariatric Surgery in response to inquiries made to the society by patients, physicians, society members, hospitals, health insurance payors, and others regarding one-anastomosis gastric bypass as a treatment for obesity and metabolic disease. This statement is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. The statement may be revised in the future as more information becomes available. [ABSTRACT FROM AUTHOR]

Primary care visits present an opportune time to assess behaviors that contribute to patient health. Smoking, alcohol use, and illicit drugs are routinely documented in electronic health records, but less is known about screening for E-cigarette use and the prevalence of E-cigarette use in primary care settings. Data include 134,931 adult patients who visited 1 of 41 primary care clinics within a 12-month period (June 1, 2021–June 1, 2022). Data on demographics, combustible tobacco, alcohol, illicit drug, and E-cigarette use were extracted from electronic medical records. Logistic regression was utilized to examine the variables associated with differential odds of being screened for E-cigarette use. Rates of E-cigarette screening (n =46,997; 34.8%) were significantly lower than that of tobacco (n =134,196; 99.5%), alcohol (n =129,766; 96.2%), and illicit drug (n =129,766; 92.6%) use. Of those assessed for E-cigarette use, 3.6% (n =1,669) reported current use. Of those with documented nicotine use (n =7,032), 17.2% (n =1,207) used mono E-cigarettes exclusively, 76.3% (n =5,364) used combustible tobacco exclusively, and 6.6% (n =461) reported dual use (both E-cigarette use and combustible tobacco use). Those who used combustible tobacco or illicit substances as well as younger patients were more likely to have been screened for E-cigarette use. Overall rates of E-cigarette screening were significantly lower than those of other substances. The use of combustible tobacco or illicit substances was associated with an increased likelihood of being screened. This finding may be because of the relatively recent proliferation of E-cigarettes, the recent addition of E-cigarette documentation to the electronic health record, or a lack of training on screening for E-cigarette use. [ABSTRACT FROM AUTHOR]

There are no randomized controlled trials to guide surgical margins for invasive head and neck (H&N) melanoma using conventional excision. Mohs micrographic surgery (MMS) has shown improved local recurrence rates and survival for invasive H&N melanomas. Determine local recurrence (LR), nodal recurrence, and distant recurrence rates, and disease specific survival for invasive melanoma of the H&N treated with MMS. A retrospective multicenter study of 785 cases of invasive H&N melanoma treated with MMS using frozen sections with melanoma antigen recognized by T-cells 1 immunohistochemical staining was performed to evaluate long-term outcomes over 12-years. 785 melanomas (thickness: 0.3 mm-8.5 mm) were treated with MMS. LR, nodal recurrence, and distant recurrence rates were 0.51% (4/785), 1.0% (8/785), and 1.1% (9/785) respectively. For T1, T2, T3, and T4 tumors LR was 0.16% (1/636), 1.18% (1/85), 2.22% (1/45), and 5.26% (1/19), respectively. Five and 10-year disease specific survival were 96.8% (95% CI 95.0% to 98.5%) and 93.4% (95% CI 88.5% to 98.3%). A nonrandomized retrospective study. MMS achieves significant improvements in LR compared to a meta-analysis of historical cohorts of patients treated with conventional excision. MMS should be considered an important surgical option for invasive H&N melanoma. [ABSTRACT FROM AUTHOR]

'Long COVID' affects nearly one in five adults who have had coronavirus disease 2019 (COVID-19), yet the mechanisms underlying this disorder remain poorly understood. In a new study, Cheong et al. show that the epigenetic and transcriptional state of myeloid immune cells and their progenitors are durably altered in patients following severe COVID-19. 'Long COVID' affects nearly one in five adults who have had coronavirus 2019 (COVID-19), yet the mechanisms underlying this disorder remain poorly understood. In a new study, Cheong et al. show that the epigenetic and transcriptional state of myeloid immune cells and their progenitors are durably altered in patients following severe COVID-19. [ABSTRACT FROM AUTHOR]

Syndromal classification has failed to produce a progressive science of case conceptualization for mental and behavioral health issues. An idiographic application of processes of change can provide a viable empirical functional analytic alternative if it could be linked to an idionomic approach , modeling idiographic effects first, and retaining nomothetic findings if they improve idiographic fit. Method: The present study examined this possibility by using the Process-Based Assessment Tool (PBAT), a new assessment tool linked to the Extended Evolutionary Meta-Model (EEMM) of Process-Based Therapy. The PBAT and items assessing common clinical outcomes were assessed repeatedly in 50 individuals in an experience sampling format over a 35 day period yielding at least 60 measurement occasions per person. These data were then analyzed in an idionomic fashion using Group Iterative Multiple Model Estimation (GIMME). Results: Analyses showed that the PBAT related to common clinical outcomes for virtually all participants in the individual complex networks identified by GIMME. Data showed that relationships had to be studied using an idionomic approach because participants' responses violated the ergodic assumptions underlying classical normative statistics. No overall group patterns were found. Subgroup relations did emerge for three common outcomes (sadness, anxiety, and life satisfaction) but most process to outcome relationships were idiographic. Idiographic networks were interpretable, however, using the broadened psychological flexibility approach of the EEMM. Conclusion: Idionomic network analysis of processes of change may provide a replicable form of empirical functional analysis and process-based case conceptualization. • Empirical forms of functional analysis could lead to effective case conceptualization. • Idionomic networks linked to processes of change represents possible approach. • Processes of change and common outcomes were assessed repeatedly over a month. • 45 individuals were analyzed using idionomic statistical procedures. • Processes of change related to outcomes in a coherent way for most participants. [ABSTRACT FROM AUTHOR]

Impulsivity undergoes a normative developmental trajectory from childhood to adulthood and is thought to be driven by maturation of brain structure. However, few large-scale studies have assessed associations between impulsivity, brain structure, and genetic susceptibility in children. In 9112 children ages 9–10 from the ABCD study, we explored relationships among impulsivity (UPPS-P impulsive behavior scale; delay discounting), brain structure (cortical thickness (CT), cortical volume (CV), and cortical area (CA)), and polygenic scores for externalizing behavior (PGS EXT). Both higher UPPS-P total scores and more severe delay-discounting had widespread, low-magnitude associations with smaller CA in frontal and temporal regions. No associations were seen between impulsivity and CV or CT. Additionally, higher PGS EXT was associated with both higher UPPS-P scores and with smaller CA and CV in frontal and temporal regions, but in non-overlapping cortical regions, underscoring the complex interplay between genetics and brain structure in influencing impulsivity. These findings indicate that, within large-scale population data, CA is significantly yet weakly associated with each of these impulsivity measures and with polygenic risk for externalizing behaviors, but in distinct brain regions. Future work should longitudinally assess these associations through adolescence, and examine associated functional outcomes, such as future substance use and psychopathology. [ABSTRACT FROM AUTHOR]

Research has been conducted on the interferon transcriptional induction requiring tyrosine and serine phosphorylation of signal transducers and activators of transcription (STAT) factors. The arginine methylation of STAT1 by protein arginine methyl-transferase as a requirement for the IFN(alpha)/beta-induced transcription has been carried out and the results are reported.

Background: The efficacy of Mohs micrographic surgery (MMS) in treating cutaneous squamous cell carcinoma has been demonstrated. The cost effectiveness of MMS has rarely been studied to support the perceived higher cost.Objective: Perform a cost-effectiveness analysis to determine whether MMS is cost effective over wide local excision (WLE) for Brigham and Women's Hospital tumor stage T2a cutaneous squamous cell carcinoma over a 5-year period.Methods: A Markov model with a 5-year time horizon was created using variables from published data. Costs in United States dollars and quality-adjusted life-years (QALY) were calculated.Results: MMS was $333.83 less expensive ($4365.57 [95% CI, $3664.68-$6901.66] vs $4699.41 [95% CI, $3782.94-$10,019.31]) than WLE. MMS gained 2.22 weeks of perfect health (3.776 QALY [95% CI, 3.774-3.777] for MMS and 3.733 QALY [95% CI, 3.728-3.777]) over 5 years. The incremental cost-effectiveness ratio was -$7,822.19. MMS had a 99.9% probability of being more cost effective than WLE. Annualized savings of choosing MMS over WLE would be $200 million and over 25,000 QALY. MMS could cost 3.1 times its current rate and remain cost effective.Limitations: Relied on data from external retrospective sources.Conclusion: MMS is less costly and more effective than WLE and should be strongly considered for stage T2a cSCC, given improvements in costs and QALY. [ABSTRACT FROM AUTHOR]

Fungi cause diseases in a variety of marine animal hosts. After a thorough review of published literature, we identified 225 fungal species causing infections of 193 animal species, for a total of 357 combinations of pathogenic fungi and marine animal hosts. Among the 193 animal host species, Chordata (100 species, 51.8 %) and Arthropoda (68 species, 35.2 %) were discovered to be the most frequently reported hosts of fungal pathogens. Microsporidia (111 species, 49.3 %) constitutes over half of the described pathogenic fungal species of marine animals, followed by Ascomycota (85 species, 37.8 %), Mucoromycota (22 species, 9.8 %), Basidiomycota (6 species, 2.7 %) and Chytridiomycota (1 species, 0.4 %). Microsporidia primarily parasitize marine arthropods and Teleostei fish, while Basidiomycota are primarily known to cause respiratory diseases of marine mammals. Ascomycota has a diverse host range, from mammals, fish, crustaceans, soft corals and sea turtle. Few Mucoromycota and Chytridiomycota were reported to infect marine animals. Fungal diseases documented in this review likely represent a fraction of fungal diseases in the ocean, where it was estimated to be inhabited by 2.15 million animal species. Intensification of aquaculture practices, global warming and marine pollution may increase fungal disease outbreak of marine animals. All the topics mentioned above will be discussed in greater details in this review. • 225 fungal species cause infections of 193 marine animal species. • Chordata and Arthropoda are the main reported hosts of fungal pathogens. • Microsporidia is the major group of pathogenic fungi of marine animals. • Ascomycota has a diverse marine animal host range. • Few Mucoromycota and Chytridiomycota infect marine animals. [ABSTRACT FROM AUTHOR]

Osteochondral defects present a unique clinical challenge due to their combination of phenotypically distinct cartilage and bone, which require specific, stratified biochemical cues for tissue regeneration. Furthermore, the articular cartilage exhibits significantly worse regeneration than bone due to its largely acellular and avascular nature, prompting significant demand for regenerative therapies. To address these clinical challenges, we have developed a bilayered, modular hydrogel system that enables the click functionalization of cartilage- and bone-specific biochemical cues to each layer. In this system, the crosslinker poly(glycolic acid)-poly(ethylene glycol)-poly(glycolic acid)-di(but-2-yne-1,4-dithiol) (PdBT) was click conjugated with either a cartilage- or bone-specific peptide sequence of interest, and then mixed with a suspension of thermoresponsive polymer and mesenchymal stem cells (MSCs) to generate tissue-specific, cell-encapsulated hydrogel layers targeting the cartilage or bone. We implanted bilayered hydrogels in rabbit femoral condyle defects and investigated the effects of tissue-specific peptide presentation and cell encapsulation on osteochondral tissue repair. After 12 weeks implantation, hydrogels with a chondrogenic peptide sequence produced higher histological measures of overall defect filling, cartilage surface regularity, glycosaminoglycan (GAG)/cell content of neocartilage and adjacent cartilage, and bone filling and bonding compared to non-chondrogenic hydrogels. Furthermore, MSC encapsulation promoted greater histological measures of overall defect filling, cartilage thickness, GAG/cell content of neocartilage, and bone filling. Our results establish the utility of this click functionalized hydrogel system for in vivo repair of the osteochondral unit. Osteochondral repair requires mimicry of both cartilage- and bone-specific biochemical cues, which are highly distinct. While traditional constructs for osteochondral repair have mimicked gross compositional differences between the cartilage and bone in mineral content, mechanical properties, proteins, or cell types, few constructs have recapitulated the specific biochemical cues responsible for the differential development of cartilage and bone. In this study, click biofunctionalized, bilayered hydrogels produced stratified presentation of developmentally inspired peptide sequences for chondrogenesis and osteogenesis. This work represents, to the authors' knowledge, the first application of bioconjugation chemistry for the simultaneous repair of bone and cartilage tissue. The conjugation of tissue-specific peptide sequences successfully promoted development of both cartilage and bone tissues in vivo. [Display omitted] [ABSTRACT FROM AUTHOR]

The Georgia Coast of the eastern United States boasts some of the largest and spatially complex Late Archaic sites in North America, with the most famous of these being shell rings. The shell ring village phenomenon and its larger ceremonial landscapes did not, however, last throughout the Late Archaic. Climate shifts that led to local relative sea level change in the area at around 3800 cal. BP appears to have resulted in conditions that suppressed shellfish productivity and ultimately led to the uneven abandonment of shell ring sites. Our understanding of these changes along the Georgia Coast is limited by the fact that much of the research focuses exclusively on large shell midden sites. Investigations at several large terminal Late Archaic sites demonstrate continuity in the size of these occupations compared to earlier Late Archaic sites (i.e., shell rings), demonstrating a socio-ecological resiliency in these small-scale societies. We argue that, contrary to narratives of collapsing socio-ecological systems, the terminal Late Archaic was a time when displaced communities coalesced and forged new community bonds in the wake of a shifting resource base. [ABSTRACT FROM AUTHOR]

Background: Information about the frequency and timing of subsequent cutaneous squamous cell carcinoma (cSCC), along with associated risk factors, is limited. However, this information is crucial to guide follow-up care for these patients.Objective: To evaluate the risk and timing of subsequent cSCC in patients who presented with an initial diagnosis of cSCC.Methods: Retrospective review of an institutional review board-approved, single-institution registry of invasive cSCC. All patients had at least 2 primary cSCCs diagnosed on 2 separate dates 2 months apart.Results: A total of 299 primary cSCCs were included. At 6 months from initial cSCC diagnosis, 18.06% (n = 54) of patients developed subsequent cSCC; at 1 year, 31.77% (n = 94); at 3 years, 67.56% (n = 202); and at 5 years, 87.96% (n = 263) developed subsequent cSCC. Risk factors associated with subsequent cSCC include age at initial diagnosis (hazard ratio [HR], 1.02; 95% confidence interval, 1.004-1.027; P = .008), T2 stage (HR, 1.66; 95% CI, 1.07-2.57; P = .025), and poor tumor grade. Tumor grades well, moderate, and unknown have HRs of 0.21 (P < .001), 0.16 (P .001), and 0.25 (P = .001), respectively.Conclusions: Of patients who develop subsequent cSCC, 18.06% do so within 6 months, and 31.77% do so within 1 year of initial cSCC diagnosis. Patients with advanced age, poor histologic differentiation, and American Joint Committee on Cancer T2 stage are at highest risk. Close clinical follow-up after the initial diagnosis is recommended. [ABSTRACT FROM AUTHOR]

To compare clinical outcomes following arthroscopic superior capsule reconstruction (SCR) using a dermal allograft (DA) with reverse total shoulder arthroplasty (RTSA) when used to treat irreparable posterosuperior rotator cuff tears without glenohumeral osteoarthritis (GHOA) in patients younger than 70 years. In this case-control study, patients who underwent SCR or RTSA for the treatment of irreparable posterosuperior rotator cuff tears, who were younger than 70 years at the time of surgery, and who were at least 2 years out of surgery were included. Clinical outcomes were assessed using the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Single Assessment Numerical Evaluation (SANE), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores and the 12-Item Short Form Health Survey (SF-12). Return to sports and patient satisfaction along with clinical failures (recurrent pain or persistent pain or loss of function), revisions, and complications were reported. Two-year follow-up was obtained on 22/22 patients (100%) in the SCR group and 29/33 patients (88%) in the RTSA group. Group differences were significant for age (SCR mean, 57 ± 6.6 years, vs. RTSA mean, 63 ± 4.9 years; P <.001) and follow-up interval (SCR mean, 2.1 years, vs. RTSA mean, 2.9 years; P =.001). Preoperative outcome scores showed no significant differences (all P >.05) between groups. No significant differences in postoperative outcome scores were detected (P >.05) between SCR and RTSA: the mean ASES score was 82.6 ± 15.5 vs. 79.3 ± 21.4, mean SANE score was 71.4 ± 24.5 vs. 75.4 ± 23.3, mean QuickDASH score was 16.2 ± 16.9 vs. 25.3 ± 21.0, and mean SF-12 was 47.7 ± 8.8 vs. 46.9 ± 10.4. No significant differences in return-to-sport responses were noticed between groups at baseline or postoperatively (P =.585, P =.758). One SCR was revised at 1.2 years with revision SCR and 1 RTSA had the glenoid component revised day 1 postoperatively for instability. Both patient groups achieved successful clinical outcomes. SCR using DA results in similar postoperative functional outcomes in a younger patient population when compared to RTSA for the treatment of irreparable posterosuperior rotator cuff tears, without GHOA, at short-term follow-up. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this meta-analysis and systematic review was to critically evaluate the biomechanical outcomes of different fixation constructs for a variety of biceps tenodesis techniques in cadaveric models based on both type of fixation and location.Methods: A PROSPERO-registered systematic review (CCRD42018109243) of the current literature was conducted with the terms "long head of biceps" AND "tenodesis" AND "biomechanics" and numerous variations thereof in the PubMed, Embase, and Cochrane databases, yielding 1,460 abstracts. After screening by eligibility criteria, 18 full-text articles were included. The individual biomechanical factors evaluated included ultimate load to failure (in newtons), stiffness (in newtons per millimeter), and cyclic displacement (in millimeters). After reviewing the included literature, we performed a quality analysis of the studies (Quality Appraisal for Cadaveric Studies scale score) and a meta-analysis comparing raw mean differences in data between the suprapectoral and subpectoral fixation location groups, as well as between the fixation construct groups.Results: Among the 18 included studies, 347 cadaveric specimens were evaluated for ultimate load to failure, stiffness, and cyclic displacement when comparing both location (suprapectoral vs subpectoral) and tenodesis fixation type (interference screw vs cortical button, suture anchor, or all-soft-tissue techniques). Interference screw fixation showed significantly greater mean stiffness by 8.0 N/mm (P = .013) compared with the other grouped techniques but did not show significant differences when evaluated for ultimate load to failure and cyclic displacement (P = .28 and P = .18, respectively). Additionally, no difference in construct strength was seen when comparing the fixation strength of suprapectoral versus subpectoral techniques for stiffness, ultimate load to failure, and cyclic loading (P = .47, P = .053, and P = .13, respectively).Conclusions: In this meta-analysis, no significant biomechanical differences were found when the results were stratified by specific surgical technique (interference screw vs other tenodesis techniques) and location (suprapectoral vs subpectoral biceps tenodesis).Clinical Relevance: As a result of this study, when biomechanically evaluating specific tenodesis constructs, the individual clinician has the liberty of choosing the fixation technique based on his or her preference and knowledge of shortcomings of each type of fixation construct. [ABSTRACT FROM AUTHOR]