JMIRx med最新文献

{"title":"The Impact of Rural Alimentation on the Motivation and Retention of Indigenous Community Health Workers in India: A Qualitative Study.","authors":"Ajit Kerketta, Raghavendra A N","doi":"10.2196/48346","DOIUrl":"https://doi.org/10.2196/48346","url":null,"abstract":"<p><strong>Background: </strong>Rural health care delivery remains a global challenge and India is no exception, particularly in regions with Indigenous populations such as the state of Jharkhand. The Community Health Centres in Jharkhand, India, are staffed by Indigenous workers who play a crucial role in bridging the health care gap. However, their motivation and retention in these challenging areas are often influenced by a complex mix of sociocultural and environmental factors. One such significant but understudied influencing factor is alimentation, or nutrition, in rural settings. Previous studies have identified several motivators, including community ties, cultural alignment, job satisfaction, and financial incentives. However, the role of alimentation in their motivation and retention in rural areas has not been sufficiently explored.</p><p><strong>Objective: </strong>This study aims to explore how the strong bond with locally produced food products impacts the retention of Indigenous community health workers (CHWs) in Jharkhand, India, and shed light on a crucial aspect of rural health care workforce sustainability.</p><p><strong>Methods: </strong>This study adopted a phenomenological research design to explore the lived experiences and perspectives of Indigenous CHWs in Jharkhand. A purposive sampling method was used to select CHWs who had worked in rural areas for at least five years. Data were collected through semistructured interviews, focusing on the participants' experiences of rural alimentation and how it influences their motivation and retention for rural health care. The interviews were audio recorded, transcribed, and analyzed using thematic analysis to identify common themes and patterns in their experiences related to nutrition and retention.</p><p><strong>Results: </strong>The study revealed that rural alimentation plays a significant role in both the motivation and retention of CHWs in Jharkhand. CHWs who experienced consistent access to local food reported higher job satisfaction, better physical well-being, and a stronger commitment to their roles. It has also been perceived that consuming nutrient-dense food products decreases the risk of chronic illness among rural populations. Additionally, community support systems related to alimentation were found to be crucial in maintaining motivation, with many CHWs emphasizing the importance of local food availability and cultural ties. The findings suggest that improving access to organic nutrition can positively influence the retention of CHWs in rural areas.</p><p><strong>Conclusions: </strong>Indigenous communities have unique food habits and preferences deeply rooted in agriculture and arboriculture. Their traditional eating practices are integral to their rich cultural heritage, with significant social, symbolic, and spiritual importance. This study highlights the critical role of rural alimentation in motivating and retaining CHWs in rural Community Health Centres in J","PeriodicalId":73558,"journal":{"name":"JMIRx med","volume":"6 ","pages":"e48346"},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applications of Indocyanine Green in Breast Cancer for Sentinel Lymph Node Mapping: Protocol for a Scoping Review.","authors":"Feryal Kurdi, Yahya Kurdi, Igor Vladimirovich Reshetov","doi":"10.2196/66213","DOIUrl":"10.2196/66213","url":null,"abstract":"<p><strong>Intro: </strong>Breast cancer is the leading cause of morbidity and mortality worldwide. Accurate sentinel lymph node (SLN) mapping is crucial for staging and treatment planning in early-stage breast cancer. Indocyanine green (ICG) has emerged as a promising agent for fluorescence imaging in SLN mapping. However, comprehensive assessment of its clinical utility, including accuracy and adverse effects, remains limited. This scoping review aims to consolidate evidence on the use of ICG in breast cancer SLN mapping.</p><p><strong>Objective: </strong>The objective of this scoping review is to evaluate the current literature on the use of ICG in SLN mapping for patients with breast cancer. This review aims to assess the accuracy, efficacy, and safety of ICG in this context and to identify gaps in the existing research. The outcomes will contribute to the development of further research as part of a PhD project.</p><p><strong>Methods: </strong>Five electronic databases will be searched (PubMed, Embase, MEDLINE, Web of Science, and Scopus) using search strategies developed in consultation with an academic supervisor. The search strategy is set to human studies published in English within the last 11 years. All retrieved citations will be imported to Zotero and then uploaded to Covidence for the screening of titles, abstracts, and full text according to prespecified inclusion criteria. Patients with early-stage breast cancer (T1 and T2), selected T3 cases where the SLN biopsy is accurate, and those with clinically node-negative breast cancer will be included. The intervention criterion includes studies using ICG for SLN mapping and studies on the assessment of fluorescence imaging cameras. Citations meeting the inclusion criteria for full-text review will have their data extracted by 2 independent reviewers, with disagreements resolved by discussion. A data extraction tool will be developed to capture full details about the participants, concept, and context, and findings relevant to the scoping review will be summarized.</p><p><strong>Results: </strong>The preliminary search began in December 2023. As of September 2024, papers have been screened and data are currently being extracted. Out of the 2130 references initially imported, 126 studies met the inclusion criteria after screening. The scoping review is expected to be published in January 2025.</p><p><strong>Conclusions: </strong>Although ICG technology has been used for SLN mapping in patients with breast cancer, initial searches in 2022 revealed limited data on this technique's feasibility, safety, and effectiveness. At that time, preliminary search of Scopus, MEDLINE, Embase, and PubMed identified no current or forthcoming systematic reviews or scoping reviews on the topic. However, recent searches indicate a substantial increase in research and reviews, reflecting a growing interest and evidence in this area.</p>","PeriodicalId":73558,"journal":{"name":"JMIRx med","volume":"6 ","pages":"e66213"},"PeriodicalIF":0.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11728196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Weekly Community-Based Dance Training Over 8 Months on Depression and Blood Oxygen Level-Dependent Signals in the Subcallosal Cingulate Gyrus for People With Parkinson Disease: Observational Study.","authors":"Karolina A Bearss, Rebecca E Barnstaple, Rachel J Bar, Joseph F X DeSouza","doi":"10.2196/44426","DOIUrl":"10.2196/44426","url":null,"abstract":"<p><strong>Background: </strong>Dance has emerged as a complementary treatment that may promote adaptive neural plasticity while improving symptoms of Parkinson disease (PD), such as balance, gait, posture, and walking. Understanding brain changes that arise from participation in dance interventions is important as these neural plastic changes play an important role in protecting and healing the brain. Although dance has been shown to improve PD motor and nonmotor symptoms, the neural mechanisms underlying these changes, specifically depression and mood, remain elusive. Further, many side effects of PD drug treatments can be exacerbated or even induced by dopaminergic drugs, particularly depression and anxiety, making these nonmotor symptoms more noticeable throughout the progression of the disease.</p><p><strong>Objective: </strong>In this study, we focused on the impact of dance interventions on PD nonmotor symptoms by conducting an 8-month observational study, tracking the relationship between depression scores and functional neuroimaging measures for people with PD.</p><p><strong>Methods: </strong>A total of 34 dancers-23 (68%) people with PD and 11 (32%) healthy controls-completed the Geriatric Depression Scale (GDS) before and after attending weekly community-based dance classes, referred to as Dance for PD classes. Specifically, we examined changes within the functional magnetic resonance imaging signal from the subcallosal cingulate gyrus (SCG), an important node within the depression network and a controversial target for deep brain stimulation in the treatment of major depressive disorder.</p><p><strong>Results: </strong>Depression scores on the GDS decreased in each preintervention to postintervention comparison (all P<.025). In addition, GDS scores also improved over the 8-month dance period (all P<.01). Blood oxygen level-dependent signals from frontal cortex brain region implicated for emotional regulation within the SCG decreased at each testing time point (all P<.05). Also, a significant decrease in depression scores (GDS) was correlated with reduced blood oxygen level-dependent signals from the SCG (P=.02).</p><p><strong>Conclusions: </strong>This study contributes to an improved understanding of the neural mechanisms that are involved in depression, as well as the beneficial contribution that longitudinal dance interventions have in reducing nonmotor symptoms associated with PD, particularly in depression symptoms.</p>","PeriodicalId":73558,"journal":{"name":"JMIRx med","volume":"5 ","pages":"e44426"},"PeriodicalIF":0.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11660722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Expected Patterns in Insulin Needs of People With Type 1 Diabetes: Temporal Analysis of Automated Insulin Delivery Data.","authors":"Isabella Degen, Kate Robson Brown, Henry W J Reeve, Zahraa S Abdallah","doi":"10.2196/44384","DOIUrl":"10.2196/44384","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Type 1 diabetes (T1D) is a chronic condition in which the body produces too little insulin, a hormone needed to regulate blood glucose. Various factors such as carbohydrates, exercise, and hormones impact insulin needs. Beyond carbohydrates, most factors remain underexplored. Regulating insulin is a complex control task that can go wrong and cause blood glucose levels to fall outside a range that protects people from adverse health effects. Automated insulin delivery (AID) has been shown to maintain blood glucose levels within a narrow range. Beyond clinical outcomes, data from AID systems are little researched; such systems can provide data-driven insights to improve the understanding and treatment of T1D.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim is to discover unexpected temporal patterns in insulin needs and to analyze how frequently these occur. Unexpected patterns are situations where increased insulin does not result in lower glucose or where increased carbohydrate intake does not raise glucose levels. Such situations suggest that factors beyond carbohydrates influence insulin needs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We analyzed time series data on insulin on board (IOB), carbohydrates on board (COB), and interstitial glucose (IG) from 29 participants using the OpenAPS AID system. Pattern frequency in hours, days (grouped via k-means clustering), weekdays, and months were determined by comparing the 95% CI of the mean differences between temporal units. Associations between pattern frequency and demographic variables were examined. Significant differences in IOB, COB, and IG across temporal dichotomies were assessed using Mann-Whitney U tests. Effect sizes and Euclidean distances between variables were calculated. Finally, the forecastability of IOB, COB, and IG for the clustered days was analyzed using Granger causality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;On average, 13.5 participants had unexpected patterns and 9.9 had expected patterns. The patterns were more pronounced (d&gt;0.94) when comparing hours of the day and similar days than when comparing days of the week or months (0.3&lt;d&lt;0.52). Notably, 11 participants exhibited a higher IG overnight despite concurrently higher IOB (10/11). Additionally, 17 participants experienced an increase in IG after COB decreased after meals. The significant associations between pattern frequency and demographics were moderate (0.31≤τ≤0.48). Between clusters, mean IOB (P=.03, d=0.7) and IG (P=.02, d=0.67) differed significantly, but COB did not (P=.08, d=0.55). IOB and IG were most similar (mean distance 5.08, SD 2.25), while COB and IG were most different (mean distance 11.43, SD 2.6), suggesting that AID attempts to counteract both observed and unobserved factors that impact IG.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our study shows that unexpected patterns in the insulin needs of people with T1D are as common as expected patterns. Unexpected patterns cannot be explained by carbo","PeriodicalId":73558,"journal":{"name":"JMIRx med","volume":"5 ","pages":"e44384"},"PeriodicalIF":0.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11612581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of COVID-19-Associated Hepatitis in Children as an Emerging Complication in the Wake of SARS-CoV-2 Infections: Ambispective Observational Study.","authors":"Sumit Kumar Rawat, Ajit Anand Asati, Nitu Mishra, Ashish Jain, Radha Kanta Ratho","doi":"10.2196/48629","DOIUrl":"10.2196/48629","url":null,"abstract":"<p><strong>Background: </strong>Although the pediatric population has largely remained free of severe COVID-19 symptoms, in some cases, SARS-CoV-2 infection has been associated with complications such as multiple inflammatory syndrome in children (MIS-C). We identified another a unique form of hepatitis occurring subsequent to asymptomatic SARS-CoV-2 infection, designated by us as COVID-19-associated hepatitis in children (CAH-C), in a subset of children who presented with hepatitis.</p><p><strong>Objective: </strong>Our study describes the clinical presentations, temporal association, and viral parameters of the CAH-C cases and compares them to those of MIS-C cases or other known forms of hepatitis in children.</p><p><strong>Methods: </strong>In an ambispective (retrospective and follow-up) observational study, records from April to July 2021 were reviewed for all children aged ≤14 years who were previously healthy and presented with a sudden onset of hepatitis, elevated transaminases, and nonobstructive jaundice. After performing all routine tests, those lacking marked inflammatory responses and without evidence of (1) other known causes of acute hepatitis or previous underlying liver disease and (2) multisystem involvement were classified as having CAH-C. Their characteristics were compared to those of children with MIS-C or other known forms of hepatitis.</p><p><strong>Results: </strong>Among the 5539 children tested for SARS-CoV-2, a total of 475 (8.6%) tested positive and 47 (0.8%) presented with hepatitis. Among the 47 children with hepatitis, 37 (79%) had features of CAH-C: having symptoms of hepatitis only, without protracted illness (mean length of stay 5 d), and an uneventful recovery following supportive treatment. In contrast, the remaining 10 (21%) had features of MIS-C-associated hepatitis: multiple system involvement; protracted illness (mean length of stay 8 d); and requiring admission to critical care, with a mortality rate of 30% (3/10).</p><p><strong>Conclusions: </strong>Our data suggest that CAH-C might be one of the new clinical complications associated with the emergence of newer variants of concern of SARS-CoV-2, which often result in changing presentations. Our findings should facilitate its early identification and thorough workup and aid its differentiation from other emerging syndromes in children, which would help initiate appropriate measures, enable better resource prioritization, and thus limit adversities.</p>","PeriodicalId":73558,"journal":{"name":"JMIRx med","volume":"5 ","pages":"e48629"},"PeriodicalIF":0.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Assessment of a Point-of-Care Application (Genomic Medicine Guidance) for Heritable Thoracic Aortic Disease.","authors":"Rohan Patil, Fatima Ashraf, Samer Abu Dayeh, Siddharth K Prakash","doi":"10.2196/55903","DOIUrl":"10.2196/55903","url":null,"abstract":"<p><strong>Background: </strong>Genetic testing can determine familial and personal risks for heritable thoracic aortic aneurysms and dissections (TAD). The 2022 American College of Cardiology/American Heart Association guidelines for TAD recommend management decisions based on the specific gene mutation. However, many clinicians lack sufficient comfort or insight to integrate genetic information into clinical practice.</p><p><strong>Objective: </strong>We therefore developed the Genomic Medicine Guidance (GMG) application, an interactive point-of-care tool to inform clinicians and patients about TAD diagnosis, treatment, and surveillance. GMG is a REDCap-based application that combines publicly available genetic data and clinical recommendations based on the TAD guidelines into one translational education tool.</p><p><strong>Methods: </strong>TAD genetic information in GMG was sourced from the Montalcino Aortic Consortium, a worldwide collaboration of TAD centers of excellence, and the National Institutes of Health genetic repositories ClinVar and ClinGen.</p><p><strong>Results: </strong>The application streamlines data on the 13 most frequently mutated TAD genes with 2286 unique pathogenic mutations that cause TAD so that users receive comprehensive recommendations for diagnostic testing, imaging, surveillance, medical therapy, and preventative surgical repair, as well as guidance for exercise safety and management during pregnancy. The application output can be displayed in a clinician view or exported as an informative pamphlet in a patient-friendly format.</p><p><strong>Conclusions: </strong>The overall goal of the GMG application is to make genomic medicine more accessible to clinicians and patients while serving as a unifying platform for research. We anticipate that these features will be catalysts for collaborative projects aiming to understand the spectrum of genetic variants contributing to TAD.</p>","PeriodicalId":73558,"journal":{"name":"JMIRx med","volume":"5 ","pages":"e55903"},"PeriodicalIF":0.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11478091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning-Based Hyperglycemia Prediction: Enhancing Risk Assessment in a Cohort of Undiagnosed Individuals.","authors":"Kolapo Oyebola, Funmilayo Ligali, Afolabi Owoloye, Blessing Erinwusi, Yetunde Alo, Adesola Z Musa, Oluwagbemiga Aina, Babatunde Salako","doi":"10.2196/56993","DOIUrl":"10.2196/56993","url":null,"abstract":"<p><strong>Background: </strong>Noncommunicable diseases continue to pose a substantial health challenge globally, with hyperglycemia serving as a prominent indicator of diabetes.</p><p><strong>Objective: </strong>This study employed machine learning algorithms to predict hyperglycemia in a cohort of individuals who were asymptomatic and unraveled crucial predictors contributing to early risk identification.</p><p><strong>Methods: </strong>This dataset included an extensive array of clinical and demographic data obtained from 195 adults who were asymptomatic and residing in a suburban community in Nigeria. The study conducted a thorough comparison of multiple machine learning algorithms to ascertain the most effective model for predicting hyperglycemia. Moreover, we explored feature importance to pinpoint correlates of high blood glucose levels within the cohort.</p><p><strong>Results: </strong>Elevated blood pressure and prehypertension were recorded in 8 (4.1%) and 18 (9.2%) of the 195 participants, respectively. A total of 41 (21%) participants presented with hypertension, of which 34 (83%) were female. However, sex adjustment showed that 34 of 118 (28.8%) female participants and 7 of 77 (9%) male participants had hypertension. Age-based analysis revealed an inverse relationship between normotension and age (r=-0.88; P=.02). Conversely, hypertension increased with age (r=0.53; P=.27), peaking between 50-59 years. Of the 195 participants, isolated systolic hypertension and isolated diastolic hypertension were recorded in 16 (8.2%) and 15 (7.7%) participants, respectively, with female participants recording a higher prevalence of isolated systolic hypertension (11/16, 69%) and male participants reporting a higher prevalence of isolated diastolic hypertension (11/15, 73%). Following class rebalancing, the random forest classifier gave the best performance (accuracy score 0.89; receiver operating characteristic-area under the curve score 0.89; F1-score 0.89) of the 26 model classifiers. The feature selection model identified uric acid and age as important variables associated with hyperglycemia.</p><p><strong>Conclusions: </strong>The random forest classifier identified significant clinical correlates associated with hyperglycemia, offering valuable insights for the early detection of diabetes and informing the design and deployment of therapeutic interventions. However, to achieve a more comprehensive understanding of each feature's contribution to blood glucose levels, modeling additional relevant clinical features in larger datasets could be beneficial.</p>","PeriodicalId":73558,"journal":{"name":"JMIRx med","volume":"5 ","pages":"e56993"},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11441453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author's Response to Peer Reviews of \"Incidence of Postoperative Diabetes Mellitus After Roux-en-Y Reconstruction for Gastric Cancer: Retrospective Single-Center Cohort Study\".","authors":"Tatsuki Onishi","doi":"10.2196/63859","DOIUrl":"10.2196/63859","url":null,"abstract":"","PeriodicalId":73558,"journal":{"name":"JMIRx med","volume":"5 ","pages":"e63859"},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11337137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peer Review of \"Incidence of Postoperative Diabetes Mellitus After Roux-en-Y Reconstruction for Gastric Cancer: Retrospective Single-Center Cohort Study\".","authors":"Vanessa Fairhurst, James Olivier, Olajumoke Oladoyin, Maria J C Machado, Femi Qudus Arogundade, Mohammed Noushad, Rozmin Jiwani","doi":"10.2196/63862","DOIUrl":"10.2196/63862","url":null,"abstract":"","PeriodicalId":73558,"journal":{"name":"JMIRx med","volume":"5 ","pages":"e63862"},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11337136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of Postoperative Diabetes Mellitus After Roux-en-Y Reconstruction for Gastric Cancer: Retrospective Single-Center Cohort Study.","authors":"Tatsuki Onishi","doi":"10.2196/56405","DOIUrl":"10.2196/56405","url":null,"abstract":"<p><strong>Background: </strong>Sleeve gastrectomy is an effective surgical option for morbid obesity, and it improves glucose homeostasis. In patients with gastric cancer and type 2 diabetes mellitus (DM), gastrectomy, including total gastrectomy, is beneficial for glycemic control.</p><p><strong>Objective: </strong>This study aims to clarify the effects of gastrectomy and different reconstructive techniques on the incidence of postoperative DM in patients with gastric cancer.</p><p><strong>Methods: </strong>This retrospective, single-center, cohort study included 715 patients without DM who underwent total gastrectomy at the Tokyo Metropolitan Bokutoh Hospital between August 2005 and March 2019. Patients underwent reconstruction by Roux-en-Y (RY) gastric bypass or other surgical techniques (OT), with DM onset determined by hemoglobin A1c levels or medical records. Analyses included 2-sample, 2-tailed t tests; χ2 tests; and the Kaplan-Meier method with log-rank tests to compare the onset curves between the RY and OT groups, along with additional curves stratified by sex. A Swimmer plot for censoring and new-onset DM was implemented.</p><p><strong>Results: </strong>Stratified data analysis compared the RY and OT reconstruction methods. The hazard ratio was 1.52 (95% CI 1.06-2.18; P=.02), which indicated a statistically significant difference in the incidence of new-onset diabetes between the RY and OT groups in patients with gastric cancer. The hazard ratio after propensity score matching was 1.42 (95% CI 1.09-1.86; P=.009).</p><p><strong>Conclusions: </strong>This first-of-its-kind study provides insight into how different methods of gastric reconstruction affect postoperative diabetes. The results suggest significant differences in new-onset DM after surgery based on the reconstruction method. This research highlights the need for careful surgical planning to consider potential postoperative DM, particularly in patients with a family history of DM. Future studies should investigate the role of gut microbiota and other reconstructive techniques, such as laparoscopic jejunal interposition, in developing postoperative DM.</p>","PeriodicalId":73558,"journal":{"name":"JMIRx med","volume":"5 ","pages":"e56405"},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11337235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}