Category: Nevin Manimala

Urol Int. 2021 Apr 29:1-5. doi: 10.1159/000515646. Online ahead of print.

ABSTRACT

PURPOSE: Low-dose computer tomography (NCCT) is the standard imaging modality for patients with acute flank pain with a suspicion of urolithiasis. The stone size is usually measured 2D by a radiologist. We compared 3D stone measurement using different windows to the 2D measurement and evaluated the clinical impact on ureterorenoscopic stone removal (URS).

METHODS: One hundred sixty-four patients (201 stones) with a preoperative NCCT, following a URS within 4 weeks, were included in this study. Stone location, number and size of stones, operating time, and laser lithotripsy were documented. Stones were measured in 3D using bone and soft tissue window. The maximum diameter was compared to the radiological report. The U test, Kruskal-Wallis, and regression were used for statistical analyses.

RESULTS: Almost two-thirds (64.68%; 130 stones) of stone measurements in 3D with the bone window were lower than the radiologist reports in 2D. One-third (34.83%; 70 stones) of stone measurements were higher and 0.5% (1 stone) reported the same size. Using the 3D soft tissue window, 81.09% (163 stones), 17.91% (37 stones), and 1% (2 stones) of stones were measured bigger, smaller, or had the same measurement results, respectively. In the clinical setting, we could calculate a cutoff for laser lithotripsy at a maximum stone diameter of 5.70 mm (p < 0.01) with the 3D and 6.01 mm with the 2D measurements, respectively, and found a significant correlation between maximum stone diameter and operating time (p < 0.01) and number of stones and operating time (p < 0.01 with and p = 0.02 without laser).

CONCLUSION: 3D stone measurement with bone window seems to be more accurate than 2D measurement, but 2D is sufficient for planning stone treatment.

PMID:33915535 | DOI:10.1159/000515646

Gerontology. 2021 Apr 29:1-9. doi: 10.1159/000514948. Online ahead of print.

ABSTRACT

INTRODUCTION: Frailty has gained increasing attention as it is by far the most prevalent geriatric condition amongst older patients which heavily impacts chronic health status. However, the relationship between frailty and adverse health outcomes in China is far from clear. This study explored the relation between frailty and a panel of adverse health outcomes.

METHODS: We performed a multicentre cohort study of older inpatients at 6 large hospitals in China, with two-stage cluster sampling, from October 2018 to April 2019. Frailty was measured according to the FRAIL scale and categorized into robust, pre-frail, and frail. A multivariable logistic regression model and multilevel multivariable negative binomial regression model were used to analyse the relationship between frailty and adverse outcomes. Outcomes were length of hospitalization, as well as falls, readmission, and mortality at 30 and 90 days after enrolment. All regression models were adjusted for age, sex, BMI, surgery, and hospital ward.

RESULTS: We included 9,996 inpatients (median age 72 years and 57.8% male). The overall mortality at 30 and 90 days was 1.23 and 1.88%, respectively. At 30 days, frailty was an independent predictor of falls (odds ratio [OR] 3.19; 95% CI 1.59-6.38), readmission (OR 1.45; 95% CI 1.25-1.67), and mortality (OR 3.54; 95% confidence interval [CI] 2.10-5.96), adjusted for age, sex, BMI, surgery, and hospital ward clustering effect. At 90 days, frailty had a strong predictive effect on falls (OR 2.10; 95% CI 1.09-4.01), readmission (OR 1.38; 95% CI 1.21-1.57), and mortality (OR 6.50; 95% CI 4.00-7.97), adjusted for age, sex, BMI, surgery, and hospital ward clustering effect. There seemed to be a dose-response association between frailty categories and fall or mortality, except for readmission.

CONCLUSIONS: Frailty is closely related to falls, readmission, and mortality at 30 or 90 days. Early identification and intervention for frailty amongst older inpatients should be conducted to prevent adverse outcomes.

PMID:33915544 | DOI:10.1159/000514948

Transl Oncol. 2021 Apr 26;14(7):101080. doi: 10.1016/j.tranon.2021.101080. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies have shown the prognostic value of delta like canonical Notch ligand 3 (DLL3) in patients with different types of tumors, but the role and predictive value of DLL3 in invasive breast cancer (IBC) have not been reported. In this study, we explored the prognostic ability and potential ways of DLL3 in IBC patients.

METHODS: We retrospectively enrolled 130 IBC patients from a single institution from 2004 to 2019 for bioinformatics and statistical analysis. The Cancer Genome Atlas breast invasive carcinoma (TCGA-BRCA) cohort was used for verification.

RESULTS: High expression of DLL3 was associated with overall survival (OS) in IBC patients (P = 0.023). Multivariate analysis further showed that DLL3 expression was an independent prognostic factor (hazard ratio [HR]: 1.08; 95% confidence interval [CI]: 1.01-1.15; P = 0.017). Time-dependent receiver operating characteristic (ROC) with the area under the curve (0.786) demonstrated that DLL3 expression can predict the survival outcome of IBC patients. Furthermore, the expression of DLL3 was related to a variety of tumor infiltrating immune cells (TIICs), particularly T cells regulatory (Tregs). Gene set enrichment analysis (GSEA) and immunohistochemistry (IHC) results indicated that DLL3 was closely related to p53 signaling pathway.

CONCLUSIONS: High expression of DLL3 was associated with poor prognosis and immune cell infiltration in IBC patients. Moreover, P53 signaling pathway may be the key pathway.

PMID:33915517 | DOI:10.1016/j.tranon.2021.101080

Phys Med Biol. 2021 Apr 29. doi: 10.1088/1361-6560/abfce2. Online ahead of print.

ABSTRACT

Organ delineation is crucial to diagnosis and therapy, while is also labor-intensive and observer-dependent. Dual energy CT (DECT) provides additional image contrast than conventional single energy CT (SECT), which may facilitate automatic organ segmentation. This work aims to develop an automatic multi-organ segmentation approach using deep learning for head-and-neck region on DECT. We proposed a Mask scoring R-CNN where comprehensive features are firstly learnt from two independent pyramid networks and are then combined via deep attention strategy to highlight the informative ones extracted from DECT. To perform multi-organ segmentation and avoid misclassification, a mask scoring subnetwork was integrated into the Mask R-CNN framework to build the correlation between the class of potential detected organ’s region-of-interest (ROI) and the shape of that organ’s segmentation within that ROI. We evaluated our model on DECT images from 127 head-and-neck cancer patients (66 training, 61 testing) with manual contours of 19 organs as ground truth. For large- and mid-sized organs such as brain and parotid, the proposed method successfully achieved average Dice similarity coefficient (DSC) larger than 0.8. For small-sized organs with very low contrast such as chiasm, cochlea, lens and optic nerves, the DSCs ranged between around 0.5 and 0.8. With the propose method, using DECT images outperforms using SECT in almost all 19 organs with statistical significance in DSC (p<0.05). Meanwhile, by using the DECT, the proposed method is also significantly superior to a recently developed FCN-based method in most of organs in terms of DSC and the 95th percentile Hausdorff distance. Quantitative results demonstrated the feasibility of the proposed method, the superiority of using DECT to SECT, and the advantage of the proposed R-CNN over FCN on the head-and-neck patient study. The proposed method has the potential to facilitate the current head-and-neck cancer radiation therapy workflow in treatment planning.

PMID:33915524 | DOI:10.1088/1361-6560/abfce2

Public Health. 2021 Mar 26;194:149-155. doi: 10.1016/j.puhe.2021.03.011. Online ahead of print.

ABSTRACT

Definition of the incubation period for COVID-19 is critical for implementing quarantine and thus infection control. Whereas the classical definition relies on the time from exposure to time of first symptoms, a more practical working definition is the time from exposure to time of first live virus excretion. For COVID-19, average incubation period times commonly span 5-7 days which are generally longer than for most typical other respiratory viruses. There is considerable variability reported however for the late right-hand statistical distribution. A small but yet epidemiologically important subset of patients may have the late end of the incubation period extend beyond the 14 days that is frequently assumed. Conservative assumptions of the right tail end distribution favor safety, but pragmatic working modifications may be required to accommodate high rates of infection and/or healthcare worker exposures. Despite the advent of effective vaccines, further attention and study in these regards are warranted. It is predictable that vaccine application will be associated with continued confusion over protection and its longevity. Measures for the application of infectivity will continue to be extremely relevant.

PMID:33915459 | DOI:10.1016/j.puhe.2021.03.011

Surg Oncol. 2021 Apr 21;38:101566. doi: 10.1016/j.suronc.2021.101566. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the inter- and intra-rater variability of lymphovascular space invasion (LVSI) in early stage cervical cancer.

METHODS: We identified invasive cervical cancer tissue samples from radical hysterectomies in our institutional pathology database. The cases were stained with Hematoxylin & Eosin (H&E) and immunostains (CD-31 and D2-40). They were evaluated for the presence of LVSI by 6 pathologists on 3 separate occasions: with H&E staining only, then with H&E and immunostained specimens, and finally using a shared written criterion for diagnosis of LVSI. With 80 cases, a two-sided 95% confidence interval for the Kappa of 0.7 with a precision of 0.1 on each side was estimated.

RESULTS: Stage distribution was: IA 10%, IB 85%, and IIA 5%. The majority of cases were squamous cell carcinoma (55%), followed by adenocarcinoma (39%) and adenosquamous or other histology (6%). The mean inter-rater Kappa was 0.41 (95% CI: 0.37-0.45) for H&E. Usage of immunohistochemistry made a statistically significant improvement in the mean Kappa, but it still remained low: 0.52 (p = 0.02). Adding evaluation criteria for LVSI did not significantly increase the mean Kappa: 0.49 (p = 0.16). The mean intra-rater variability of H&E staining alone compared with H&E staining plus immunostaining was 0.53 (range: 0.43-0.64). The mean Kappa comparing H&E staining and H&E staining with criteria was 0.50 (range: 0.40-0.59).

CONCLUSIONS: We noted high inter- and intra-rater variability in the diagnosis of LVSI underscoring the challenges of LVSI diagnosis. Considering the significance assigned to LVSI and its implication for treatment, comprehensive guidelines with regards to determination of LVSI status are of paramount importance.

PMID:33915484 | DOI:10.1016/j.suronc.2021.101566

Eur J Obstet Gynecol Reprod Biol. 2021 Apr 15;261:103-109. doi: 10.1016/j.ejogrb.2021.04.014. Online ahead of print.

ABSTRACT

OBJECTIVE: The association between vitamin D deficiency and devastating preeclampsia is still debated. In this present study, our aim is to evaluate whether a statistically significant association exists between vitamin D deficiency and preeclampsia in Indian gravidas. As to the best of our knowledge, no study of this context with such a large sample size is done in the Indian population till now.

METHOD: A case-control study was performed in the year 2015-2019 where we enrolled 1000 pregnant women with preeclampsia admitted either in labor or for induction of labor in the study group and 1000 pregnant women without preeclampsia either in labor or admitted for induction of labor at term gestation in the control group. Serum 25-hydroxyvitamin D [25 (OH)] D levels of both the groups were measured through the radioimmunoassay method and analyzed. In both the groups, samples were collected equally across all the seasons of the year to avoid confounding by seasonal variation of vitamin D. Primary outcome measures the association of vitamin D deficiency and preeclampsia. While secondary outcome measures the correlation between levels of vitamin D deficiency with the severity of preeclampsia.

RESULT: A significantly low mean vitamin D level was seen in preeclamptic women (11.0 ± 7.1 ng /ml) compared to normotensive (31.4 ± 1.7 ng/ml) with p < .001. We observed approximately 11 fold increased odds of having preeclampsia in vitamin D deficient women (OR: 11.308; 95 % CI 7.5982-14.0097). Moreover, we observed that as vitamin D level decreases, the severity of preeclampsia increases (p < .001).

CONCLUSION: Compared with normotensive women, preeclamptic women had a significantly low level of vitamin D, suggesting a significant association between vitamin D deficiency and preeclampsia.

PMID:33915489 | DOI:10.1016/j.ejogrb.2021.04.014

Sleep Med. 2020 Aug 28;82:134-143. doi: 10.1016/j.sleep.2020.08.026. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate alterations in neurocognitive, attention, paediatric sleep questionnaire (PSQ) scores and whole brain white matter (WM) integrity between children with mild and severe obstructive sleep apnoea (OSA) according to sex and whether these changes are associated with OSA severity.

METHODS: Fifty-seven children (36 males and 21 females) diagnosed with OSA were recruited for this study. Children of both sexes were divided into mild (male-MG, female-MG) and severe (male-SG, female-SG) groups according to OSA severity. Polysomnography (PSG), neurocognitive, attention and PSQ tests were compared between groups by one-way samples analysis of variance (ANOVA) F test. Diffusion tensor imaging (DTI) was scanned using a 3T GE MRI scanner and analysed by Tract-based Spatial Statistics (TBSS). Spearman correlation was calculated between DTI Eigenvalues and clinical characteristics.

RESULTS: Compared to mild OSA patients, severe OSA patients presented greater severity of obstructive apnoea hypopnea index (OAHI), neurocognition, PSQ and attention tests in both male and female patients. Brain WM integrity in the male-SG, compared to the male-MG, demonstrated significantly reduced fractional anisotropy (FA) values in the right middle frontal gyrus and the right frontal sub-gyral regions and increased axial diffusivity (AD) values in the right inferior frontal gyrus, left parietal angular gyrus and sub-gyral regions, while no differences were found between the female-MG and female-SG. Alterations in male-SG brain regions were observably correlated with severity in male OSA patients.

CONCLUSIONS: The integrity of WM, which regulates autonomic, cognitive, and attention functions, is impaired in male, but not female, children with severe OSA.

PMID:33915429 | DOI:10.1016/j.sleep.2020.08.026

Neural Netw. 2021 Feb 28;140:336-343. doi: 10.1016/j.neunet.2021.01.017. Online ahead of print.

ABSTRACT

A differential-algebraic neural network (DANN) with delay (DDANN) is proposed. Firstly, the global existence and uniqueness theorems are established for a DDANN, respectively. Next, a new differential-algebraic inequality is established. Then, a theorem on global exponential stability of DDANN is shown by using this inequality. As an application of DDANN, a very concise criterion on global exponential stability for a neutral-type neural network is given by using DDANNs. Finally, two examples are given to illustrate the theoretical results.

PMID:33915455 | DOI:10.1016/j.neunet.2021.01.017

Oral Dis. 2021 Apr 29. doi: 10.1111/odi.13892. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the accuracy of MeMoSA^® , a mobile phone application to review images of oral lesions in identifying oral cancers and oral potentially malignant disorders requiring referral.

SUBJECTS AND METHODS: A prospective study of 355 participants, including 280 with oral lesions/variants was conducted. Adults aged ≥18 treated at tertiary referral centres were included. Images of the oral cavity were taken using MeMoSA^® . The identification of the presence of lesion/variant and referral decision made using MeMoSA^® were compared to clinical oral examination, using Kappa statistics for intra-rater agreement. Sensitivity, specificity, concordance and F1 score were computed. Images were reviewed by an off-site specialist and inter-rater agreement was evaluated. Images from sequential clinical visits were compared to evaluate observable changes in the lesions.

RESULTS: Kappa values comparing MeMoSA^® with clinical oral examination in detecting a lesion and referral decision was 0.604 and 0.892 respectively. Sensitivity and specificity for referral decision was 94.0% and 95.5%. Concordance and F1 score were 94.9% and 93.3% respectively. Inter-rater agreement for a referral decision was 0.825. Progression or regression of lesions were systematically documented using MeMoSA^® .

CONCLUSION: Referral decisions made through MeMoSA^® is highly comparable to clinical examination demonstrating it is a reliable telemedicine tool to facilitate the identification of high-risk lesions for early management.

PMID:33914993 | DOI:10.1111/odi.13892