Category: Nevin Manimala

Radiat Oncol. 2024 Dec 3;19(1):172. doi: 10.1186/s13014-024-02562-y.

ABSTRACT

BACKGROUND/AIM: Current approaches for locally advanced rectal cancer (LARC) typically recommend neoadjuvant chemoradiotherapy (nCRT) with 5-fluorouracil (5FU) or its oral analogs followed by surgery as the standard of care. However, the question of whether intensifying concurrent chemotherapy by adding oxaliplatin to the 5FU-based backbone can yield better outcomes remains unresolved. This study aimed to investigate the benefits of incorporating oxaliplatin into fluoropyrimidine-based chemoradiotherapy (CRT) to increase locoregional control and survival.

METHODS: Among 290 patients with LARC admitted to the Iran Cancer Institute’s radiation oncology department between January 2008 and December 2019, 29 received CAPEOX (capecitabine 625 mg/m²/bid on RT days and weekly oxaliplatin 50 mg/m²), whereas 293 received capecitabine (825 mg/m² twice daily or rarely 5FU in the first 4 days and last week of radiotherapy (RT)). Variables potentially affecting treatment outcomes were used for propensity score matching. Kaplan‒Meier and log-rank tests were employed for overall survival (OS) and disease-free survival (DFS) analyses and were adjusted with propensity score matching.

RESULTS: Data from 29 patients who received CAPEOX and 216 patients who received capecitabine were analyzed after propensity score matching without replacement. After propensity score matching, in the multivariate analysis, CAPEOX significantly increased the likelihood of achieving a pathologic complete response (pCR) by 4.38 times (CI: 1.90-10.08, p value < 0.001). However, CAPEOX did not demonstrate any statistically significant predictive value for DFS (P = 0.500) or OS (P = 0.449).

CONCLUSION: The addition of oxaliplatin resulted in a significantly higher rate of pCR without any translation into long-term survival outcomes.

PMID:39627803 | DOI:10.1186/s13014-024-02562-y

Sr Care Pharm. 2024 Dec 1;39(12):449-457. doi: 10.4140/TCP.n.2024.449.

ABSTRACT

Background: Cholinesterase (ChE) inhibitors enhance central cholinergic function and are considered as standard treatments to ameliorate symptoms relating to Alzheimer’s disease. Though anticholinergic medications directly antagonize the effects of ChE inhibitors, they are commonly prescribed among hospitalized adults. Objective: To determine the impact of high anticholinergic burden (ACB) on length of stay (LOS) and 30-day readmission rates among hospitalized patients receiving concomitant ChE inhibitors. Methods: This was a retrospective cohort study conducted at a tertiary care academic medical center involving hospitalized patients on medical floors who received any Food and Drug Administration-approved ChE inhibitors during their hospital stay from October 1, 2022, to September 30, 2023. The primary outcome of the study was to compare hospital LOS among patients with high (ACB ≥ 3) versus low (ACB < 3) ACB. The secondary outcome was to assess the impact of ACB burden on 30-day readmission rates. Results: Among hospitalized adults, patients with high ACB exposure had a significantly longer hospital LOS (median: 5.50 vs 4.25 days; P < 0.001) than patients with low ACB exposure, after adjusting for covariates. Analysis of secondary outcome revealed that though the high ACB group had a higher 30-day readmission rate compared with the lower ACB group (6.8% vs. 2.2%), the difference was not statistically significant (OR = 3.46, 95% CI 0.85-14.08; P = 0.083). Conclusion: A high ACB exposure among older individuals taking concurrent ChE inhibitors is associated with a longer hospital stay.

PMID:39627800 | DOI:10.4140/TCP.n.2024.449

BMC Pregnancy Childbirth. 2024 Dec 3;24(1):808. doi: 10.1186/s12884-024-07007-8.

ABSTRACT

BACKGROUND: Approaches to improve physical activity (PA), diet, and health-related quality of life (HRQOL) during postpartum in diverse women with elevated weight are needed.

METHODS: Health In Pregnancy and Postpartum (HIPP) was a randomized controlled trial that followed African American and white women with overweight or obesity from pregnancy through 12 months postpartum. Participants were randomized to a behavioral intervention grounded in social cognitive theory (n = 112) or standard care (n = 107). From enrollment (≤ 18 weeks gestation) through 6 months postpartum, the intervention group received two in-depth counseling sessions (one each during pregnancy and postpartum), counseling calls, behavioral podcasts, and access to a private Facebook group, while the standard care group received monthly mailings and podcasts focused on healthy pregnancy and infant development. PA (SenseWear armband), diet (ASA24), and HRQOL (SF-12) measurements were obtained from blinded assessors at baseline and 6- and 12-months postpartum. Linear or quantile regression models, depending on conformity to normality assumptions, were used to test differences between behavioral intervention and standard groups in PA outcomes (minutes/day of total PA, light PA, and moderate-to-vigorous intensity PA (MVPA), and total steps/day), dietary outcomes (diet quality and six measures of dietary intake), and HRQOL at 6- and 12-months postpartum, controlling for baseline values, race, parity, weight status, education, maternal age, gestational age, and caloric intake (for most diet models).

RESULTS: There were no statistically significant differences by group for any PA, diet, or HRQOL outcomes at 6 or 12 months postpartum. Irrespective of group assignment, all PA outcomes improved from pregnancy to postpartum, as did kcals and the mental component of HRQOL. Furthermore, while not statistically significant, virtually all PA outcomes, except MVPA at 12 months, and several dietary outcomes, including diet quality, had patterns favoring the intervention group but with small effect sizes.

CONCLUSIONS: Postpartum PA, diet, and HRQOL did not differ significantly between women in the behavioral intervention group and those in the standard care group. Given the increased responsibilities and stress that women face during the postpartum period, this appears to be a challenging time to make lifestyle changes.

TRIAL REGISTRATION: This trial was registered at ClinicalTrials.gov on 10/09/2014. Identifier: NCT02260518.

PMID:39627794 | DOI:10.1186/s12884-024-07007-8

BMC Musculoskelet Disord. 2024 Dec 3;25(1):990. doi: 10.1186/s12891-024-08132-3.

ABSTRACT

BACKGROUND: Musculoskeletal disorders are an extensive burden to society, yet few studies have explored and replicated modifiable prognostic factors associated with high societal costs. This study aimed to replicate previously identified associations between nine modifiable prognostic factors and high societal costs among people on sick leave due to musculoskeletal disorders.

METHODS: Pooled data from a three-arm randomised controlled trial with 6 months of follow-up were used, including 509 participants on sick leave due to musculoskeletal disorders in Norway. Consistent with the identification study, the primary outcome was societal costs dichotomised as high (top 25th percentile) or low. Societal costs included healthcare utilization (primary, secondary, and tertiary care) and productivity loss (absenteeism, work assessment allowance and disability benefits) collected from public records. Binary unadjusted and adjusted logistic regression analyses were used to replicate previously identified associations between each modifiable prognostic factor and having high costs.

RESULTS: Adjusted for selected covariates, a lower degree of return-to-work expectancy was associated with high societal costs in both the identification and replication sample. Depressive symptoms and health literacy showed no prognostic value in both the identification and replication sample. There were inconsistent results with regards to statistical significance across the identification and replication sample for pain severity, self-perceived health, sleep quality, work satisfaction, disability, and long-lasting disorder expectation. Similar results were found when high costs were related to separately healthcare utilization and productivity loss.

CONCLUSION: This study successfully replicated the association between return-to-work expectancy and high societal costs among people on sick leave due to musculoskeletal disorders. Other factors showed no prognostic value or inconsistent results.

TRIAL REGISTRATION: ClinicalTrials.gov NCT03871712, 12th of March 2019.

PMID:39627785 | DOI:10.1186/s12891-024-08132-3

BMC Med Imaging. 2024 Dec 3;24(1):327. doi: 10.1186/s12880-024-01494-z.

ABSTRACT

OBJECTIVE: Ductal carcinoma in situ (DCIS) of the breast has a wide disease spectrum with risks of progression to invasive cancer linked to pathological factors. High-grade histology, large tumor volume, and comedonecrosis are adverse prognostic factors. This study explores the correlation between conventional ultrasound (Con-US) and shears wave elastography (SWE) features with DCIS prognostic factors and evaluates their predictive efficacy.

METHODS: A retrospective analysis was conducted on clinical data, Con-US, and SWE imaging features of 83 DCIS patients who underwent surgical resection between June 2018 and December 2022. Binary logistic regression analysis was performed to explore the relationship between sonogram indices and pathological prognostic factors.

RESULTS: The results revealed that microcalcification observed on Con-US was an independent risk factor for high-grade DCIS and comedonecrosis [odds ratio (OR): 5.316 and 4.512]. In SWE analysis, the Emax value was significantly different between the non-high-grade and high-grade DCIS groups(P = 0.006), with an Emax value greater than 75.03 kPa identified as an independent risk factor for high-grade DCIS [OR:1.022, the area under the curve (AUC): 0.682, 95% confidence interval (CI): 0.555-0.808]. Additionally, the Ecolor, Emax, Emean, and Emean SD values were statistically different between the groups with and without comedonecrosis (P = 0.049, 0.006, 0.012, 0.022), with an Emean value exceeding 30.45 kPa identified as an independent risk factor for comedonecrosis (OR:1.025, AUC:0.708, 95% CI:0.562-0.854). Furthermore, combining microcalcification on Con-US with specific SWE indicators demonstrated an improved predictive specificity for high-grade DCIS and comedonecrosis (0.902 and 0.889, respectively). No significant difference was found in other indexes on SWE.

CONCLUSIONS: The microcalcification signs on Con-US, Emax and Emean values on SWE analysis are associated with the high nuclear grade and comedonecrosis of DCIS, the combination of Con-US and SWE can improve the predictive specificity of DCIS-related prognostic factors.

PMID:39627774 | DOI:10.1186/s12880-024-01494-z

Clinics (Sao Paulo). 2024 Dec 2;80:100540. doi: 10.1016/j.clinsp.2024.100540. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: Malignant hilar obstruction usually presents in advanced-stage disease with a poor prognosis. Effective biliary drainage is essential for the beginning of palliative chemotherapy. There is a debate on the amount of liver parenchyma that should be drained to achieve clinical success. This study aimed to correlate the volume of liver drained with clinical success rate.

METHODS: The authors conducted a retrospective study including patients with malignant hilar biliary obstruction who underwent retrograde endoscopic cholangiography for biliary drainage from January 2014 to December 2018. The main outcome was a correlation of clinical success rate with hepatic volume drained. Secondary outcomes were correlation of clinical success rate with the quantity of liver sectors drained and unilateral versus bilateral drainage.

RESULTS: 82 patients met inclusion criteria (58.5 % female), with a mean age of 60±13 years. The main cause of hilar obstruction was cholangiocarcinoma (32.9 %) followed by lymph node metastasis (23.2 %). Technical success was achieved in 75 patients (91.5 %), and clinical success in 45 patients (60 %). The authors found a significant correlation between clinical success rate when at least 50 % of viable parenchyma was drained (p = 0.016; OR = 4.15, 95 % CI 1.4-12.5). Considering liver sectors, higher clinical success rates were found when at least 2 sectors were drained (p < 0.001; OR = 8.50, 95 % CI 2.7-26.7). The correlation between unilateral versus bilateral drainage and clinical success was not statistically significant.

CONCLUSION: Drainage of at least 50 % of volume hepatic parenchyma was associated with better outcomes as well as drainage of at least 2 hepatic sectors, regardless of if unilateral or bilateral.

PMID:39626325 | DOI:10.1016/j.clinsp.2024.100540

Nanotechnology. 2024 Dec 3. doi: 10.1088/1361-6528/ad99df. Online ahead of print.

ABSTRACT

The optothermal Raman method is useful in determining the in-plane thermal conductivity of two-dimensional (2D) materials that are either suspended or supported on a substrate. We compare this method with the Stokes/anti-Stokes scattering thermometry method, which can play a role in both calibration of Raman peak positions as well as extraction of the local phonon temperature. This work demonstrates that the Stokes/anti-Stokes intensity ratio plays an important role in determining the in-plane thermal conductivity of 2D tin diselenide (SnSe₂) dry-transferred onto a polished copper (Cu) substrate. The statistically-averaged thermal conductivity of the 108±24 nm-thick SnSe₂yielded 5.4±3.5 Wm^-1K^-1for the optothermal Raman method, and 2.40±0.81 Wm^-1K^-1for the Stokes/anti-Stokes thermometry method, indicating that the Stokes/anti-Stokes thermometry method to calculate the thermal conductivity of a material can simultaneously increase both precision and accuracy. The uncertainty value was also lowered by a factor of 1.9 from the traditional optothermal Raman method to the Stokes/anti-Stokes thermometry method. The low in-plane thermal conductivity of 2D SnSe₂, 1.3-2.9 times lower than bulk, is useful for applications in thermal and electrical energy conversion and thermoelectric devices.

PMID:39626316 | DOI:10.1088/1361-6528/ad99df

J Natl Cancer Inst. 2024 Nov 29:djae310. doi: 10.1093/jnci/djae310. Online ahead of print.

ABSTRACT

BACKGROUND: Oncoplastic breast conserving surgery (OP-BCS) is becoming increasingly popular to avoid mastectomy or optimize cosmetic outcomes of breast conserving surgery (BCS). Few studies have compared clinical outcomes and patient-reported outcomes (PROs) of OP-BCS to conventional BCS (C-BCS). This study aims to compare clinical outcomes and short and long-term PROs after OP-BCS and C-BCS in a large prospective breast cancer cohort.

METHODS: Women in the prospective, multicenter UMBRELLA-breast cancer cohort who underwent OP-BCS or C-BCS were included. Clinical outcomes and PROs (measured by EORTC QLQ-C30/BR23) up to 24 months postoperatively were evaluated. Mixed-model analysis was performed to assess differences in PROs over time between groups.

RESULTS: 1628 (84.9%) patients received C-BCS and 290 (15.1%) OP-BCS. After C-BCS and OP-BCS, free resection margins were obtained in 84.2% (n = 1370) and 86.2% (n = 250), respectively, reoperation for re-exision of margins <3 months occurred in 5.3% (n = 86) and 4.8% (n = 14), median time interval from surgery until adjuvant systemic therapy was 66 and 63 days, and 36 and 41 days until radiotherapy. Shortly postoperative, OP-BCS was associated with statistically significant lower mean scores for physical functioning (83.6 vs 87.2) and body image (82.8 vs 89.4) and more pain (19.8 vs 26.5) and breast symptoms (22.7 vs 30.3) than C-BCS. Body image scores remained significantly less favorable after OP-BSC than C-BCS up to 24 months postoperatively (87.8 vs 92.2).

CONCLUSIONS: Oncoplastic surgery safely enables BCS, but may lead to less favorable long-term body image compared to C-BCS. These findings are important for patient education and shared decision-making.

PMID:39626303 | DOI:10.1093/jnci/djae310

Am J Trop Med Hyg. 2024 Dec 3:tpmd240221. doi: 10.4269/ajtmh.24-0221. Online ahead of print.

ABSTRACT

In refugee and internally displaced person settlements, hygienic water handling and free residual chlorine (FRC) are crucial for protecting water against recontamination after distribution up to the household point-of-consumption. We conducted a secondary analysis of water quality and water handling data collected in refugee camps in South Sudan, Jordan, and Rwanda using statistical and process-based modeling to explore how water handling practices affect FRC decay and household FRC outcomes. The two practices that consistently produced a significant effect on FRC decay and household FRC were storing water in direct sunlight and transferring water between containers during household storage. Samples stored in direct sunlight had 0.22-0.31 mg/L lower household FRC and had FRC decay rates between 2 and 3.7 times higher than samples stored in the shade, and samples that were transferred between containers had 0.031-0.51 mg/L lower household FRC and decay rates 1.65-3 times higher than non-transferred samples in sites in which the effect was significant, suggesting that humanitarian responders should aim to provide additional water storage containers to prevent water transferring in households and encourage water-users not to store water in direct sunlight. By contrast, the effect of the three recommended hygienic water handling behaviors (clean, covered containers and drawing by tap or pouring) was mixed or inconclusive. These inconclusive results were likely due to imbalanced or unreliable approaches to gathering the data, and we recommend that hygienic water handling practices that mechanistically provide a physical barrier against recontamination should always be promoted in humanitarian settings.

PMID:39626299 | DOI:10.4269/ajtmh.24-0221

J Anim Sci. 2024 Nov 29:skae363. doi: 10.1093/jas/skae363. Online ahead of print.

ABSTRACT

Genetic selection for traits that have direct impact on profitability, such as productive longevity (PL), which blends cow longevity with regular reproductive performance, is fundamental for the economic success of beef cow-calf operations. The purpose of this study was to develop data screening strategy and a statistical model to predict genetic merit for PL in a multibreed beef cattle population. Pedigree (n = 1,352,765) and phenotype (n = 978,382) information were provided by Leachman Cattle of Colorado and genotypes (n = 26,342) were provided by the Zoetis commercial genotyping laboratory. A repeatability model (REP) including the systematic effects of age at first calving, year-season of progeny birth, pedigree-based retained heterosis, and parity number, as well as the random effects of additive genetic, permanent environment, contemporary group, and residual were fitted to adjust PL. In addition, a random regression model (RRM) was fitted to investigate PL considering the same effects, with the difference that random effects were regressed on parity. Estimated breeding value (EBV) were obtained by single-step GBLUP (ssGBLUP) and transformed to predict differences in number of calves through linear regression. Predictive performance was assessed in a group of 7,268 cows born in 2010. Heritability estimates for PL were relatively low, with values of 0.109 for REP and a decreasing trend for RRM with values ranging from 0.16 to 0.04. Repeatability for PL was of moderate magnitude, with values of 0.415 for REP and from 0.29 to 0.57 for RRM. Heritability estimates suggest that most of phenotypic variation was accounted for by environmental factors, but long-term genetic selection could still be effective. REP was more efficient than RRM, showing lower number of iterations and time to reach convergence with comparable solutions to RRM. Validation results showed that correlations between EBV and phenotypes (observed/pre-corrected) increased over the years ranging from 0.04 to 0.92. Repeatability values and the validation approach suggested that using a cow’s first record (second parity success or failure) is a reasonably good indicator of posterior performance for PL. Therefore, the inclusion of PL in a multibreed genetic evaluation program, incorporation into selection indexes with existing economic traits, can enable more profitable selection and breeding decisions in beef cattle herds.

PMID:39626265 | DOI:10.1093/jas/skae363