Category: Nevin Manimala

EJNMMI Phys. 2024 Apr 6;11(1):36. doi: 10.1186/s40658-024-00637-z.

ABSTRACT

PURPOSE: A 2D image navigator (iNAV) based 3D whole-heart sequence has been used to perform MRI and PET non-rigid respiratory motion correction for hybrid PET/MRI. However, only the PET data acquired during the acquisition of the 3D whole-heart MRI is corrected for respiratory motion. This study introduces and evaluates an MRI-based respiratory motion correction method of the complete PET data.

METHODS: Twelve oncology patients scheduled for an additional cardiac ¹⁸F-Fluorodeoxyglucose (¹⁸F-FDG) PET/MRI and 15 patients with coronary artery disease (CAD) scheduled for cardiac ¹⁸F-Choline (¹⁸F-FCH) PET/MRI were included. A 2D iNAV recorded the respiratory motion of the myocardium during the 3D whole-heart coronary MR angiography (CMRA) acquisition (~ 10 min). A respiratory belt was used to record the respiratory motion throughout the entire PET/MRI examination (~ 30-90 min). The simultaneously acquired iNAV and respiratory belt signal were used to divide the acquired PET data into 4 bins. The binning was then extended for the complete respiratory belt signal. Data acquired at each bin was reconstructed and combined using iNAV-based motion fields to create a respiratory motion-corrected PET image. Motion-corrected (MC) and non-motion-corrected (NMC) datasets were compared. Gating was also performed to correct cardiac motion. The SUV_max and TBR_max values were calculated for the myocardial wall or a vulnerable coronary plaque for the ¹⁸F-FDG and ¹⁸F-FCH datasets, respectively.

RESULTS: A pair-wise comparison showed that the SUV_max and TBR_max values of the motion corrected (MC) datasets were significantly higher than those for the non-motion-corrected (NMC) datasets (8.2 ± 1.0 vs 7.5 ± 1.0, p < 0.01 and 1.9 ± 0.2 vs 1.2 ± 0.2, p < 0.01, respectively). In addition, the SUV_max and TBR_max of the motion corrected and gated (MC_G) reconstructions were also higher than that of the non-motion-corrected but gated (NMC_G) datasets, although for the TBR_max this difference was not statistically significant (9.6 ± 1.3 vs 9.1 ± 1.2, p = 0.02 and 2.6 ± 0.3 vs 2.4 ± 0.3, p = 0.16, respectively). The respiratory motion-correction did not lead to a change in the signal to noise ratio.

CONCLUSION: The proposed respiratory motion correction method for hybrid PET/MRI improved the image quality of cardiovascular PET scans by increased SUV_max and TBR_max values while maintaining the signal-to-noise ratio. Trial registration METC162043 registered 01/03/2017.

PMID:38581561 | DOI:10.1186/s40658-024-00637-z

EJNMMI Phys. 2024 Apr 6;11(1):35. doi: 10.1186/s40658-024-00633-3.

ABSTRACT

BACKGROUND: The administration of a ¹⁶⁶Ho scout dose is available as an alternative to ^99mTc particles for pre-treatment imaging in Selective Internal Radiation Therapy (SIRT). It has been reported that the ¹⁶⁶Ho scout dose may be more accurate for the prediction of microsphere distribution and the associated therapy planning. The aim of the current study is to compare the scintigraphic imaging characteristics of both isotopes, considering the objectives of the pre-treatment imaging using clinically geared phantoms.

METHODS: Planar and SPECT/CT images were obtained using a NEMA image quality phantom in different phantom setups and another body-shaped phantom with several inserts. The influence of collimator type, count statistics, dead time effects, isotope properties and patient obesity on spatial resolution, contrast recovery and the detectability of small activity accumulations was investigated. Furthermore, the effects of the imaging characteristics on personalized dosimetry are discussed.

RESULTS: The images with ^99mTc showed up to 3 mm better spatial resolution, up to two times higher contrast recovery and significantly lower image noise than those with ¹⁶⁶Ho. The contrast-to-noise ratio was up to five times higher for ^99mTc than for ¹⁶⁶Ho. Only when using ^99mTc all activity-filled spheres could be distinguished from the activity-filled background. The measurements mimicking an obese patient resulted in a degraded image quality for both isotopes.

CONCLUSIONS: Our measurements demonstrate better scintigraphic imaging properties for ^99mTc compared to ¹⁶⁶Ho in terms of spatial resolution, contrast recovery, image noise, and lesion detectability. While the ¹⁶⁶Ho scout dose promises better prediction of the microsphere distribution, it is important to consider the inferior imaging characteristics of ¹⁶⁶Ho, which may affect individualized treatment planning in SIRT.

PMID:38581559 | DOI:10.1186/s40658-024-00633-3

Surg Today. 2024 Apr 6. doi: 10.1007/s00595-024-02822-0. Online ahead of print.

ABSTRACT

PURPOSE: Predicting nonalcoholic fatty liver disease (NAFLD) following pancreaticoduodenectomy (PD) is challenging, which delays therapeutic intervention and makes its prevention difficult. We conducted this study to assess the potential application of preoperative computed tomography (CT) radiomics for predicting NAFLD.

METHODS: The subjects of this retrospective study were 186 patients with PD from a single institution. We extracted the predictors of NAFLD after PD statistically from conventional clinical and radiomic features of the estimated remnant pancreas and whole liver region on preoperative nonenhanced CT images. Based on these predictors, we developed a machine-learning predictive model, which integrated clinical and radiomic features. A comparative model used only clinical features as predictors.

RESULTS: The incidence of NAFLD after PD was 43.5%. The variables of the clinicoradiomic model included one shape feature of the pancreas, two texture features of the liver, and sex; the variables of the clinical model were age, sex, and chemoradiotherapy. The accuracy%, precision%, recall%, F1 score, and area under the curve of the two models were 75.0, 72.7, 66.7, 69.6, and 0.80; and 69.6, 68.4, 54.2, 60.5, and 0.69, respectively.

CONCLUSIONS: Preoperative CT-derived radiomic features from the pancreatic and liver regions are promising for the prediction of NAFLD post-PD. Using these features enhances the predictive model, enabling earlier intervention for high-risk patients.

PMID:38581555 | DOI:10.1007/s00595-024-02822-0

J Thromb Thrombolysis. 2024 Apr 6. doi: 10.1007/s11239-024-02969-0. Online ahead of print.

ABSTRACT

Non-activated four-factor prothrombin complex concentrate (4 F-PCC) has emerged as the preferred reversal strategy for patients on warfarin with life-threatening bleeding. Current dosing recommendations for 4 F-PCC require pre-treatment international normalized ratio (INR) and bodyweight values, resulting in ordering and administration delays. Studies have shown that alternative dosing regimens are safe and efficacious. This retrospective, single-center, pre- and post-protocol analysis was conducted to assess the efficacy of a pharmacist driven modified fixed-dose 4 F-PCC regimen versus package insert weight- and INR-based dosing regimen for warfarin reversal. The primary outcome was achievement of INR less than two. Secondary outcomes included dose and cost of 4 F-PCC, a time analysis, incidence of concomitant vitamin K administration, and incidence of thrombosis within seven days of 4 F-PCC. There were 195 patients included in the analysis, with 74 in the pre-cohort and 121 in the post-cohort. Baseline characteristics were similar between cohorts with the most common indication for warfarin use being atrial fibrillation (48.6% versus 47.1%) and reversal being intracerebral hemorrhage (68.9% versus 43.0%). Achievement of the primary endpoint occurred in 92% versus 95% (p = 0.097) of patients. A statistically significant difference was seen between cohorts regarding median dose and cost of 4 F-PCC administered (p < 0.001). Eleven thromboembolic events occurred with three events in the pre-cohort and eight events in the post-cohort (p = 0.453). A fixed-dose of 1500IU of 4 F-PCC was effective in reversing INR to less than two in most patients regardless of reversal indication with minimal thrombotic risks.

PMID:38581551 | DOI:10.1007/s11239-024-02969-0

World J Urol. 2024 Apr 6;42(1):213. doi: 10.1007/s00345-024-04890-w.

ABSTRACT

INTRODUCTION: There is limited evidence on the outcomes of robotic partial nephrectomy (RPN) and open partial nephrectomy (OPN) in obese patients (BMI ≥ 30 kg/m²). In this study, we aimed to compare perioperative and oncological outcomes of RPN and OPN.

METHODS: We relied on data from patients who underwent PN from 2009 to 2017 at 16 departments of urology participating in the UroCCR network, which were collected prospectively. In an effort to adjust for potential confounders, a propensity-score matching was performed. Perioperative outcomes were compared between OPN and RPN patients. Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared using the log-rank test.

RESULTS: Overall, 1277 obese patients (932 robotic and 345 open were included. After propensity score matching, 166 OPN and 166 RPN individuals were considered for the study purposes; no statistically significant difference among baseline demographic or tumor-specific characteristics was present. A higher overall complication rate and major complications rate were recorded in the OPN group (37 vs. 25%, p = 0.01 and 21 vs. 10%, p = 0.007; respectively). The length of stay was also significantly longer in the OPN group, before and after propensity-score matching (p < 0.001). There were no significant differences in Warm ischemia time (p = 0.66), absolute change in eGFR (p = 0.45) and positive surgical margins (p = 0.12). At a median postoperative follow-up period of 24 (8-40) months, DFS and OS were similar in the two groups (all p > 0.05).

CONCLUSIONS: In this study, RPN was associated with better perioperative outcomes (improvement of major complications rate and LOS) than OPN. The oncological outcomes were found to be similar between the two approaches.

PMID:38581466 | DOI:10.1007/s00345-024-04890-w

Environ Monit Assess. 2024 Apr 6;196(5):432. doi: 10.1007/s10661-024-12585-3.

ABSTRACT

The East Kolkata Wetlands (EKWT), designated as a Ramsar Site for its crucial role in sewage water purification, agriculture and pisciculture, faces escalating environmental threats due to rapid urbanisation. Employing the pressure-state-response (PSR) framework and Environmental Risk Assessment (ERA), this study spans three decades to elucidate the evolving dynamics of EKWT. Using Landsat TM and OLI images from 1991, 2001, 2011 and 2021, the research identifies key parameters within the PSR framework. Principal component analysis generates environmental risk maps, revealing a 46% increase in urbanisation, leading to reduced vegetation cover and altered land surface conditions. The spatial analysis, utilizing Getis-Ord Gi* statistics, pinpoints risk hotspots and coldspots in the EKWT region. Correlation analysis underscores a robust relationship between urbanisation, climatic response and environmental risk. Decadal ERA exposes a noteworthy surge in high-risk areas, indicating a deteriorating trend. Quantitative assessments pinpoint environmental risk hotspots, emphasizing the imperative for targeted conservation measures. The study establishes a direct correlation between environmental risk and air quality, underscoring the broader implications of EKWT’s degradation. While acknowledging the East Kolkata administration’s efforts, the research recognises its limitations and advocates a holistic, multidisciplinary approach for future investigations. Recommendations encompass the establishment of effective institutions, real-time monitoring, public engagement and robust anti-pollution measures. In offering quantitative insights, this study provides an evidence-based foundation for conservation strategies and sustainable management practices essential to safeguard the East Kolkata Wetlands.

PMID:38581451 | DOI:10.1007/s10661-024-12585-3

Arch Orthop Trauma Surg. 2024 Apr 6. doi: 10.1007/s00402-024-05235-3. Online ahead of print.

ABSTRACT

BACKGROUND: Routine total hip arthroplasty (THA) using a short cemented stem as compared with a standard length cemented stem may have benefits in terms of stress distribution, bone preservation, stem subsidence and ease of revision surgery. Two senior arthroplasty surgeons transitioned their routine femoral implant from a standard 150 mm Exeter V40 cemented stem to a short 125 mm Exeter V40 cemented stem for all patients over the course of several years. We analysed revision rates, adjusted survival, and PROMS scores for patients who received a standard stem and a short stem in routine THA.

METHODS: All THAs performed by the two surgeons between January 2011 and December 2021 were included. All procedures were performed using either a 150 mm or 125 mm Exeter V40 stem. Demographic data, acetabular implant type, and outcome data including implant survival, reason for revision, and post-operative Oxford Hip Scores were obtained from the New Zealand Joint Registry (NZJR), and detailed survival analyses were performed. Primary outcome was revision for any reason. Reason for revision, including femoral or acetabular failure, and time to revision were also recorded.

RESULTS: 1335 THAs were included. 516 using the 150 mm stem and 819 using the 125 mm stem. There were 4055.5 and 3227.8 component years analysed in the standard stem and short stem groups respectively due to a longer mean follow up in the 150 mm group. Patient reported outcomes were comparable across all groups. Revision rates were comparable between the standard 150 mm stem (0.44 revisions/100 component years) and the short 125 mm stem (0.56 revisions/100 component years) with no statistically significant difference found (p = 0.240).

CONCLUSION: Routine use of a short 125 mm stem had no statistically significant impact on revision rate or PROMS scores when compared to a standard 150 mm stem. There may be benefits to routine use of a short cemented femoral implant.

PMID:38581441 | DOI:10.1007/s00402-024-05235-3

Graefes Arch Clin Exp Ophthalmol. 2024 Apr 6. doi: 10.1007/s00417-024-06478-x. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to investigate the potential of microRNAs (miRNAs) in tears, blood, and aqueous humor as biomarkers for predicting treatment response in wet age-related macular degeneration (AMD) patients undergoing anti-vascular endothelial growth factor (anti-VEGF) therapy.

METHODS: In a single-center prospective cohort study, treatment-naïve wet AMD patients and age-matched controls were enrolled. Clinical data and miRNA levels (miR-199a-3p, miR-365-3p, miR-200b-3p, miR-195-5p, miR-335-5p, and miR-185-5p) in tears, blood, and aqueous humor were collected. Treatment response was categorized into responders and non-responders based on visual acuity and central subfield thickness. MiRNA levels were quantified using reverse-transcription PCR. Statistical analyses were performed, including ROC analysis, to evaluate predictive accuracy.

RESULTS: Dysregulated miRNA profiles were observed in wet AMD tears and blood compared to controls. Specifically, miR-199a-3p, miR-195-5p, and miR-185-5p were upregulated, while miR-200b-3p was downregulated in tears. All six miRNAs were elevated in wet AMD blood samples. Notably, responders showed higher tear expression of miR-195-5p and miR-185-5p. Combining these miRNAs yielded the highest predictive power (AUC = 0.878, p = 0.006) for anti-VEGF responders.

CONCLUSIONS: Dysregulated miRNA profiles in tears and blood suggest their potential as biomarkers for wet AMD. MiR-195-5p and miR-185-5p in tears demonstrate predictive value for anti-VEGF treatment responders. This study underscores the non-invasive prediction potential of miRNA tear analysis in wet AMD treatment responses.

PMID:38581435 | DOI:10.1007/s00417-024-06478-x

Eur J Med Res. 2024 Apr 6;29(1):222. doi: 10.1186/s40001-024-01712-y.

ABSTRACT

BACKGROUND: Pneumonia is a major public health problem with an impact on morbidity and mortality. Its management still represents a challenge. The aim was to determine whether a new diagnostic algorithm combining lung ultrasound (LUS) and procalcitonin (PCT) improved pneumonia management regarding antibiotic use, radiation exposure, and associated costs, in critically ill pediatric patients with suspected bacterial pneumonia (BP).

METHODS: Randomized, blinded, comparative effectiveness clinical trial. Children < 18y with suspected BP admitted to the PICU from September 2017 to December 2019, were included. PCT was determined at admission. Patients were randomized into the experimental group (EG) and control group (CG) if LUS or chest X-ray (CXR) were done as the first image test, respectively. Patients were classified: 1.LUS/CXR not suggestive of BP and PCT < 1 ng/mL, no antibiotics were recommended; 2.LUS/CXR suggestive of BP, regardless of the PCT value, antibiotics were recommended; 3.LUS/CXR not suggestive of BP and PCT > 1 ng/mL, antibiotics were recommended.

RESULTS: 194 children were enrolled, 113 (58.2%) females, median age of 134 (IQR 39-554) days. 96 randomized into EG and 98 into CG. 1. In 75/194 patients the image test was not suggestive of BP with PCT < 1 ng/ml; 29/52 in the EG and 11/23 in the CG did not receive antibiotics. 2. In 101 patients, the image was suggestive of BP; 34/34 in the EG and 57/67 in the CG received antibiotics. Statistically significant differences between groups were observed when PCT resulted < 1 ng/ml (p = 0.01). 3. In 18 patients the image test was not suggestive of BP but PCT resulted > 1 ng/ml, all of them received antibiotics. A total of 0.035 mSv radiation/patient was eluded. A reduction of 77% CXR/patient was observed. LUS did not significantly increase costs.

CONCLUSIONS: Combination of LUS and PCT showed no risk of mistreating BP, avoided radiation and did not increase costs. The algorithm could be a reliable tool for improving pneumonia management.

CLINICAL TRIAL REGISTRATION: NCT04217980.

PMID:38581075 | DOI:10.1186/s40001-024-01712-y

Trop Dis Travel Med Vaccines. 2024 Apr 5;10(1):11. doi: 10.1186/s40794-024-00221-4.

ABSTRACT

BACKGROUND: Dengue fever caused by dengue virus is a tropical disease and is among the deadliest vector-borne diseases. The humid and hot summers of Pakistan support the probation of the vectors responsible for the transmission of viral and other parasitic diseases.

METHODOLOGY: A retrospective study, from 2012- 2019, of dengue infected individuals from the Punjab province of Pakistan was carried out to analyze epidemiology, clinical and laboratory findings of subjects with dengue virus infection. Data was derived from National Institute of Health (NIH) followed by Dengue control program of Pakistan, covering the incidence rate in 36 districts of Punjab and Islamabad Capital Territory (ICT) respectively. Patients data including the presence of dengue specific antigen or/and antibodies such as NS1 and IgG/IgM were observed. The study also included the analysis of demographic data, geographic data, and the month-wise distribution of dengue cases to examine seasonal trends.

RESULTS: We analyzed 25,682 dengue infected individuals. The statistical analysis revealed a significant association between genders in which male population was more affected by dengue than females. It was also noted that the middle age group was the most affected age group while the highest number of cases were reported in October. Rawalpindi and Lahore were the most affected cities in Punjab province while Islamabad represented the highest number of cases during the recent outbreak in 2019. The IgM and IgG antibodies were highly prevalent among the infected patients.

CONCLUSION: Dengue is endemic in Pakistan, circulating throughout the year. Highest number of cases were observed in the month of October, September and November respectively. Association between climate change and vector-borne diseases need to be investigated in Pakistan as they significantly influence the timing and intensity of dengue and other disease outbreaks. Further exploration of hematological parameters is required to better diagnose and treat the disease. For the effective control of dengue outbreaks, awareness campaigns on sewage management and vector control along with social factors are strongly recommended for better control and eradication of the disease.

PMID:38581059 | DOI:10.1186/s40794-024-00221-4