Category: Nevin Manimala

J Appl Clin Med Phys. 2024 Feb 19:e14297. doi: 10.1002/acm2.14297. Online ahead of print.

ABSTRACT

PURPOSE: Deep learning-based auto-segmentation algorithms can improve clinical workflow by defining accurate regions of interest while reducing manual labor. Over the past decade, convolutional neural networks (CNNs) have become prominent in medical image segmentation applications. However, CNNs have limitations in learning long-range spatial dependencies due to the locality of the convolutional layers. Transformers were introduced to address this challenge. In transformers with self-attention mechanism, even the first layer of information processing makes connections between distant image locations. Our paper presents a novel framework that bridges these two unique techniques, CNNs and transformers, to segment the gross tumor volume (GTV) accurately and efficiently in computed tomography (CT) images of non-small cell-lung cancer (NSCLC) patients.

METHODS: Under this framework, input of multiple resolution images was used with multi-depth backbones to retain the benefits of high-resolution and low-resolution images in the deep learning architecture. Furthermore, a deformable transformer was utilized to learn the long-range dependency on the extracted features. To reduce computational complexity and to efficiently process multi-scale, multi-depth, high-resolution 3D images, this transformer pays attention to small key positions, which were identified by a self-attention mechanism. We evaluated the performance of the proposed framework on a NSCLC dataset which contains 563 training images and 113 test images. Our novel deep learning algorithm was benchmarked against five other similar deep learning models.

RESULTS: The experimental results indicate that our proposed framework outperforms other CNN-based, transformer-based, and hybrid methods in terms of Dice score (0.92) and Hausdorff Distance (1.33). Therefore, our proposed model could potentially improve the efficiency of auto-segmentation of early-stage NSCLC during the clinical workflow. This type of framework may potentially facilitate online adaptive radiotherapy, where an efficient auto-segmentation workflow is required.

CONCLUSIONS: Our deep learning framework, based on CNN and transformer, performs auto-segmentation efficiently and could potentially assist clinical radiotherapy workflow.

PMID:38373289 | DOI:10.1002/acm2.14297

J Phys Chem A. 2024 Feb 19. doi: 10.1021/acs.jpca.3c06894. Online ahead of print.

ABSTRACT

Computational quantum chemical techniques were utilized to systematically examine how electron-donating groups affect the electronic and spectroscopic properties of halogen bond donors and their corresponding complexes. Unlike the majority of studies on halogen bonding, where electron-withdrawing groups are utilized, this work investigates the influence of electron-donating substituents within the halogen bond donors. Statistical analyses were performed on the descriptors of halogen bond donors in a prescribed set of archetype, halo-alkyne, halo-benzene, and halo-ethynyl benzene halogen bond systems. The σ-hole magnitude, binding and interaction energies, and the vibrational X···N local force constant (where X = Cl, Br, I, and At) were found to correlate very well in a monotonic and linear manner with all other properties studied. In addition, enhanced halogen bonds were found when the systems contained electron-donating groups that could form intramolecular hydrogen bonds with the electronegative belt of the halogen atom and adjacent linker features.

PMID:38373286 | DOI:10.1021/acs.jpca.3c06894

Ann Work Expo Health. 2024 Feb 19:wxae008. doi: 10.1093/annweh/wxae008. Online ahead of print.

ABSTRACT

INTRODUCTION: Upper respiratory tract infections (URTI) are common and a common cause of sick-leave for healthcare workers, and furthermore pose a threat especially for patients susceptible to other diseases. Sufficient use of respiratory protective equipment (RPE) may protect both the workers and the patients. The COVID-19 pandemic provided a unique opportunity to study the association between use of RPE and URTI in a real-life setting. The aim of this study was to examine if failure of RPE or non-compliance with RPE guidelines increases the risk of non-COVID-19 URTI symptoms among healthcare workers.

METHODS: In a longitudinal cohort study, we collected self-reported data daily on work tasks, use of RPE, and URTI symptoms among healthcare workers with patient contact in 2 Danish Regions in 2 time periods during the COVID-19 pandemic. The association between failure of RPE or non-compliance with RPE guidelines and URTI symptoms was analyzed separately by generalized linear models. Persons tested positive for severe acute respiratory syndrome coronavirus 2 were censored from the analyses. The 2 waves of data collection were analyzed separately, as there were differences in recommendations of RPE during the 2 waves.

RESULTS: We found that for healthcare workers performing work tasks with a risk of transmission of viruses or bacteria, failure of RPE was associated with an increased risk of URTI symptoms, RR: 1.65[0.53-5.14] in wave 1 and RR: 1.30[0.56-3.03] in wave 2. Also non-compliance with RPE guidelines was associated with an increased risk of URTI symptoms compared to the use of RPE in wave 1, RR: 1.28[0.87-1.87] and wave 2, RR: 1.39[1.01-1.91]. Stratifying on high- versus low-risk tasks showed that the risk related to failure and non-compliance was primarily associated with high-risk tasks, although not statistically significant.

DISCUSSION: The study was conducted during the COVID-19 pandemic and thus may be affected by other preventive measures in society. However, this gave the opportunity to study the use of RPE in a real-life setting, also in departments that did not previously use RPE. The circumstances in the 2 time periods of data collection differed and were analyzed separately and thus the sample size was limited and affected the precision of the estimates.

CONCLUSION: Failures of RPE and non-compliance with RPE guidelines may increase the risk of URTI, compared to those who reported use of RPE as recommended. The implications of these findings are that the use of RPE to prevent URTI could be considered, especially while performing high-risk tasks where other prevention strategies are not achievable.

PMID:38373246 | DOI:10.1093/annweh/wxae008

Free Radic Res. 2024 Feb 19:1-12. doi: 10.1080/10715762.2024.2320381. Online ahead of print.

ABSTRACT

INTRODUCTION: Prostate Cancer (PC) is a global health concern affecting men worldwide. Oxidative stress is believed to contribute to the initiation of early-stage PC lesions. Additionally, inflammation has long been acknowledged as a factor in the development of PC. We aimed to examine the biomarkers of oxidative stress and inflammation in PC patients before and after surgery.

PATIENTS AND METHODS: A cross-sectional study was conducted at the Urology Outpatient Clinic of Bezmialem Vakif University Hospital. A total of 150 individuals were included in the study, divided into five groups: 50 Healthy controls, 25 patients with Benign Prostatic Hyperplasia (BPH), 25 patients with Low-Risk Prostate Cancer (LRPC), 25 patients with Medium-Risk Prostate Cancer (MRPC), and 25 patients with High-Risk Prostate Cancer (HRPC). Measurements of Total Oxidant Status (TOS), Total Antioxidant Status (TAS), Total Thiol (TT), and Native Thiol (NT) were performed using photometric methods. Oxidative Stress Index (OSI) and Disulfide (DIS) levels were calculated mathematically. Levels of Interleukin-10 (IL-10), Interleukin-1beta (IL-1β), Tumor Necrosis Factor-alpha (TNF-α), Interleukin-6 (IL-6), and Presepsin were determined using commercially available enzyme-linked immunosorbent assay (ELISA) kits.

RESULTS: Compared to the healthy control group, the results indicated a statistically significant increase in both oxidative stress and inflammation levels. In the groups receiving both pharmaceutical therapy and surgical treatment (PC), a significant decrease in oxidative stress and inflammation levels was observed.

CONCLUSION: Consequently, it is suggested that the assessment of oxidative stress and inflammatory biomarkers should be incorporated in the pre- and postoperative monitoring of patients with PC.

PMID:38373238 | DOI:10.1080/10715762.2024.2320381

Urogynecology (Phila). 2024 Jan 16. doi: 10.1097/SPV.0000000000001447. Online ahead of print.

ABSTRACT

IMPORTANCE: Rectovaginal fistula (RVF) is a challenging condition associated with recurrences and significant functional impairment.

OBJECTIVES: The internal pudendal artery perforator (IPAP) flap has become a viable option for reconstructing the vagina and perineal regions. This study aims to introduce a modified technique of IPAP flap interposition and evaluate its postoperative outcomes in the treatment of low RVF.

STUDY DESIGN: Sixteen patients with RVF who underwent modified IPAP flap interposition between 2016 and 2021 were retrospectively enrolled. Recurrence rate, the satisfaction of vulvar appearance (Visual Analog Scale), and quality of sexual life (Female Sexual Function Index score) were followed up and analyzed.

RESULTS: All patients presented with low fistula with a mean diameter of 8.3 mm. The mean width and length of the IPAP flaps were 3.8 and 6.2 cm, respectively. The mean follow-up period was 14.1 months. All patients achieved successful healing without recurrence. High satisfaction was reported for the cosmetic effect of the vulva with a mean Visual Analog Scale score of 8.4. The proportion of female sexual disorder exhibited a statistically significant reduction, decreasing from 100% preoperatively to 38% after surgery (P < 0.05).

CONCLUSIONS: The modified IPAP flap interposition is a reliable and safe option for repairing low RVF, with high success rates and minimal donor site morbidity. Moreover, this procedure provides a suitable volume flap and preserves the vaginal physiological environment, which benefits postoperative sexual function.

PMID:38373234 | DOI:10.1097/SPV.0000000000001447

Community Dent Health. 2024 Feb 19. doi: 10.1922/CDH_00183McGoldrick06. Online ahead of print.

ABSTRACT

INTRODUCTION: Dental settings were considered high risk settings for COVID-19. A Dental Public Health Team in East Scotland worked to risk assess each situation timeously to break chains of transmission.

AIM: To present learning from routine data collected from contact tracing COVID-19 cases in the dental setting.

DESIGN: Retrospective analysis of a routine data set of COVID-19 cases associated with a dental setting reported via the national contact tracing system for two health board areas in the East of Scotland.

METHODS: Descriptive statistics summarise the data collected over a 13-month period (Oct 2020-Dec 2021) during which all included COVID-19 cases were confirmed by PCR. A narrative presents output from contact tracing of all cases and includes themes identified during contact tracing that led to transmission within a dental setting. A case study illustrates impact of transmission.

RESULTS: 752 cases are included. No evidence of staff to patient transmission or vice versa was found in this study. Staff to staff transmission occurred in non-clinical areas contributing to 33% of total staff cases with the remainder assessed to result from community transmission.

CONCLUSION: Transmission of COVID-19 in a dental setting, in the context of this study, appears to be confined to non-clinical areas with the majority of staff cases resulting from community transmission. Future pandemic plans should include tools to aid with implementation of guidance in non-clinical areas.

PMID:38373225 | DOI:10.1922/CDH_00183McGoldrick06

Eur J Prosthodont Restor Dent. 2024 Feb 2. doi: 10.1922/EJPRD_2529Twigg09. Online ahead of print.

ABSTRACT

AIM: Insufficient evidence is available in quantifying the retention between the simplified and conventional non-balanced dentures. The aim of the study was to quantify, compare the maxillary denture retention and patient satisfaction between conventional and simplified removable non-balanced complete dentures.

METHOD: The randomized clinical trial recruited 44 patients (n=22) with definitive criteria. Simplified and conventional non-balanced complete dentures were fabricated for the intervention groups. The denture retention of maxillary complete denture was assessed with dynamometer and patient satisfaction with visual analogue scale. The mean retention of maxillary denture and satisfaction were recorded at 0-,3-, and 6 – month interval. The data were statistically analyzed. (α=.05).

RESULTS: The mean ±SD of retention for conventional denture at 0, 3, and 6 months by dynamometer ranged from 121.73 ± 1.64 N to 120.55 ± 1.57 N and 110.77 ±1.45N to 109.59±1.97 N for simplified denture. The mean ±SD of visual analogue score varied between 9.45±0.35 to 7.19± 0.69 for conventional dentures and 8.00 ±1.39 to 6.81±0.82 for simplified dentures. The repeated ANOVA, t-test and post-hoc Bonferroni revealed statistically significant differences between the two types of denture. (P⟨.05) Conclusion: Numerical retention and satisfaction were higher in conventional non-balanced denture than simplified denture.

PMID:38373222 | DOI:10.1922/EJPRD_2529Twigg09

Hum Reprod. 2024 Feb 19:deae025. doi: 10.1093/humrep/deae025. Online ahead of print.

ABSTRACT

STUDY QUESTION: Do different boys with different types of cryptorchidism exhibit different anogenital distances (AGDs)?

SUMMARY ANSWER: Length of AGD seemed to differ in different groups of patients with cryptorchidism.

WHAT IS KNOWN ALREADY: AGD, which is used as an indicator of prenatal androgen action, tends to be shorter in boys with cryptorchidism compared to unaffected boys. Shorter AGDs have also been reported in boys with hypospadias, in men with poor semen quality, and in men with testicular cancer.

STUDY DESIGN, SIZE, DURATION: A prospective descriptive cohort study was performed using data from consecutively selected boys with cryptorchidism (n = 169) operated in a single center over a period of 3 years (September 2019 to October 2022).

PARTICIPANTS/MATERIALS, SETTING, METHODS: AGD was measured in 169 infant boys, at 3 to 26 months of age, during anesthesia with a vernier caliper measuring the distance from the anus to the base of the scrotum (AGDAS) and from the anus to the anterior base of the penis (AGDAP) in two body positions according to the methods by ‘The Infant Development and the Environment Study’ (TIDES) and ‘Cambridge Baby Growth Study’, resulting in four mean values per patient (TIDES AGDAS/AP and Cambridge AGDAS/AP). Normal values for AGD by age were set by our hospital Department of Growth and Reproduction based on a large cohort of healthy infant boys (n = 1940). Testicular biopsies were performed at orchidopexy as a clinical routine. The germ cell number (G/T) and type Ad spermatogonia number (AdS/T) per cross-sectional tubule of at least 100 and 250 tubules, respectively were measured and related to normal samples. Blood samples were obtained by venipuncture for measuring serum LH, FSH, and inhibin B. They were analyzed in our hospital Department of Growth and Reproduction where the normal reference was also established. Correlations between the four mean AGD measurements for each boy were evaluated by Spearman rank correlation analyses. The AGD measurement of every boy was transferred to the multiple of the median (MoM) of the normal AGD for age and named MoM AGD.

MAIN RESULTS AND THE ROLE OF CHANCE: There were 104 boysoperated for unilateral, and 47 boys operated for bilateral, undescended testes, whereas 18 boys had vanished testis including one boy with bilateral vanished testes. Only 6% of cases with vanished testes had a MoM AGD higher than the normal median compared to 32% with undescended testes (P < 0.05). MoM AGD increased with the age at surgery for boys with vanished testis (Spearman r = 0.44), but not for boys with undescended testes (Spearman r = 0.14). Boys with bilateral cryptorchidism had longer AGDs and more often had hypogonadotropic hypogonadism than boys with unilateral cryptorchidism (P < 0.005) and (P < 0.000001).

LIMITATIONS, REASONS FOR CAUTION: Although being the largest published material of AGD measurements of infant boys with cryptorchidism, one limitation of this study covers the quite small number of patients in the different groups, which may decrease the statistical power. Another limitation involves the sparse normal reference material on G/T and AdS/T. Finally, there are currently no longitudinal studies evaluating AGD from birth to adulthood and evaluating childhood AGD in relation to fertility outcome. Our study is hypothesis generating and therefore the interpretation of the results should be regarded as exploratory rather than reaching definite conclusions.

WIDER IMPLICATIONS OF THE FINDINGS: The study findings are in agreement with literature as the total included group of boys with cryptorchidism exhibited shorter than normal AGDs. However, new insights were demonstrated. Boys with vanished testis had shorter AGDs compared to unaffected boys and to boys with undescended testes. This finding challenges the current concept of AGD being determined in ‘the masculinization programming window’ in Week 8 to 14 of gestation. Furthermore, boys with bilateral cryptorchidism had longer AGDs and more often had hypogonadotropic hypogonadism than boys with unilateral cryptorchidism, suggesting that the lack of fetal androgen in hypogonadotropic hypogonadism is not that significant.

STUDY FUNDING/COMPETING INTEREST(S): No external funding was used and no competing interests are declared.

TRIAL REGISTRATION NUMBER: The trial was not registered in an ICMJE-recognized trial registry.

PMID:38373213 | DOI:10.1093/humrep/deae025

Rev Esc Enferm USP. 2024 Feb 19;57:e20230079. doi: 10.1590/1980-220X-REEUSP-2023-0079en. eCollection 2024.

ABSTRACT

OBJECTIVE: To characterize the perceptions and feelings of parents diagnosed with cancer in relation to communication with their children between 3 and 12 years old.

METHOD: A cross-sectional, multicenter, with data triangulation, through structured and semi-structured interviews, with a question with a Semantic Differential Scale, carried out with the father or mother with cancer undergoing outpatient treatment in two hospital institutions in the city of São Paulo, São Paulo, Brazil. Data were analyzed using descriptive statistics, content analysis, using the ATLAS.ti 8.0R software and the Social Representation Theory.

RESULTS: Forty-three respondents participated, 37 (86.0%) were female, 23 (53.5%) aged between 31 and 50 years old, 29 (67.5%) with only children between 7 and 12 years old. The experience was considered painful (73.1%), stressful (53.6%), clear (53.7%) and safe (51.2%). The feelings experienced generated two categories: Trial by fire; and Grateful rewards. Children’s reactions from parents’ perspective generated the categories: Sadness and suffering; Trust and support; Change of behavior; and Denial or insensitivity.

CONCLUSION: Communication was assessed as negative and conflicting, positive and welcoming, and causing changes in children’s behaviors.

PMID:38373186 | DOI:10.1590/1980-220X-REEUSP-2023-0079en

J Gerontol A Biol Sci Med Sci. 2024 Feb 19:glae055. doi: 10.1093/gerona/glae055. Online ahead of print.

ABSTRACT

BACKGROUND: Body composition can be accurately quantified from abdominal CT exams and is a predictor for the development of aging-related conditions and for mortality. However, reference ranges for CT-derived body composition measures of obesity, sarcopenia, and bone loss have yet to be defined in the general population.

METHODS: We identified a population-representative sample of 4,900 persons aged 20 to 89 years who underwent an abdominal CT exam from 2010 to 2020. The sample was constructed using propensity score matching to an age and sex stratified sample of persons residing in the 27-county region of Southern Minnesota and Western Wisconsin. The matching included race, ethnicity, education level, region of residence and the presence of 20 chronic conditions. We used a validated deep learning based algorithm to calculate subcutaneous adipose tissue area, visceral adipose tissue area, skeletal muscle area, skeletal muscle density, vertebral bone area, and vertebral bone density from a CT abdominal section.

RESULTS: We report CT-based body composition reference ranges on 4,649 persons representative of our geographic region. Older age was associated with a decrease in skeletal muscle area and density, and an increase in visceral adiposity. All chronic conditions were associated with a statistically significant difference in at least one body composition biomarker. The presence of a chronic condition was generally associated with greater subcutaneous and visceral adiposity, and lower muscle density and vertebrae bone density.

CONCLUSIONS: We report reference ranges for CT-based body composition biomarkers in a population-representative cohort of 4,649 persons by age, sex, body mass index, and chronic conditions.

PMID:38373180 | DOI:10.1093/gerona/glae055