Category: Nevin Manimala

Phys Med Biol. 2023 Dec 2. doi: 10.1088/1361-6560/ad11a4. Online ahead of print.

ABSTRACT

The delivery efficiency is the bottleneck of spot-scanning proton arc therapy (SPArc) because of the numerous energy layers (EL) ascending switches. This study aims to develop a new algorithm to mitigate the need for EL ascending via water equivalent thickness (WET) sector selection followed by particle swarm optimization (SPArc- particle swarm).
Approach. SPArc- particle swarm divided the full arc trajectory into the optimal sectors based on the K-means clustering analysis of the relative mean WET. Within the sector, particle swarm optimization was used to minimize the total energy switch time, optimizing the energy selection integrated with EL delivery sequence and relationship. This novel planning framework was implemented on the open-source platform matRad (Department of Medical Physics in Radiation Oncology, German Cancer Research Center-DKFZ). Three representative cases (brain, liver, and prostate cancer) were selected for testing purposes. Two kinds of plans were generated: SPArc_seq and SPArc-particle swarm. The plan quality and delivery efficiency were evaluated.
Main results. With a similar plan quality, the delivery efficiency was significantly improved using SPArc-particle swarm compared to the SPArc_seq. More specifically, it reduces the number of EL ascending switching compared to the SPArc_seq (from 21 to 7 in the brain case, from 21 to 5 in the prostate case, from 21 to 6 in the liver case), leading to 16-26% beam delivery time (BDT) reducing in the SPArc treatment. 
Significance. A novel planning framework SPArc-particle swarm could significantly improve the delivery efficiency, which paves the roadmap towards routine clinical implementation. &#xD.

PMID:38041874 | DOI:10.1088/1361-6560/ad11a4

Am J Clin Pathol. 2023 Dec 2:aqad159. doi: 10.1093/ajcp/aqad159. Online ahead of print.

ABSTRACT

OBJECTIVES: National societies recommend against performing routine daily laboratory testing without a specific indication. Unnecessary testing can lead to patient harm, such as hospital-acquired anemia. The objective of this study was to reduce repeat complete blood counts (CBCs) after initial testing.

METHODS: This was a quality improvement initiative implemented across 11 safety net hospitals in New York City. A best practice advisory (BPA) was implemented that asked the user to remove a CBC if the last 2 CBCs within 72 hours had normal white blood cell and platelet counts and unchanged hemoglobin levels. The outcome measure was the rate of CBCs per 1000 patient days preintervention (January 8, 2020, to December 22, 2020) to postintervention (December 23, 2020, to December 7, 2021). The process measure was the acceptance rate of the BPA, defined as the number of times the repeat CBC order was removed through the BPA divided by the total number of times the BPA triggered.

RESULTS: Across 11 hospitals, repeat CBC testing decreased by 12.3% (73.05 to 64.04 per 1000 patient days, P < .001). Six of the 11 hospitals exhibited statistically significant decreases, ranging from a 10% to 48.9% decrease of repeat CBCs. The overall BPA action rate was 20.0% (24,029 of 119,944 repeat CBCs).

CONCLUSIONS: This low-effort, electronic health record-based intervention can effectively reduce unnecessary laboratory testing.

PMID:38041859 | DOI:10.1093/ajcp/aqad159

Bratisl Lek Listy. 2024;125(1):59-63. doi: 10.4149/BLL_2023_137.

ABSTRACT

INTRODUCTION: HBeAg-negative chronic HBV infection is defined by viremia < 2,000 IU/ml (or < 20,000 IU/ml), normal ALT activity and minimal liver fibrosis. Some patients do not meet all the criteria and belong to the so-called grey zone. The aim of the work was to analyse a group of patients with asymptomatic chronic HBV infection, divide them according to the levels of HBV DNA during follow-up and to compare the clinical and laboratory parameters of the patients within the groups.

METHODS: We retrospectively analysed patients with HBeAg-negative chronic HBV infection examined in the Centre for Viral Hepatitis of the Department of Infectology in Košice, Slovakia, from September 2018 to December 2021. Patients were divided into three groups based on HBV DNA levels ​​during long-term follow-up ( 2,000 IU/ ml). We evaluated selected demographic, anamnestic and laboratory data (HBV DNA, ALT, fibrosis stage).

RESULTS: Of the 280 enrolled patients, 160 were men (57.1 %), the average age was 48.0 years, and the mean length of follow-up was 4.7 years. HBV DNA levels ​​were consistently 2,000 IU/ml in 62 patients. 165 patients had normal ALT activity, 74 had fluctuating ALT activity, and permanently increased ALT in 41 patients. 139 patients underwent transient elastography examination, 16 of them had stage F2 fibrosis, two stage F3 and 1 had cirrhosis. When comparing the three groups divided according to HBV DNA, patients with fluctuating HBV DNA had the longest follow-up, but patients with HBV DNA permanently over 2,000 IU/ml were the youngest and the highest proportion of them had elevated ALT activity. 165 patients (58.9%) met the extended criteria of asymptomatic carriers, 115 were in the grey zone.

CONCLUSION: Patients with HBeAg-negative chronic HBV infection often have fluctuating HBV DNA and ALT values ​​during follow-ups. Statistically significantly higher proportion of abnormal ALT activity in patients with HBV DNA > 2,000 IU/ml may suggest higher risk of adverse outcomes. Initiation of treatment in such patients is not always necessary unless they also meet the other indication criteria for treatment. The exact definition of the grey zone is currently absent (Tab. 2, Fig. 2, Ref. 16).

PMID:38041848 | DOI:10.4149/BLL_2023_137

Bratisl Lek Listy. 2024;125(1):50-54. doi: 10.4149/BLL_2024_009.

ABSTRACT

OBJECTIVE: This study estimated delirium incidence in Slovak COVID-19 patients, explored treatment associations and examined the impact on hospitalization and mortality.

BACKGROUND: The COVID-19 pandemic caused by SARS-CoV-2 has significantly affected global health. Delirium, a severe form of acute brain dysfunction, is common in hospitalized patients, including those with COVID-19.

METHODS: A retrospective study analyzed data from 474 hospitalized patients with confirmed SARS-CoV-2 infection in Kosice, Slovakia. Delirium was diagnosed using standardized ICD-10 criteria. Statistical analyses examined associations between delirium, psychiatric symptoms, treatment modalities, hospitalization duration, and mortality.

RESULTS: 29.54 % (140 patients) had delirium. Insomnia, anxiety, and delirium were prevalent psychiatric symptoms. Delirium patients had higher insomnia, anxiety, somnolence, agitation, and aggression rates. Treatments like high-flow nasal oxygen, glucocorticoids, antibiotics, and anakinra were associated with higher delirium incidence. Delirium was more common with antipsychotic use (tiapride, quetiapine, haloperidol), while citalopram seemed protective. No significant associations were found with mortality. Patients using benzodiazepines, hypnotics, or tiapride had longer hospital stays.

CONCLUSION: This study provides insights into delirium incidence in Slovak COVID-19 patients, treatment associations, and the importance of managing psychiatric symptoms and treatment choices for optimal outcomes (Tab. 6, Ref. 33).

PMID:38041846 | DOI:10.4149/BLL_2024_009

Bratisl Lek Listy. 2024;125(1):17-23. doi: 10.4149/BLL_2024_004.

ABSTRACT

AIMS: The aim of the presented study was to determine the distribution of HBV genotypes and their influence on selected parameters in patients in eastern Slovakia.

METHODS: The study includes 202 patients with confirmed chronic HBV infection or hepatitis. For each patient, basic demographic data, and serum samples were collected. The degree of liver fibrosis was determined by transient elastography. The obtained data were evaluated statistically.

RESULTS: Out of a total of 202 patients, 96.0 % of the patients were from the EU region and 27 patients (13.4 %) self-identified as Roma ethnic group. The most common genotype among our patients was genotype A (n = 104; 51.5 %), followed by genotype D (n = 76; 37.6 %) and A/D (n = 13; 6.4 %). In patients from the EU region, genotypes A and D predominated statistically significantly (p < 0.0001). Due to a low number of patients with other genotypes, in the subsequent analysis, we only compared patients with HBV genotypes A or D. Patients with genotypes D and A/D significantly more often mention tattoos as a possible risk factor for disease transmission compared to patients with genotype A (p = 0.043). Subsequently, we divided patients into two groups – treated and untreated. The level of qHBsAg was significantly higher in untreated patients with genotypes A (p < 0.0001). The influence of HBV genotypes on other laboratory parameters was not confirmed in our study.

CONCLUSION: This is the first HBV genotypes study from Slovakia. We suggest that HBV genotypes may play a role in the virus-host relationship Keywords: chronic hepatitis B, genotypes, hepatitis B virus, prognostic factors, distribution.

PMID:38041841 | DOI:10.4149/BLL_2024_004

J Magn Reson Imaging. 2023 Dec 2. doi: 10.1002/jmri.29162. Online ahead of print.

ABSTRACT

BACKGROUND: Pancreatic ductal adenocarcinoma (PDA) is the third leading cause of cancer-related death in the United States. However, early response assessment using the current approach of measuring changes in tumor size on computed tomography (CT) or MRI is challenging.

PURPOSE: To investigate the feasibility of hyperpolarized (HP) [1-¹³ C]pyruvate MRI to quantify metabolism in the normal appearing pancreas and PDA, and to assess changes in PDA metabolism following systemic chemotherapy.

STUDY TYPE: Prospective.

SUBJECTS: Six patients (65.0 ± 7.6 years, 2 females) with locally advanced or metastatic PDA enrolled prior to starting a new line of systemic chemotherapy.

FIELD STRENGTH/SEQUENCE: 3-T, T1-weighted gradient echo, metabolite-selective ¹³ C echoplanar imaging.

ASSESSMENT: Time-resolved HP [1-¹³ C]pyruvate data were acquired before (N = 6) and 4-weeks after (N = 3) treatment initiation. Pyruvate metabolism, as quantified by pharmacokinetic modeling and metabolite area-under-the-curve ratios, was assessed in manually segmented PDA and normal appearing pancreas ROIs (N = 5). The change in tumor metabolism before and 4-weeks after treatment initiation was assessed in primary PDA (N = 2) and liver metastases (N = 1), and was compared to objective tumor response defined by response evaluation criteria in solid tumors (RECIST) on subsequent CTs.

STATISTICAL TESTS: Descriptive tests (mean ± standard deviation), model fit error for pharmacokinetic rate constants.

RESULTS: Primary PDA showed reduced alanine-to-lactate ratios when compared to normal pancreas, due to increased lactate-to-pyruvate or reduced alanine-to-pyruvate ratios. Of the three patients who received HP [1-¹³ C]pyruvate MRI before and 4-weeks after treatment initiation, one patient had a primary tumor with early metabolic response (increase in alanine-to-lactate) and subsequent partial response according to RECIST, one patient had a primary tumor with relatively stable metabolism and subsequent stable disease by RECIST, and one patient had metastatic PDA with increase in lactate-to-pyruvate of the liver metastases and corresponding progressive disease according to RECIST.

DATA CONCLUSION: Altered pyruvate metabolism with increased lactate or reduced alanine was observed in the primary tumor. Early metabolic response assessed at 4-weeks after treatment initiation correlated with subsequent objective tumor response assessed using RECIST.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 2.

PMID:38041836 | DOI:10.1002/jmri.29162

J Immigr Minor Health. 2023 Dec 2. doi: 10.1007/s10903-023-01572-4. Online ahead of print.

ABSTRACT

This study aims to assess relationships between previous stroke diagnosis and demographic or disability status variables, stratified by U.S. citizenship status. The 2019 and 2021 National Health Interview Survey data were analyzed for both descriptive statistics and logistic regression models. Age, sex, income level, race/ethnicity, health insurance status, and indicators of disability common after stroke were predictor variables of interest. For each disability predictor variable, higher odds of having stroke were seen regardless of citizenship status, except for the ‘difficulty remembering’ variable. For U.S. citizens, increasing age corresponded with higher odds of stroke diagnosis. For noncitizens, odds ratios decreased from 40.3 (95% CI 38.88-41.82) for the 40-65 age group to 29.6 (95% CI 28.38-30.77) in the 80 + group, when compared with the 18-39 age reference group. Female noncitizens had higher odds of stroke, while male citizens had higher odds. Non-Hispanic Black citizens had higher odds of stroke, while the other racial/ethnic groups had higher odds for noncitizens. The results indicated the existence of several socio-demographic disparities in stroke. Notably, noncitizens experienced stroke at a younger age and reported more severe disability outcomes after stroke diagnosis than citizens.

PMID:38041795 | DOI:10.1007/s10903-023-01572-4

Langenbecks Arch Surg. 2023 Dec 2;408(1):454. doi: 10.1007/s00423-023-03181-z.

ABSTRACT

BACKGROUND: Rectal prolapse is a distressing condition for patients and no consensus exists on optimal surgical management. We compared outcomes of two common perineal operations (Delorme’s and Altemeier’s) used in the treatment of rectal prolapse.

METHODS: A systematic search of multiple electronic databases was conducted. Peri- and post-operative outcomes following Delorme’s and Altemeier’s procedures were extracted. Primary outcomes included recurrence rate, anastomotic dehiscence rate and mortality rate. The secondary outcomes were total operative time, volume of blood loss, length of hospital stay and coloanal anastomotic stricture formation. Revman 5.3 was used to perform all statistical analysis.

RESULTS: Ten studies with 605 patients were selected; 286 underwent Altemeier’s procedure (standalone), 39 had Altemeier’s with plasty (perineoplasty or levatoroplasty), and 280 had Delorme’s. Recurrence rate [OR: 0.66; 95% CI [0.44-0.99], P = 0.05] was significantly lower and anastomotic dehiscence [RD: 0.05; 95% CI [0.00-0.09], P = 0.03] was significantly higher in the Altemeier’s group. However, sub group analysis of Altemeier’s with plasty failed to show significant differences in these outcomes compared with the Delorme’s procedure. Length of hospital stay was significantly more following an Altemeier’s operation compared with Delorme’s [MD: 3.05, 95% CI [0.95 – 5.51], P = 0.004]. No significant difference was found in total operative time, intra-operative blood loss, coloanal anastomotic stricture formation and mortality rates between the two approaches.

CONCLUSIONS: A direct comparison of two common perineal procedures used in the treatment of rectal prolapse demonstrated that the Altemeier’s approach was associated with better outcomes. Future, well-designed high quality RCTs with long-term follow up are needed to corroborate our findings.

PMID:38041773 | DOI:10.1007/s00423-023-03181-z

Community Ment Health J. 2023 Dec 2. doi: 10.1007/s10597-023-01213-y. Online ahead of print.

ABSTRACT

This study examined the intersectional effects of gender, race, and socioeconomic status (SES) on mental health service utilization (MHSU) employing the intersectionality framework. Data was extracted from Canadian Community Health Survey 2015-2016 with a total of 85,619 sample. Covariate adjusted prevalence ratio (aPR) and the predicted probability of MHSU from intersectional analyses were estimated using Poisson regression with robust variance. The prevalence of MHSU was 15.04% overall, 19.61% among women, 10.27% among men, 21.56% among white women and 11.12% among white men. The study observed overall significant intersectional effect of SES by gender and race on MHSU. For instance, white men with the lowest income were more likely to have MHSU compared to their counterparts. Similarly, the predicted probability of MHSU decreased with the increase of SES that varied by gender and race. Two-way and three-way interactions also confirmed statistical significance (p-interaction < 0.05) of intersectional effect of gender, race, and SES. The observed socioeconomic differences in MHSU across gender and racial groups can be explained by intersectionality.

PMID:38041771 | DOI:10.1007/s10597-023-01213-y

Egypt Heart J. 2023 Dec 2;75(1):99. doi: 10.1186/s43044-023-00427-5.

ABSTRACT

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a hereditary myocardial disorder, often due to sarcomere gene mutations, characterized by the left ventricular hypertrophy. Current treatments offer symptomatic relief but lack specificity. Mavacamten, an allosteric inhibitor, has shown significant improvements in HCM patients in trials, reducing the requirement for invasive treatments. This meta-analysis assesses Mavacamten’s efficacy and safety as a targeted HCM intervention.

METHODS: This study examined four randomized controlled trials comparing Mavacamten to placebo in HCM patients. Each trial had a unique primary endpoint, and secondary outcomes included improvements in NYHA-FC, eligibility for septal reduction therapy (SRT) or undergoing it, adverse events (serious and treatment-related), atrial fibrillation, and non-sustained ventricular tachycardia. Statistical analysis involved calculating risk ratios (RRs) and assessing heterogeneity.

RESULTS: The four included studies showed minimal risk of bias and involved 503 patients with HCM (273 Mavacamten and 230 placebo). Mavacamten significantly increased the primary endpoint (RR 2.15, 95% CI 1.20-3.86, P = 0.01) and ≥ 1 NYHA-FC class (RR 2.21, 95% CI 1.48-3.3, P = 0.0001). Mavacamten group had lower rates of SRT compared to those receiving placebo (RR, 0.30, 95% CI 0.22-0.40; P < 0.00001). No significant differences existed in rates adverse events between the Mavacamten and placebo groups.

CONCLUSIONS: Our study suggests that Mavacamten may have therapeutic benefits for HCM patients, as indicated by its positive impact on certain endpoints. Further research with larger samples, longer follow-up, and comprehensive analysis is needed to understand Mavacamten’s safety and efficacy in HCM patients.

PMID:38041770 | DOI:10.1186/s43044-023-00427-5