Category: Nevin Manimala

J Stomatol Oral Maxillofac Surg. 2023 Jul 14:101563. doi: 10.1016/j.jormas.2023.101563. Online ahead of print.

ABSTRACT

BACKGROUND: The optimal management of cervical lymph nodes in N0M0 maxillary sinus squamous cell carcinoma (MSSCC) remains a subject of debate. This study aimed to investigate the impact of elective neck dissection (END) on the prognosis of N0M0 MSSCC patients and explore potential prognostic factors.

METHODS: A retrospective analysis was conducted using the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was employed to minimize bias between the END and non-END groups. Cox regression analysis was performed to identify prognostic factors, and subgroup analyses were conducted based on patient characteristics. Furthermore, the optimal number of lymph nodes in END was determined using maximally selected test statistics.

RESULTS: A total of 777 N0M0 MSSCC patients were included in the study. After PSM, patients who underwent END demonstrated significantly improved overall survival (OS) and cancer-specific survival (CSS) compared to those who did not undergo END (p < 0.05). Subgroup analyses revealed a favorable prognosis for patients receiving radiotherapy and END, with a hazard ratio of 0.729 (95% CI: 0.549-0.967; p = 0.029) for OS. Furthermore, patients with a lymph node count greater than 5 in END had significantly better OS and CSS compared to those with 5 or fewer lymph nodes (p = 0.013, p = 0.018, respectively).

CONCLUSION: Our findings suggest that END provides a survival benefit for N0M0 MSSCC patients. Additionally, a lymph node count greater than 5 in END is associated with improved staging accuracy and better prognosis. Prospective research is needed to validate these findings and inform clinical decision-making for N0M0 MSSCC patients.

PMID:37454815 | DOI:10.1016/j.jormas.2023.101563

Am J Pharm Educ. 2023 Jul 14:100571. doi: 10.1016/j.ajpe.2023.100571. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the economic considerations, including cost-saving strategies, associated with nonsterile compounding education for students in schools and colleges of pharmacy across the United States.

METHODS: An electronic survey was sent to American Association of Colleges of Pharmacy Pharmaceutics Section and Laboratory Instructor’s Special Interest Group members. Quantitative and qualitative data were collected about the institution, student cohorts, compounding courses, equipment, budgets, personnel, and cost-saving measures. Descriptive statistics were calculated using SPSS. Open-ended responses were used by respondents if the primary question could not adequately capture their institution specific information. These answers were added to the study findings.

RESULTS: Of 555 surveys sent, 46 were completed. Reported annual compounding budgets ranged from $3,000 and $96,000. Reported annual equipment maintenance costs ranged from $400 and $18,000. Fifty percent of respondents reported students shared equipment, and 29.6% collected a lab fee from students to offset costs. Approximately half of respondents reported use of cost-saving measures, including contract pricing, purchasing supplies in bulk, price comparisons, use of simulated drugs, re-use of personal protective equipment, and procurement of donations. Fifty percent of respondents employed laboratory assistants to support nonsterile compounding sessions, with paid positions ranging from $200-$1,000 per semester.

CONCLUSION: Findings from this study may assist pharmacy administrators and course directors in evaluating the costs associated with nonsterile compounding education across the Academy and, more importantly, determining ways to reduce such costs while maintaining the intent and quality of these courses.

PMID:37454811 | DOI:10.1016/j.ajpe.2023.100571

J Environ Manage. 2023 Jul 14;344:118532. doi: 10.1016/j.jenvman.2023.118532. Online ahead of print.

ABSTRACT

The management of Soil Organic Carbon (SOC) is a critical component of both nature-based solutions for climate change mitigation and global food security. Agriculture has contributed substantially to a reduction in global SOC through cultivation, thus there has been renewed focus on management practices which minimize SOC losses and increase SOC gain as pathways towards maintaining healthy soils and reducing net greenhouse gas emissions. Mechanistic models are frequently used to aid in identifying these pathways due to their scalability and cost-effectiveness. Yet, they are often computationally costly and rely on input data that are often only available at coarse spatial resolutions. Herein, we build statistical meta-models of a multifactorial crop model in order to both (a) obtain a simplified model response and (b) explore the biophysical determinants of SOC responses to management and the geospatial heterogeneity of SOC dynamics across Europe. Using 5600 unique simulations of crop growth from the gridded Environmental Policy Integrated Climate-based Gridded Agricultural Model (EPIC-IIASA GAM) covering 86,000 simulation units across Europe, we build multiple polynomial regression ensemble meta-models for unique combinations of climate and soil across Europe in order to predict SOC responses to varying management intensities. We find that our biophysically-explicit meta models are highly accurate (R² = 0.97) representations of the full mechanistic model and can be used in lieu of the full EPIC-IIASA GAM model for the estimation of SOC responses to cropland management. Model stratification by means of climate and soil clustering improved the performance of the meta-models compared to the full EU-scale model. In regional and local validations of the meta-model predictions, we find that the meta-models largely capture broad SOC dynamics such as the linear nature of SOC responses to residue application, yet they often underestimate the magnitude of SOC responses to management. Furthermore, we find notable differences between the results from the biophysically-specific models throughout Europe, which point to spatially-distinct SOC responses to management choices such as nitrogen fertilizer application rates and residue retention that illustrate the potential for these models to be used for future management applications. While more accurate input data, calibration, and validation will be needed to accurately predict SOC change, we demonstrate the use of our meta-models for biophysical cluster and field study scale analyses of broad SOC dynamics with basically zero fine-tuning of the models needed. This work provides a framework for simplifying large-scale agricultural models and identifies the opportunities for using these meta-models for assessing SOC responses to management at a variety of scales.

PMID:37454447 | DOI:10.1016/j.jenvman.2023.118532

Eur J Cancer. 2023 Jun 20;191:112948. doi: 10.1016/j.ejca.2023.112948. Online ahead of print.

ABSTRACT

BACKGROUND: Cyclin-dependent kinase (CDK)4/6-inhibitors with endocrine therapy represent the standard of treatment of hormone receptor-positive(HR+)/human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (MBC). Gut microbiota seems to predict treatment response in several tumour types, being directly implied in chemotherapy resistance and development of adverse effects. No evidence is available on gut microbiota impact on efficacy of HR+ breast cancer treatment.

PATIENTS AND METHODS: We assessed the potential association among faecal microbiota and therapeutic efficacy of CDK4/6-inhibitors on 14 MBC patients classified as responders (R) and non-responders (NR) according to progression-free survival. A stool sample was collected at baseline and V3-V4 16S targeted sequencing was employed to assess its bacterial composition. Statistical associations with R and NR were studied.

RESULTS: No significant differences were observed between R and NR in terms of α-/β-diversity at the phylum and species level. Machine-learning (ML) algorithms evidenced four bacterial species as a discriminant for R (Bifidobacterium longum, Ruminococcus callidus) and NR (Clostridium innocuum, Schaalia odontolytica), and an area under curve (AUC) of 0.946 after Random Forest modelling. Network analysis evidenced two major clusters of bacterial species, named Species Interacting Groups (SIG)1-2, with SIG1 harbouring 75% of NR-related bacterial species, and SIG2 regrouping 76% of R-related species (p < 0.001). Cross-correlations among several patients’ circulating immune cells or biomarkers and bacterial species’ relative abundances showed associations with potential prognostic implications.

CONCLUSIONS: Our results provide initial insights into the gut microbiota involvement in sensitivity and/or resistance to CDK4/6-inhibitors + endocrine therapy in MBC. If confirmed in larger trials, several microbiota manipulation strategies might be hypothesised to improve response to CDK4/6-inhibitors.

DATA AVAILABILITY STATEMENT: All raw data (fastq.gz files) and clinical metadata, complying with FAIR principles (https://www.go-fair.org/fair-principles/), are available at NCBI SRA portal under PRJNA946762 Bioproject.

PMID:37454444 | DOI:10.1016/j.ejca.2023.112948

J Clin Neurosci. 2023 Jul 14;115:1-7. doi: 10.1016/j.jocn.2023.06.014. Online ahead of print.

ABSTRACT

BACKGROUND: Visual evoked potential (VEP) recording is traditionally regarded as an unreliable evoked potential monitoring technique, precluding widespread use in intracranial neurosurgery. However, VEPs can serve as a useful intraoperative adjunct for real-time detection of mechanical damage to optic apparatuses. The low obtainability and prognostic utility of VEPs are associated with transcranial recording, which typically provides non-focal information and poor signal-to-noise ratio. Direct cortical VEP (DC-VEP) recordings may offer a solution.

METHODS: We evaluated the obtainability of DC-VEPs as well as their prognostic utility in predicting postoperative visual function deterioration in a series of brain tumor patients undergoing craniotomies for tumor resection. Patient records were retrospectively reviewed for all consecutive patients undergoing brain tumor resections with DC-VEP monitoring. Pre- and postoperative visual fields were characterized from patient charts and associated with the presence of intraoperative monitoring alerts to determine the sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of DC-VEPs in detecting postoperative visual field deficits.

RESULTS: Twenty-two patients (9 male, 13 female) were included, with a median age of 60 years. DC-VEPs were reliably detected in 19 of 23 included surgeries (82.6%). The reported sensitivity, specificity, PPV, and NPV in detecting postoperative visual field deficits was 60%, 92.9%, 75%, and 86.7%, respectively. There was a statistically significant association between monitoring alerts and the presence of visual field deterioration by Fischer’s exact test (p = 0.0374).

CONCLUSIONS: DC-VEPs can be reliably obtained and are useful for detecting mechanical injury to optic areas and tracts during tumor resection.

PMID:37454439 | DOI:10.1016/j.jocn.2023.06.014

Am J Otolaryngol. 2023 Jul 8;44(6):103967. doi: 10.1016/j.amjoto.2023.103967. Online ahead of print.

ABSTRACT

PURPOSE: Pediatric neck abscesses are a common pathology seen in an ambulatory setting. Although some pediatric neck abscesses are managed medically with antibiotics, surgical intervention is often required. Given the often non-emergent presentation of many abscesses, a variety of logistical and perioperative factors may delay time to care and subsequently prolong hospital stay. The objective of this study was to examine factors that influence the overall time to surgery (TTS) and hospital length of stay (LOS) in a pediatric population with neck abscesses who ultimately require surgical drainage.

MATERIALS AND METHODS: 161 pediatric patients who underwent incision and drainage of a neck abscess over a ten-year period at a tertiary referral children’s center were reviewed. Demographic information, radiographic studies, and surgical information were extracted from patient charts. Descriptive statistics, Mann-Whitney U tests, and multivariate analyses were performed.

RESULTS: The most common subcategory location was deep neck abscesses (33.1 %). Computed tomography (CT) was the most common pre-operative imaging modality (54.1 %) followed by ultrasound (US) (49.1 %) and magnetic resonance imaging (2.6 %). US and a combination of multiple preoperative imaging modalities were associated with increased LOS and TTS. Repeat surgery was associated with increased LOS. Pre-admission antibiotic use was associated with increased LOS and TTS. Younger patients were more likely to have a longer LOS.

CONCLUSIONS: A variety of factors can influence TTS, LOS, and time from surgery to discharge including patient age, abscess location, a non-optimized utilization of imaging modalities, the utilization of pre-admission antibiotics, and the need for repeat operations.

PMID:37454430 | DOI:10.1016/j.amjoto.2023.103967

Public Health. 2023 Jun 19;221:142-149. doi: 10.1016/j.puhe.2023.06.018. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to spatiotemporally analyze the profile of influenza-like illness (ILI) outbreaks in the state of São Paulo, Brazil, between 2020 and 2022.

STUDY DESIGN: This was a cross-sectional retrospective study.

METHODS: Outbreaks of ILI with final diagnoses of COVID-19, influenza, or other respiratory viruses (ORVs) recorded between January 2020 and November 2022, obtained from the Notifiable Diseases Information System (SINAN NET) Outbreak module, were analyzed. Kernel density estimates and Getis-Ord Gi∗ statistics were performed to identify spatial clusters.

RESULTS: A total of 13,314 ILI outbreaks were identified, involving 130,568 cases and 2649 deaths. Of these, 104,399 (80%) were confirmed as COVID-19, 15,861 (12%) were confirmed as ORV, and 10,308 (8%) were confirmed as influenza. The year 2021 had the highest number of outbreaks and cases. Schools recorded the most outbreaks and cases, followed by long-term care facilities for older adults (LTCs). The highest average number of cases per outbreak and the highest attack rates occurred at social gatherings and prisons. Prisoners were three times more likely to contract COVID-19 during outbreaks than people in other institutions. The highest hospitalization and mortality rates for all virus types occurred in the LTC group. The occurrence and intensity of outbreaks were highly heterogeneous among the different institutions after the introduction of new SARS-CoV-2 variants in the state.

CONCLUSIONS: ILI outbreaks were not randomly distributed; they clustered in specific areas. Transmissibility varied among different institutions with different responses to the COVID-19 pandemic. These results can be used as a basis for prioritizing actions and allocating resources during future pandemics.

PMID:37454404 | DOI:10.1016/j.puhe.2023.06.018

Insights Imaging. 2023 Jul 16;14(1):124. doi: 10.1186/s13244-023-01475-w.

ABSTRACT

OBJECTIVES: To evaluate the diagnostic value of whole-body low-dose computed tomography (CT) to detect bone metastasis in prostate cancer (PCa) patients and its possible utility in therapeutic decision-making. Also, to determine the valuable CT features for lesion characterisation.

METHODS: This IRB-approved retrospective study reviewed PCa patients who underwent ⁶⁸Ga-PSMA PET/CT in our centre from March 2017 to August 2022. Two board-certified radiologists and one nuclear medicine specialist reported all whole-body low-dose CT scans separately, unaware of the ⁶⁸Ga-PSMA-PET results. The per-lesion and per-patient diagnostic performances were calculated. Also, the significance of CT features was evaluated. Moreover, the inter-observer agreement was analysed. A two-tailed p value < 0.05 was considered significant.

RESULTS: From 727 reviewed PCa patients, 601 (mean age = 68.7 ± 8.1) were found to be eligible, including 211 (35.1%) referrals for initial staging and 390 (64.9%) for evaluating the extent of the disease after biochemical recurrence. Per-patient diagnostic analysis for three reviewers showed 81.0-89.4% sensitivity and 96.6-98.5% specificity in detecting osteo-metastasis. It was able to correctly detect high-burden disease based on both CHAARTED and LATITUDE criteria. Regarding the value of underlying CT features, size > 1 cm, ill-defined borders, presence of soft-tissue component, and cortical destruction were statistically in favour of metastasis. Also, Hu > 900 was in favour of benign entities with 93% specificity.

CONCLUSIONS: Although not as accurate as ⁶⁸Ga-PSMA PET/CT, whole-body low-dose CT might precisely classify PCa patients considering therapeutic decision-making. Additionally, we proposed diagnostic CT features that could help radiologists with better characterisation of the detected lesions.

CRITICAL RELEVANCE STATEMENT: The whole-body low-dose CT can be considered valuable in the clinical decision-making of prostate cancer patients. This modality may obviate performing multiple imaging sessions and high-cost scans in patients diagnosed with the high-burden disease.

PMID:37454388 | DOI:10.1186/s13244-023-01475-w

Environ Sci Pollut Res Int. 2023 Jul 16. doi: 10.1007/s11356-023-28835-9. Online ahead of print.

ABSTRACT

The global economic growth is hindered by resources shortage, energy demand, air pollution and climate. Energy efficiency can reduce some pollutants while potentially increase others. This study refers to sulfur dioxide (SO₂), nitrogen oxides (NO_x), and dust and smoke (DS) as primary pollutants to distinguish it from secondary ones. The influence of energy efficiency, socioeconomic, and natural climatic factors on air quality is analyzed under the theory of STIRPAT. It is highly coupled between energy efficiency and the spatial distribution of air quality. Increased energy efficiency can improve air quality by reducing SO₂ and NO_x, but the impact on DS is insignificant. Air pollutants decrease by about 0.531% for every 1% increase in temperature and 0.105% for every 1% increase in precipitation. Consumption will reduce air pollution, and there is an inverted U-shaped relationship between population density, economic scale, urbanization, technology innovation, and air pollution. It is worth mentioning that this work adds temperature and precipitation to the STIRPAT as natural climatic factors, analyzing the impact of energy efficiency on air pollution under the two-factor restrictions of socioeconomic and natural climatic factors. Finally, management suggestions are made to improve air quality.

PMID:37454380 | DOI:10.1007/s11356-023-28835-9

Langenbecks Arch Surg. 2023 Jul 16;408(1):279. doi: 10.1007/s00423-023-03003-2.

ABSTRACT

BACKGROUND: Celiac axis stenosis (CAS) often is an incidental finding in terms of diagnostic for hepatobiliary surgery since most cases remain asymptomatic. It remains unclear whether CAS is a risk factor for postoperative complications after hepatobiliary surgery. Therefore, the aim of this study was to evaluate the impact of an asymptomatic CAS on the postoperative morbidity and survival of patients undergoing hepatobiliary surgery.

METHODS: We retrospectively analyzed CT scans and clinicopathological data of 250 consecutive patients undergoing hepatobiliary surgery between 2011 and 2018 in our tertiary center. We compared the postoperative course between patients with and without an incidental CAS as well as their overall survival.

RESULTS: CAS was caused by atherosclerotic stenosis in 16 (64%) patients, by ligamentous stenosis in 4 (16%) and by combined conditions in 5 cases (20%). Mean age of patients in the CAS group was significantly higher in comparison to patients of the non-CAS group (71.0 vs. 59.1 years, p < 0.001). Major hepatectomy was conducted in 40% of the CAS patients and 19.6% of non-CAS patients, respectively (p = 0.036). Interestingly, no statistically significant differences in postoperative morbidity (40 vs. 46.2%, p = 0.673) or in overall survival between the groups (41.3 vs. 51.9 months, p = 0.611) were observed.

CONCLUSION: Our analysis found no correlation between an asymptomatic celiac axis stenosis and postoperative complications or overall survival after hepatobiliary surgery. Which impact the incidental CAS may have in highly complex cases remains unclear. Further studies are needed to identify patients who benefit from CAS treatment before hepatobiliary surgery.

PMID:37454337 | DOI:10.1007/s00423-023-03003-2