Category: Nevin Manimala

JCO Clin Cancer Inform. 2023 Jul;7:e2200142. doi: 10.1200/CCI.22.00142.

ABSTRACT

PURPOSE: Pakistan has been systematically collecting cancer data since 1994 through cancer registries.

METHODS: This article presents a comprehensive analysis of cancer statistics in Pakistan from 1994 to 2021, including incidence and patterns.

RESULTS: The total number of patients with malignant neoplasm was 111,941, and the number of patients registered was 109,863. Most patients were from Punjab (67.6%) and Khyber Pakhtunkhwa (20.2%). Breast cancer (22.2%), colorectum cancer (5.6%), leukemia (5.3%), lip and oral cavity cancer, and non-Hodgkin lymphoma (5.1%) were the top five prevalent cancers in all age groups and sexes. Breast (24.2%), colorectum (6.2%), lip and oral cavity (5.8%), non-Hodgkin lymphoma (4.4%), and prostate cancers (4.0%) were most common in adults in both sexes. In both sexes, the most common cancers among children were Hodgkin lymphoma (20.1%), acute lymphoblastic leukemia (19.8%), non-Hodgkin lymphoma (11.6%), osteosarcoma (7.0%), and retinoblastoma (6.2%). Breast (45.9%), ovary and uterine adnexa (4.9%), lip and oral cavity (4.2%), cervix uteri (4.0%), and colorectum cancers (3.9%) were most common in adult females. In adult males, colorectum cancer (8.7%), prostate cancer (8.5%), lip and oral cavity cancer (7.6%), non-Hodgkin lymphoma (6.4%), and liver and intrahepatic bile duct cancers were the top five most common malignancies.

CONCLUSION: It has been found that breast cancer, colorectum cancer, prostate cancer, leukemia, and bone cancer rates are among the highest in Pakistan. This information may be useful in assessing the effectiveness of future intervention strategies.

PMID:37450777 | DOI:10.1200/CCI.22.00142

Int Braz J Urol. 2023 Jun 20;49. doi: 10.1590/S1677-5538.IBJU.2023.9907. Online ahead of print.

ABSTRACT

OBJECTIVES: This review discusses deep infiltrating endometriosis (DIE) diagnosis and surgery using current urological knowledge and technologies.

MATERIALS AND METHODS: Narrative review of deep infiltrating endometriosis that result in urological issues. We examined manuscripts from Pubmed, Embase, and Scielo’s database using the following MeSH terms: (‘endometriosis’) AND (‘urology’ OR ‘urological’ OR ‘urologist’) AND (‘bladder’ OR’vesical’) AND (‘ureteral’ OR ‘ureter’).Selection followed PRISMA guidelines. Sample images from our records were brought to endorse the findings.

RESULTS: Thirty four related articles were chosen from 105. DIE may affect the urinary system in 52.6% of patients. Lower urinary tract symptoms may require urodynamic examination. Ultrasonography offers strong statistical yields for detecting urinary tract lesions or distortions, but magnetic resonance will confirm the diagnosis. Cystoscopy can detect active lesions, although any macroscopic visual appeal is pathognomonic. Endourology is utilized intraoperatively for bladder and ureteral assessment, however transurethral endoscopic excision of bladder lesions had higher recurrence rates. Laparoscopy is the route of choice for treatment; partial cystectomy, and bladder shaving were the most prevalent surgical treatments for bladder endometriosis. Regarding the ureteral treatment, the simple ureterolysis and complex reconstructive techniques were described in most papers. Using anatomical landmarks or neuronavigation, pelvic surgical systematization allows intraoperative neural structure identification.

CONCLUSIONS: DIE in the urinary system is common, however the number of publications with high level of evidence is limited. The initial tools for diagnosis are ultrasonography and cystoscopy, but magnetic resonance is the most reliable tool. When the patient has voiding symptoms, the urodynamic examination is crucial. Laparoscopy improves lesion detection and anatomical understanding. This approach must be carried out by professionals with high expertise, since the surgery goes beyond the resection of lesions and includes the preservation of nerve structures and urinary tract reconstruction techniques.

PMID:37450770 | DOI:10.1590/S1677-5538.IBJU.2023.9907

Opt Lett. 2023 Jul 15;48(14):3793-3796. doi: 10.1364/OL.488848.

ABSTRACT

We demonstrate an extended Kalman filtering-enhanced linewidth measurement in short-delay self-heterodyne interferometry (SDSHI). We found that a modified SDSHI trace closely resembles a biased cosine wave, which would enable convenient linewidth estimation by its uniform envelope contrast without any correction factor. Experimentally, we adopted this approach for kHz laser linewidth measurement, taking advantages of extended Kalman filtering (EKF) to adaptively track the cosine wave. Apart from the measurement noise suppression, this approach could use as many data points as possible in the noisy trace to make a linewidth estimation at each tracked data point, from which we can deduce valuable statistical parameters such as the mean and standard deviation. This approach involves no more equipment than conventional SDSHI and sophisticated EKF so that it can be easily implemented. Therefore, we believe it will find wide applications in ultra-narrow laser linewidth measurement.

PMID:37450752 | DOI:10.1364/OL.488848

Opt Lett. 2023 Jul 15;48(14):3741-3744. doi: 10.1364/OL.493731.

ABSTRACT

We demonstrate an all-optical random number generator based on spontaneous symmetry breaking in a coherently driven Kerr resonator. Random bit sequences are generated by repeatedly tuning a control parameter across a symmetry-breaking bifurcation that enacts random selection between two possible steady-states of the system. Experiments are performed in a fiber ring resonator, where the two symmetry-broken steady-states are associated with orthogonal polarization modes. Detrimental biases due to system asymmetries are suppressed by leveraging a recently discovered self-symmetrization phenomenon that ensures the symmetry-breaking dynamics act as an unbiased coin toss, with a genuinely random selection between the two available steady-states. We optically generate bits at a rate of 3 MHz without post-processing and verify their randomness using the National Institute of Standards and Technology and Dieharder statistical test suites.

PMID:37450739 | DOI:10.1364/OL.493731

Opt Lett. 2023 Jul 15;48(14):3677-3680. doi: 10.1364/OL.494543.

ABSTRACT

Spatial beam self-cleaning, a manifestation of the Kerr effect in graded-index multimode fibers, involves a nonlinear transfer of power among modes, which leads to robust bell-shaped output beams. The resulting mode power distribution can be described by statistical mechanics arguments. Although the spatial coherence of the output beam was experimentally demonstrated, there is no direct study of modal phase evolutions. Based on a holographic mode decomposition method, we reveal that nonlinear spatial phase-locking occurs between the fundamental and its neighboring low-order modes, in agreement with theoretical predictions. As such, our results dispel the current belief that the spatial beam self-cleaning effect is the mere result of a wave thermalization process.

PMID:37450723 | DOI:10.1364/OL.494543

Opt Lett. 2023 Jul 15;48(14):3645-3648. doi: 10.1364/OL.494609.

ABSTRACT

In this Letter, we present a simple and versatile scheme for enhancing the nonclassical properties of light states using only linear optics and photodetectors. By combining a coherent state |α〉 and an arbitrary pure state of light |ϕ〉 (excluding coherent states) at two beam splitters, we show that the amplitude α of the coherent state can be tuned to filter out specific Fock components and generate states of light with increased nonclassical features. We provide two examples of input states and demonstrate the effectiveness of our scheme in enhancing the sub-Poissonian statistics or the quadrature squeezing of the output states.

PMID:37450715 | DOI:10.1364/OL.494609

Ann Surg. 2023 Jul 14. doi: 10.1097/SLA.0000000000006006. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop and update evidence- and consensus-based guidelines on laparoscopic and robotic pancreatic surgery.

SUMMARY BACKGROUND DATA: Minimally invasive pancreatic surgery (MIPS), including laparoscopic and robotic surgery, is complex and technically demanding. Minimizing the risk for patients requires stringent, evidence-based guidelines. Since the International Miami Guidelines on MIPS in 2019, new developments and key publications have been reported, necessitating an update.

METHODS: Evidence-based guidelines on 22 topics in 8 domains were proposed: terminology, indications, patients, procedures, surgical techniques and instrumentation, assessment tools, implementation and training, and artificial intelligence. The Brescia Internationally Validated European Guidelines on Minimally Invasive Pancreatic Surgery (EGUMIPS, September 2022) used the Scottish Intercollegiate Guidelines Network (SIGN) methodology to assess the evidence and develop guideline recommendations, the Delphi method to establish consensus on the recommendations among the Expert Committee, the AGREE II-GRS tool for methodological guideline quality assessment, and external validation by a Validation Committee.

RESULTS: Overall, 27 European experts, 6 international experts, 22 international Validation Committee members, 11 Jury Committee members, 18 Research Committee members, and 121 registered attendees of the two-day meeting were involved in the development and validation of the guidelines. In total, 98 recommendations were developed, including 33 on laparoscopic, 34 on robotic and 31 on general MIPS covering 22 topics in 8 domains. Out of 98 recommendations, 97 reached at least 80% consensus among the experts and congress attendees, and all recommendations were externally validated by the Validation Committee.

CONCLUSIONS: The EGUMIPS evidence-based guidelines on laparoscopic and robotic MIPS can be applied in current clinical practice to provide guidance to patients, surgeons, policy-makers and medical societies.

PMID:37450702 | DOI:10.1097/SLA.0000000000006006

Ann Surg. 2023 Jul 17. doi: 10.1097/SLA.0000000000005948. Online ahead of print.

ABSTRACT

OBJECTIVES: To report the results of a rigorous quality control (QC) process in the grading of total mesorectal excision (TME) specimens during a multicenter prospective phase II trial of transanal TME.

SUMMARY BACKGROUND DATA: Grading of TME specimens is based on macroscopic assessment of the mesorectum and standardized through synoptic pathology reporting. TME grade is a strong predictor of outcomes with incomplete (IC) TME associated with increased rates of local recurrence relative to complete or near complete (C/NC) TME. Although TME grade serves as an endpoint in most rectal cancer trials, in protocols incorporating centralized review of TME specimens for quality assurance, discordance in grading and the management thereof has not been previously described.

METHODS: A phase II prospective taTME trial was conducted from 2017-2022 across 11 North American centers with TME quality as primary study endpoint. QC measures included training of site pathologists in TME protocols, (2) blinded grading of de-identified TME specimen photographs by central pathologists, and (3) reconciliation of major discordance prior to trial reporting. Cohen’s Kappa statistic was used to assess agreement in grading.

RESULTS: Overall agreement in grading of 100 TME specimens between site and central reviewer was rated as fair, (κ=0.35 (95% CI, 0.10-0.61, P<0.0001). Concordance was noted in 54%, with minor and major discordance in 32% and 14% of cases respectively. Upon reconciliation, 13/14 (93%) major discordances were resolved. Pre- versus post-reconciliation rates of C/NC and IC TME are 77%/16% and 7% versus 69%/21% and 10%. Reconciliation resulted in a major upgrade (IC to NC, N=1) or major downgrade (NC/C to IC, N=4) in 5 cases overall (5%).

CONCLUSIONS: A 14% rate of major discordance was observed in TME grading between site and central reviewers. Resolution resulted in a major change in final TME grade in 5% of cases, which suggests that reported rates or TME completeness are likely overestimated in trials. QC through central review of TME photographs and reconciliation of major discordances is strongly recommended.

PMID:37450694 | DOI:10.1097/SLA.0000000000005948

Compend Contin Educ Dent. 2023 Jul-Aug;44(7):392-401.

ABSTRACT

An intact extraction socket has been considered a prerequisite for an immediate implant placement and provisionalization (IIPP) procedure. Recent studies, however, have shown successful outcomes when IIPP was performed in sockets with a facial bone wall defect. This retrospective study evaluated the facial implant mucosal stability following IIPP in extraction sockets with a facial bone wall defect in the esthetic zone. The study included 16 cases in 16 patients who received maxillary anterior single IIPP with contour bone graft (C-BG) and contour connective tissue graft (C-CTG) in compromised extraction sockets (V- or U-shaped defect). After a mean follow-up of 6 years, the implant success rate was 100% (16/16). Minimal and non-statistically significant changes were noted in the facial implant mucosal and marginal bone level. Statistically significant changes were observed in facial implant mucosal thickness gain (2.5 mm [1.8 mm to 3.5 mm]) and midfacial bone sounding reduction (6 mm). Within the confines of this study, IIPP with simultaneous C-BG and C-CTG in fresh extraction sockets exhibiting a V- or U-shaped facial bone wall defect can lead to long-term successful outcomes in terms of mucosal stability, contour bone gain, and marginal bone level stability.

PMID:37450677

Urogynecology (Phila). 2023 Jul 13. doi: 10.1097/SPV.0000000000001397. Online ahead of print.

ABSTRACT

IMPORTANCE: Pudendal nerve block has been frequently used as a pain management modality for vaginal prolapse surgery. However, studies investigating its efficacy and the type of anesthetic used have had conflicting results.

OBJECTIVE: This study aimed to evaluate the effect of intraoperative pudendal nerve block with liposomal bupivacaine on postoperative pain after sacrospinous ligament suspension surgery.

STUDY DESIGN: In this single-blinded randomized controlled trial, 83 women undergoing sacrospinous ligament suspension were randomized to receive either intraoperative pudendal nerve block with liposomal bupivacaine or no block. Participants recorded their pain level on postoperative days (PODs) 1-3 and 7, the number of pain medication pills consumed, and the quality of their recovery using a validated questionnaire.

RESULTS: There were no significant differences in pain scores between the groups on POD 1 and POD 3: 5 (2-6.25) versus 5.5 (4-8; P = 0.058) and 4 (1-6) versus 5 (2-7; P = 0.146), respectively. On POD 2, the overall pain score was statistically different between the groups, with the block group having lower interquartile ranges. This difference, however, was not clinically significant: 5 (1.75-5) versus 5 (3.25-7.75; P = 0.023). In the subset of participants who underwent a concomitant midurethral sling procedure, POD 2 and POD3 pain scores were significantly lower in those who received the block: 3 (1-5) versus 6 (5-8; P = 0.006) for POD 2 and 3 (1-5) versus 5 (3.250-7; P = 0.042) for POD 3. There were no significant differences in pain medication consumption or the quality of recovery scores.

CONCLUSION: Pudendal nerve block with liposomal bupivacaine did not result in significant differences in postoperative pain after sacrospinous ligament suspension, except in those participants who underwent a concomitant midurethral sling procedure.

PMID:37450670 | DOI:10.1097/SPV.0000000000001397