Category: Nevin Manimala

Radiol Technol. 2023 Jul;94(6):397-408.

ABSTRACT

PURPOSE: To investigate the effects of patient-induced artifacts on the diagnostic performance of the COVID-19 Reporting and Data System (CO-RADS) and the computed tomography chest severity score (CT-SS).

METHODS: A single-center retrospective analysis of patients aged 18 years and older who were admitted to the authors’ hospital with laboratory-confirmed COVID-19 and underwent chest CT between July and November 2021 was conducted. Patients’ chest CT scans were examined by 3 radiologists for CT-SS and CO-RADS classifications. Patient-based artifacts, including metal artifacts, incomplete projection artifacts, motion artifacts, and insufficient inspiration, were identified by 3 readers who were unaware of each other. For statistical analysis, interreader agreement was investigated using Fleiss kappa () agreement analysis.

RESULTS: The study population included 549 patients with a median age of 66 years (IQR, 55-75 years), 321 (58.5%) of whom were men. According to the overall CO-RADS classification, the highest interreader agreement was in patients without CT artifacts ( = 0.924), while the lowest interreader agreement was in patients with motion artifacts ( = 0.613). For the CO-RADS 1 and 2 patient groups, insufficient inspiration decreased the interreader agreement most ( = 0.712 and = 0.250, respectively). For the CO-RADS 3, 4, and 5 patient groups, motion artifacts reduced the interreader agreement most ( = 0.464, = 0.453, and = 0.705, respectively). For total CT-SS, the highest kappa value was in patients without artifacts ( = 0.574), while the lowest kappa value was in patients with motion artifacts ( = 0.374).

DISCUSSION: The CT technologist can avoid patient-induced artifacts by placing patients carefully on the CT table, giving patients necessary instructions before CT acquisition, and selecting optimal scanning parameters. The authors are not aware of another study in the literature investigating the effects of patient-based artifacts on interreader agreement of CO-RADS classification and CT-SS for COVID-19.

CONCLUSION: CT artifacts degrade image quality and might lead to interreader disagreement of CO-RADS classification and CT-SS for patients with COVID-19.

PMID:37433603

BJU Int. 2023 Jul 11. doi: 10.1111/bju.16124. Online ahead of print.

ABSTRACT

BACKROUND: Kidney is an essential regulator of arterial blood pressure (BP) via the renin-angiotensin system. The impact of kidney surgery on BP is unclear.

OBJECTIVE: To evaluate the consequences of kidney surgery for renal tumor on BP.

DESIGN, SETTING AND PARTICIPANTS: In a multicenter prospective study, we evaluated 200 patients who underwent nephrectomy for renal tumor between 2018 and 2020 at 7 departments of the UROCCR network. All patients had localized cancer without pre-existing hypertension.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: BP was measured the week before nephrectomy, one month and six months after nephrectomy, according to the recommendations for home blood pressure measurement. Plasmatic renin was measured one week before surgery and 6 months after surgery. The primary endpoint was the occurrence of de novo hypertension (HTN). The secondary endpoint was a clinically significant increase in BP at six months defined by an increase in systolic and / or diastolic ABP ≥10 mmHg or if medical anti-hypertensive treatment was required RESULTS AND LIMITATIONS: BP and renin measurements were available for 182 (91%) and 136 (68%) patients, respectively. We excluded from the analysis 18 patients who had undeclared HTN detected on preoperative measurements. At six months, 31 (19.2%) patients had de novo HTN and 43 (26.3%) patients had a significant increase in their BP. The type of surgery was not associated with an increased risk of HTN (21.7% PN vs 15.7% RN; p=0.59). There was no difference between plasmatic renin levels before and after surgery (18.5 vs. 16, p=0.46). In multivariable analysis, age (O.R 1.07; CI-95 1.02-1.12; p=0.03) and BMI (O.R. 1.14; CI-95 1.03-1.26; p=0.01) were the only predictors of de novo HTN.

CONCLUSION: Surgical treatment of renal tumors is associated with significant changes in BP. These changes are not impacted by the type of surgery (PN vs RN).

PATIENT SUMMARY: In this study we evaluated blood pressure changes after surgery for renal tumors. We found that 19% of the patients developed de novo hypertension 6 months after surgery. We feel that patients who are scheduled to undergo kidney cancer surgery should be informed of these findings and have their blood pressure closely monitored after the operation.

PMID:37433580 | DOI:10.1111/bju.16124

Ann Rheum Dis. 2023 Jul 10:ard-2023-224416. doi: 10.1136/ard-2023-224416. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop evidence-based recommendations for the non-pharmacological management of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc).

METHODS: A task force comprising 7 rheumatologists, 15 other healthcare professionals and 3 patients was established. Following a systematic literature review performed to inform the recommendations, statements were formulated, discussed during online meetings and graded based on risk of bias assessment, level of evidence (LoE) and strength of recommendation (SoR; scale A-D, A comprising consistent LoE 1 studies, D comprising LoE 4 or inconsistent studies), following the European Alliance of Associations for Rheumatology standard operating procedure. Level of agreement (LoA; scale 0-10, 0 denoting complete disagreement, 10 denoting complete agreement) was determined for each statement through online voting.

RESULTS: Four overarching principles and 12 recommendations were developed. These concerned common and disease-specific aspects of non-pharmacological management. SoR ranged from A to D. The mean LoA with the overarching principles and recommendations ranged from 8.4 to 9.7. Briefly, non-pharmacological management of SLE and SSc should be tailored, person-centred and participatory. It is not intended to preclude but rather complement pharmacotherapy. Patients should be offered education and support for physical exercise, smoking cessation and avoidance of cold exposure. Photoprotection and psychosocial interventions are important for SLE patients, while mouth and hand exercises are important in SSc.

CONCLUSIONS: The recommendations will guide healthcare professionals and patients towards a holistic and personalised management of SLE and SSc. Research and educational agendas were developed to address needs towards a higher evidence level, enhancement of clinician-patient communication and improved outcomes.

PMID:37433575 | DOI:10.1136/ard-2023-224416

Biostatistics. 2023 Jul 11:kxad012. doi: 10.1093/biostatistics/kxad012. Online ahead of print.

ABSTRACT

Existing methods for fitting continuous time Markov models (CTMM) in the presence of covariates suffer from scalability issues due to high computational cost of matrix exponentials calculated for each observation. In this article, we propose an optimization technique for CTMM which uses a stochastic gradient descent algorithm combined with differentiation of the matrix exponential using a Padé approximation. This approach makes fitting large scale data feasible. We present two methods for computing standard errors, one novel approach using the Padé expansion and the other using power series expansion of the matrix exponential. Through simulations, we find improved performance relative to existing CTMM methods, and we demonstrate the method on the large-scale multiple sclerosis NO.MS data set.

PMID:37433567 | DOI:10.1093/biostatistics/kxad012

J Phys Act Health. 2023 Jul 11:1-9. doi: 10.1123/jpah.2022-0666. Online ahead of print.

ABSTRACT

BACKGROUND: There is little known about physical activity (PA) behaviors and its determinants in Cambodian adolescents, particularly with regard to the home and school settings. Therefore, we aimed to investigate these behaviors and determinants on their PA.

METHODS: The samples collected were from 168 high school students, aged 14-15 years. They were requested to complete the self-report PA questionnaire. Time spent in PA during weekday and weekend by school location and gender, and determinants on PA were analyzed. Differences in the mean values of the PA levels (in minutes) during weekday and the weekend between genders, and between school locations were analyzed using independent sample t tests. The percentage of students’ perceptions on the determinants were calculated. Chi-squared test was used to compare the differences in prevalence of students’ activities during their free time with respect to school location and gender.

RESULTS: The majority of the parents (86.9%-98.2%) demonstrated strong support for their children for academic work. Rural students spent an average time of moderate-to-vigorous PA greater than their counterparts from the urban areas during their weekend days (329.1 vs 239.2 min, respectively). Moderate to vigorous PA was likely to be higher during the weekends compared with weekdays among the boys (387.9 vs 361.4 min, respectively). Girls were more likely to spend their time on moderate to vigorous PA during the weekdays compared with the weekends (205.4 vs 180.5 min, respectively).

CONCLUSION: Consideration should be given to gender, school location, free time, and the environmental setting for the contextualization of more effective PA interventions with Cambodian youths.

PMID:37433521 | DOI:10.1123/jpah.2022-0666

J Natl Compr Canc Netw. 2023 Jul;21(7):715-723.e17. doi: 10.6004/jnccn.2023.7021.

ABSTRACT

BACKGROUND: Adolescents and young adults (AYAs) with advanced cancer often receive intensive end-of-life care, yet it is unclear if this is goal-concordant. Advance care planning (ACP) video tools may promote identification and communication of AYA preferences.

PATIENTS AND METHODS: We conducted a dual-site, 1:1 pilot randomized controlled trial of a novel video-based ACP tool in 50 dyads of AYA patients aged 18 to 39 years with advanced cancer and their caregivers. ACP readiness and knowledge, preferences for future care, and decisional conflict were obtained pre, post, and 3 months after the intervention and compared between groups.

RESULTS: Of the 50 AYA/caregiver dyads enrolled, 25 (50%) were randomized to the intervention. Participants primarily identified as female, white, and non-Hispanic. Most AYAs (76%) and caregivers (86%) identified their overall goal as life-prolonging preintervention; less identified this goal postintervention (42% AYAs; 52% caregivers). There was no significant difference in change in proportion of AYAs or caregivers choosing life-prolonging care, CPR, or ventilation between arms postintervention or at 3 months. The change in participant scores for ACP knowledge (AYAs and caregivers) and ACP readiness (AYAs) from preintervention to postintervention was greater in the video arm compared with the control arm; the difference in caregivers’ scores for decisional conflict from preintervention to postintervention in the video arm was statistically significant (15 vs 7; P=.005). Feedback from the video participants was overwhelmingly positive; of the 45 intervention participants who provided video feedback, 43 (96%) found the video helpful, 40 (89%) were comfortable viewing the video, and 42 (93%) indicated they would recommend the video to other patients facing similar decisions.

CONCLUSIONS: Most AYAs with advanced cancer and their caregivers preferred life-prolonging care in advanced illness, with fewer preferring this type of care postintervention. A brief video-based ACP tool was well-liked by participants and improved caregiver decisional certainty. Videos may be a useful tool to inform AYAs and caregivers about end-of-life care options and promote ACP discussions.

PMID:37433434 | DOI:10.6004/jnccn.2023.7021

Transpl Immunol. 2023 Jul 9:101891. doi: 10.1016/j.trim.2023.101891. Online ahead of print.

ABSTRACT

BACKGROUND: We have performed a retrospective analysis of anti-HLA class I MHC and class II MHC antibodies measured using a single antigen bead (SAB) assay and a panel reactive antibody (PRA) assay.

MATERIAL AND METHODS: A group of 256 patients with end-stage renal disease (ESRD) was tested for anti-HLA antibodies in the tissue typing laboratory between 2017 and 2020. In the cohort, the serum samples of patients waiting for transplantation were tested. Both the PRA and SAB tests of these patients were analyzed using the Luminex (Immucor) method. The threshold of positivity was accepted as median fluorescence intensities (MFI) ≥1000 for PRA screening and MFI ≥750 for SAB screening.

RESULTS: Overall, antibodies to HLA antigens were detected in 202 (78.9%) out of 256 patients in the PRA study. Antibodies against both class I/II antigens were detected only in 15.6% of these patients, whereas antibodies against only against class I HLA in 31.3% and only against class II HLA in 32.0%. By comparison, the SAB study found that 66.8% of patients were positive for HLA antigens. Furthermore, donor-specific antibodies (DSA) were detected in 52.0% of PRA-positive patients and 52.6% of SAB-positive patients. It was shown that 168 patients (83.2%) out of 202 PRA-positive patients were found to be SAB-positive. In addition, 51 patients negative in the SAB assay (94.4%) were also negative in the PRA assay. Statistical analysis established a significant correlation between the PRA and SAB positivity (p > 0.001). It was also shown that MFI ≥3000 PRA positivity for class I HLA antigens (p = 0.049) and MFI ≥5000 PRA positivity for class II antigens (p < 0.001) correlated with the SAB positivity in patients.

CONCLUSION: Our results showed the importance of both PRA and SAB assays to define the status of sensitization in patients.

PMID:37433395 | DOI:10.1016/j.trim.2023.101891

J Affect Disord. 2023 Jul 9:S0165-0327(23)00872-8. doi: 10.1016/j.jad.2023.07.042. Online ahead of print.

ABSTRACT

INTRODUCTION: The present article aimed to investigate 1) if mental health problems (depression and burnout including the dimensions; emotional exhaustion, mental distance and cognitive and emotional impairment) differed between nurses and physicians in Sweden, 2) if any differences were explained by differences in sex compositions, and 3) if any sex differences were larger within either of the two professions.

METHOD: Data were derived from a representative sample of nurses (n = 2903) and physicians (n = 2712) in 2022. Two scales were used to assess burnout (KEDS and BAT) and one to assess depression (SCL-6). The BAT scale has four sub-dimensions. Descriptive statistics and logistic regression were used to analyse each scale and dimension separately.

RESULTS: Results showed that 16-28 % of nurses and physicians reported moderate to severe symptoms of burnout. The prevalence differed between occupations across the scales and dimensions used. Nurses reported higher scores on KEDS while physicians reported higher scores on BAT including the four dimensions. Also, 7 % of nurses’ and 6 % of physicians’ score were above the cut-off for major depression. The inclusion of sex in the models changed the odds ratios of differences between doctors and nurses in all mental health dimensions except mental distance and cognitive impairment.

LIMITATIONS: This study was based on cross-sectional survey data which has some limitations.

CONCLUSION: Our study suggests that the prevalence of mental health problems is prominent among nurses and physicians in Sweden. Sex plays an important role in the difference in prevalence of mental health problems between the professions.

PMID:37433382 | DOI:10.1016/j.jad.2023.07.042

Int J Radiat Oncol Biol Phys. 2023 Jul 9:S0360-3016(23)07628-9. doi: 10.1016/j.ijrobp.2023.07.002. Online ahead of print.

ABSTRACT

BACKGROUND: Rectal dose delivered during prostate radiotherapy is associated with gastrointestinal toxicity. Treatment plans are commonly optimised using rectal dose-volume constraints, often whole-rectum relative-volumes (%). We investigate whether improved rectal contouring, use of absolute-volumes (cc) or rectal truncation might improve toxicity prediction.

MATERIALS/METHODS: Patients from the XXXXXX trial (receiving 74Gy/37 fractions (Fr) vs 60Gy/20Fr vs 57Gy/19Fr) were included if radiotherapy plans were available (2350/3216 patients), plus toxicity data for relevant analyses (2170/3216 patients). Whole solid rectum relative-volumes (%) dose-volume-histogram (DVH), as submitted by treating centre (original contour), was assumed standard-of-care. Three investigational rectal DVHs were generated: i) reviewed contour per XXXXXX protocol; ii) original contour absolute volumes (cc); iii) truncated original contour (two versions; ±0 and ±2cm from planning target volume (PTV)). Dose levels of interest (V30,40,50,60,70,74Gy) in 74Gy arm were converted by equivalent-dose-in-2Gy-fractions (EQD2_α/β=3Gy) for 60Gy/57Gy arms. Bootstrapped logistic models predicting late toxicities (frequency G1+/G2+, bleeding G1+/G2+, proctitis G1+/G2+, sphincter control G1+, stricture/ulcer G1+) were compared by area-under-curve (AUC) between standard-of-care and the three investigational rectal definitions.

RESULTS: The alternative dose/volume parameters were compared with the original relative-volume (%) DVH of the whole rectal contour, itself fitted as a weak predictor of toxicity (AUC range 0.57-0.65, across the 8 toxicity measures). There were no significant differences in toxicity prediction for: i) original vs reviewed rectal contours (AUCs 0.57-0.66, p-values 0.21-0.98); ii) relative- vs absolute-volumes (AUCs 0.56-0.63, p-values 0.07-0.91) iii) whole-rectum vs truncation at PTV±2cm (AUCs 0.57-0.65, p-values 0.05-0.99), nor PTV±0cm (AUCs 0.57-0.66, p-values 0.27-0.98).

CONCLUSIONS: We used whole-rectum relative-volume DVH, submitted by the treating centre, as the standard-of-care dosimetric predictor for rectal toxicity. There were no statistically significant differences in prediction performance when using central rectal contour review, use of absolute-volume dosimetry, nor rectal truncation relative to PTV. Whole-rectum relative-volumes were not improved upon for toxicity prediction and should remain standard-of-care.

PMID:37433374 | DOI:10.1016/j.ijrobp.2023.07.002

J Equine Vet Sci. 2023 Jul 9:104892. doi: 10.1016/j.jevs.2023.104892. Online ahead of print.

ABSTRACT

Accumulating high-speed exercise has been identified as a significant risk factor for catastrophic injuries in racing Thoroughbreds. Injuries, regardless of severity, are a main cause of withdrawal from the racing industry, raising animal welfare concerns and resulting in significant economic losses. While most of the current literature focuses on injuries incurred during racing rather than training, the present study aims to help fill this gap. As such, peripheral blood was collected weekly, prior to exercise or administration of medication, from eighteen, two-year-old Thoroughbreds throughout their first season of race training. Messenger RNA (mRNA) was isolated and used to analyze the expression of 34 genes via RT-qPCR. Statistical analysis of the non-injured horses (n=6) showed that 13 genes were significantly correlated with increasing average weekly furlong performance. Additionally, there was a negative correlation for CXCL1, IGFBP3, and MPO with both cumulative high-speed furlongs and week of training for all horses. Comparison of both groups showed opposing correlations between the anti-inflammation index (IL1RN, IL-10, and PTGS1) and average weekly furlong performance. Furthermore, evaluation of training effects on mRNA expression during the weeks surrounding injury, showed differences between groups in IL-13 and MMP9 at -3 and -2 weeks prior to injury. While some previously reported relationships between exercise adaptation and mRNA expression were not noted in this study, this may have been due to the small sample size. Several novel correlations, however, were identified and warrant further investigation as markers of exercise adaptation or potential risk for injury.

PMID:37433342 | DOI:10.1016/j.jevs.2023.104892