Category: Nevin Manimala

Cancer Med. 2023 Jun 2. doi: 10.1002/cam4.6198. Online ahead of print.

ABSTRACT

BACKGROUND: Despite the rising incidence and mortality of breast cancer among women in China, there are currently few predictive models for breast cancer in the Chinese population and with low accuracy. This study aimed to identify major genetic and life-style risk factors in a Chinese population for potential application in risk assessment models.

METHODS: A case-control study in southeast China was conducted including 1321 breast cancer patients and 2045 controls during 2013-2016, in which the data were randomly divided into a training set and a test set on a 7:3 scale. The association between genetic and life-style factors and breast cancer was examined using logistic regression models. Using AUC curves, we also compared the performance of the logistic model to machine learning models, namely LASSO regression model and support vector machine (SVM), and the scores calculated from CKB, Gail and Tyrer-Cuzick models in the test set.

RESULTS: Among all factors considered, the best model was achieved when polygenetic risk score, lifestyle, and reproductive factors were considered jointly in the logistic regression model (AUC = 0.73; 95% CI: 0.70-0.77). The models created in this study performed better than those using scores calculated from the CKB, Gail, and Tyrer-Cuzick models. However, the logistic model and machine learning models did not significantly differ from one another.

CONCLUSION: In summary, we have found genetic and lifestyle risk predictors for breast cancer with moderate discrimination, which might provide reference for breast cancer screening in southeast China. Further population-based studies are needed to validate the model for future applications in personalized breast cancer screening programs.

PMID:37264741 | DOI:10.1002/cam4.6198

ESC Heart Fail. 2023 Jun 1. doi: 10.1002/ehf2.14378. Online ahead of print.

ABSTRACT

AIMS: Despite advances in heart failure (HF) treatment, HF with preserved ejection fraction (HFpEF) remains a health problem with a high mortality rate. HFpEF is composed of diverse phenogroups, of which patients with concomitant renal impairment have worse outcomes. Renal tubular damage (RTD) is associated with the development of HF and chronic kidney disease (CKD). However, the impact of RTD on HF progression in patients with HFpEF and CKD remains unclear. The aim of the present study was to examine whether RTD could predict HF-related events in patients with HFpEF and CKD.

METHODS AND RESULTS: We measured RTD markers, such as urinary β₂ -microglobulin to creatinine ratio (UBCR) and N-acetyl-β-d-glucosamidase (NAG) level, in 319 consecutive patients with HFpEF and CKD who were hospitalized for acute HF (49% females, mean age 76 ± 12). Based on previous reports, high UBCR and high NAG levels were defined as UBCR ≥300 μg/gCr and NAG >14.2 U/gCr, respectively. There were 91 HF-related events, defined as HF hospitalizations or HF deaths, during the median follow-up period of 5.2 years. The prevalence of high UBCR increased with advancing New York Heart Association functional class and albuminuria. Kaplan-Meier analysis demonstrated that patients with high UBCR had more HF-related events than those with normal or low UBCR. Multivariate Cox proportional hazards regression analyses demonstrated that high UBCR, but not high NAG level, was an independent predictor of HF-related events after adjusting for confounding risk factors in patients with HFpEF and CKD (hazard ratio, 2.60; 95% confidence interval, 1.52-4.72; P = 0.0009). UBCR significantly improved the C-statistic, with a significant net reclassification index and integrated discrimination improvement (0.738 vs. 0.684; P = 0.0244).

CONCLUSION: RTD, as assessed by a high UBCR, was associated with the severity and clinical outcomes of HFpEF and CKD, indicating that it could be a feasible marker for HF progression.

PMID:37264723 | DOI:10.1002/ehf2.14378

Hum Vaccin Immunother. 2023 Jun 1:2215677. doi: 10.1080/21645515.2023.2215677. Online ahead of print.

ABSTRACT

Certain aspects of the immunogenicity and effectiveness of the messenger ribonucleic acid (mRNA) vaccines (mRNA-1273 and BNT162b2) developed in response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic are still uncharacterized. Serum or plasma samples from healthy donor recipients of either vaccine (BNT162b2 n = 53, mRNA-1273 n = 49; age 23-67), and individuals naturally infected with SARS-CoV-2 (n = 106; age 18-82) were collected 0-2 months post-infection or 1- and 4 months after second dose of vaccination. Anti-Spike antibody levels and avidity were measured via an enzyme-linked immunosorbent assay (ELISA). Overall, vaccination induced higher circulating anti-Spike protein immunoglobulin G (IgG) antibody levels and avidity compared to infection at similar time intervals. Both vaccines produced similar anti-Spike IgG concentrations at 1 month, while mRNA-1273 demonstrated significantly higher circulating antibody concentrations after 4 months. mRNA-1273 induced significantly higher avidity at month 1 compared to BNT162b2 across all age groups. However, the 23-34 age group was the only group to maintain statistical significance by 4 months. Male BNT162b2 recipients were approaching statistically significant lower anti-Spike IgG avidity compared to females by month 4. These findings demonstrate enhanced anti-Spike IgG levels and avidity following vaccination compared to natural infection. In addition, the mRNA-1273 vaccine induced higher antibody levels by 4 months compared to BNT162b2.

PMID:37264688 | DOI:10.1080/21645515.2023.2215677

Expert Rev Pharmacoecon Outcomes Res. 2023 Jun 1. doi: 10.1080/14737167.2023.2221436. Online ahead of print.

ABSTRACT

OBJECTIVES: The correlations between economic modeling input parameters directly impact the variance, and may impact the expected values of model outputs. However, correlation coefficients are not often reported in literature. We aim to understand the correlations between model inputs for probabilistic analysis from summary statistics.

METHODS: We provide proof that for correlated random variables X and Y (e.g. inpatient visits and outpatient visits), the Pearson correlation coefficients of sample means and samples are equal to each other ($\text{c}orr\left(X,Y\right)=\text{c}orr\left(\overline{X},\overline{Y}\right)$). Therefore, when studies report summary statistics of correlated parameters, we can quantify the correlation coefficient between parameters.

RESULTS: We use examples to illustrate how to estimate the correlation coefficient between the incidence rates of non-severe and severe hypoglycemia events, and the common coefficient of five cost components for patients with diabetic foot ulcers. We further introduce three types of correlations for utilities and provide two examples to estimate the correlations for utilities based on published data. We also evaluate how correlations between cost parameters and utility parameters impact the cost-effectiveness results using a Markov model for major depression.

CONCLUSION: Incorporation of the correlations can improve the precision of cost-effectiveness results and increase confidence in evidence-based decision-making. Further empirical evidence is warranted.

PMID:37264680 | DOI:10.1080/14737167.2023.2221436

Eur J Prev Cardiol. 2023 Jun 2:zwad187. doi: 10.1093/eurjpc/zwad187. Online ahead of print.

ABSTRACT

BACKGROUND: In clinical practice, factors associated with cardiovascular disease (CVD) like albuminuria, education level, or coronary artery calcium are often known, but not incorporated in cardiovascular risk prediction models. The aims of the current study were to evaluate a methodology for the flexible addition of risk modifying characteristics on top of SCORE2 and to quantify the added value of several clinically relevant risk modifying characteristics.

METHODS AND RESULTS: Individuals without previous CVD or DM were included from the UK Biobank, ARIC, MESA, EPIC-NL and HNR studies (n=409,757) in whom 16,166 CVD events and 19,149 non-cardiovascular deaths were observed over exactly 10.0 years of follow-up. The effect of each possible risk modifying characteristic was derived using competing risk-adjusted Fine and Gray models. The risk modifying characteristics were applied to individual predictions with a flexible method using the population prevalence and the subdistribution hazard ratio (SHR) of the relevant. Risk modifying characteristics that increased discrimination most were CAC percentile with 0.0198 (95%CI 0.0115; 0.0281) and hs-Troponin-T with 0.0100 (95%CI 0.0063; 0.0137). External validation was performed in the CPRD cohort (UK, n = 518,015, 12,675 CVD events). Adjustment of SCORE2 predicted risks with both single and multiple risk modifiers did not negatively affect calibration and led to a modest increase in discrimination (0.740 (95%CI 0.736-0.745) versus unimproved SCORE2 risk C-index 0.737 [95%CI 0.732-0.741]).

CONCLUSIONS: The current paper presents a method on how to integrate possible risk modifying characteristics that are not included in existing CVD risk models for the prediction of CVD event risk in apparently healthy people. This flexible methodology improves the accuracy of predicted risks and increases applicability of prediction models for individuals with additional risk known modifiers.

PMID:37264679 | DOI:10.1093/eurjpc/zwad187

Technol Cancer Res Treat. 2023 Jan-Dec;22:15330338231171470. doi: 10.1177/15330338231171470.

ABSTRACT

PURPOSE: Compared and analyzed the MRI imaging features of brain invasion otherwise benign (BIOB) meningiomas and WHO grade 1, grade 2 meningiomas, discussed the WHO grading of BIOB from the perspective of imaging.

MATERIALS AND METHODS: A retrospective analysis was performed on 675 meningiomas patients who carried on MRI examination from January 2006 to February 2022. Setting the 2022 Central nervous system (CNS) WHO Guidelines as the gold standard for pathological diagnosis. Statistical analysis of age, gender, and MRI features of meningiomas in relation to WHO grade and brain invasion.

RESULTS: Among 675 cases meningiomas, 543 (80.4%) were WHO grade 1, 123 (18.2%) were WHO grade 2, and 9 (1.3%) were WHO grade 3. There were 108 cases meningiomas with brain invasion (BI) (16.0%) and 567 cases without BI (84.0%). Among BI cases, 67 cases were BIOB. Compared the MRI features between BIOB and WHO grade 1 meningiomas, multivariate analysis demonstrated that the most strongly factors associated with distinguish them were enhancement degree, peritumoral edema, tumor-brain interface, fingerlike protrusion, mushroom sign, and bone invasion (AUC: 0.925 (0.901∼0.945), sensitivity: 0.925, specificity: 0.801). Compared the MRI features between BIOB and WHO grade 2 meningiomas, multivariate analysis demonstrated that the most strongly factors associated with distinguish them were enhancement degree and the tumor-brain interface (AUC: 0.779 (0.686∼0.841), sensitivity: 0.746, specificity: 0.732), their efficacy was slightly weaker.

CONCLUSIONS: BIOB is more similar to WHO grade 2 meningiomas in clinical and imaging features than WHO grade 1, so we think that it may be reasonable to classify BIOB as WHO Grade 2 meningiomas in the guidelines.

PMID:37264676 | DOI:10.1177/15330338231171470

Scand J Surg. 2023 Jun 1:14574969231176111. doi: 10.1177/14574969231176111. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: The aim of gender affirmation surgery is to ease gender dysphoria. In transgender men, chest wall masculinization is the most common gender affirmation surgery. The BODY-Q Chest module is currently the only instrument developed to measure health-related quality of life (HRQL) in men undergoing chest wall surgery. Linguistic validation and cultural adaption to Finnish were performed previously. The study aims to validate the BODY-Q Chest module in transgender men who have undergone surgical chest wall masculinization.

METHODS: All transgender patients who underwent chest wall masculinization at Helsinki University Hospital between 2005 and 2018 were invited to the study. The BODY-Q Chest module comprises two scales-chest and nipple. Data were obtained using the BODY-Q Chest module, the 15D questionnaire, and specifically targeted items designed by the authors. The statistical analyses were conducted to exclude selection bias, evaluate validity of the instrument, and compare it to other instruments.

RESULTS: Of the 220 patients invited, 123 participated in the survey (response rate 56%). Ceiling effects were observed with 18.9% and 20.5% scoring maximum points. Cronbach’s alpha was 0.92 and 0.88 for the chest and nipple scales, respectively. In exploratory factor analysis, both scales loaded to one factor confirming unidimensionality. Correlation with the generic 15D questionnaire was low.

CONCLUSIONS: The BODY-Q Chest module provides valid scores with sufficient consistency and reliability when measuring HRQL in transgender men undergoing chest wall masculinization. Moreover, it offers specificity that existing or generic instruments cannot provide. Ceiling effect was expected due to the postoperative status of participants.

PMID:37264645 | DOI:10.1177/14574969231176111

J Intensive Care Med. 2023 Jun 2:8850666231177602. doi: 10.1177/08850666231177602. Online ahead of print.

ABSTRACT

Background and Objectives: In lactic acidosis, lactate can only explain 30% of the variance in the anion gap (AG), and the elevated AG not explained by lactate is due to unmeasured organic anions (UOAs). Some studies using less precise surrogates for UOA have suggested that UOA may predict clinical outcomes better than lactate. The aim of this study was to determine whether UOA predicts clinical outcomes better than lactate levels. Design, Setting, Participants, & Measurements: This was a retrospective cohort study of adult ICU patients with sepsis. Baseline AG and albumin measurements were obtained. An albumin-corrected delta AG was calculated. UOAs were estimated using the formula: Delta AG – serum lactate. A multivariate logistic regression model with its respective ROC curve was constructed to explore the relationship between in-hospital mortality, UOA, and lactate. Results: 526 patients were included. In the combined model examining both lactate and UOA, the odds ratio (OR) [95% CI] for predicting ICU length of stay (LOS) was 1.050 [1.029-1.072] and 1.022 [1.009-1.035], respectively; the OR [95% CI] for predicting in-hospital mortality was 1.224 [1.104-1.358] and 0.997 [0.943-1.054], respectively. The ROC curve for in-hospital mortality demonstrated that the Area Under the Curve (AUC) for lactate, UOA, and combined lactate and UOA was 0.7726, 0.7486, and 0.7732, respectively. The AUC for combined lactate and UOA were not statistically significantly higher than the AUC for lactate alone (P .9193). Conclusions: As expected, serum lactate predicted both ICU LOS and in-hospital mortality. UOA did predict ICU LOS, although the reason for this association is not known. UOA did not predict in-hospital mortality based on the OR and the ROC curve’s AUC, contrary to some previous studies. However, our study used a more precise quantitative estimate of UOA, including the use of baseline albumin-corrected AG. Prior studies attempting to identify UOA have identified Krebs cycle intermediates including citrate and isocitrate, suggesting that in our study these anions associated with the Krebs cycle contributed to the UOA.

PMID:37264611 | DOI:10.1177/08850666231177602

Food Sci Technol Int. 2023 Jun 1:10820132231179492. doi: 10.1177/10820132231179492. Online ahead of print.

ABSTRACT

Cassava starch-based edible food wraps were prepared by incorporating leaf powder from Indian curry leaf and Malabar bay leaf, reinforced with different (0.2, 0.4, 0.6, 0.8) wt.% of chitosan. Eleven combinations of films were prepared and their sensory acceptability, physical properties, Fourier-transform infrared spectroscopic (FTIR) spectrum, and scanning electron microscopy (SEM) image, were evaluated. The thickness of the films ranged from 0.198 ± 0.12 to 0.372 ± 0.27 mm. Tensile strength was reported to be the highest (40.71 ± 1.21 MPa) in the curry leaf powder incorporated sample. Maximum elongation at break was reported by bay leaf powder incorporated (5.8 ± 1.59%) sample. The Young’s modulus values were observed to be increasing along with the concentration of chitosan. Maximum seal strength values were reported by curry leaf powder incorporated film with 0.8% chitosan (2.93 ± 0.22 N/mm). The leaf powder incorporated samples reported a higher flavonoid content compared to the control. The color analysis (L*, a*, b*) of the films was identical to the natural leaf color. The SEM images indicated a rough texture for the leaf powder incorporated films. The FTIR evaluation confirmed the presence of the respective functional groups. The statistical evaluation done by statistical package for social sciences software showed that all the data were significantly different (P ≤ 0.05.). The study demonstrated the potential of incorporation of leaf powder and chitosan to enhance the properties of starch-based edible packaging.

PMID:37264607 | DOI:10.1177/10820132231179492

BMJ Support Palliat Care. 2023 Jun 1:spcare-2022-004034. doi: 10.1136/spcare-2022-004034. Online ahead of print.

ABSTRACT

PURPOSE: The objective of this study was to summarise the literature on current interventions available for carers of men with prostate cancer and analyse the outcomes of these interventions in supporting carers’ needs.

METHODS: A systematic review was conducted, searching databases MEDLINE, PsycINFO, CINAHL, Scopus and Cochrane, using terms related to prostate cancer, carers and interventions. Randomised controlled trials and non-randomised controlled trials of interventions for informal carers with or without patients were included. Data were analysed using descriptive and frequency statistics; interventions and their impact on carers’ outcomes were reported on narratively. The SwiM guidelines were applied to guide data synthesis.

RESULTS: Overall, 24 articles were included in the review. On average, participants were spouses (92%) and women (97%). Interventions largely rwere delivered face-to-face (42%) or used a combination of face to face and online modalities (38%). Two-thirds (63%) showed a significant improvement in carer’s outcomes including psychological, sexual, physical and relationship/marital. The majority of studies (79%) tailored contents to carers’ circumstances, most within a couples counselling format. Over one-third (42%) of studies focused on a range of supportive care needs, most commonly were psychological (58%), sexual (42%) and informational (25%).

CONCLUSIONS: Interventions for carers of men with prostate cancer were largely face to face, patient-spouse focused and two-thirds had some measurable impact on carer’s outcomes. Research continues to underserve other patient-carer roles, including non-spousal carers. Interventions delivered solely for carers are required to meet gaps in care, and determine the impact on carer outcomes. Further research and more targeted interventions are needed.

PROSPERO REGISTRATION NUMBER: CRD42021249870.

PMID:37263759 | DOI:10.1136/spcare-2022-004034