Category: Nevin Manimala

Chin Med J (Engl). 2023 May 31. doi: 10.1097/CM9.0000000000002674. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer is one of the most common cancer in women and a proportion of patients experiences brain metastases with poor prognosis. The study aimed to construct a novel predictive clinical model to evaluate the overall survival (OS) of patients with postoperative brain metastasis of breast cancer (BCBM) and validate its effectiveness.

METHODS: From 2010 to 2020, a total of 310 female patients with BCBM were diagnosed in The Affiliated Cancer Hospital of Xinjiang Medical University, and they were randomly assigned to the training cohort and the validation cohort. Another 173 BCBM patients were collected from the Surveillance, Epidemiology, and End Results Program (SEER) database as an external validation cohort. In the training cohort, the least absolute shrinkage and selection operator (LASSO) Cox regression model was used to determine the fundamental clinical predictive indicators and the nomogram was constructed to predict OS. The model capability was assessed using receiver operating characteristic, C-index, and calibration curves. Kaplan-Meier survival analysis was performed to evaluate clinical effectiveness of the risk stratification system in the model. The accuracy and prediction capability of the model were verified using the validation and SEER cohorts.

RESULTS: LASSO Cox regression analysis revealed that lymph node metastasis, molecular subtype, tumor size, chemotherapy, radiotherapy, and lung metastasis were statistically correlated with BCBM. The C-indexes of the survival nomogram in the training, validation, and SEER cohorts were 0.714, 0.710, and 0.670, respectively, which showed good prediction capability. The calibration curves demonstrated that the nomogram had great forecast precision, and a dynamic diagram was drawn to increase the maneuverability of the results. The Risk Stratification System showed that the OS of low-risk patients was considerably better than that of high-risk patients (P <0.001).

CONCLUSION: The nomogram prediction model constructed in this study has a good predictive value, which can effectively evaluate the survival rate of patients with postoperative BCBM.

PMID:37257115 | DOI:10.1097/CM9.0000000000002674

Water Sci Technol. 2023 May;87(10):2457-2473. doi: 10.2166/wst.2023.076.

ABSTRACT

A novel treatment method, consisting of pea-gravel with a marine coating supplemented with alkyldimethylbenzylammonium chloride (ADBAC or benzalkonium chloride), has been examined for its antimicrobial performance and coating stability in aqueous environments. Initial column studies examining the porous media’s ability to reduce bacterial loads in heating, ventilation, and air conditioning (HVAC) water found average reductions of 94% from pre-flush levels (10⁶ colony forming unit (CFU)/mL) when assessed with R2A spread plates and 83% reductions with SimPlates. There was no observed statistical difference between the average of pre- and post-flush waters from four tests of the media without ADBAC. Taxonomic identification, by 16S rRNA gene sequencing, of colonies drawn from pre- and post-ABDAC R2A plates showed similarities with taxa observed in high frequency from prior cultivation-independent surveys of other cooling tower systems. With this proof of concept, two versions of the media were evaluated for potential coating components released during aqueous exposure. Neither released measurable volatile organic compounds (VOC) components, but one did release bisphenol A and ABDAC compounds. Subsequent column tests of the more durable coating were conducted using cultures of interest in industrial water and demonstrated significant reductions in neutralized post-column Enterococcus faecalis samples and near complete loss of Legionella pneumophila in non-neutralized fluids, but lower reductions in Pseudomonas aeruginosa.

PMID:37257103 | DOI:10.2166/wst.2023.076

Plast Reconstr Surg. 2023 May 31. doi: 10.1097/PRS.0000000000010775. Online ahead of print.

ABSTRACT

BACKGROUND: Dupuytren’s disease (DD) is a common complex trait, with varying severity and incompletely understood etiology. Genome-wide association studies (GWAS) have identified risk loci. Here, we examine whether genetic risk profiles of DD in patients are associated with clinical variation and disease severity as well as with patient genetic risk profiles of genetically correlated traits, including body mass index (BMI), triglycerides (TG), high-density lipoproteins (HDL), type 2 diabetes mellitus (T2D), and endophenotypes fasting glucose (FG), and glycated hemoglobin (HbA1c).

METHODS: We used a well-characterized cohort of 1,461 DD patients with available phenotypic and genetic data. Phenotype data include age of onset, recurrence, and family history of disease. Polygenic risk scores (PRSs) of DD, BMI, TG, HDL, T2D, FG, and HbA1c using various significance thresholds were calculated with PRSice using the most recent GWAS summary statistics. Control data from LifeLines were used to determine p-value cut-offs for PRSs generation explaining most variance.

RESULTS: The PRS for DD was significantly associated with a positive family history for DD, age of onset, disease onset before the age of 50, and recurrence. We also found a significant negative correlation between the PRSs for DD and BMI.

CONCLUSIONS: While GWAS studies of DD are designed to identify genetic risk factors distinguishing case/control status, we show that the genetic risk profile for DD also explains part of its clinical variation and disease severity. The PRS may therefore aid in accurate prognostication, choosing initial treatment and in personalized medicine in future.

PMID:37257093 | DOI:10.1097/PRS.0000000000010775

J Chem Theory Comput. 2023 May 31. doi: 10.1021/acs.jctc.3c00308. Online ahead of print.

ABSTRACT

In molecular dynamics simulations in the NPT ensemble at constant pressure, the size and shape of the periodic simulation box fluctuate with time. For particle images far from the origin, the rescaling of the box by the barostat results in unbounded position displacements. Special care is thus required when a particle trajectory is unwrapped from a projection into the central box under periodic boundary conditions to a trajectory in full three-dimensional space, e.g., for the calculation of translational diffusion coefficients. Here, we review and compare different schemes in use for trajectory unwrapping. We also specify the corresponding rewrapping schemes to put an unwrapped trajectory back into the central box. On this basis, we then identify a scheme for the calculation of diffusion coefficients from NPT simulations, which is a primary application of trajectory unwrapping. In this scheme, the wrapped and unwrapped trajectory are mutually consistent and their statistical properties are preserved. We conclude with advice on best practice for the consistent unwrapping of constant-pressure simulation trajectories and the calculation of accurate translational diffusion coefficients.

PMID:37257090 | DOI:10.1021/acs.jctc.3c00308

Diabetes Care. 2023 May 31:dc222372. doi: 10.2337/dc22-2372. Online ahead of print.

ABSTRACT

OBJECTIVE: Identify the improvement in diabetes performance measures and population-based clinical outcomes resulting from changes in care management processes (CMP) in primary care practices over 3 years.

RESEARCH DESIGN AND METHODS: This repeated cross-sectional study tracked clinical performance measures for all diabetes patients seen in a cohort of 330 primary care practices in 2017 and 2019. Unit of analysis was patient-year with practice-level CMP exposures. Causal inference is based on dynamic changes in individual CMPs between years by practice. We used the Bayesian method to simultaneously estimate a five-outcome model: A1c, systolic and diastolic blood pressure, guideline-based statin use, and Optimal Diabetes Care (ODC). We control for unobserved time-invariant practice characteristics and secular change. We modeled correlation of errors across outcomes. Statistical significance was identified using 99% Bayesian credible intervals (analogous to P < 0.01).

RESULTS: Implementation of 18 of 62 CMPs was associated with statistically significant improvements in patient outcomes. Together, these resulted in 12.1% more patients meeting ODC performance measures. Different CMPs affected different outcomes. Three CMPs accounted for 47% of the total ODC improvement, 68% of A1c decrease, 21% of SBP reduction, and 55% of statin use increase: 1) systems for identifying and reminding patients due for testing, 2) after-visit follow-up by a nonclinician, and 3) guideline-based clinician reminders for preventive services during a clinic visit.

CONCLUSIONS: Effective quality improvement in primary care focuses on practice redesign that clearly improves diabetes outcomes. Tailoring CMP adoption in primary care provides effective improvement in ODC performance through focused changes in diabetes outcomes.

PMID:37257083 | DOI:10.2337/dc22-2372

JBRA Assist Reprod. 2023 May 31. doi: 10.5935/1518-0557.20220000. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the willingness of patients with infertility to continue with their in vitro fertilization (IVF) treatment during the COVID-19 pandemic.

METHODS: This cross-sectional survey was conducted in the reproductive, endocrine, and infertility medicine department (REIMD) at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia. Patients that were planned to undergo IVF treatment at REIMD were contacted and asked about whether they would like to start IVF treatment during the COVID-19 pandemic from August 2020 to August 2021. Data was analyzed using the SPSS version 24. Statistics obtained as means and standard deviations from continuous variables correlated with the Chi-square test and results were considered significant at p≤0.05.

RESULTS: Of the 400 participants, 245 (61.25%) were between the ages of 30-39 years. About 42.75% (n=171) of the patients had 6-10 years of infertility, and 18% (n=72) had at least one pregnancy but no living children. While 64.7% (n=259) of the participants responded on the first call, 83% (n=332) agreed to continue their treatment. Of those, 13% (n=43) preferred to book appointments as soon as possible; 29.8% (n=99) preferred booking within three months; while 57.2% (n=190) chose to book after three months. From our sample, 86.8% (n=59) were afraid to contract the virus and the choice to delay the IVF treatment correlated with the patient’s age (p<0.001) and duration of infertility (p=0.007).

CONCLUSIONS: The COVID-19 pandemic affected IVF treatment courses, and many patients were afraid to be infected during this pandemic.

PMID:37257077 | DOI:10.5935/1518-0557.20220000

Int J Urol. 2023 May 31. doi: 10.1111/iju.15209. Online ahead of print.

ABSTRACT

OBJECTIVES: To report outcomes of surgical treatment in patients with penile foreign body granuloma and compare surgical outcomes between single- and two-stage scrotal flap reconstructions.

METHODS: Medical records of patients with penile foreign body granuloma who underwent surgical treatment were reviewed. Patients with single- and two-stage scrotal flap reconstructions were compared.

RESULTS: Forty-two patients underwent surgical treatment from January 1, 2018 to October 31, 2022. Twenty-three patients underwent single-stage reconstruction with bilateral scrotal flap while 12 patients underwent two-stage repair with 19 operations. Five patients underwent circumcision; one had excision with primary closure. Another patient underwent reconstruction by penile skin preservation technique. There was no statistically significant differences between single- and two-stage groups in wound infection (8.69% vs. 0%, RR 2.71, 95%CI; 0.14-52.29), wound dehiscence (21.74% vs. 8.33%, RR 2.61, 95%CI 0.34-19.87), reoperation rate (26.08% vs. 8.33%, RR 3.13, 95%CI; 0.42-23.10). Postoperative fever was significantly higher in single-stage group (56.52 vs. 8.33%, RR 6.78, 95%CI; 1.01-43.83). Total length of hospital stay was shorter in single-stage group (7.43 ± 3.19 days vs. 10.86 ± 1.57 days, MD -3.42, 95%CI; -5.28 to -1.57). Incidence of patients without Clavien-Dindo surgical complications was significantly lower in single-stage group (43.48% vs. 83.33%, RR 0.53, 95%CI; 0.31-0.89).

CONCLUSIONS: Both single- and two-stage techniques may be considered for penile foreign body granuloma reconstruction. Although the hospital stay was longer in two-stage group, the complication rates were lower.

PMID:37257041 | DOI:10.1111/iju.15209

Eur Endod J. 2023 May;8(3):215-224. doi: 10.14744/eej.2023.36449.

ABSTRACT

OBJECTIVE: This study compared the effects of calcium chloride dihydrate (CaCl2.2H2O) on the physical properties and push-out bond strength of white Mineral Trioxide Aggregate (WMTA) and an experimental Malaysian Portland cement mixed with nano-zirconium oxide (nano-ZrO) [(radiopaque Malaysian Portland cement (RMPC). Mineral Trioxide Aggregate (MTA) was the first calcium silicate cement (CSC) introduced in dentistry, but up to date, it is an expensive cement with long setting time and causes tooth discolouration. Although Portland cement has been introduced as a potential substitute to MTA, it still faces some challenges such as long setting time and lack of sufficient radiopacity.

METHODS: Four groups [WMTA, RMPC, fast-set WMTA (FS-WMTA) and fast-set RMPC (FS-RMPC)] were prepared. Initial setting time was evaluated using Vicat apparatus. The pH was measured at seven-day intervals. For discolouration potential, cements were packed in the pulp chamber of 46 extracted maxillary incisors. Spectrophotometric readings were obtained at seven-day intervals, and the rate of colour change (ΔE) was recorded. For the push-out bond strength testing, cements were applied in 48 sectioned root samples, and the test was performed using universal testing machine at crosshead speed of 0.5 mm/min until bond failure. Statistical analysis was done according to the nature of each group of data using SPSS 26.

RESULTS: Addition of CaCl2.2H2O decreased the initial setting times of both RMPC and WMTA significantly (p<0.05). The pH values of FS-WMTA and FS-RMPC were comparable to their non-accelerated counterparts ranging from 10 to 12. Discolouration effect was more obviously observed with WMTA and FS-WMTA with time compared to RMPC formulations. Push-out bond strength of the two materials also showed an increase with the addition of the accelerator, however, only FS-WMTA showed statistically significant difference compared to WMTA (p<0.05).

CONCLUSION: The addition of CaCl2.2H2O improves the physical and mechanical properties of the newly formulated RMPC and WMTA. The RMPC formulation overcomes the discolouration potential of WMTA. (EEJ-2022-12-155).

PMID:37257037 | DOI:10.14744/eej.2023.36449

Eur Endod J. 2023 May;8(3):201-206. doi: 10.14744/eej.2023.73792.

ABSTRACT

OBJECTIVE: To compare the fatigue resistance of different heat-treated reciprocating instruments tested in a dynamic cyclic fatigue model.

METHODS: Forty-eight new instruments were inspected under magnification and selected for this study, and then divided as follows (n=12): X1 Blue (MK Life, Porto Alegre, RS, Brazil), Pro-R (MK Life), Reciproc (VDW, Munich, Germany), and Reciproc Blue (VDW). Artificial canals presenting a curvature of 60° angle and 5 mm radius were milled in zirconia. The block containing the artificial canals was mounted in a container filled with water kept at 37°C. A specially designed device was used to perform controlled axial movements while the instruments were activated inside the canals. Time to failure was recorded in seconds, and fragment lengths were measured (mm). Data were analyzed statistically with the significance level set at 5% (One-Way ANOVA and Tukey test).

RESULTS: Pro-R and Reciproc Blue instruments presented the highest fatigue resistance, being significantly different from the other tested files (p<0.05). Reciproc presented intermediate results, significantly different X1 Blue (p<0.05). The fractographic analysis showed typical features of cyclic fatigue for all instruments.

CONCLUSION: Pro-R and Reciproc Blue instruments are more resistant to dynamic cyclic fatigue than the Reciproc and X1 Blue. (EEJ-2022-10-124).

PMID:37257036 | DOI:10.14744/eej.2023.73792

J Med Internet Res. 2023 May 31;25:e46924. doi: 10.2196/46924.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) has advanced substantially in recent years, transforming many industries and improving the way people live and work. In scientific research, AI can enhance the quality and efficiency of data analysis and publication. However, AI has also opened up the possibility of generating high-quality fraudulent papers that are difficult to detect, raising important questions about the integrity of scientific research and the trustworthiness of published papers.

OBJECTIVE: The aim of this study was to investigate the capabilities of current AI language models in generating high-quality fraudulent medical articles. We hypothesized that modern AI models can create highly convincing fraudulent papers that can easily deceive readers and even experienced researchers.

METHODS: This proof-of-concept study used ChatGPT (Chat Generative Pre-trained Transformer) powered by the GPT-3 (Generative Pre-trained Transformer 3) language model to generate a fraudulent scientific article related to neurosurgery. GPT-3 is a large language model developed by OpenAI that uses deep learning algorithms to generate human-like text in response to prompts given by users. The model was trained on a massive corpus of text from the internet and is capable of generating high-quality text in a variety of languages and on various topics. The authors posed questions and prompts to the model and refined them iteratively as the model generated the responses. The goal was to create a completely fabricated article including the abstract, introduction, material and methods, discussion, references, charts, etc. Once the article was generated, it was reviewed for accuracy and coherence by experts in the fields of neurosurgery, psychiatry, and statistics and compared to existing similar articles.

RESULTS: The study found that the AI language model can create a highly convincing fraudulent article that resembled a genuine scientific paper in terms of word usage, sentence structure, and overall composition. The AI-generated article included standard sections such as introduction, material and methods, results, and discussion, as well a data sheet. It consisted of 1992 words and 17 citations, and the whole process of article creation took approximately 1 hour without any special training of the human user. However, there were some concerns and specific mistakes identified in the generated article, specifically in the references.

CONCLUSIONS: The study demonstrates the potential of current AI language models to generate completely fabricated scientific articles. Although the papers look sophisticated and seemingly flawless, expert readers may identify semantic inaccuracies and errors upon closer inspection. We highlight the need for increased vigilance and better detection methods to combat the potential misuse of AI in scientific research. At the same time, it is important to recognize the potential benefits of using AI language models in genuine scientific writing and research, such as manuscript preparation and language editing.

PMID:37256685 | DOI:10.2196/46924