Category: Nevin Manimala

Ann Surg Oncol. 2023 Jan 31. doi: 10.1245/s10434-023-13147-6. Online ahead of print.

ABSTRACT

BACKGROUND: Current success in transplant oncology for select liver tumors, such as hepatocellular carcinoma, has ignited international interest in liver transplantation (LT) as a therapeutic option for nonresectable colorectal liver metastases (CRLM). In the United States, the CRLM LT experience is limited to reports from a handful of centers. This study was designed to summarize donor, recipient, and transplant center characteristics and posttransplant outcomes for the indication of CRLM.

METHODS: Adult, primary LT patients listed between December 2017 and March 2022 were identified by using United Network Organ Sharing database. LT for CRLM was identified from variables: “DIAG_OSTXT”; “DGN_OSTXT_TCR”; “DGN2_OSTXT_TCR”; and “MALIG_TY_OSTXT.”

RESULTS: During this study period, 64 patients were listed, and 46 received LT for CRLM in 15 centers. Of 46 patients who underwent LT for CRLM, 26 patients (56.5%) received LTs using living donor LT (LDLT), and 20 patients received LT using deceased donor (DDLT) (43.5%). The median laboratory MELD-Na score at the time of listing was statistically similar between the LDLT and DDLT groups (8 vs. 9, P = 0.14). This persisted at the time of LT (8 vs. 12, P = 0.06). The 1-, 2-, and 3-year, disease-free, survival rates were 75.1, 53.7, and 53.7%. Overall survival rates were 89.0, 60.4, and 60.4%, respectively.

CONCLUSIONS: This first comprehensive U.S. analysis of LT for CRLM suggests a burgeoning interest in high-volume U.S. transplant centers. Strategies to optimize patient selection are limited by the scarce oncologic history provided in UNOS data, warranting a separate registry to study LT in CRLM.

PMID:36719568 | DOI:10.1245/s10434-023-13147-6

Med Biol Eng Comput. 2023 Jan 31. doi: 10.1007/s11517-023-02770-w. Online ahead of print.

ABSTRACT

In brain computer interface-based neurorehabilitation system, a large number of electrodes may increase the difficulty of signal acquisition and the time consumption of decoding algorithm for motor imagery EEG (MI-EEG). The traditional electrode optimization methods were limited by the low spatial resolution of scalp EEG. EEG source imaging (ESI) was further applied to reduce the number of electrodes, in which either the electrodes covering activated cortical areas were selected, or the reconstructed electrodes of EEGs with higher Fisher scores were retained. However, the activated dipoles do not all contribute equally to decoding, and the Fisher score cannot represent the correlations between electrodes and dipoles. In this paper, based on ESI and correlation analysis, a novel electrode optimization method, denoted ECCEO, was developed. The scalp MI-EEG was mapped to cortical regions by ESI, and the dipoles with larger amplitudes were chosen to designate a region of interest (ROI). Then, Pearson correlation coefficients between each dipole of the ROI and the corresponding electrode were calculated, averaged, and ranked to obtain two average correlation coefficient sequences. A small but important group of electrodes for each class were alternately added to the predetermined basic electrode set to form a candidate electrode set. Their features were extracted and evaluated to determine the optimal electrode set. Experiments were conducted on two public datasets, the average decoding accuracies achieved 95.99% and 88.30%, and the reduction of computational cost were 65% and 56%, respectively; statistical significance was examined as well.

PMID:36719563 | DOI:10.1007/s11517-023-02770-w

J Racial Ethn Health Disparities. 2023 Jan 31. doi: 10.1007/s40615-023-01523-7. Online ahead of print.

ABSTRACT

INTRODUCTION: Despite increased attention to the societal consequences of aggressive policing, the focus on rarer instances of deaths/severe injuries fails to fully capture the day-to-day experiences that racially minoritized groups face during police encounters (PEs). We explored differential vulnerability by race/ethnicity in the relationship between PEs and cardiovascular disease (CVD) risk.

METHODS: Using data from the National Longitudinal Study of Adolescent to Adult Health, we regressed the Framingham 30-Year CVD risk score on a high number of lifetime PEs (6 + among men and 2 + among women). To explore differential vulnerability by race, we added an interaction between PEs and race/ethnicity. We also examined sex- and race and sex-stratified models.

RESULTS: We observed no association between PEs and CVD risk in the sample overall, but the interaction between PEs and race/ethnicity was statistically significant. In race stratified models, we found that higher PEs were associated with a lower CVD risk among Black respondents, whereas among White respondents there was no relationship. In the sex-stratified analysis, reporting higher PEs was associated with lower CVD risk among men, while among women there was no relationship. In sex- and race-stratified models, higher PEs was associated with lower CVD risk among Black men and higher CVD risk among White women, while there was no association among Black women and White men.

CONCLUSION: The association between PEs and CVD risk depends on race/ethnicity and sex. More work is needed to understand the counterintuitive finding that high PEs are associated with lower CVD risk among Black men.

PMID:36719543 | DOI:10.1007/s40615-023-01523-7

Int Urol Nephrol. 2023 Jan 31. doi: 10.1007/s11255-023-03487-3. Online ahead of print.

ABSTRACT

CONTEXT: Prostate cancer (PCa) is the second largest male tumor in the world and one of the most common malignant tumors in the urinary system. In recent years, the incidence rate of PCa in China has been increasing year by year. Meanwhile, refractory hormone resistance and adverse drug reactions of advanced PCa cause serious harm to patients.

OBJECTIVE: The present study aims to systematically review the recent advances in molecularly targeted drugs for prostate cancer and to use the retrieval and analysis of the literature library to summarize the adverse effects of different drugs so as to maximize the treatment benefits of targeted therapies.

EVIDENCE ACQUISITION: We performed a systematic literature search of the Medline, EMBASE, PubMed, and Cochrane databases up to March 2022 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Medical Subject Heading (MeSH) terms and keywords such as (prostate cancer) AND (molecular target drugs) AND (side effect) were used. No language restrictions were set on the search process, and all these results were processed independently by two authors. Consensus was reached through discussion once met with any disagreements. The primary endpoint was differential features between different molecular targeted drugs. Secondary endpoints were side effects of different drugs on the body and corresponding prognostic values.

EVIDENCE SYNTHESIS: The Cochrane Collaboration risk of bias tool was used to assess the study quality in terms of sequence generation, allocation concealment, blinding, the completeness of outcome data, selective reporting and other biases. We retrieved 332 articles, of which 49 met the criteria for inclusion. Included studies show that prostatic tumor cells, tumor neovascularization and immune checkpoints are the main means for targeted therapy. Common drugs include 177 Lu-PSMA, Olaparib, Rucaparib, Bevacizumab, Pazopanib, Sorafenib, Cabozantinib, Aflibercept, Ipilimumab, Atezolizumab, Avelumab, Durvalumab. A series of publicly available data suitable for further analysis of side effects. An over-representation analysis of these datasets revealed reasonable dosage and usage is the key to controlling the side effects of targeted drugs. Important information such as the publication year, the first author, location and outcome observation of adverse effects was extracted from the original article. If the study data has some insufficient data, contacting the corresponding authors is necessary. All the studies included prospective nonrandomized and randomized research. Retrospective reviews were also screened according to the relevant to the purpose of this study. Meeting abstracts as well as letters to the editor and editorials were excluded.

STATISTICAL ANALYSIS: Data analysis was based on Cochrane’s risk of bias tools to obtain the quality assessment. The included randomized studies used RoB2 and non-randomized ones corresponded to ROBINS-I. Standardized mean differences (SMD) were used to determine relative risk (RR) and side effects between groups. The eggers’ test was used to check the publication bias from variable information in the included studies. All p < 0.05 were considered to be significant, and 95% was set as the confidence interval.

CONCLUSIONS: With the approval of a variety of targeted drugs, targeted therapy will be widely used in the treatment of advanced or metastatic prostate cancer. Despite the existence of adverse reactions related to targeted drug treatment, it is still meaningful to adjust the drug dosage or treatment cycle to reduce the occurrence of adverse reactions, improving the treatment benefits of patients.

PMID:36719528 | DOI:10.1007/s11255-023-03487-3

Int J Biometeorol. 2023 Jan 31. doi: 10.1007/s00484-022-02422-y. Online ahead of print.

ABSTRACT

Leptospirosis is a zoonosis that has been linked to hydrometeorological variability. Hydrometeorological averages and extremes have been used before as drivers in the statistical prediction of disease. However, their importance and predictive capacity are still little known. In this study, the use of a random forest classifier was explored to analyze the relative importance of hydrometeorological indices in developing the leptospirosis model and to evaluate the performance of models based on the type of indices used, using case data from three districts in Kelantan, Malaysia, that experience annual monsoonal rainfall and flooding. First, hydrometeorological data including rainfall, streamflow, water level, relative humidity, and temperature were transformed into 164 weekly average and extreme indices in accordance with the Expert Team on Climate Change Detection and Indices (ETCCDI). Then, weekly case occurrences were classified into binary classes “high” and “low” based on an average threshold. Seventeen models based on “average,” “extreme,” and “mixed” indices were trained by optimizing the feature subsets based on the model computed mean decrease Gini (MDG) scores. The variable importance was assessed through cross-correlation analysis and the MDG score. The average and extreme models showed similar prediction accuracy ranges (61.5-76.1% and 72.3-77.0%) while the mixed models showed an improvement (71.7-82.6% prediction accuracy). An extreme model was the most sensitive while an average model was the most specific. The time lag associated with the driving indices agreed with the seasonality of the monsoon. The rainfall variable (extreme) was the most important in classifying the leptospirosis occurrence while streamflow was the least important despite showing higher correlations with leptospirosis.

PMID:36719482 | DOI:10.1007/s00484-022-02422-y

Discov Oncol. 2023 Jan 31;14(1):13. doi: 10.1007/s12672-023-00622-5.

ABSTRACT

BACKGROUND: Cutaneous malignant melanoma (CMM) ranks among the ten most frequent malignancies, clinicopathological staging being of key importance to predict prognosis. Artificial intelligence (AI) has been recently applied to develop prognostically reliable staging systems for CMM. This study aims to provide a useful machine learning based tool to predict the overall CMM short-term survival.

METHODS: CMM records as collected at the Veneto Cancer Registry (RTV) and at the Veneto regional health service were considered. A univariate Cox regression validated the strength and direction of each independent variable with overall mortality. A range of machine learning models (Logistic Regression classifier, Support-Vector Machine, Random Forest, Gradient Boosting, and k-Nearest Neighbors) and a Deep Neural Network were then trained to predict the 3-years mortality probability. Five-fold cross-validation and Grid Search were performed to test the best data preprocessing procedures, features selection, and to optimize models hyperparameters. A final evaluation was carried out on a separate test set in terms of balanced accuracy, precision, recall and F1 score. The best model was deployed as online tool.

RESULTS: The univariate analysis confirmed the significant prognostic value of TNM staging. Adjunctive clinicopathological variables not included in the AJCC 8th melanoma staging system, i.e., sex, tumor site, histotype, growth phase, and age, were significantly linked to overall survival. Among the models, the Neural Network and the Random Forest models featured the best prognostic performance, achieving a balanced accuracy of 91% and 88%, respectively. According to the Gini importance score, age, T and M stages, mitotic count, and ulceration appeared to be the variables with the greatest impact on survival prediction.

CONCLUSIONS: Using data from patients with CMM, we developed an AI algorithm with high staging reliability, on top of which a web tool was implemented ( unipd.link/melanomaprediction ). Being essentially based on routinely recorded clinicopathological variables, it can already be implemented with minimal effort and further tested in the current clinical practice, an essential phase for validating the model’s accuracy beyond the original research context.

PMID:36719475 | DOI:10.1007/s12672-023-00622-5

World J Urol. 2023 Jan 31. doi: 10.1007/s00345-023-04301-6. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the influencing factors of acute kidney injury (AKI) following retrograde intrarenal surgery (RIRS).

METHODS: The data of patients who underwent RIRS for kidney stones between January 2018 and June 2022 at two tertiary centers were retrospectively analyzed. Demographic data of patients were obtained. According to kidney disease: Improving Global Outcomes (KDIGO) criteria, those with and without AKI were divided into two groups. Preoperative, intraoperative, and postoperative predictive factors of patients were investigated between the groups. In addition, the influencing factors of AKI were examined by multivariate analysis.

RESULTS: This study included 295 (35.7%) women and 532 (64.3%) men. The mean age was 50.03 ± 15.4 years (range 18-89), and mean stone size was 15.5 ± 6.1 mm (range 6-47). Overall, 672 of patients (81.3%) were stone-free after the initial treatment. According to KDIGO, 110 of patients (13.3%) had AKI during the postoperative period. Univariate analysis showed that stone size (P = .003), previous stone surgery (P = .010), renal malformations (P = .017), high operative time (P = < .001), high preoperative creatinine value (P = .036), intraoperative complications (P = .018), and postoperative urinary tract infection (P = .003) had significant influence on the AKI after RIRS. Multivariate analysis excluded previous stone surgery, high preoperative creatinine value, renal malformations, and intraoperative complications from the logistic regression model, whereas other factors maintained their statistically significant effect on AKI, indicating that they were independent predictors.

CONCLUSIONS: Stone size, operative time, postoperative urinary tract infection, and diabetes mellitus are significant predictors of AKI. During RIRS, urologists should consider the factors that increase the risk of AKI and evaluate the treatment outcomes based on these factors.

PMID:36719465 | DOI:10.1007/s00345-023-04301-6

Microb Ecol. 2023 Jan 31. doi: 10.1007/s00248-023-02183-0. Online ahead of print.

ABSTRACT

How the coral microbiome responds to oceanic pH changes due to anthropogenic climate change, including ocean acidification and deliberate artificial alkalization, remains an open question. Here, we applied a 16S profile and GeoChip approach to microbial taxonomic and gene functional landscapes in the coral Galaxea fascicularis under three pH levels (7.85, 8.15, and 8.45) and tested the influence of pH changes on the cell growth of several coral-associated strains and bacterial populations. Statistical analysis of GeoChip-based data suggested that both ocean acidification and alkalization destabilized functional cores related to aromatic degradation, carbon degradation, carbon fixation, stress response, and antibiotic biosynthesis in the microbiome, which are related to holobiont carbon cycling and health. The taxonomic analysis revealed that bacterial species richness was not significantly different among the three pH treatments, but the community compositions were significantly distinct. Acute seawater alkalization leads to an increase in pathogens as well as a stronger taxonomic shift than acidification, which is worth considering when using artificial ocean alkalization to protect coral ecosystems from ocean acidification. In addition, our co-occurrence network analysis reflected microbial community and functional shifts in response to pH change cues, which will further help to understand the functional ecological role of the microbiome in coral resilience.

PMID:36719456 | DOI:10.1007/s00248-023-02183-0

Int Urogynecol J. 2023 Jan 31. doi: 10.1007/s00192-023-05467-8. Online ahead of print.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: Both urogynecologic surgeries and transdermal scopolamine (TDS) patches are independently associated with postoperative urinary retention (POUR). It is unclear if the risk of POUR increases when these interventions are used in combination. This systematic review and meta-analysis aim to synthesize current evidence to optimize clinical management and outcomes for patients undergoing urogynecologic procedures.

METHODS: This systematic review was conducted in concordance with the PRISMA 2020 guidelines. MEDLINE, ClinicalTrials.gov, and Cochrane Library were searched. Publications were filtered by inclusion and exclusion criteria. Inclusion criteria required: (1) preoperative or perioperative application of TDS, (2) surgery indicated for stress urinary incontinence and/or pelvic organ prolapse, (3) results given for postoperative voiding trials, and (4) were available in English. Exclusion criteria included: (1) oral or parenteral formulations of scopolamine, (2) administration of alternative preoperative antiemetics, and (3) use of combination antiemetic therapy. Quality was assessed using the Joanna Briggs Institute Checklist. Publication bias was evaluated via the ROBINS-I assessment tool, and Egger regression and Begg and Mazumumdar rank correlation tests. A meta-analysis was conducted using Meta-Essentials Excel Workbook.

RESULTS: Four publications were identified which complied with inclusion and exclusion criteria. Included studies comprised 752 patients (237 experimental group, 515 control group). All were retrospective cohort studies conducted via chart review in America. Meta-analysis revealed a risk ratio (RR) of 2.35 with a confidence interval (CI) of 0.61 to 9.07, indicating a positive association between TDS and POUR, but without statistical significance.

CONCLUSIONS: Current evidence suggests that TDS application may be associated with increased risk of POUR following urogynecologic procedures. While research on this topic is greatly limited, this systematic review and meta-analysis highlights that alternative antiemetic therapy may be necessary for patients undergoing such interventions in effort to limit the risk of POUR.

PMID:36719449 | DOI:10.1007/s00192-023-05467-8

J Cosmet Dermatol. 2023 Jan 31. doi: 10.1111/jocd.15648. Online ahead of print.

ABSTRACT

INTRODUCTION: Melasma is a human melanogenesis dysfunction that results in localized, chronic acquired hypermelanosis of the skin difficult to treat.

METHODS: This prospective, randomized, single-blind, study aimed to compare the efficacy and tolerability of a liposomal emulsion based on Politranexamide® (SAMPLE A) with that of a competitor based on acetylglucosamine, ethyl linoleate and phenyl ethyl resorcinol (SAMPLE B) in patients affected by facial melasma on 26 patients. Disease severity was assessed by the Melasma Area Severity Index (MASI) at baseline and after 6 and 12 weeks of therapy. All patients were subjected to photo documentation using DermaView camera and Antera 3D camera.

RESULTS: The mean MASI score at baseline was 10.93 ± 7 in the group A and 9.34 ± 6.29 in the group B, respectively. A significant decrease in MASI score from baseline was noted in both treatment groups as early as 6 weeks of follow-up (p = 0.00096 for SAMPLE A and p = 0.0049 for SAMPLE B) and was confirmed at the end of the treatment (p = 0.0006 for SAMPLE A and p = 0.00039 for SAMPLE B). Intergroup comparison revealed a greater improvement of melasma among patients in group A compared to those in group B that was quite statistically significant at weeks 6 (p = 0.055009) and significant after 12 weeks of follow-up (p = 0.032942). Both treatment groups experienced an improvement in Antera average level of melanin.

CONCLUSION: Our results suggested Politranexamide® to be a useful and safe therapeutic option in treating melasma, more effective than competitor used in this study.

PMID:36718844 | DOI:10.1111/jocd.15648