Category: Nevin Manimala

JAMA Otolaryngol Head Neck Surg. 2022 Dec 1. doi: 10.1001/jamaoto.2022.3781. Online ahead of print.

ABSTRACT

IMPORTANCE: Tall cell morphology (TCM) is a rare and aggressive variant of papillary thyroid carcinoma (PTC) that has been associated with poor outcomes; however, the risk factors for worse survival are not well characterized.

OBJECTIVE: To identify prognostic factors associated with cancer recurrence and death in patients with PTC-TCM.

DESIGN, SETTING, AND PARTICIPANTS: All patients treated for PTC-TCM at a single tertiary-level academic health care institution from January 1, 1997, through July 31, 2018, were included. Tall cell variant (TCV) was defined as PTC with TCM of 30% or more; and tall cell features (TCF) was defined as PTC with TCM of less than 30%. Patients with other coexisting histologic findings and/or nonsurgical management were excluded. Clinicopathologic features associated with worse outcomes were identified using Kaplan-Meier and Cox proportional-hazards model. Data were analyzed from March 1, 2018, to August 15, 2018.

MAIN OUTCOMES AND MEASURES: Locoregional recurrence-free survival (LRRFS), distant recurrence-free survival (DRFS), and overall survival (OS) after surgery.

RESULTS: A total of 365 patients (median [range] age, 51.8 [15.9-91.6] years; 242 [66.3%] female) with PTC-TCM (TCV, 32%; TCF, 68%) were evaluable. Total thyroidectomy was performed in 336 (92%) patients; 19 (5.2%) received radiotherapy; and 15 (4.1%) received radioactive iodine. Clinical features were pT3 or T4, 65%; node-positive, 53%; and positive surgical margins, 24%. LRRFS at 1-, 3-, 5-, and 10-year was 95%, 87%, 82%, and 73%, respectively. On multivariable analysis, male sex and age were not independent predictors of inferior 5-year LRRFS, whereas positive surgical margins (HR, 3.5; 95% CI, 2.0-6.3), positive lymph nodes (HR, 2.8; 95% CI, 1.4-5.8), and primary tumor size of 3 cm or more (HR, 3.3; 95% CI, 1.4-7.8) were strongly associated with worse LRRFS. Age 55 years or older (HR, 3.2; 95% CI, 1.5-7.0), male sex (HR 4.5; 95% CI, 2.1-10.0), positive surgical margins (HR, 2.7; 95% CI, 1.2-6.0), nodal positivity (HR, 3.1; 95% CI, 1.3-7.7), tumor diameter of 1.5 cm or more (HR, 20.6; 95% CI, 2.8-152.1), and TCV vs TCF (HR, 3.1; 95% CI, 1.5-6.7) were associated with worse DRFS. Male sex (HR, 3.1; 95% 1.4-6.8) and tumor diameter of 1.5 cm or more (HR, 2.8; 95% CI, 1.0-7.4) were associated with worse OS. A findings-based nomogram was constructed to predict 10-year LRRFS (C index, 0.8).

CONCLUSIONS AND RELEVANCE: This retrospective cohort study found that in patients with PTC-TCM, positive surgical margins, node positive disease, and tumor size of 3 cm or more were risk factors for worse LRRFS. Intensified locoregional therapy, including adjuvant radiation, may be considered for treating these patients.

PMID:36454559 | DOI:10.1001/jamaoto.2022.3781

JAMA Ophthalmol. 2022 Dec 1. doi: 10.1001/jamaophthalmol.2022.4942. Online ahead of print.

ABSTRACT

IMPORTANCE: The association of proliferative diabetic retinopathy (PDR) interventions of panretinal photocoagulation (PRP) and intravitreal injections (IVIs) with tractional retinal detachment (TRD) is unclear.

OBJECTIVES: To determine whether different treatment types or a 6-month or longer period of loss to follow-up (LTFU) is associated with TRD.

DESIGN, SETTING, AND PARTICIPANTS: This nested case-control study included data from January 1, 2000, to June 30, 2021, of patients with PDR. Those who progressed to TRD were matched to non-TRD controls up to a 5:1 ratio. Exclusion criteria included 2 or fewer years in the plan, history of nondiabetic retinopathy, vitreous hemorrhage, previous RD, or any other surgically indicated diagnosis. Patient data were obtained from a deidentified commercial and Medicare Advantage medical claims database. Statistical analysis was performed from January to May 2022.

EXPOSURES: Primary exposures of interest were prior treatment (PRP, IVI, both) and any period of 6 months or longer in which the patient received no eye care.

MAIN OUTCOMES AND MEASURES: Odds ratios (ORs) of IVI only compared with PRP and 6-month or longer LTFU on development of TRD.

RESULTS: After application of inclusion and exclusion criteria, a total of 214 patients (mean [SD] age, 55.6 [12.4] years; 115 female [53.7%]) with PDR and TRD were matched to 978 controls (mean [SD] age, 65.6 [11.3] years; 507 female [51.8%]) with only PDR. Among patients with TRD, 69 (32.2%) were treated with laser only, 17 (7.9%) were treated with injection only, 39 (18.2%) were treated with both, and 89 (41.6%) had no prior treatment. Among patients in the PDR-only group, 207 (21.2%) received laser only, 83 (8.5%) received injection only, 57 (5.8%) received both, and 631 (64.5%) received no treatment. After adjusted analysis, no difference in odds of TRD for patients who received injection only compared with patients who received laser only was found (adjusted OR [aOR], 0.56; 95% CI, 0.27-1.14). Patients who received both treatments had higher odds of TRD compared with those who received laser only (aOR, 2.33; 95% CI, 1.21-4.48), and patients who had no treatment had lower odds of TRD (aOR, 0.46; 95% CI, 0.29-0.71; P < .001 for treatment category). Similarly, no difference was seen in the odds of TRD between those with LTFU for 6 months or longer and those without LTFU (aOR, 0.72; 95% CI, 0.49-1.07; P = .11).

CONCLUSIONS AND RELEVANCE: Results of this case-control analysis suggest that there is no increased risk of TRD associated with IVI-only treatment or with 6-month or longer periods of LTFU, which supports the findings of other investigations. Nonetheless, LTFU rates continue to remain high in patients with PDR, which can contribute to substantial vision loss regardless of treatment regimen.

PMID:36454552 | DOI:10.1001/jamaophthalmol.2022.4942

Protein Sci. 2022 Dec 1:e4523. doi: 10.1002/pro.4523. Online ahead of print.

ABSTRACT

Understanding protein-protein interactions (PPIs) is fundamental to infer how different molecular systems work. A major component to model molecular recognition is the Buried Surface Area (BSA), i.e., the area that becomes inaccessible to solvent upon complex formation. Till date many attempts tried to connect BSA to molecular recognition principles, and in particular, to the underlying binding affinity. However, the most popular approach to calculate BSA is to use a single (or in some cases few) bound structures, consequently neglecting a wealth of structural information of the interacting proteins derived from ensembles corresponding to their unbound and bound states. Moreover, the most popular method inherently assumes the component proteins to bind as rigid entities. To address the above shortcomings, we developed a Monte Carlo method-based Interface Residue Assessment Algorithm (IRAA), to calculate a combined distribution of BSA for a given complex. Further, we apply our algorithm to human ACE2 and SARS-CoV-2 Spike protein complex, a system of prime importance. Results show a much broader distribution of BSA compared to that obtained from only the bound structure or structures and extended residue members of the interface with implications to the underlying biomolecular recognition. We derive that specific interface residues of ACE2 and of S-protein are consistently highly flexible, whereas other residues systematically show minor conformational variations. In effect, IRAA facilitates use of all available structural data for any biomolecular complex of interest, extracting quantitative parameters with statistical significance, thereby providing a deeper biophysical understanding of the molecular system under investigation. This article is protected by copyright. All rights reserved.

PMID:36454539 | DOI:10.1002/pro.4523

Ir J Med Sci. 2022 Dec 1. doi: 10.1007/s11845-022-03239-9. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate urodynamic examination results and treatment methods of neurogenic lower urinary tract dysfunction (NLUTD) in patients with traumatic thoracic spinal cord injury (SCI).

METHODS: Ninety-one patients with traumatic thoracic SCI were included in the study. The urodynamic analyses of the patients were conducted retrospectively using their laboratory outcomes. The patients were divided into subgroups according to the sensory innervation of the bladder (T1-10/T11-12), the preservation of sensory functions in the sacral segment (complete lesion/incomplete lesion), and the duration of injury (< 6 months/ ≥ 6 months) and evaluations in subgroups were carried out.

RESULTS: A total of 91 patients (69 males, 22 females) were included in the study. When comparing between the subgroups, the sense of bladder fullness was preserved more in the T11-T12 group with a statistically significant difference (p < 0.001). While storage disorder, the rate of indwelling catheter use during hospitalization, bacterial growth of 10⁵ CFU/ml in the urine culture, and anticholinergic drug recommendation after urodynamic examination were higher in the complete lesion group, the rate of spontaneous/catheter-free voiding, the number of patients in which sense of bladder fullness was preserved-partially preserved, and alpha-blocker drug recommendation after urodynamic examination was higher in the incomplete lesion group, with a statistically significant difference in all parameters (all p values < 0.05).

CONCLUSION: Our results demonstrate that there are differences in neurogenic lower urinary tract dysfunction features in subgroups of traumatic thoracic SCI patients. Regular urinary system evaluation and necessary changes in treatment should be carried out in this patient group.

PMID:36454536 | DOI:10.1007/s11845-022-03239-9

Indian J Pediatr. 2022 Dec 1. doi: 10.1007/s12098-022-04350-6. Online ahead of print.

ABSTRACT

OBJECTIVES: To describe prevalence of various imaging findings in chronic granulomatous disease (CGD) patients; and find imaging biomarkers for differentiating chest infections caused by different micro-organisms.

METHODS: A retrospective study was conducted on 15 patients (49 scans) with proven CGD. Scans which had a correlative microbiological diagnosis for organisms were included in the analysis. The scans were reviewed by 3 radiologists on a predefined proforma, under the lung parenchymal, airway, pleural, mediastinal, and extrathoracic abnormalities. Analysis of various imaging parameters on a semiquantitative scale was performed, followed by a correlation of each imaging findings with causative organisms.

RESULT: The mean age of presentation was nearly 7 y, with a male preponderance. Definitive proof of causative organisms was obtained in 22 scans. Bacterial infection was found in 7, fungal in 12, tubercular in 2, and viral in 1 scan. Most prevalent thoracic imaging manifestations included lymphadenopathy (commonest), consolidation, nodules, air trapping, and bronchiectasis. Fungal infections showed necrotic conglomerate lymphadenopathy, cavitating nodules, and multilobar consolidation more frequently than bacterial infections (though not statistically significant). Abscesses and lymphadenopathy were the most common extrathoracic manifestations.

CONCLUSION: In patients with CGD, multifocal or multilobar consolidation, mass-like consolidation, cavitating nodules, and conglomerate necrotic lymphadenopathy should alert the radiologist to a possible fungal cause.

PMID:36454508 | DOI:10.1007/s12098-022-04350-6

Forensic Toxicol. 2022 Jul;40(2):357-365. doi: 10.1007/s11419-022-00627-9. Epub 2022 May 10.

ABSTRACT

PURPOSE: Prevalence measures of sociological interest concerning cocaine presence on banknotes are fraught with (i) the extreme variability of its concentration (seven orders of magnitude); (ii) the high number of banknotes needed for the statistical significance. Banknote dust from counting machines from a large and representative number of banknotes in circulation in a specific area represents the most eligible sample to ascertain cocaine circulation. No chromatographic method is available in this respect. This study aims at developing the first analytical methodology for the determination of cocaine in banknote dust samples.

METHODS: This novel and straightforward approach consists of a simple methanol extraction followed by analytical determinations via ultra-high performance liquid chromatography coupled to Orbitrap high-resolution mass spectrometry.

RESULTS: Satisfactory analytical performance was obtained with a coefficient of determination of 0.996; maximum within-run and between-run precisions were, respectively, 1.85% and 5.20%. Limits of detection and quantification were, respectively, 3 and 9 ng/mL with an overall process efficiency of 93.2%. The method developed was successfully applied to 9 banknote dust samples from local banknote counter machines. The found concentrations ranged from 2.18E + 02 to 2.31E + 03 μg of cocaine per gram of banknote dust and varied only one order of magnitude, much less than cocaine concentration on banknotes.

CONCLUSIONS: To have an idea of cocaine circulation in a geographical area, the sampling of banknote dust, compared to banknotes, consists of tremendous advantages in terms of statistical significance, higher cocaine concentrations, and lower variability: this is crucial from the sociological point of view.

PMID:36454419 | DOI:10.1007/s11419-022-00627-9

Eur Arch Otorhinolaryngol. 2022 Dec 1. doi: 10.1007/s00405-022-07763-3. Online ahead of print.

ABSTRACT

OBJECTIVES: The study aimed to construct prognostic models for OS and CSS in patients with T1N0M0 glottic SCC. In addition, we used PSM to re-assess the effect of surgery alone and radiation alone.

METHODS: The Surveillance, Epidemiology, and End Results database was searched for patients with confirmed T1N0M0 glottic SCC. Patients with complete data were randomly divided into the training and the validation cohort (7:3), Cox-regression analysis was performed to identified significant predictors of OS and CSS. PSM was used to mimic randomized controlled the trials. Kaplan-Meier survival method and log-rank tests were utilized for survival analysis.

RESULTS: A total 1827 patients met the inclusion criteria. Survival analysis indicated that the patients who underwent the primary site surgery had a better OS (P = 0.002) and CSS (P = 0.008), compared with non-surgery patients. Cox-regression analysis proved that age, marital status, T1 stages, surgery, radiation, sequential treatments, and chemotherapy had significant effects on OS. While age, marital status, histologic grade, surgery, radiation, sequential treatments, and chemotherapy were substantially associated with CSS. Patients who received primary site surgery had a better OS and CSS, compared with non-surgical patients. Patients receiving radiation had a better CSS than non-radiation patients. However, patients who received sequential treatments or chemotherapy had a worse OS and CSS, compared with controlled groups. Predictive nomogram models were established to predict patients’ prognosis with good consistency between the actual observation and the nomogram prediction. Before PSM, patients who underwent surgery alone had a better OS and CSS than those who received radiation alone. After PSM, patients receiving surgery still had a better OS than those receiving radiation. However, there were no statistically significant differences in CSS.

CONCLUSIONS: Nomogram models were developed to predict OS and CSS in patients with T1N0M0 glottic SCC. Primary site surgery could definitely increase OS and CSS, while radiation could significantly increase CSS. Using PSM, surgery alone could significantly enhance OS, as compared to radiation alone. Chemotherapy should not be recommended for early glottic carcinoma.

PMID:36454384 | DOI:10.1007/s00405-022-07763-3

Clin Oral Investig. 2022 Dec 1. doi: 10.1007/s00784-022-04781-7. Online ahead of print.

ABSTRACT

PURPOSE: To identify clinically relevant factors for changes in axial angulation of incisors during routine fixed appliance orthodontic treatment.

METHODS: A total of 106 patients (grades 1-2 of IOTN, 64 females, 42 males; mean age: 15.5 years) from a private practice and treated with metal or ceramic brackets were included in this retrospective cohort study. The axial angulation of the upper and lower incisors was measured on lateral cephalograms before insertion of the first rectangular 0.016 × 0.022-in NiTi archwire (T0) and at the end of treatment about 8 weeks after insertion of the working 0.019 × 0.025-in stainless steel archwire (T1). Treatment-related changes according to bracket type, initial situation, premolar extraction, angle class, and skeletal vertical configuration were analyzed.

RESULTS: Although statistically significant treatment-related changes were seen for both the upper incisors (+ 1.3°) and the lower incisors (- 5.2°), only in ten patients (9.4%) was the prescribed torque value of 17° for the upper incisors and in no patient for the lower incisors achieved. A negative association between the induced change of axial angulation of incisors and the initial values was detected for the upper incisors as well as for the lower incisors. A comparison of the angle classes revealed significant differences in incisor changes. At the end of therapy, only a slight change for the upper central incisors in patients in angle class I cases and a significantly greater change in patients with angle class II/2 was observed. Cases with premolar extraction ended with lower axial angulation of the incisor than cases without extraction. The individual analysis of possible influencing factors also revealed an association with the vertical skeletal configuration.

CONCLUSIONS: For the first time, the presented data show clinically relevant influencing factors for incisor axial angulation changes of the upper and lower incisors in relation to the torque value of the applied brackets in the course of routine clinical practice. For the orthodontist, it remains mandatory to decide whether a customized system must be individualized in order to achieve individual therapy goals.

PMID:36454356 | DOI:10.1007/s00784-022-04781-7

Clin Oral Investig. 2022 Dec 1. doi: 10.1007/s00784-022-04808-z. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the influence of different heat treatments and temperatures on the cyclic fatigue resistance of 2Shape instruments (Micro Mega, Besancon, France) with the same design.

MATERIALS AND METHODS: A total of 80 2Shape TS1 (#25/.04) and 80 TS2 (#25/.06) files with different heat treatments (no heat-treated, NHT; C-Wire; T-Wire; CM-Wire) were tested at room (25° ± 1 °C) and body (37° ± 1 °C) temperatures in 16-mm stainless steel artificial canal with a curvature of 60° and 5 mm of radius. Files were tested in continuous rotation at 300 rpm using a customized device. Cyclic fatigue resistance was expressed in the number of cyclic to fracture (NCF). The phase transformation temperature of each file was determined by differential scanning calorimetry. Data were statistically analyzed using the two-way ANOVA and the Bonferroni post-hoc test with p < 0.05.

RESULTS: All CM-Wire TS1 and TS2 files showed higher NCF than the other groups at both temperatures (p < 0.001). C-Wire TS2 showed higher resistance than NHT and T-Wire TS2 (p < 0.001), with no significant differences between the last two. Body temperature significantly decreased NCF of all tested files (p < 0.05) except for NHT and T-Wire TS1.

CONCLUSIONS: Body temperature negatively affected the cyclic fatigue resistance of C-Wire and CM-Wire TS1 and of all TS2 files compared with room temperature. The CM-Wire instruments exhibited the highest cyclic fatigue resistance of all tested files.

CLINICAL RELEVANCE: Heat-treated nickel-titanium files can differently perform according to environmental temperature and file dimensions. The CM-Wire 2Shape prototypes displayed the highest flexural resistance in all experimental conditions.

PMID:36454355 | DOI:10.1007/s00784-022-04808-z

Urolithiasis. 2022 Dec 1;51(1):2. doi: 10.1007/s00240-022-01386-3.

ABSTRACT

We performed a meta-analysis to compare the safety and effectiveness of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in treating nephrolithiasis ≥ 2 cm in patients with solitary kidneys. This systematic review was registered on PROSPERO (registration ID: CRD42021270519). The search time was set from the establishment of the databases until April 30, 2021. A systematic search was performed in the PubMed, MEDLINE, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), Cochrane Library, and Embase databases. Stata 16 was used to perform the statistical analysis of the extracted data. After screening using strict inclusion and exclusion criteria, five studies with a total of 474 patients were included in the final meta-analysis. According to the literature quality assessment scale statistics, the five studies included were of high quality. The results of the meta-analysis showed that RIRS had lesser hemoglobin loss (HL), shorter length of hospital stay (LOS), lower initial (OR = 3.39, 95% CI [1.97, 5.83], P = 0.02) and final stone-free rates (OR = 2.24, 95% CI [1.24, 4.06], P = 0.03), but a higher incidence of grade III-IV complications (OR = 0.29, 95% CI [0.08, 0.97], P = 0.04) than PCNL. The difference between the two surgical methods was not statistically significant in terms of operation time (OT), grade I-II complication rate, and total complication rate. For nephrolithiasis ≥ 2 cm in patients with a solitary kidney, RIRS has the advantage of less HL and shorter LOS, while PCNL benefits from its higher SFR (both initial and final). Both RIRS and PCNL are effective treatments for nephrolithiasis in patients with a solitary kidney, and clinicians should choose the most appropriate option to achieve the best treatment outcome, taking into account the patient’s underlying conditions and medical conditions.

PMID:36454348 | DOI:10.1007/s00240-022-01386-3