Category: Nevin Manimala

Clin Gastroenterol Hepatol. 2022 Oct 29:S1542-3565(22)01009-6. doi: 10.1016/j.cgh.2022.10.020. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: Most noninvasive tests (NITs) for hepatic fibrosis are designed for middle-aged patients with chronic liver disease. We compared the diagnostic performance of major NITs (aspartate aminotransferase-to-platelet ratio index [APRI], Fibrosis-4 index, and nonalcoholic fatty liver disease fibrosis score) for a community-based cohort.

METHODS: This cross-sectional study analyzed 8775 participants who underwent magnetic resonance elastography at community health check-up centers. Advanced hepatic fibrosis (≥F3) was defined by magnetic resonance elastography thresholds of 3.6 kPa. The diagnostic performance of 3 NITs was evaluated according to the etiology of liver disease, sex, metabolic syndrome, obesity, and increased aminotransferase levels in 4 age groups.

RESULTS: The APRI generally showed the best area under the receiver operating characteristic curve in patients aged 45 years or younger, and it was statistically significant in patients with chronic viral hepatitis and alcoholic fatty liver disease (P < .043). The best APRI cut-off value for detecting advanced hepatic fibrosis was 0.4, with a sensitivity and specificity of 75.8% and 73.5%, respectively, in the community-based cohort. The APRI showed balanced sensitivity and specificity across all age groups, whereas the other metrics showed low sensitivity in those aged <45 and low specificity in those >65 years.

CONCLUSIONS: The APRI showed better sensitivity and negative predictive value than the Fibrosis-4 index and the nonalcoholic fatty liver disease fibrosis score in community-based populations with mixed etiology, and, thus, can be performed as the primary test in young adults (age, ≤45 y).

PMID:37115504 | DOI:10.1016/j.cgh.2022.10.020

World J Pediatr. 2023 Apr 28. doi: 10.1007/s12519-023-00717-7. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric sepsis is a complicated condition characterized by life-threatening organ failure resulting from a dysregulated host response to infection in children. It is associated with high rates of morbidity and mortality, and rapid detection and administration of antimicrobials have been emphasized. The objective of this study was to evaluate the diagnostic biomarkers of pediatric sepsis and the function of immune cell infiltration in the development of this illness.

METHODS: Three gene expression datasets were available from the Gene Expression Omnibus collection. First, the differentially expressed genes (DEGs) were found with the use of the R program, and then gene set enrichment analysis was carried out. Subsequently, the DEGs were combined with the major module genes chosen using the weighted gene co-expression network. The hub genes were identified by the use of three machine-learning algorithms: random forest, support vector machine-recursive feature elimination, and least absolute shrinkage and selection operator. The receiver operating characteristic curve and nomogram model were used to verify the discrimination and efficacy of the hub genes. In addition, the inflammatory and immune status of pediatric sepsis was assessed using cell-type identification by estimating relative subsets of RNA transcripts (CIBERSORT). The relationship between the diagnostic markers and infiltrating immune cells was further studied.

RESULTS: Overall, after overlapping key module genes and DEGs, we detected 402 overlapping genes. As pediatric sepsis diagnostic indicators, CYSTM1 (AUC = 0.988), MMP8 (AUC = 0.973), and CD177 (AUC = 0.986) were investigated and demonstrated statistically significant differences (P < 0.05) and diagnostic efficacy in the validation set. As indicated by the immune cell infiltration analysis, multiple immune cells may be involved in the development of pediatric sepsis. Additionally, all diagnostic characteristics may correlate with immune cells to varying degrees.

CONCLUSIONS: The candidate hub genes (CD177, CYSTM1, and MMP8) were identified, and the nomogram was constructed for pediatric sepsis diagnosis. Our study could provide potential peripheral blood diagnostic candidate genes for pediatric sepsis patients.

PMID:37115484 | DOI:10.1007/s12519-023-00717-7

Int Ophthalmol. 2023 Apr 28. doi: 10.1007/s10792-023-02716-z. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the distribution of 50 layers of corneal densitometry and related factors.

METHODS: Clinical data, including age, sex, central corneal thickness, corneal keratometry, and diopters, were collected from 102 healthy participants (102 eyes) in this retrospective study. The cornea was divided into 50 layers, and densitometry of each layer at 19 points was measured by the Pentacam. The value versus the depth curve was plotted. Paired-sample t test and one-way analysis of variance were used to compare densitometry in different regions or depth. Statistical significance was defined as P < .05.

RESULTS: The densitometry values of the Bowman membrane (10-14% depth), anterior stroma (14-30% depth), epithelium (0-10% depth), and Descemet membrane (94-98% depth) decreased sequentially, and the densitometry values of the middle and posterior stroma (30-94% depth) and endothelium (98-100% depth) were the lowest. The higher the degree of astigmatism, the higher the second densitometry peak (R = 0.277, P < .001). The densitometry values of the vertex and superior parts of the cornea were higher than those in the periphery and inferior parts, respectively (all P < .001). In the Bowman membrane, the densitometry is lowest in the inferior nasal part, while in the Descemet membrane, it is lowest in the inferior temporal part.

CONCLUSION: Two densitometry peaks appeared near the Bowman membrane and Descemet membrane. For different depths, the distribution of densitometry within a layer is different. We provide a methodological reference and data basis for corneal research based on local changes in densitometry, and help understand the details of corneal structure from an optical perspective through detailed layering and zoning analysis of densitometry.

PMID:37115476 | DOI:10.1007/s10792-023-02716-z

Neurol Ther. 2023 Apr;12(Suppl 1):5-12. doi: 10.1007/s40120-023-00469-6. Epub 2023 Apr 28.

ABSTRACT

The prevalence of major depressive disorder (MDD) has been increasing, and MDD is now a leading cause of global disability. Depression often coexists with anxiety, and the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced the ‘anxious distress’ specifier to identify those patients within the MDD category who have anxiety as well. The prevalence of anxious depression is high, with studies suggesting that 50-75% of patients with MDD meet the DSM-5 criteria for anxious depression. However, it can be difficult to discern whether a patient has MDD with anxiety or an anxiety disorder that has triggered an episode of depression. In fact, approximately 60-70% of patients with comorbid anxiety and depression experience anxiety first, but it is often depression that leads the patient to seek treatment. Patients with MDD who also have anxiety have significantly worse psychosocial functioning and poorer quality of life compared with patients with MDD without anxiety. In addition, patients with MDD and anxiety take significantly longer to achieve remission, and are less likely to achieve remission, than patients with MDD without anxiety. Therefore, it is essential that physicians have a high index of suspicion for comorbid anxiety in patients with depression, and that anxiety symptoms in patients with MDD are effectively treated. This commentary is based on a virtual symposium presented at the 33rd International College of Neuropsychopharmacology (CINP) World Congress, Taipei, Taiwan, in June 2022.

PMID:37115459 | DOI:10.1007/s40120-023-00469-6

Int Urol Nephrol. 2023 Apr 28. doi: 10.1007/s11255-023-03613-1. Online ahead of print.

ABSTRACT

AIM: To determine the effect of heparin administered during the early post urethral trauma period on inflammation and spongiofibrosis in rats.

MATERIALS AND METHODS: The study included 24 male rats that were randomized into 3 groups of 8 each. The urethra was traumatized using a 24-G needle sheath in all rats. Group 1 (control group) received intraurethral saline 0.9% injected b.i.d. for 27 days, group 2 received intraurethral Na-heparin (liquemine-Roche) 1500 IU kg^-1 injected b.i.d. for 27 days, and group 3 received intraurethral Na-heparin 1500 IU kg^-1 injected b.i.d and saline 0.9% s.i.d. for 27 days. On day 28 the rats’ penises were degloved and penectomy was performed. Inflammation, spongiofibrosis, and congestion in the urethra were investigated in each group.

RESULTS: A statistically significant difference was found between the three groups (control, heparin, and heparin + saline) in the histopathological status of spongiofibrosis, inflammation, and congestion, respectively (P = 0.0001, P = 0.002, P = 0.0001). Severe spongiofibrosis was observed in six (75%) of the rats in group 1 (control group), whereas severe spongiofibrosis was not observed in group 2 (heparin) or group 3 (heparin + saline).

CONCLUSION: We observed that intraurethral Na-heparin 1500 IU kg^-1 injectioned during the early posturethral trauma period in rats significantly decreased inflammation, spongiofibrosis, and congestion.

PMID:37115457 | DOI:10.1007/s11255-023-03613-1

Int J Clin Oncol. 2023 Apr 28. doi: 10.1007/s10147-023-02339-5. Online ahead of print.

ABSTRACT

The definition of the anal canal was revised in the TNM classification (8th edition). The Japanese Society for Cancer of the Colon and Rectum (JSCCR) conducted a retrospective multi-institutional study to clarify the characteristics of anal canal cancer (ACC) in Japan. The diagnoses of 1781 patients treated for ACC were squamous cell carcimoma (SCC; n = 428; 24.0%), adenosquamous cell carcinoma (n = 7; 0.4%), and adenocarcinoma (n = 1260; 70.7%). Anal carcinoma is associated with human papillomavirus (HPV) infection and is risk factor for anal SCC. Among 40 cases analyzed at Takano Hospital and 47 cases analyzed at National Cancer Center Hospital, 34 cases (85.0%) and 40 cases (85.1%), respectively were infected with HPV; HPV-16 was the most common genotype (79.4% and 82.5%). In the JSCCR retrospective multi-institutional study, the prognosis analysis by stage was performed for anal SCC cases (202 cases treated by CRT and 91 cases treated by surgery). The 5-year overall survival (OS) rates by stage did not differ between the two treatment groups to a statistically significant extent. Regarding the results of cancer treatment of patients who underwent HPV infection tests, although the 5-year OS rates by stage did not differ to a statistically significant extent due to the small number of cases, HPV-positive patients had better survival. While an HPV vaccine for anal canal SCC has already been approved internationally, HPV vaccination has already been implemented in Japan as a national immunization program for young women but not for men at present. An HPV vaccination for men is urgently needed.

PMID:37115427 | DOI:10.1007/s10147-023-02339-5

Int J Clin Oncol. 2023 Apr 28. doi: 10.1007/s10147-023-02320-2. Online ahead of print.

ABSTRACT

BACKGROUND: This study assesses the feasibility of minimally invasive surgery (MIS) for well-selected epithelial ovarian cancer (EOC) patients.

METHODS: We performed a review of data prospectively collected from a single center from 2017 to 2022. Only patients with histologically confirmed EOC, with a tumor diameter of less than 10 cm, were eligible. We also performed a meta-analysis of similar studies comparing the outcomes of laparoscopy and laparotomy. We used MINORS (Methodological Index for Non-Randomized Studies) to assess the risk of bias and calculated the odds ratio or mean difference.

RESULTS: Eighteen patients were included; 13 in re-staging group, four in PDS group, and one in IDS group. All achieved complete cytoreduction. One case was converted to laparotomy. The median number of removed pelvic lymph nodes was 25 (range 16-34), and 32 (range 19-44) for para-aortic nodes. There were two (15.4%) intraoperative urinary tract injuries. The median follow-up was 35 months (range 1-53). Recurrence was observed in one case (7.7%). Thirteen articles for early-stage ovarian cancer were included in our meta-analysis. Analysis of the pooled results found that MIS had a higher frequency of spillage (OR, 2.15; 95% CI 1.27-3.64). No differences were observed in recurrence, complications, or up-staging.

CONCLUSIONS: Our experience supports the possibility of conducting MIS for EOC in well-selected patients. Except for spillage, our meta-analysis findings are consistent with previous reports, the majority of which were also retrospective. Ultimately, randomized clinical trials will be needed to authenticate the safety.

PMID:37115425 | DOI:10.1007/s10147-023-02320-2

Radiol Med. 2023 Apr 28. doi: 10.1007/s11547-023-01636-3. Online ahead of print.

ABSTRACT

PURPOSE: To determine whether the presence of calcifications in specimens collected during stereotactic-guided vacuum-assisted breast biopsies (VABB) is sufficient to ascertain their adequacy for final diagnosis at pathology.

MATERIALS AND METHODS: Digital breast tomosynthesis (DBT)-guided VABBs were performed on 74 patients with calcifications as target. Each biopsy consisted of the collection of 12 samplings with a 9-gauge needle. This technique was integrated with a real-time radiography system (IRRS) which allowed the operator to determine whether calcifications were included in the specimens at the end of each of the 12 tissue collections through the acquisition of a radiograph of every sampling. Calcified and non-calcified specimens were separately sent to pathology and evaluated.

RESULTS: A total of 888 specimens were retrieved, 471 containing calcifications and 417 without. In 105 (22.2%) samples out of 471 with calcifications cancer was detected, while the remaining 366 (77.7%) were non-cancerous. Out of 417 specimens without calcifications 56 (13.4%) were cancerous, whereas 361 (86.5%) were non-cancerous. Seven hundred and twenty-seven specimens out of all 888 were cancer-free (81.8%, 95%CI 79-84%).

CONCLUSION: Although there is a statistical significative difference between calcified and non-calcified samples and the detection of cancer (p < 0.001), our study shows that the sole presence of calcifications in the specimens is not sufficient to determine their adequacy for final diagnosis at pathology because non-calcified samples can be cancerous and vice-versa. Ending biopsies when calcifications are first detected through IRRS could lead to false negative results.

PMID:37115391 | DOI:10.1007/s11547-023-01636-3

Sleep Breath. 2023 Apr 28. doi: 10.1007/s11325-023-02821-4. Online ahead of print.

ABSTRACT

PURPOSE: To explore the association between rapid eye movement-related obstructive sleep apnea (REM-OSA) and common cardiometabolic diseases (CMDs) in patients with mild OSA.

METHODS: This retrospective study was conducted by reviewing the medical records and polysomnograms (PSGs) of patients at Siriraj Hospital. The PSGs of patients diagnosed with mild OSA who had ≥ 15 min of REM sleep were included. REM-OSA was defined if the apnea-hypopnea index (AHI) in REM was ≥ 2 times that of non-REM. Common CMDs included coronary artery disease, stroke, heart failure, diabetes mellitus, and hypertension.

RESULTS: The data of 518 patients with a mean age of 48.3 years, 198 males, and mean AHI of 9.8 events/h were analyzed in this study. When compared with the control group, the REM-OSA group (308 patients) were predominantly female (72%), overweight (62%), and had more severe oxygen desaturation, p-value < 0.001. CMDs were significantly more common in the REM-OSA group than in the controls [odds ratio (OR) 1.52, 95% confidence interval 1.04-2.21, p-value = 0.029]. Patients with a REM AHI of ≥ 20 events/h were significantly associated with hypertension compared to those with a REM AHI of < 20 events/h, p-value = 0.001. However, these associations were found not to be statistically significant after controlling for age, sex, BMI, and prevalent coexisting CMD (OR = 1.13, 95% CI: 0.72-1.76, p-value = 0.605).

CONCLUSION: Common CMDs, particularly HT, tend to show an association with REM-OSA in patients with mild OSA, but this association did not reach statistically significant levels.

PMID:37115354 | DOI:10.1007/s11325-023-02821-4

Support Care Cancer. 2023 Apr 28;31(5):309. doi: 10.1007/s00520-023-07778-4.

ABSTRACT

PURPOSE: Most previous reports on dysphagia in cancer have focused on specific cancer types, particularly head and neck cancer. Therefore, we aimed to investigate the incidence of dysphagia in patients with various cancers using a nationwide database in South Korea.

METHODS: This was a retrospective cohort study using the National Health Insurance Service database. Claim codes were used for the selection criteria and operational definitions. The total population data from 2010 to 2015 were extracted. The crude incidence of dysphagia was calculated per 1,000 person-years. The multivariate adjusted Cox proportional hazards regression was used to determine the effects of different cancers on the incidence of dysphagia.

RESULTS: People with cancer had a lower income and suffered from a higher risk of comorbidities compared to people without cancer. The risk of dysphagia increased in all types of cancers, particularly in the oral cavity and pharynx (hazard ratio [HR]: 20.65, 95% confidence interval [CI]: 17.73-24.06), esophagus (HR: 18.25, 95% CI: 15.66-21.26), larynx (HR: 12.87, 95% CI: 10.33-16.02), and central nervous system (HR: 12.42, 95% CI: 10.33-14.94).

CONCLUSIONS: The risk of dysphagia was significantly higher in the cancer group than in the non-cancer group. As the survival of cancer patients is improving with the development of new treatments, more attention should be paid to dysphagia in the management of cancer. Prompt and appropriate multidisciplinary interventions for dysphagia are necessary to improve the recovery and quality of life in cancer patients.

PMID:37115351 | DOI:10.1007/s00520-023-07778-4