Category: Nevin Manimala

Abdom Radiol (NY). 2021 Mar 8. doi: 10.1007/s00261-021-03011-0. Online ahead of print.

ABSTRACT

PURPOSE: To assess the need of the dynamic contrast-enhanced (DCE) sequence in addition to T2-weighted imaging (T2-WI) and diffusion-weighted imaging (DWI) for the detection of clinically significant prostate cancer in the presence of artifacts associated with rectal gas (which compromise the diffusion assessment) and/or PIRADS 3 lesions.

METHODS: This retrospective study was approved by the institutional review board; informed consent was not required. Patients referred consecutively over a period of 5 months for elevated PSA underwent multiparametric magnetic resonance imaging (mpMRI). mpMRI was performed using a 3T MRI system without an endorectal coil. The MRI findings were reviewed by two radiologists and were scored according to the Prostate Imaging Reporting and Data System version 2.0 (PI-RADSv2). Any discrepancies were resolved by consensus. For statistical purposes, lesions were classified as PIRADS 1-2, PIRADS 3, or PIRADS 4-5. First, all studies were reviewed using a biparametric assessment (T2-WI + DWI), and the presence or absence of susceptibility artifacts was assessed for each prostate. Subsequently, all images were analyzed using the standard multiparametric approach (T2-WI + DWI + DCE).

RESULTS: The biparametric evaluation (T2-WI + DWI) showed artifacts (due to the presence of rectal gas or other) in 87 patients (43.5%) and no artifacts in 113 patients (56.5%). In the latter group, 15 patients had peripheral zone (PZ) PIRADS 3 lesions. Thus, a total of 102 patients (51%) had artifacts or PZ PIRADS 3 lesions and therefore required DCE. When evaluating the group of prostates without artifacts, 13.3% of prostates required DCE. A total of 17 (23.9%) PIRADS 4-5 prostate lesions would have not been detected without the use of DCE.

CONCLUSION: Biparametric evaluation of the prostate revealed some limitation due to the presence of artifacts or PIRADS 3 PZ lesions. Artifacts were present in almost 44% of our patients, but when the DWI was correctly evaluated, only 13.3% of prostates required DCE.

PMID:33683430 | DOI:10.1007/s00261-021-03011-0

Graefes Arch Clin Exp Ophthalmol. 2021 Mar 8. doi: 10.1007/s00417-021-05144-w. Online ahead of print.

ABSTRACT

PURPOSE: Two-year post-operative outcomes of both deep sclerectomy (DS) and trabeculectomy surgery (Trab) augmented with Mitomycin C (MMC) at a single tertiary eye centre.

METHODS: Retrospective review of DS + MMC and trabeculectomy + MMC at a single centre between February 2015 and March 2018. Patients with a minimum of 12-month follow-up were included. Post-operative follow-up: day 1, week 1, months 1/3/6/12/18/24. Primary outcomes: changes in intraocular pressure (IOP) and changes in LogMAR visual acuity (BCVA) pre- and post-procedure.

SECONDARY OUTCOMES: changes in number of eye drops, number of follow-up clinic visits, post-operative complications and further surgical interventions. Complete success: IOP ≤ 21 mmHg off all IOP-lowering medications. Qualified success: IOP ≤ 21 mmHg on medication. Failure: IOP > 21 mmHg at 24 months or ≤ 5 mmHg on 2 consecutive follow-up visits after 3 months +/- additional incisional glaucoma surgery +/- loss of light perception. Statistical analysis performed using Microsoft Excel + SPSS.

RESULTS: 90 eyes: DS + MMC = 46 eyes, Trab + MMC = 44 eyes. DS + MMC v Trab + MMC: mean pre-op IOP = 19.57 mmHg v 18.89 mmHg, significantly reduced at all post-operative time-points for both groups (p < 0.001). Mean IOP reduction from baseline = 33.94% v 38.39%; > 30% IOP reduction = 54.35% v 68.18%. IOP ≤ 16 mmHg = 82.61% (38/46) v 95.46% (42/44), IOP ≤ 12 mmHg = 52.17% (24/46) v 72.72% (32/44). Complete success = 67.39% v 61.36%, qualified success = 26.09% v 29.55%, failure = 6.52% v 9.09%. Post-op BCVA: no statistically significant differences between two groups (p = 0.09). Mean pre-op drops v post-op drops = 2.98 v 0.38 (DS + MMC; p < 0.001); 2.68 v 0.39 (Trab + MMC; p < 0.001). Further surgical intervention = 13% v 29.55%. Mean number of post-op clinic visits DS + MMC v Trab + MMC = 10.09 v 13.02 (p = 0.005).

CONCLUSION: Both procedures achieve sustained intraocular pressure and drop reduction at 2 years post-op. DS + MMC has lower complication rates requiring less intervention and significantly fewer clinic visits, which may be an important factor for deciding surgical management of glaucoma patients in the era of Covid-19 to reduce patient/clinician exposure to the virus.

PMID:33683432 | DOI:10.1007/s00417-021-05144-w

Aesthetic Plast Surg. 2021 Mar 8. doi: 10.1007/s00266-021-02137-2. Online ahead of print.

ABSTRACT

BACKGROUND: Labiaplasty (labia minora reduction) has been increasingly requested in recent years. The surgical procedures previously reported in the literature may have some complications that affect patient satisfaction.

METHODS: Patients who underwent a new bilateral labiaplasty procedure that combined wedge de-epithelialization on the medial side with edge resection on the lateral side were retrospectively reviewed. Satisfaction rates were assessed, and questionnaires, namely the Female Sexual Function Index (FSFI) and Genital Appearance Satisfaction (GAS) scale, were distributed and analyzed. The data from the study group were compared with data from cases who underwent traditional labiaplasty with wedge resection (control group).

RESULTS: From October 2015 to February 2020, fifty-one women underwent modified labiaplasty, while 26 women underwent traditional labiaplasty. A total of 94.1% (48/51) of patients in the modified group were satisfied with the genital appearance. Compared with the 96.2% (25/26) satisfaction rate in the control group, the difference was not statistically significant. A total of 43/55 valid questionnaires were returned, including 29 in the modified labiaplasty group and 14 in the control group. There was a significant improvement in the postoperative GAS scale compared to the preoperative scale in both groups (P<0.05). The new modified method had a significant FSFI improvement after the operation compared with preoperative scores (P<0.05), while the FSFI improvement was not significant in the control group (P>0.05). There was no significant difference in the FSFI score improvement, postoperative GAS score or postoperative FSFI between the two groups (P>0.05).

CONCLUSION: This new modified labiaplasty is a satisfying and safe method with low risks, and it may result in better sexual sensitivity for the patients LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

PMID:33683383 | DOI:10.1007/s00266-021-02137-2

Neuroradiology. 2021 Mar 8. doi: 10.1007/s00234-021-02686-y. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study is to demonstrate the diagnostic effect of VWI in differentiating PACNS from other vasculopathies and its role in post-treatment follow-up in PACNS patients in this study.

METHODS: In this prospective study, we included patients with clinical suspicion of PACNS who presented with new-onset ischemic events and had significant intracranial large vessel stenosis on DSA or MRA. VWI was performed on all patients. The imaging findings and final diagnoses were recorded. Control VWI was performed on patients with PACNS diagnosis after at least 3 months of treatment, and the change in findings was also evaluated.

RESULTS: Twenty-three patients were included in the study had a median age of 40 (range 12-58). The most common clinical manifestations were focal neurologic deficits. According to the initial clinical evaluation, 10 patients (43.5%) were classified as PACNS and 13 patients (56.5%) as indeterminate for PACNS. After incorporating the VWI findings, the diagnosis of PACNS was confirmed in all clinically diagnosed PACNS patients. Concentric wall thickening and contrast enhancement were statistically significant in the PACNS group (p <0.001). According to concentric thickening and VWE features, sensitivity and specificity in distinguishing PACNS and other vasculopathies were 95.2%, 75% and 95.2%, 68.8%, respectively. Vessel wall enhancement regressed in 7 of 9 patients during a median follow-up period of 8 months (range 5.5-11.5) in PACNS patients who followed up.

CONCLUSION: VWI seems a new and useful imaging method in the differential diagnosis of PACNS and might be a useful adjunct for post-treatment follow-up.

PMID:33683406 | DOI:10.1007/s00234-021-02686-y

World J Urol. 2021 Mar 8. doi: 10.1007/s00345-021-03644-2. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the impact of 5-alpha reductase inhibitors (5-ARIs) on definitive treatment (DT) and pathological progression (PP) in patients on active surveillance (AS) for prostate cancer.

METHODS: We identified 361 consecutive patients, from an IRB-approved database, on AS for prostate cancer with minimum 2 years follow-up. Patients were grouped into two cohorts, those using 5-ARIs (5-ARI; n = 119) or not using 5-ARIs (no 5-ARI; n = 242). Primary and secondary endpoints were treatment-free survival (TFS) and PP-free survival (PPFS), which were evaluated by Kaplan-Meier analysis. Univariate and multivariable cox regression analysis were used to identify predictors for PP and DT. A p value < 0.05 was considered statistically significant.

RESULTS: Baseline characteristics and the prostate biopsy rate were similar between the two groups. Median (range) follow-up was 5.7 (2.0-17.2) years. Five-year and 10-year TFS was 92% and 59% for the 5-ARI group versus 80% and 51% for the no 5-ARI group (p = 0.005), respectively. Five-year and 10-year PPFS was 77% and 41% for the 5-ARI group versus 70% and 32% for the no 5-ARI group (p = 0.04), respectively. Independent predictors for treatment and PP were not taking 5-ARIs (p = 0.005; p = 0.02), entry PSA > 2.5 ng/mL (p = 0.03; p = 0.01) and Gleason pattern 4 on initial biopsy (p < 0.001; p < 0.001), respectively. The main limitation is the retrospective study design.

CONCLUSIONS: 5-ARIs reduces reclassification and cross-over to treatment in men on active surveillance for prostate cancer. Further, taking 5-ARIs was an independent predictor for prostate cancer progression and definitive treatment.

PMID:33683411 | DOI:10.1007/s00345-021-03644-2

JAMA Netw Open. 2021 Mar 1;4(3):e211020. doi: 10.1001/jamanetworkopen.2021.1020.

ABSTRACT

IMPORTANCE: Caregivers of people with mental illness are at increased risk of developing depression, anxiety, and stress.

OBJECTIVE: To investigate the effect of a compassion cultivation training (CCT) program on decreasing caregiver psychological distress.

DESIGN, SETTING, AND PARTICIPANTS: This waitlist-controlled randomized clinical trial was conducted in 2 different community settings in Denmark. Caregivers were excluded if they had a diagnosed and untreated mental illness, addiction, meditation practice, or current psychotherapeutic treatment. Enrollment occurred between May 2018 and March 2019. A repeated measurement model was used to examine the impact of the intervention. The primary analysis was based on the intention-to-treat principle. Data analysis was conducted from June 4 to July 7, 2020.

INTERVENTIONS: Participants were randomized 1-to-1 to an 8-week CCT course or waitlist control. Block randomization was used with 40 participants in each block.

MAIN OUTCOMES AND MEASURES: The main outcome was reduction in psychological distress, as measured by the Depression, Anxiety, Stress Scale (DASS). Baseline, postintervention, and 3- and 6-month follow-up measurements were collected.

RESULTS: Among 192 participants assessed for eligibility, 161 participants were included in the study (mean [SD] age, 52.6 [12.5] years; 142 [88.2%] women), with 79 participants randomized to the CCT intervention and 82 participants in the waitlist control group. At baseline, the mean (SD) DASS scores for the intervention vs control groups were 10.89 (8.66) vs 10.80 (8.38) for depression, 6.89 (6.48) vs 6.68 (5.33) for anxiety, and 14.96 (7.90) vs 15.77 (7.40) for stress. The CCT group experienced statistically significant improvement in the primary outcome in mean change from baseline vs the control group at postintervention (adjusted mean difference: depression, -4.16 [95% CI, -6.75 to -1.58]; P = .002; anxiety, -2.24 [95% CI, -3.99 to -0.48]; P = .01; stress, -4.20 [95% CI, -6.73 to -1.67]; P = .001), the 3-month follow-up (adjusted mean difference: depression, -3.78 [95% CI, -6.40 to -1.17]; P = .005; anxiety, -2.50 [95% CI, -4.27 to -0.73]; P = .006; stress, -3.76 [95% CI, -6.32 to -1.21]; P = .004), and the 6-month follow-up (adjusted mean difference: depression: -4.24 [95% CI, -6.97 to -1.52]; P = .002; anxiety, -2.12 [95% CI, -3.96 to -0.29]; P = .02; stress: -3.79 [95% CI, -6.44 to -1.13]; P = .005).

CONCLUSIONS AND RELEVANCE: These findings suggest that CCT was superior to the waitlist control in supporting caregivers’ mental health. Statistically and clinically significant reductions in psychological distress were found and sustained at the 6-month follow-up. The improvements noted in this randomized clinical trial could serve to encourage implementation of future evidence-based programs for caregivers.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03730155.

PMID:33683334 | DOI:10.1001/jamanetworkopen.2021.1020

Blood Adv. 2021 Mar 9;5(5):1474-1482. doi: 10.1182/bloodadvances.2020003727.

ABSTRACT

Although ∼80% of adult patients with cytogenetically normal acute myeloid leukemia (CN-AML) achieve a complete remission (CR), more than half of them relapse. Better identification of patients who are likely to relapse can help to inform clinical decisions. We performed RNA sequencing on pretreatment samples from 268 adults with de novo CN-AML who were younger than 60 years of age and achieved a CR after induction treatment with standard “7+3” chemotherapy. After filtering for genes whose expressions were associated with gene mutations known to impact outcome (ie, CEBPA, NPM1, and FLT3-internal tandem duplication [FLT3-ITD]), we identified a 10-gene signature that was strongly predictive of patient relapse (area under the receiver operating characteristics curve [AUC], 0.81). The signature consisted of 7 coding genes (GAS6, PSD3, PLCB4, DEXI, JMY, NRP1, C10orf55) and 3 long noncoding RNAs. In multivariable analysis, the 10-gene signature was strongly associated with relapse (P < .001), after adjustment for the FLT3-ITD, CEBPA, and NPM1 mutational status. Validation of the expression signature in an independent patient set from The Cancer Genome Atlas showed the signature’s strong predictive value, with AUC = 0.78. Implementation of the 10-gene signature into clinical prognostic stratification could be useful for identifying patients who are likely to relapse.

PMID:33683341 | DOI:10.1182/bloodadvances.2020003727

Int J Epidemiol. 2021 Mar 3:dyab012. doi: 10.1093/ije/dyab012. Online ahead of print.

ABSTRACT

BACKGROUND: C-reactive protein (CRP) is a non-specific acute phase reactant elevated in infection or inflammation. Higher levels indicate more severe infection and have been used as an indicator of COVID-19 disease severity. However, the evidence for CRP as a prognostic marker is yet to be determined. The aim of this study is to examine the CRP response in patients hospitalized with COVID-19 and to determine the utility of CRP on admission for predicting inpatient mortality.

METHODS: Data were collected between 27 February and 10 June 2020, incorporating two cohorts: the COPE (COVID-19 in Older People) study of 1564 adult patients with a diagnosis of COVID-19 admitted to 11 hospital sites (test cohort) and a later validation cohort of 271 patients. Admission CRP was investigated, and finite mixture models were fit to assess the likely underlying distribution. Further, different prognostic thresholds of CRP were analysed in a time-to-mortality Cox regression to determine a cut-off. Bootstrapping was used to compare model performance [Harrell’s C statistic and Akaike information criterion (AIC)].

RESULTS: The test and validation cohort distribution of CRP was not affected by age, and mixture models indicated a bimodal distribution. A threshold cut-off of CRP ≥40 mg/L performed well to predict mortality (and performed similarly to treating CRP as a linear variable).

CONCLUSIONS: The distributional characteristics of CRP indicated an optimal cut-off of ≥40 mg/L was associated with mortality. This threshold may assist clinicians in using CRP as an early trigger for enhanced observation, treatment decisions and advanced care planning.

PMID:33683344 | DOI:10.1093/ije/dyab012

JAMA Neurol. 2021 Mar 8. doi: 10.1001/jamaneurol.2021.0178. Online ahead of print.

ABSTRACT

IMPORTANCE: Meta-analyses of randomized clinical trials have indicated that improved hypertension control reduces the risk for cognitive impairment and dementia. However, it is unclear to what extent pathways reflective of Alzheimer disease (AD) pathology are affected by hypertension control.

OBJECTIVE: To evaluate the association of intensive blood pressure control on AD-related brain biomarkers.

DESIGN, SETTING, AND PARTICIPANTS: This is a substudy of the Systolic Blood Pressure Intervention Trial (SPRINT MIND), a multicenter randomized clinical trial that compared the efficacy of 2 different blood pressure-lowering strategies. Potential participants (n = 1267) 50 years or older with hypertension and without a history of diabetes or stroke were approached for a brain magnetic resonance imaging (MRI) study. Of these, 205 participants were deemed ineligible and 269 did not agree to participate; 673 and 454 participants completed brain MRI at baseline and at 4-year follow-up, respectively; the final follow-up date was July 1, 2016. Analysis began September 2019 and ended November 2020.

INTERVENTIONS: Participants were randomized to either a systolic blood pressure goal of less than 120 mm Hg (intensive treatment: n = 356) or less than 140 mm Hg (standard treatment: n = 317).

MAIN OUTCOMES AND MEASURES: Changes in hippocampal volume, measures of AD regional atrophy, posterior cingulate cerebral blood flow, and mean fractional anisotropy in the cingulum bundle.

RESULTS: Among 673 recruited patients who had baseline MRI (mean [SD] age, 67.3 [8.2] years; 271 women [40.3%]), 454 completed the follow-up MRI at a median (interquartile range) of 3.98 (3.7-4.1) years after randomization. In the intensive treatment group, mean hippocampal volume decreased from 7.45 cm3 to 7.39 cm3 (difference, -0.06 cm3; 95% CI, -0.08 to -0.04) vs a decrease from 7.48 cm3 to 7.46 cm3 (difference, -0.02 cm3; 95% CI, -0.05 to -0.003) in the standard treatment group (between-group difference in change, -0.033 cm3; 95% CI, -0.062 to -0.003; P = .03). There were no significant treatment group differences for measures of AD regional atrophy, cerebral blood flow, or mean fractional anisotropy.

CONCLUSIONS AND RELEVANCE: Intensive treatment was associated with a small but statistically significant greater decrease in hippocampal volume compared with standard treatment, consistent with the observation that intensive treatment is associated with greater decreases in total brain volume. However, intensive treatment was not associated with changes in any of the other MRI biomarkers of AD compared with standard treatment.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01206062.

PMID:33683313 | DOI:10.1001/jamaneurol.2021.0178

Radiat Prot Dosimetry. 2021 Mar 4:ncab010. doi: 10.1093/rpd/ncab010. Online ahead of print.

ABSTRACT

The purpose of this study was to qualitatively evaluate recently introduced Model-based iterative reconstruction method (IMR) and routinely used iterative reconstruction algorithm iDose4 to investigate future dose reduction possibilities for abdominal CT exams. The study contained data from 34 patients who underwent abdominal CT in SkåneUniversityHospital Lund, Sweden. A low-dose scan (CTDIvol3.4 mGy) reconstructed with both iDose4 and IMR and a standard-dose scan (CTDIvol 5.3 mG) reconstructed with iDose4 alone were visually graded in ViewDEX v2.0 by four radiologists using modified EU image criteria. The visual grading characteristics analysis for the evaluation comparing iDose4 standard dose with IMR low dose did not show any statistically significant difference in five of six criteria. In one of the criteria, iDose4 was superior to IMR. The result show promising possibilities are introduced for substantial radiation dose reduction (35%) in abdominal CT imaging when replacing iDose4 with IMR. Still, care should be taken when considering the reproduction of adrenal glands.

PMID:33683328 | DOI:10.1093/rpd/ncab010