Category: Nevin Manimala

J Appl Clin Med Phys. 2021 May 24. doi: 10.1002/acm2.13271. Online ahead of print.

ABSTRACT

PURPOSE: Helical tomotherapy (HT) is a form of intensity-modulated radiation therapy that is employed in total body irradiation (TBI). Because TBI targets the whole body, accurate setup positioning at the edge of the treatment volume is made difficult by the whole-body rotational posture. The purpose of this study is to clarify the tolerance for rotational setup error (SE) in the vertical direction. In addition, we perform a retrospective analysis of actually irradiated dose distributions using previous patients’ irradiation data.

METHODS: To clarify the effects of rotational SE on the dose distribution, the planned CT images of 10 patients were rotated by 1-5° in the vertical (pitch) direction to create a pseudo-rotational SE image. Then, the effect of the magnitude of the rotational SE on the dose distribution was simulated. In addition, the irradiated dose to the patients was analyzed by obtaining recalculated dose distributions using megavoltage CT images acquired before treatment.

RESULTS: The simulation results showed that the average value of the lung volume receiving at least 10 Gy did not exceed the allowable value when the SE value was ≤2°. When the rotational SE was ≤3°, it was possible to maintain the clinical target volume dose heterogeneity within ±10% of the prescribed dose, which is acceptable according to the guidelines. A retrospective analysis of previous patients’ irradiation data showed their daily irradiation dose distribution. The dose to the clinical target volume was reduced by up to 3.4% as a result of the residual rotational SE. Although whole-course retrospective analyses showed a statistically significant increase in high-dose areas, the increase was only approximately 1.0%.

CONCLUSIONS: Dose errors induced by rotational SEs of ≤2° were acceptable in this study.

PMID:34028944 | DOI:10.1002/acm2.13271

Intern Med J. 2021 May 24. doi: 10.1111/imj.15396. Online ahead of print.

ABSTRACT

BACKGROUND: The anion gap (AG) is often used to evaluate acid-base disorders. The reference interval for normal AG is used to differentiate between raised (gap) or normal AG (non-gap) acidosis. Historically accepted AG values may not be valid with the evolution of modern analytical techniques and the reference interval requires revalidation.

AIMS: To determine the reference interval for AG based on current laboratory techniques.

METHODS: During a health-screening exercise, 284 participants with no major illnesses volunteered surplus blood for analysis. The samples were tested in an internationally-accredited clinical laboratory. AG was calculated by (Na⁺ ) – (Cl^– ) – (HCO3^– ) and AG_K by (Na⁺ ) + (K⁺ ) – (Cl^– ) – (HCO₃^– ). The reference interval was determined at 2.5th-97.5th percentiles. Analysis was further undertaken for a sub-cohort of 156 individuals with no sub-optimal health indicators.

RESULTS: Median age was 35 years, BMI 23.4 kg/m² and glomerular filtration rate 106 mL/min/1.73m² . Median AG was 13 mmol/L and the reference interval for normal AG is 10-18 mmol/L with a 99% level of confidence. Statistically significant differences in AG were detected for sex, race, obesity and serum albumin but the difference was 1 mmol/L between subgroups. The reference interval was the same for the sub-cohort of 156 individuals. Median AG_K was 17.7 mmol/L and reference interval was 14.6-22.5 mmol/L.

CONCLUSIONS: The AG reference interval of 10-18 mmol/L is valid for laboratories with similar reference intervals for electrolytes. Lower values expected with current laboratory techniques were not observed. The median AG of 13 mmol/L may be used to differentiate gap acidosis, non-gap acidosis or mixed acid-base disorders. This article is protected by copyright. All rights reserved.

PMID:34028972 | DOI:10.1111/imj.15396

Clin Implant Dent Relat Res. 2021 May 24. doi: 10.1111/cid.13008. Online ahead of print.

ABSTRACT

OBJECTIVE: Compare the dimensional changes of the peri-implant soft and hard tissues clinically and radiographically around single immediate implants in the esthetic zone with socket shield technique versus filling the buccal gap with xenograft.

MATERIALS AND METHODS: Forty-two patients with a single non-restorable tooth in the esthetic zone replaced with an immediate implant were randomly assigned either to the socket shield technique (test) or to grafting the buccal gap with xenograft (control). The vertical and horizontal buccal bone resorption were measured 6-months following implant placement. The esthetic outcomes were evaluated by assessing the Pink Esthetic Score (PES) and the amount of midfacial mucosal alteration, in addition to patient satisfaction assessment through a Visual Analogue Scale (VAS) based questionnaire 1-year following implant restoration.

RESULTS: The present study showed that the socket shield group yielded significantly less vertical and horizontal buccal bone resorption of 0.35 (±0.62) mm and 0.29 (±0.34) mm compared to 1.71 (±1.02) mm and 1.45 (±0.72) mm in the xenograft group respectively. Also, there was a significantly greater midfacial mucosal recession in the xenograft group of 0.466 (±0.58) mm compared to midfacial mucosal coronal migration of 0.45 (±0.75) mm in the socket shield group. However, there was no statistically significant difference regarding the total PES and patient satisfaction in both treatment groups.

CONCLUSION: The socket shield technique can preserve hard and soft peri-implant tissues following immediate implant placement. (ClinicalTrials.gov Identifier: NCT03684356).

PMID:34028974 | DOI:10.1111/cid.13008

J Prosthodont. 2021 May 24. doi: 10.1111/jopr.13393. Online ahead of print.

ABSTRACT

PURPOSE: To asses trueness of the intaglio surface of milled dentures fabricated according to a fully digital protocol starting from intraoral scans in a clinical study by means of 3-dimensional (3D) digital analysis.

MATERIALS AND METHODS: Ten maxillary and 10 mandibular dentures, designed on intraoral scans and milled in-house, were studied. Intraoral scans were compared with the scans of intaglio surface of milled dentures. To this end, they were aligned, trimmed and used in a metrology software to measure their mean 3D distance, absolute mean deviation, and other parameters. Measured differences for all parameters were statistically investigated. Subgroup analysis for the maxillary and mandibular dentures was performed using independent samples t test or, in case of non-normal distribution, by means of Mann-Whitney test.

RESULTS: Using a mean of 24.9 ±2.8 measurement points/mm² , a mean 3D distance of 0.0006 ±0.007 mm between intraoral scans and the scans of the intaglio surface of milled dentures was measured. The corresponding absolute mean deviation was 0.055 ±0.032 for maxillary dentures and 0.061 ±0.016 for mandibular dentures; such a difference between arches was statistically significant (P = .035).

CONCLUSIONS: Milled dentures fabricated using a fully digital protocol and intraoral scans have accurate intaglio surfaces. It is reasonable to assume that they may achieve an adequate fit. This article is protected by copyright. All rights reserved.

PMID:34028902 | DOI:10.1111/jopr.13393

Eur J Cancer Care (Engl). 2021 May 24:e13464. doi: 10.1111/ecc.13464. Online ahead of print.

ABSTRACT

OBJECTIVE: Many women choose to have breast reconstruction after mastectomy; however, decision-making can be difficult and expectations are often unmet. The PEGASUS intervention (Patient Expectations and Goals: Assisting Shared Understanding of Surgery) was developed to support shared decision-making by helping women and healthcare professionals to clarify and discuss their individual expectations around surgery. This study aimed to explore patients’ and health professionals’ experiences of using the intervention and its implementation.

METHODS: Forty interviews were conducted with participants in a large scale, multi-site trial of the effectiveness of PEGASUS, from ‘intervention’ (n=16) and ‘usual care’ groups (n=11), and healthcare professionals (n=13). Data were analysed using thematic analysis.

RESULTS: ‘Usual care’ participants described feeling overwhelmed in decision-making (‘bombarded’), often using their own research to break down information (‘process of elimination’). In contrast, intervention group participants described PEGASUS providing focus (‘focus amongst the frenetic’), and increased connection with clinicians (‘more than a number’). Healthcare professionals described increased focus on patient priorities (‘shifting focus’), but stressed the need for whole team buy-in (‘collective commitment’).

CONCLUSIONS: The PEGASUS intervention offered a qualitatively different experience to individuals considering breast reconstruction, with potential to enhance patients’ and healthcare professionals’ feelings of shared decision-making and patient-centred care.

TRIAL REGISTRATION: ISRCTN 18000391 (https://doi.org/10.1186/ISRCTN18000391) 27/01/2016.

PMID:34028913 | DOI:10.1111/ecc.13464

Physiother Res Int. 2021 May 24:e1914. doi: 10.1002/pri.1914. Online ahead of print.

ABSTRACT

OBJECTIVES: The objectives of this study were the following: (1) to determine if there was a difference in outcomes between immediate responders to glenohumeral mobilizations at the initial evaluation, 2-week, 4-week, and 6-month follow-up as compared to those that do not respond in participants with subacromial pain syndrome; (2) to see if there were statistically significant differences in outcomes within these groups between these time frames of interest, and (3) to see if symptom response at the initial evaluation was predictive of a favorable recovery.

METHODS: This was a prospective, single-group observational design. Clinicians pragmatically identified positive responders as improving at least two points on the Numeric Pain Rating Scale and/or a 20° improvement in shoulder active range of motion (AROM) following shoulder mobilization at the initial evaluation. Data were collected for the subjective and objective variables of interest at the initial evaluation, 2-week, 4-week, and 6-month follow-up.

RESULTS: The prevalence of responders at the initial evaluation was 99 (81.8%). There were no statistically significant between-group differences for the variables of interest except for the Global Rating of Change (GRoC; f = 2.79, p = 0.006). The shoulder abduction AROM between-group difference exceeded the minimal detectable change at 4 weeks. The pair-wise comparison showed statistically significant differences for the outcomes of interest at each time point except for the GRoC between 4 weeks and 6 months. There was a statistically significant correlation between responders at the initial evaluation and shoulder abduction AROM at the 4-week follow-up (r_pb (112) = 0.27, p = 0.004).

CONCLUSION: Individuals with SAPS may benefit from shoulder mobilization independent of their within-session response to shoulder mobilization at the initial evaluation. Future research should seek to differentiate if these improvements are related to the within-session positive treatment response at the initial evaluation in individuals who are randomized to receive shoulder mobilization or not.

PMID:34028940 | DOI:10.1002/pri.1914

Biom J. 2021 May 24. doi: 10.1002/bimj.202000148. Online ahead of print.

ABSTRACT

Much of the research on multiple comparison and simultaneous inference in the past 60 years or so has been for the comparisons of several population means. Spurrier seems to have been the first to investigate multiple comparisons of several simple linear regression lines using simultaneous confidence bands. In this paper, we extend the work of Liu et al. for finite comparisons of several univariate linear regression models using simultaneous confidence bands to finite comparisons of several multivariate linear regression models using simultaneous confidence tubes. We show how simultaneous confidence tubes can be constructed to allow more informative inferences for the comparison of several multivariate linear regression models than the current approach of hypotheses testing. The methods are illustrated with examples.

PMID:34028832 | DOI:10.1002/bimj.202000148

Stat Med. 2021 May 24. doi: 10.1002/sim.9015. Online ahead of print.

ABSTRACT

Bulk and single-cell RNA-seq (scRNA-seq) data are being used as alternatives to traditional technology in biology and medicine research. These data are used, for example, for the detection of differentially expressed (DE) genes. Several statistical methods have been developed for the classification of bulk and single-cell RNA-seq data. These feature genes are vitally important for the classification of bulk and single-cell RNA-seq data. The majority of genes are not DE and they are thus irrelevant for class distinction. To improve the classification performance and save the computation time, removal of irrelevant genes is necessary. Removal will aid the detection of the important feature genes. Widely used schemes in the literature, such as the BSS/WSS (BW) method, assume that data are normally distributed and may not be suitable for bulk and single-cell RNA-seq data. In this article, a category encoding (CAEN) method is proposed to select feature genes for bulk and single-cell RNA-seq data classification. This novel method encodes categories by employing the rank of sequence samples for each gene in each class. Correlation coefficients are considered for gene and class with the rank of sample and a new rank of category. The highest gene correlation coefficients are considered feature genes, which are the most effective for classifying bulk and single-cell RNA-seq dataset. The sure screening method was also established for rank consistency properties of the proposed CAEN method. Simulation studies show that the classifier using the proposed CAEN method performs better than, or at least as well as, the existing methods in most settings. Existing real datasets were analyzed, with the results demonstrating superior performance of the proposed method over current competitors. The application has been coded into an R package named “CAEN” to facilitate wide use.

PMID:34028849 | DOI:10.1002/sim.9015

Adv Mater. 2021 May 24:e2008498. doi: 10.1002/adma.202008498. Online ahead of print.

ABSTRACT

Recently, great progress has been achieved in the design and preparation of conjugated organic polymer photocatalysts for hydrogen generation. However, it is still challenging to develop an organic polymer photocatalyst with high photoconversion efficiency. Rational structure design of organic polymer photocatalysts holds the key point to realize high photocatalytic performance. Herein, a series of donor-π-acceptor (D-π-A) conjugated organic copolymer photocatalysts is developed using statistical copolymerization by tuning the feed molar ratio of pyrene (donor) to dibenzothiophene-S,S-dioxide (acceptor) units. It reveals that the photocatalytic activity of the resulting copolymers is significantly dependent on the molar ratio of donor to acceptor, which efficiently changes the polymer structure and component. When the monomer feed ratio is 25:75, the random copolymer PyBS-3 of 10 mg with Pt cocatalyst shows a high hydrogen evolution rate of 1.05 mmol h^-1 under UV/Vis light irradiation using ascorbic acid as the hole-scavenger, and an external quantum efficiency of 29.3% at 420 nm, which represents the state-of-the-art of organic polymer photocatalysts. This work demonstrates that statistical copolymerization is an efficient strategy to optimize the polymer structure for improving the photocatalytic activity of conjugated organic polymer catalysts.

PMID:34028900 | DOI:10.1002/adma.202008498

Clin J Gastroenterol. 2021 May 24. doi: 10.1007/s12328-021-01407-5. Online ahead of print.

ABSTRACT

A 60-year-old man with autosomal dominant polycystic kidney disease presented with malaise, melena, and epigastric discomfort. Esophagogastroduodenoscopy revealed a massive elevated gastric cancer lesion involving the cardia. Histopathological evaluation of a biopsy specimen showed poorly differentiated adenocarcinoma. Fluorodeoxyglucose-positron emission tomography revealed significant fluorodeoxyglucose uptake in the stomach, liver, bones, and bone marrow. He was diagnosed with metastatic gastric cancer resistant to chemotherapy, and he developed bone marrow carcinomatosis and disseminated intravascular coagulation and died 8 weeks after disease onset. A statistically significant association is reported between autosomal dominant polycystic kidney disease and gastric cancer. Moreover, the specific clinical features observed in our patient could be attributed to the molecular disorders like PC-1 and mechanistic target of rapamycin that are known to occur in autosomal dominant polycystic kidney disease.

PMID:34028786 | DOI:10.1007/s12328-021-01407-5