Category: Nevin Manimala

J Environ Manage. 2021 Apr 30;291:112656. doi: 10.1016/j.jenvman.2021.112656. Online ahead of print.

ABSTRACT

Ecotourism in national parks of developing countries is increasingly recognised as a promising option to achieve sustainable development goals, regardless, might imply various paradoxical managerial challenges. This paper, therefore, seeks to contribute a methodological framework utilising ES-based social landscape metrics (SLM) to address the potential barriers in managing ecotourism-integrated multi-functional national parks. We present a mixed-method case study in Vietnam’s Tram Chim National Park (TCNP), conducted via semi-structural interviews and PGIS with tourists and locals. Multiple key informants, i.e. TCNP’s authorities were also interviewed to provide their managerial insights and assist in verifying the PGIS results obtained from the tourists and locals. Via the quantified and mapped SLMs, the study reveals the differences between tourists and locals in terms of how and where they perceive and appreciate the intangible values of TCNP. Through spatial statistics, we reported important spatial correlations (i) between different categories of Ecosystem Services (ES) and (ii) between ES richness and diversity on different TCNP’s land covers. As a contribution to the decision-making outlook, we remarked potential areas to expand of ecotourism activities based on the spatial hot and cold spots. This study concludes by highlighting opportunities for future research in expanding on socio-geographical assessments of ES, especially in the fields of ecotourism.

PMID:33940358 | DOI:10.1016/j.jenvman.2021.112656

Mar Pollut Bull. 2021 Apr 30;168:112428. doi: 10.1016/j.marpolbul.2021.112428. Online ahead of print.

ABSTRACT

Plastic production and pollution of the environment with plastic items is rising rapidly and outpacing current mitigation measures. Success of mitigation actions can only be determined if progress can be measured reliably through incorporation of specific, measurable targets. Here we evaluate temporal changes in the amount and composition of plastic in boluses from Flesh-footed Shearwaters during 2002-2020 and assess their suitability for measuring progress against national and international commitments to reduce plastic pollution. Plastic in the shearwater boluses showed a generally decreasing pattern from 2002 to 2015 and increasing again to 2020. The colour and type of plastics in boluses was comparable to items recovered from live and necropsied birds, but a much smaller sample size (~35 boluses/year) was required to detect changes in plastic number and mass over time. We therefore suggest shearwater boluses are a low-effort, high-statistical power monitoring tool for quantifying progress against environmental policies in Australia.

PMID:33940375 | DOI:10.1016/j.marpolbul.2021.112428

Environ Int. 2021 Apr 30;155:106603. doi: 10.1016/j.envint.2021.106603. Online ahead of print.

ABSTRACT

Filtering respiratory protection devices (FRPD) are mandatory for workers to wear in the Portuguese waste-sorting industry. Previous results regarding microbial contamination found on FRPD interior layer raised the question of whether microbial contamination from the exhalation valve would also have cytotoxicity effects. Since the FRPD exhalation valves are very close to workers’ nose and mouth, they represent a source of exposure to bioburden by inhalation. This study aimed to evaluate the cytotoxicity of the microbial contamination present in the FRPD exhalation valves. For this purpose, the cytotoxicity effects were determined through the MTT assay in two different cell lines (human A549 epithelial lung cells, and swine kidney cells) and compared with previous results obtained with FRPD interior layers. The contamination present in the FRPD exhalation valves presented some cytotoxicity on epithelial lung cells, suggesting the inhalation route as a potential route of exposure through the use of FRPD in the waste-sorting industry. Half-maximal (50%) inhibitory concentration (IC50) values were lower for FRPD interior layer than exhalation valves in lung cells, with overall cytotoxicity lower in exhalation valves when compared to interior layer (z = -4.455, p = 0.000). Higher bacterial counts in TSA were correlated with lower IC50 values, thus, higher cytotoxicity effect in lung cells. No statistically significant differences were detected among different workplaces.

PMID:33940392 | DOI:10.1016/j.envint.2021.106603

ESMO Open. 2021 Apr 30;6(3):100124. doi: 10.1016/j.esmoop.2021.100124. Online ahead of print.

ABSTRACT

BACKGROUND: The role of tumor mutational burden (TMB) is still debated for selecting advanced non-oncogene addicted non-small-cell lung cancer (NSCLC) patients who might benefit from immune checkpoint inhibitors (ICIs). Of note, TMB failed to predict a benefit in overall survival (OS) among such patients.

MATERIALS AND METHODS: The purpose of this meta-analysis was to compare efficacy outcomes among first-line immune-oncology (IO) agents versus standard platinum-based chemotherapy (CT) within two subgroups (TMB-low and TMB-high on either tissue or blood). We collected hazard ratios (HRs) to evaluate the association for progression-free survival (PFS) and OS, with the relative 95% confidence intervals (CIs). Risk ratios (RRs) were used as an association measure for objective response rate (ORR).

RESULTS: Eight different cohorts of five randomized controlled phase III studies (3848 patients) were analyzed. In TMB-high patients, IO agents were associated with improved ORR (RRs 1.37, 95% CI 1.13-1.66), PFS (HR 0.69, 95% CI 0.61-0.79) and OS (HR 0.67, 95% CI 0.59-0.77) when compared with CT, thus suggesting a possible predictive role of high TMB for IO regimens. In TMB-low patients, the IO strategy did not lead to any significant benefit in survival and activity, whereas the pooled results of both ORR and PFS were intriguingly associated with a statistical significance in favor of CT.

CONCLUSIONS: This meta-analysis resulted in a proven benefit in OS in favor of IO agents in the TMB-high population. Although more prospective data are warranted, we postulated the hypothesis that monitoring TMB, in addition to the existing programmed death-ligand 1 (PD-L1) expression level, could represent the preferable option for future clinical research in the first-line management of advanced non-oncogene addicted NSCLC patients.

PMID:33940346 | DOI:10.1016/j.esmoop.2021.100124

ESMO Open. 2021 Apr 30;6(3):100145. doi: 10.1016/j.esmoop.2021.100145. Online ahead of print.

ABSTRACT

On 21 January 2021, the European Commission amended the marketing authorisation granted for pembrolizumab to include the first-line treatment of microsatellite instability-high (MSI-H) or mismatch repair-deficient (dMMR) metastatic colorectal cancer (mCRC) in adults. The recommended dose of pembrolizumab was either 200 mg every 3 weeks or 400 mg every 6 weeks by intravenous infusion. Pembrolizumab was evaluated in a phase III, open-label, multicentre, randomised trial versus standard of care (SOC: FOLFOX6/FOLFIRI alone or in combination with bevacizumab/cetuximab) as first-line treatment of locally confirmed mismatch repair-deficient or microsatellite instability-high stage IV CRC. Subjects randomised to the SOC arm had the option to crossover and receive pembrolizumab once disease progressed. Both progression-free survival (PFS) and overall survival were primary endpoints. Pembrolizumab showed a statistically significant improvement in PFS compared with SOC, with a hazard ratio of 0.60 [95% confidence interval (CI): 0.45-0.80], P = 0.0002. Median PFS was 16.5 (95% CI: 5.4-32.4) versus 8.2 (95% CI: 6.1-10.2) months for the pembrolizumab versus SOC arms, respectively. The most frequent adverse events in patients receiving pembrolizumab were diarrhoea, fatigue, pruritus, nausea, increased aspartate aminotransferase, rash, arthralgia, and hypothyroidism. Having reviewed the data submitted, the European Medicines Agency’s (EMA’s) Committee for Medicinal Products for Human Use (CHMP) considered that the benefit-risk balance was positive. This is the first time the CHMP has issued an opinion for a target population defined by DNA repair deficiency biomarkers. The aim of this manuscript is to summarise the scientific review of the application leading to regulatory approval in the European Union.

PMID:33940347 | DOI:10.1016/j.esmoop.2021.100145

Radiol Oncol. 2021 May 4. doi: 10.2478/raon-2021-0019. Online ahead of print.

ABSTRACT

BACKGROUND: Immunotherapy with CTLA-4 inhibitors and PD1 checkpoint inhibitors has initiated a breakthrough in the treatment and prognosis of patients with metastatic melanoma. The survival of these patients has increased from the expected survival time of less than 12 months to at least forty months. However, immunotherapy with either anti-CTLA-4 antibodies or PD1 inhibitors alone or in combination has a broad palette of significant immune-related adverse events. The aim of the study was to assess the correlation of immune-related adverse events with treatment outcomes defined as significant differences in the overall response rate (ORR) and progression-free survival (PFS) of patients, who developed immune-related adverse events during immunotherapy.

PATIENTS AND METHODS: A retrospective analysis of patients with metastatic melanoma treated with immunotherapy in 2020 at the Oncology Institute of Ljubljana was performed. Only patients with radiological evaluation of the immunotherapy response were included. The patients were divided into two cohorts: a cohort of patients with immune-related adverse events (irAE group) and a cohort of patients with no immune-related adverse events (NirAE group). Significantly better overall response and progression-free survival in the irAE cohort defined the primary aim of our study. To investigate the differences in progression-free survival between the irAE cohort and NirAE cohort, we used survival analysis. In particular, a Cox proportional hazards model with covariates of time to progression and adverse events was used for survival analysis. The Kruskal-Wallis H-test was applied, and a p-value of p <= 0.05 was considered the cut-off point for a statistically significant difference between the groups.

RESULTS: Among the 120 patients treated with immunotherapy, radiological response evaluation was performed for 99 patients: 38 patients in the irAE cohort and 61 patients in the NirAE cohort. The ORRs for the irAE and NirAE cohorts were 57% and 37%, respectively. The PFS was significantly better for the irAE cohort (301.6 days) than for the NirAE cohort (247.29 days). The results of the survival regression analysis showed a significant increase in the survival probability from less than 60% for the NirAE cohort to almost 80% for the irAE cohort.

CONCLUSIONS: Patients with metastatic melanoma treated with immunotherapy who developed immune-related adverse events showed better treatment outcomes with longer times to disease progression and better overall response rates than patients treated with immunotherapy who did not develop immune-related adverse events, with a significant increase in the survival probability from less than 60% for the NirAE cohort to almost 80% for the irAE cohort.

PMID:33939899 | DOI:10.2478/raon-2021-0019

Arch Endocrinol Metab. 2021 Apr 29:2359-3997000000365. doi: 10.20945/2359-3997000000365. Online ahead of print.

ABSTRACT

OBJECTIVE: People with Down’s syndrome (DS) have a higher risk of developing type 1 diabetes mellitus (T1D) and may have specific clinical features compared to T1D patients without DS. This study evaluated the clinical and laboratory aspects of T1D in children and adolescents with DS in an admixed population.

METHODS: A case-control study comparing patients with T1D and DS (T1D+DS) to patients with T1D without DS (T1D controls) from two tertiary academic Hospitals in São Paulo, Brazil.

RESULTS: The sample consisted of 9 patients with T1D+DS and 18 T1D age and sex-matched controls. Anti-glutamic acid decarboxylase 65 antibodies were positive in 7/7 of the 9 T1D+DS patients, confirming the presence of diabetes autoimmunity in this group. Mean age at diagnosis of T1D was 4.9 ± 3.9 years in the T1D+DS group and 6.4 years ± 3 in the T1D control group; early diagnosis (<2 years old) occurred in three T1D+DS patients but only in one T1D control patients, both suggesting lower age of diagnosis in T1D+DS group, although without statistical significance (p = 0.282 and p = 0.093, respectively). The T1D+DS group presented lower total insulin dose (0.7 IU/kg/day ± 0.2) and HbA1c (7.2% ± 0.6) than the control group (1.0 IU/kg/day ± 0.3 and 9.1% ± 0.7, respectively) (p = 0.022 and p = 0.047, respectively).

CONCLUSION: We confirmed the autoimmune etiology of diabetes in people with DS in this admixed population. T1D+DS patients developed diabetes earlier and achieved better metabolic control with a lower insulin dose than T1D controls. These findings are in agreement with previous studies in Caucasian populations.

PMID:33939908 | DOI:10.20945/2359-3997000000365

Arch Endocrinol Metab. 2021 Apr 29:2359-3997000000367. doi: 10.20945/2359-3997000000367. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine sonographic features of malignancy in partially cystic thyroid nodules and assess the diagnostic efficacy of these features for differentiating between benign and malignant lesions in the nodules with indeterminate cytology.

METHODS: From January 2016 to December 2017, a total of 91 patients with 94 partially cystic thyroid nodules who had undergone ultrasound-guided fine-needle aspiration biopsy and thyroid surgery in our hospital were included in this study. The sonographic features of the thyroid nodules were analyzed to identify the predictive features of malignancy and assess the diagnostic efficacy of these features.

RESULTS: The features of hypoechogenicity, microcalcification, composition, and an eccentric solid component with an acute angle had statistically significant associations with malignant nodule (p<005) by univariable analysis. Binary logistic regression analysis showed that microcalcification and hypoechogenicity were significantly associated with malignancy. Using the combination of microcalcification, hypoechogenicity, and a solid component comprising of greater than or equal to 50% of the total volume, the diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 97.6%, 32.7%, 53.9%, and 94.4%, respectively. In these nodules with indeterminate cytology, this combination also exhibited a high sensitivity of 92.3% and an NPV of 83.3%.

CONCLUSION: This study demonstrated that microcalcification and hypoechogenicity were independently associated with malignancy in partially cystic thyroid nodules. The combination of microcalcification, hypoechogenicity, and a solid portion that is greater than or equal to 50% of the total volume will help guide clinical decisions in mixed cystic solid nodules.

PMID:33939910 | DOI:10.20945/2359-3997000000367

Environ Microbiol. 2021 May 3. doi: 10.1111/1462-2920.15554. Online ahead of print.

ABSTRACT

Fungi have evolved diverse lifestyles and adopted pivotal new roles in both natural ecosystems and human environments. However, the molecular mechanisms underlying their adaptation to new lifestyles are obscure. Here, we hypothesize that genes shared across all species with the same lifestyle, but absent in genera with alternative lifestyles, are crucial to that lifestyle. By analyzing dozens of species within four genera in a fungal order, with each genus following a different lifestyle, we find that genus-specific genes are typically few in number. Notably, not all genus-specific genes appear to derive from de novo birth, with most instead reflecting recurrent loss across the fungi. Importantly, however, a subset of these genus-specific genes are shared by fungi with the same lifestyle in quite different evolutionary orders, thus supporting the view that some genus-specific genes are necessary for specific lifestyles. These lifestyle-specific genes are enriched for key functional classes and often exhibit specialized expression patterns. Genus-specific selection also contributes to lifestyle transitions, and is especially associated with intensity of pathogenesis. Our study therefore suggests that fungal adaptation to new lifestyles often requires just a small number of core genes, with gene turnover and positive selection playing complementary roles. This article is protected by copyright. All rights reserved.

PMID:33939870 | DOI:10.1111/1462-2920.15554

J Pediatr Endocrinol Metab. 2021 May 3. doi: 10.1515/jpem-2020-0642. Online ahead of print.

ABSTRACT

OBJECTIVES: Nonalcoholic fatty liver disease (NAFLD) is one of the most common liver diseases in the pediatric population at global level. Present study aims to assess the effect of l-carnitine supplementation on the NAFLD in children and adolescents.

METHODS: This randomized, triple-blind, placebo-controlled clinical trial was conducted in 2018-2019. Study was carried out in NAFLD participants (5-15 years). They were randomly assigned to receive either 50 mg/kg/day l-carnitine twice a day or identical placebo per day for three months. Liver enzymes and liver ultrasonography were assessed before and after the intervention. Both groups received similar consultation for lifestyle changes.

RESULTS: Overall, 55 participants completed the study, 30 patients in the l-carnitine group and 25 patients in placebo group. Mean changes of anthropometric measurements did not have significant differences between groups (p>0.05). No significant differences in the mean changes of aspartate aminotransferase (AST) (p=0.82) and alanine aminotransferase (ALT) (p=0.76) levels were documented between two groups. Based on within-group analysis, there were significant changes in AST and ALT levels before and after the intervention in both groups. The sonographic grades of fatty liver were not significantly different between two groups before (p=0.94) and after intervention (p=0.93).

CONCLUSIONS: In the present clinical trial, L-carnitine did not have significant effect on improving biochemical and sonographic markers of NAFLD in children and adolescents. Future studies are necessary to evaluate the applicability and efficacy of long-term l-carnitine supplementation to treatment of NAFLD in pediatric population.

TRIAL REGISTRATION: IRCT20170628034786N2.

PMID:33939897 | DOI:10.1515/jpem-2020-0642