Category: Nevin Manimala

Cancer Rep (Hoboken). 2021 Mar 3:e1348. doi: 10.1002/cnr2.1348. Online ahead of print.

ABSTRACT

BACKGROUND: Concurrent chemoradiotherapy followed by brachytherapy is the standard of care in locally advanced carcinoma cervix. There is no prognostic factor at present to predict the outcome of disease in locally advanced carcinoma cervix.

AIM: Differential expression of microRNAs can be used as biomarkers to predict clinical response in locally advanced carcinoma cervix patients.

METHODS: Thirty-two patients of locally advanced carcinoma cervix with International Federation of Gynecology and Obstetrics Stage IB-IVA were enrolled from 2017 to 2018. Expression of microRNA-9 5p, -31 3p, -100 5p, -125a 5p, -125b-5p, and -200a 5p in formalin-fixed paraffin embedded (FFPE) biopsied tissue were analyzed by real time quantitative reverse transcriptase polymerase chain reaction (RT qPCR). Pretreatment evaluation was done with clinical examination and MRI pelvis. All patients received concurrent chemoradiotherapy followed by brachytherapy. Patients were evaluated for the clinical response after 3 months of treatment, with clinical examination and MRI pelvis scan using RECIST 1.1 criteria. Patients with no residual disease were classified as Complete responders (CR) and with residual or progressive disease were classified as Nonresponders (NR). Results were statistically analyzed using Mann Whiney U test to examine significant difference between the expression of microRNA between complete responders (CR) and nonresponders (NR).

RESULTS: microRNA-100 5p was upregulated in complete responders (CR) which showed a trend towards statistical significance (p value = 0.05).

CONCLUSION: microRNA-100 5p can serve as a potential molecular biomarker in predicting clinical response to chemoradiation in locally advanced Carcinoma cervix. Its role should be further investigated in a larger study population.

PMID:33660436 | DOI:10.1002/cnr2.1348

Investig Clin Urol. 2021 Mar;62(2):201-209. doi: 10.4111/icu.20200319.

ABSTRACT

PURPOSE: This study aims to identify clinical factors that may predispose struvite stone patients to urosepsis following percutaneous nephrolithotomy (PCNL).

MATERIALS AND METHODS: A retrospective review was conducted on patients who received PCNL for struvite stones. The Systemic Inflammatory Response Syndrome (SIRS) criteria and quick-Sepsis Related Organ Failure Assessment (q-SOFA) criteria were used to identify patients who were at an increased risk for urosepsis. Statistical analysis was performed using Fisher’s exactness test, Wilcoxon rank test, and logistic regression.

RESULTS: Chart review identified 99 struvite stone patients treated with PCNL. Post-operatively, 40 patients were SIRS positive (≥2 criteria) and/or q-SOFA positive (score ≥2). Using SIRS as an approximation for urosepsis, longer operative times (p<0.001), higher pre-operative white blood cell counts (p=0.01), greater total stone surface area (p<0.0001), and pre-operative stenting (OR, 5.75; p=0.01) were identified as independent risk factors for urosepsis. Multivariate analysis demonstrated pre-operative stenting (OR, 1.46; p=0.01) to be a risk factor. With q-SOFA, univariable analysis found that antibiotic use within 3 months prior to a PCNL (OR, 4.44; p=0.04), medical comorbidities (OR, 4.80; p=0.02), longer operative times (p<0.001), lengthier post-operative hospitalization (p<0.01), and greater total stone surface area (p<0.0001) were risk factors for urosepsis. Multivariate analysis revealed that bladder outlet obstruction (OR, 2.74; p<0.003) and pre-operative stenting (OR, 1.27; p=0.01) significantly increased odds of being q-SOFA positive.

CONCLUSIONS: Several risk factors for urosepsis following PCNL for struvite stones have been identified. These risk factors should be taken into consideration in peri-operative care to mitigate the risks of urosepsis.

PMID:33660448 | DOI:10.4111/icu.20200319

Int J Nurs Pract. 2021 Mar 4:e12902. doi: 10.1111/ijn.12902. Online ahead of print.

ABSTRACT

AIM: This study examined the effect of an individualized educational intervention on the knowledge, attitudes and self-management ability after 12 weeks for outpatients with atrial fibrillation.

METHODS: A randomized control-group pretest-post-test experimental design was used. Elderly outpatients with atrial fibrillation aged over 65 years were recruited from a university hospital in Korea. The experimental group received a 50-min individualized education on self-management, one telephone counselling after 8 weeks and maintenance of a self-management diary for 12 weeks. Data were collected from November 2017 to April 2018 and analysed using SPSS 22.0 for descriptive statistics and hypothesis testing.

RESULTS: The participants’ mean age was 71.9 (4.6) years. Compared to the control group (n = 29), the experimental group (n = 31) showed a significantly greater improvement in knowledge regarding atrial fibrillation and stroke prevention (t = -2.27, p = .027) and self-management behaviours (t = -8.02, p < .001). There were no significant group differences in attitudes towards atrial fibrillation.

CONCLUSION: The findings suggest that education for elderly people with atrial fibrillation should be individualized, focusing on self-management in daily life to prevent cardiovascular complications. Future research is needed to confirm the long-term effects of such education programmes.

PMID:33660379 | DOI:10.1111/ijn.12902

Pharmacol Res Perspect. 2021 Apr;9(2):e00729. doi: 10.1002/prp2.729.

ABSTRACT

With the improvements in relevant policies, laws, and regulations regarding drug clinical trials in China, the quantity and quality of drug clinical trials have gradually improved, and the development prospects of drug clinical trials for endocrine disorders and metabolism and nutrition disorders are promising. Based on information from the clinical trials from the online drug clinical trial registration platform of the National Medical Products Administration, we aimed to review and evaluate the development of clinical trials of drugs for endocrine disorders and metabolism and nutrition disorders in mainland China from 2010 to 2019, as well as the trends over time. A total of 861 trials were carried out on 254 types of drugs for endocrine disorders and metabolism and nutrition disorders, among which 531 (61.67%) involved endocrine disorders, and 330 (38.33%) addressed metabolism and nutrition disorders. The annual number of clinical trials has been increasing gradually, with a significant increase in 2017. Among them, the proportion of clinical trials with Chinese epidemiological characteristics was relatively large (Wu, Annual Report on Development Health Management and Health Industry in China, 2018). The largest number of trials were for diabetes drugs (55.63%), followed by trials of drugs for hyperlipidemia (19.4%) and those for hyperuricemia (7.9%). It was found that the geographical area of the leading units also showed obvious unevenness according to the analysis of the test unit data. Based on the statistics and evaluation of the data, comprehensive information is provided to support the cooperation of global pharmaceutical R&D companies and research units in China and the development of international multicenter clinical trials in China. This work additionally provides clinical trial units with a self-evaluation of scientific research competitiveness and hospital development strategies. At the same time, it provides a reference with basic data for sponsors and stakeholders in these trials to determine their development strategy goals.

PMID:33660404 | DOI:10.1002/prp2.729

Cancer Rep (Hoboken). 2021 Mar 3:e1349. doi: 10.1002/cnr2.1349. Online ahead of print.

ABSTRACT

BACKGROUND: Oral and oropharyngeal cancer are significant health problems. They are both life-threatening conditions usually diagnosed at an advanced stage causing survival rates to decline.

AIM: To assess and compare practices, knowledge and attitude regarding oral and oropharyngeal cancer between dental and medical practitioners.

METHODS: A cross-sectional study was conducted to assess knowledge, attitude and practices of oral and oropharyngeal cancer among dental and medical practitioners at King Abdulaziz Medical City, Riyadh, Saudi Arabia. 360 participants were included in the study using a convenient sampling technique. Participants were approached in their clinics and printed self-administered questionnaire were handed over to them after signing a written consent form. Frequency distribution and Chi-Square test were used for the statistical analysis and the level of significance was set at P value of .05 or less.

RESULTS: A total of 174 participants responded. Assessment of oral and oropharyngeal cancer knowledge between dental practitioners and medical practitioners showed comparable results. Regarding practices, a significant difference was seen between medical practitioners and dental practitioners in determining the duration of intra-oral ulcer to consider urgent referral (P = .006) and in number of referrals made in relation to suspicious oral lesions (P = .002). Moreover, a significant difference (P = .006) was seen between medical practitioners and dental practitioners in determining the duration of intra-oral ulcer to consider urgent referral.

CONCLUSION: Medical and dental practitioners showed areas of differences in practice, attitude and knowledge of oral and oropharyngeal cancer that when addressed would lead to improved survival rates.

PMID:33660423 | DOI:10.1002/cnr2.1349

Aust Endod J. 2021 Mar 3. doi: 10.1111/aej.12496. Online ahead of print.

ABSTRACT

This study aimed to compare the shaping ability of ProTaper Next (PTN), HyFlex EDM (HEDM) and One Curve (OC) systems manufactured via different thermal treatment methods in simulated S-shaped canals. Sixty S-shaped canals in clear resin blocks were enlarged to a final apical size of 25 using PTN, HEDM and OC instruments (n = 20 canals/group). Composite images were obtained by superimposing pre- and post-preparation images. The amount of removed resin was measured perpendicularly to the canal surface in 22 points. Prepared canal width and canal transportation at different levels were determined. Canal aberrations were also recorded. Data were statistically analysed using analysis of variance, the Kruskal-Wallis and the chi-square tests at a 0.05 significance level. OC produced the most conservative enlargement and better maintained particularly the apical curvature of the S-shaped canals than HEDM and PTN. OC and HEDM better maintained the canal terminus and coronal curvature than PTN.

PMID:33660339 | DOI:10.1111/aej.12496

J Vet Intern Med. 2021 Mar 4. doi: 10.1111/jvim.16076. Online ahead of print.

ABSTRACT

BACKGROUND: Most dogs with sinonasal tumors (SNT) treated with radiation therapy (RT) died because of local disease progression.

HYPOTHESIS/OBJECTIVES: Our hypothesis is that the majority of local failure and residual disease would occur within the radiation field.

ANIMALS: Twenty-two dogs with SNT treated with RT.

METHODS: Retrospective cohort study.

INCLUSION CRITERIA: dogs with SNT receiving 10 daily fractions of 4.2 Gy with intensity modulated radiation therapy (IMRT)/image guided radiation therapy (IGRT) and follow-up cone beam computed tomography (CBCT). Each CBCT was registered with the original radiation planning CT and the gross tumor volume (GTV) contoured. The GTV was classified as residual (GTVr) or a failure (GTVf). The dose statistic for each GTV was calculated with the original IMRT plan. For GTVf, failures were classified as “in-field,” “marginal,” or “out-field” if at least 95, 20-95, or less than 20% of the volume of failure was within 95% (D95) of the total prescription dose, respectively.

RESULTS: There were 52 follow-up CBCT/CTs. Overall there was a GTVr for 20 dogs and GTVf for 16 dogs. The majority of GTVr volume was within the original GTV. GTVf analysis showed that 75% (12/16) were “in-field,” 19% (3/16) were “marginal” and 6% (1/16) were “out-field.”

CONCLUSION AND CLINICAL IMPORTANCE: In-field failures are the main pattern for local recurrence, and there is evidence of radioresistant subvolumes within the GTV.

PMID:33660342 | DOI:10.1111/jvim.16076

J Clin Nurs. 2021 Mar 4. doi: 10.1111/jocn.15736. Online ahead of print.

ABSTRACT

AIMS: The aim of this study was to determine the compliance with treatment and fear of hypoglycemia in patients with type 2 diabetes.

BACKGROUND: One of the important problems of patients are the fear of hypoglycemia and compliance with treatment, which impairs general health and quality of life. It is believed that nurses contribute to the improvement of compliance with treatment in patients with type 2 diabetes, a decrease in hypoglycemia rates.

DESIGN: This study was conducted as a descriptive study. The STROBE checklist was used.

METHODS: The study was carried out with 376 patients with type 2 diabetes between January-June 2019. The Patient Information Form, Type 2 Diabetes Mellitus Treatment Patient Compliance Scale, and Hypoglycemia Fear Survey applied and SAS 9.4 package program was used for statistical analysis. Data were evaluated using descriptive statistics, t-test, chi-square, and variation analysis.

RESULTS: It was determined that 58.2% of the participants were female, mean age was 62.19 ± 9.60, 57.7% were primary school graduates, 50.3% were using oral antidiabetic, 34.5% were using oral antidiabetic and insulin. Patients’ compliance with treatment was moderate (60.9%). According to the mean score of the Hypoglycemia Fear Survey, the patients had a low level of fear of hypoglycemia ( X– =1.20). There was a statistically significant difference between compliance and fear of hypoglycemia and education, economic status, self-monitoring of blood glucose, physical activity, education about diabetes (p<0.05). Patients with type 2 diabetes had decreased compliance with treatment with increased fear of hypoglycemia (p <0.05).

CONCLUSION: The participants’ compliance with the treatment was moderate and the fear of hypoglycemia mean score was low. Nursing interventions should be planned to increase compliance with treatment and reduce the fear of hypoglycemia in patients with type 2 diabetes.

RELEVANCE TO CLINICAL PRACTICE: Assessing the fear of hypoglycemia and the level of compliance with treatment by healthcare professionals, especially nurses, in patients with type 2 diabetes, and providing education on this subject can be helpful in reducing the fear of hypoglycemia, increasing treatment compliance and providing optimal glycemic control.

PMID:33660356 | DOI:10.1111/jocn.15736

Adv Respir Med. 2021;89(1):37-42. doi: 10.5603/ARM.a2021.0024.

ABSTRACT

INTRODUCTION: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard diagnostic method for sampling mediastinal and hilar lymph nodes. Non-diagnostic samples have led some pulmonologists to add a miniforceps biopsy (EBUS-TBFB) in order to increase diagnostic yield. Our study aims to analyze the impact of adding EBUS-TBFB to the EBUS-TBNA in cases where Rapid On-site Evaluation (ROSE) was negative for malignancy or was non-diagnostic.

MATERIAL AND METHODS: This retrospective chart review included 91 patients who were aged 18-90 years old and underwent EBUS with both TBNA and TBFB between January 1, 2013 and July 1, 2018.

RESULTS: There was no significant statistical difference in the diagnostic yield of TBNA vs TBFB with a McNemar value of 0.167, and this conclusion was the same when stratified by race, age and lymph node size. Using TBNA as a gold standard, the sensitivity and specificity of TBFB was 87% and 69%, respectively. Out of the non-diagnostic TBNA samples on ROSE and cell-block, subsequent TBFB resulted in additional pathologic diagnoses in 16% of cases, of which 67% were non-caseating granulomas. Furthermore, two additional malignant cases were identified by TBFB consisting of small cell carcinoma and non-Hodgkin’s lymphoma.

CONCLUSION: In conclusion, TBFB is a useful adjunctive tool in the diagnosis of non-malignant conditions (i.e. granulomatous diseases) with the potential to spare the patient from more invasive surgical biopsies. Training of future fellows in performing TBFB in addition to TBNA should be strongly encouraged.

PMID:33660247 | DOI:10.5603/ARM.a2021.0024

Med Phys. 2021 Mar 3. doi: 10.1002/mp.14820. Online ahead of print.

ABSTRACT

PURPOSE: The modulation transfer function (MTF) is widely used as an objective metric of spatial resolution of medical imaging systems. Despite advances in capability for 3D isotropic spatial resolution in CT and cone-beam CT (CBCT), MTF evaluation for such systems is typically reported only in the axial plane, and practical methodology for assessment of fully 3D spatial resolution characteristics is lacking. This work reviews fundamental theoretical relationships of 2D and 3D spread functions and reports practical methods and test tools for analysis of 3D MTF in CBCT.

METHODS: Fundamental aspects of 2D and 3D MTF measurement are reviewed within a common notational framework, and three MTF test tools with analysis code are reported and made available online (https://istar.jhu.edu/downloads/): (i) a multi-wire tool for measurement of the axial plane MTF [denoted MTF(f_r ;φ=0°), where φ is the measurement angle out of the axial plane] as a function of position in the axial plane; (ii) a wedge tool for measurement of the MTF in any direction in the 3D Fourier domain [e.g., φ = 45°, denoted MTF(f_r ;φ=45°)]; and (iii) a sphere tool for measurement of the MTF in any or all directions in the 3D Fourier domain. Experiments were performed on a mobile C-arm with CBCT capability, showing that MTF(f_r ;φ=45°) yields an informative 1D representation of the overall 3D spatial resolution characteristics, capturing important characteristics of the 3D MTF that might be missed in conventional analysis. The effects of anisotropic filters and detector readout mode were investigated, and the extent to which a system can be said to provide “isotropic” resolution was evaluated by quantitative comparison of MTF at various φ.

RESULTS: All three test tools provided consistent measurement of MTF(f_r ;φ=0°), and the wedge and sphere tools demonstrated how measurement of the MTF in directions outside the axial plane (|φ|>0°) can reveal spatial resolution characteristics to which conventional axial MTF measurement is blind. The wedge tool was shown to reduce statistical measurement error compared to the sphere tool due to improved sampling, and the sphere tool was shown to provide a basis for measurement of the MTF in any or all directions (outside the null cone) from a single scan. The C-arm system exhibited non-isotropic spatial resolution with conventional non-isotropic 1D apodization filters (i.e., frequency cutoff filters) – which is common in CBCT – and implementation of isotropic 2D apodization yielded quantifiably isotropic MTF. Asymmetric pixel binning modes were similarly shown to impart non-isotropic effects on the 3D MTF, and the overall 3D MTF characteristics were evident in each case with a single, 1D measurement of the 1D MTF(f_r ;φ=45°).

CONCLUSION: Three test tools and corresponding MTF analysis methods were presented within a consistent framework for analysis of 3D spatial resolution characteristics in a manner amenable to routine, practical measurements. Experiments on a CBCT C-arm validated many intuitive aspects of 3D spatial resolution and quantified the extent to which a CBCT system may be considered to have isotropic resolution. Measurement of MTF(f_r ;φ=45°) provided a practical 1D measure of the underlying 3D MTF characteristics and is extensible to other CT or CBCT systems offering high, isotropic spatial resolution.

PMID:33660261 | DOI:10.1002/mp.14820