Category: Nevin Manimala

Cancer Radiother. 2021 Oct 25:S1278-3218(21)00255-9. doi: 10.1016/j.canrad.2021.09.010. Online ahead of print.

ABSTRACT

PURPOSE: Interstitial brachytherapy is indicated as part of a conservative strategy for children with bladder and/or prostate rhabdomyosarcoma (RMS), providing high local control probability with acceptable functional results. Vaginal and/or rectal complications were however reported, due to the close proximity to the implanted volume. We investigated the dosimetric impact of a vaginal spacer in terms of rectal and vaginal doses.

METHODS AND PATIENTS: Medical records of 12 consecutive female patients with bladder neck RMS, median age 32 months (range: 1.3-6 years), were reviewed. Five patients were treated prior to 2017 without a vaginal spacer and seven patients treated after 2017 had their brachytherapy delivered with a vaginal spacer placed at time of implant.

RESULTS: Minimal doses delivered to the most exposed 2cm³, 1cm³, and 0.5cm³ of the rectum were all statistically significantly lower among patients treated with a vaginal spacer, as compared to those treated without a spacer. Median rectal D2cm³ was 22Gy_EQD2 versus 38Gy_EQD2 (P=0.02), D1cm³ was 29Gy_EQD2 versus 51Gy_EQD2 (P=0.013), and D0.5cm³ was 32Gy_EQD2 versus 61Gy_EQD2 (P=0.017), with and without the vaginal spacer, respectively. The posterior vaginal wall D0.5cm³ dose was also significantly decreased, with median D0.5cm³ of 92Gy_EQD2 versus 54Gy_EQD2 (P<0.0001), with and without the spacer, respectively. Acute tolerance was excellent in all patients, with no need for replanning and no acute complication.

CONCLUSIONS: The use of vaginal spacers in brachytherapy of female pediatric patients with bladder neck RMS resulted in significantly decreased doses to the rectum and the posterior vaginal wall. Though the clinical impact of such dose reduction remains undemonstrated, routine utilization of a vaginal spacer could be a method to decrease long-term morbidity in these patients.

PMID:34711484 | DOI:10.1016/j.canrad.2021.09.010

J Infect Chemother. 2021 Oct 19:S1341-321X(21)00280-4. doi: 10.1016/j.jiac.2021.10.011. Online ahead of print.

ABSTRACT

INTRODUCTION: Measurement of blood Favipiravir (FPV) levels and accumulation of data in COVID-19 patients are critical for assessing FPV efficacy and safety. We performed a retrospective study based on measurements of blood levels of FPV and related factors in COVID-19 patients admitted to our hospital. Furthermore, we also investigated the association between blood FPV levels and uric acid level alterations before and after FPV administration.

METHODS: We enrolled 27 COVID-19 patients who had received FPV treatment at Hokushin General Hospital from April 1 to December 31, 2020. Age, gender, COVID-19 severity, presence of comorbidities, and laboratory data for each subject were investigated to identify factors that correlate with blood FPV levels. Uric acid levels were measured before and after FPV administration and a difference between the levels (i.e., a change of uric acid level) was evaluated.

RESULTS: When a significant univariate variable was input by the stepwise method and a combination of variables that maintained statistical superiority was searched, serum ferritin was the only factor that independently affected blood FPV level. Furthermore, in the high-FPV group (20 μg/mL or more), a significant increase in uric acid levels was observed after FPV administration. The increment value was significantly larger than that in the low-FPV group (less than 20 μg/mL).

CONCLUSIONS: Ferritin level was an important independent factor inversely affecting blood FPV level. Furthermore, a high blood FPV level induced the elevation of uric acid levels in COVID-19 treatment.

PMID:34711508 | DOI:10.1016/j.jiac.2021.10.011

J Pediatr Nurs. 2021 Oct 25:S0882-5963(21)00301-8. doi: 10.1016/j.pedn.2021.10.004. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to examine the interrelationship of the caregiver burden, perceived social support, and quality of life of parents who have children with hematological problems.

DESIGN AND METHODS: The design and methods included a descriptive study with 141 parents of children with hematological problems. The introductory information form, the Zarit Burden Interview (ZBI), multidimensional scale of perceived social support (MSPSS), and the EUROHIS-QOL.8 (WHOQOL-8) scale were used as data collection tools. The data obtained were analyzed using descriptive statistics and structural equation models.

RESULTS: As a result of the conducted correlation analysis, it was determined that there was a positive correlation between parents’ perceptions of social support and their quality of life, and a negative correlation between their perceptions of social support and the caregiver burden (p < 0.05). As a result of the structural equation model, it was determined that the social support received by the parents had a significant effect on their caregiver burden (β = -0.40; p < 0.05), and their quality of life (β = 0.42; p < 0.05).

CONCLUSIONS: The conclusion formed was that it can be said that parents’ perceptions of social support affect their caregiver burden and quality of life. Parents with high perceptions of social support perceive the burden of caregiver to be low and their quality of life to be high.

PRACTICE IMPLICATIONS: The practice implications are that healthcare professionals can contribute to reducing the caregiver burden and improving the quality of life of parents, by strengthening the social support systems of parents with sick children.

PMID:34711471 | DOI:10.1016/j.pedn.2021.10.004

Neuromuscul Disord. 2021 Aug 24:S0960-8966(21)00617-9. doi: 10.1016/j.nmd.2021.08.011. Online ahead of print.

ABSTRACT

This single-centered, randomized, double-blind, placebo-controlled study reports the results of L-Citrulline treatment for 24 weeks in patients with post-polio syndrome (PPS). Twenty-nine patients were randomized and assigned into receiving a treatment of 15 g L-Citrulline or placebo. The primary endpoint was the change of the 6 min walking distance test. Secondary endpoints included motor function measure, quantitative muscle strength, quantitative MRI and self-reported impairment questionnaires. Patients receiving L-Citrulline walked 17.5 longer in the 6 min walking distance test when compared to placebo group, however not statistically significant (95% CI = -14.69; 49.68, p = 0.298). None of the secondary endpoints showed a statistically significant change in the L-Citrulline group when compared to placebo group. The motor function measure showed a change of -0.78 (95% CI= [-3.39; 1.83] p = 0.563). Muscle degeneration of leg muscles assessed with quantitative MRI indicated no significant change (estimate= -0.01, 95% CI =-0.13; 0.11, p = 0.869). L-Citrulline was safe and well tolerated. In conclusion, administration of 15 g L-Citrulline daily for 24 weeks to patients with PPS showed no beneficial treatment effect in timed muscle function.

PMID:34711479 | DOI:10.1016/j.nmd.2021.08.011

J Voice. 2021 Oct 25:S0892-1997(21)00305-2. doi: 10.1016/j.jvoice.2021.09.005. Online ahead of print.

ABSTRACT

OBJECTIVES: The objective of this study was to investigate the effects of speaking rate (habitual and fast) and speech task (reading and spontaneous speech) on seven dependent variables: Breath group size (in syllables), Breath group duration (in seconds), Lung volume at breath group initiation, Lung volume at breath group termination, Lung volume excursion for each breath group (in % vital capacity), Lung volume excursion per syllable (in % vital capacity) and mean speaking Fundamental frequency (f_O).

METHODS: Ten women and seven men were included as subjects. Lung volume and breathing behaviors were measured by respiratory inductance plethysmography and f_O was measured from audio recordings by the Praat software. Statistical significance was tested by analysis of variance.

RESULTS: For both reading and spontaneous speech, the group increased mean breath group size and breath group duration significantly in the fast speaking rate condition. The group significantly decreased lung volume excursion per syllable in fast speech. Females also showed a significant increase of f_O in fast speech. The lung volume levels for initiation and termination of breath groups, as well as lung volume excursions in % vital capacity, showed great individual variations and no significant effects of rate. Significant effects of speech task were found for breath group size and lung volume excursion per syllable, where reading induced more syllables produced per breath group and less % VC spend per syllable as compared to spontaneous speech. Interaction effects showed that the increases in breath group size and breath group duration associated with fast rate were significantly larger in reading than in spontaneous speech.

CONCLUSION: Our data from 17 vocally untrained, healthy subjects showed great individual variations but still significant group effects regarding increased speaking rate, where the subjects seemed to spend less air per syllable and inhaled less often as a consequence of greater breath group sizes in fast speech. Subjects showed greater changes in breath group patterns as a consequence of fast speech in reading than in spontaneous speech, indicating that effects of speaking rate are dependent on the speech task.

PMID:34711460 | DOI:10.1016/j.jvoice.2021.09.005

Diagn Cytopathol. 2021 Oct 28. doi: 10.1002/dc.24898. Online ahead of print.

ABSTRACT

BACKGROUNDS: Liquid-based cytology (LBC) has begun to be used in non-gynecological samples such as endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). This study aims to investigate the diagnostic value of LBC in intrathoracic lymph nodes and lung lesions sampled with EBUS-TBNA.

METHODS: In total, 174 cases that underwent EBUS-TBNA between July 2020 and February 2021 were included (75 and 99 cases were prepared using conventional and LBC methods, respectively). The two groups were compared in terms of diagnostic categories, number of slides, cell blocks, slides per location, locations sampled, immunohistochemical studies, sensitivity, specificity, and diagnostic accuracy.

RESULTS: The percentages of malignant, suspicious for malignancy, benign, and non-diagnostic (ND) cases were 51.8%, 1.1%, 39.6%, and 7.5%, respectively. The LBC and conventional group (CG) had similar rates in the diagnostic categories, except for ND (3.0% and 13.3%, respectively). The sensitivity of LBC and CG were 90.4% and 85.7%, respectively. There were no differences in the specificity and diagnostic accuracy between groups. There was a statistically significant difference between groups in terms of the number of slides, number of slides per location, number of cell blocks, and locations sampled (p < .001, p < .001, p < .05, p < .05).

CONCLUSION: The LBC technique can be used for samples taken with EBUS-TBNA. Rapid fixation and the absence of artificial problems greatly reduce the rate of ND samples in LBC slides. Other important advantages are a lower number of slides to examine and a greater number of cell blocks.

PMID:34709736 | DOI:10.1002/dc.24898

Methods Mol Biol. 2022;2377:391-421. doi: 10.1007/978-1-0716-1720-5_22.

ABSTRACT

TnSeq, or sequencing of transposon insertion libraries, has proven to be a valuable method for probing the functions of genes in a wide range of bacteria. TnSeq has found many applications for studying genes involved in core functions (such as cell division or metabolism), stress response, virulence, etc., as well as to identify potential drug targets. Two of the most commonly used transposons in practice are Himar1, which inserts randomly at TA dinucleotides, and Tn5, which can insert more broadly throughout the genome. These insertions cause putative gene function disruption, and clones with insertions in genes that cannot tolerate disruption (in a given condition) are eliminated from the population. Deep sequencing can be used to efficiently profile the surviving members, with insertions in genes that can be inferred to be non-essential. Data from TnSeq experiments (i.e. transposon insertion counts at specific genomic locations) is inherently noisy, making rigorous statistical analysis (e.g. quantifying significance) challenging. In this chapter, we describe Transit, a Python-based software package for analyzing TnSeq data that combines a variety of data processing tools, quality assessment methods, and analytical algorithms for identifying essential (or conditionally essential) genes.

PMID:34709629 | DOI:10.1007/978-1-0716-1720-5_22

J Ultrasound Med. 2021 Oct 28. doi: 10.1002/jum.15858. Online ahead of print.

ABSTRACT

OBJECTIVES: To explore the diagnostic value of contrast-enhanced ultrasound (CEUS) combined with the Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) for differentiation of benign and malignant thyroid nodules.

METHODS: A retrospective analysis of the conventional ultrasound and CEUS data of 388 nodules in 355 patients who had undergone thyroid nodule resection was conducted. All nodules had clear pathological results. The CEUS observation indexes included the enhancement degree in the arterial phase (no enhancement, scant punctate-linear enhancement, mild enhancement, moderate enhancement, and high enhancement) and wash-out patterns (rapid wash-out, slow wash-out, and isochronous wash-out). Chi-square test between groups and receiver operating characteristic curves (ROC) were used to determine the malignant (+1 point) and benign (-1 point) observation indexes that were statistically significant for the differentiation between benign and malignant thyroid nodules. The CEUS and C-TIRADS malignant and benign indexes were combined to score and draw the ROC curve, which was compared with the ROC curve scored by C-TIRADS alone to compare the diagnostic efficacy of the two methods for differentiating between benign and malignant thyroid nodules.

RESULTS: Among the CEUS observation indexes, mild enhancement and rapid wash-out were malignant indexes, while isochronous wash-out was a benign index. The best diagnostic cut-off value for the differentiation of benign and malignant thyroid nodules using the C-TIRADS score and the C-TIRADS and CEUS combined score (C-TIRADS + CEUS score) was 2. The sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) of the two methods were 79.97, 75.48, 82.9, 70.5%, and 89.7, 72.9, 83.3, 82.5%, respectively. The area under the curve values were 0.840 and 0.877 (P < .001), respectively.

CONCLUSIONS: The CEUS feature of mild enhancement in the arterial phase and rapid wash-out pattern are suggestive of malignancy and isochronous wash-out pattern is suggestive of benignity. The C-TIRADS + CEUS score has a higher value for distinguishing benign from malignant thyroid nodules than the C-TIRADS score alone.

PMID:34709672 | DOI:10.1002/jum.15858

J Thromb Thrombolysis. 2021 Oct 28. doi: 10.1007/s11239-021-02597-y. Online ahead of print.

ABSTRACT

Lipoprotein(a) (Lp(a)) is a prothrombotic and anti-fibrinolytic lipoprotein, whose role has not been clearly defined in the pathogenesis of coronavirus disease 2019 (COVID-19). In this prospective observational study, serum Lp(a) as well as outcomes were measured in 50 COVID-19 patients and 30 matched sick controls. Lp(a) was also assessed for correlation with a wide panel of biomarkers. Serum Lp(a) did not significantly differ between COVID-19 patients and sick controls, though its concentration was found to be significantly associated with severity of COVID-19 illness, including acute kidney failure stage (r = 0.380, p = 0.007), admission disease severity (r = 0.355, p = 0.013), and peak severity (r = 0.314; p = 0.03). Lp(a) was also positively correlated with interleukin (IL)-8 (r = 0.308; p = 0.037), fibrinogen (r = 0.344; p = 0.032) and creatinine (r = 0.327; p = 0.027), and negatively correlated with ADAMTS13 activity/VWF:Ag (r = – 0.335; p = 0.021); but not with IL-6 (r = 0.241; p = 0.106). These results would hence suggest that adverse outcomes in patients with COVID-19 may be aggravated by a genetically determined hyper-Lp(a) state rather than any inflammation induced elevations.

PMID:34709533 | DOI:10.1007/s11239-021-02597-y

J Neural Transm (Vienna). 2021 Oct 28. doi: 10.1007/s00702-021-02429-6. Online ahead of print.

ABSTRACT

Encephalopathy is a neurological complication of COVID-19. The objective of this exploratory study is to investigate the link between systemic inflammation and brain microstructural changes (measured by diffusion-weighted imaging) in patients with COVID-19 encephalopathy. 20 patients with COVID-19 encephalopathy (age: 67.3 [Formula: see text] 10.0 years; 90% men) hospitalized in the Geneva University Hospitals for a SARS-CoV-2 infection between March and May 2020 were included in this retrospective cohort study. COVID-19 encephalopathy was diagnosed following a comprehensive neurobiological evaluation, excluding common causes of delirium, such as hypoxemic or metabolic encephalopathy. We investigated the correlation between systemic inflammation (measured by systemic C-reactive protein (CRP)) and brain microstructural changes in radiologically normal white matter (measured by apparent diffusion coefficient (ADC)) in nine spatially widespread regions of the white matter previously associated with delirium. Systemic inflammation (CRP = 60.8 ± 50.0 mg/L) was positively correlated with ADC values in the anterior corona radiata (p = 0.0089), genu of the corpus callosum (p = 0.0064) and external capsule (p = 0.0086) after adjusting for patients’ age. No statistically significant association between CRP and ADC was found in the other six white matter regions. Our findings indicate high risk of white matter abnormalities in COVID-19 encephalopathy patients with high peripheral inflammatory markers, suggesting aggressive imaging monitoring may be warranted in these patients. Future studies should clarify a possible specificity of the spatial patterns of CRP-white matter microstructure association in COVID-19 encephalopathy patients and disentangle the role of individual cytokines on brain inflammatory mechanisms.

PMID:34709472 | DOI:10.1007/s00702-021-02429-6