Nevin Manimala

Eurasian J Med. 2023 Nov 2. doi: 10.5152/eurasianjmed.2023.22281. Online ahead of print.

ABSTRACT

Surgery is the primary treatment for pulmonary hydatid cysts. This systematic review and meta-analysis aimed to compare the results of capitonnage and uncapitonnage techniques for the surgery of pulmonary hydatid cysts. Descriptive Boolean queries were used to search PubMed, Scopus, and Web of Science for articles published up to June 2022 to evaluate the outcomes of pulmonary hydatid cysts in terms of mortality, postoperative complications, and hospital stay. A total of 12 studies were included. An analysis of the total side effects revealed that there was a statistically significant difference between the capitonnage and uncapitonnage groups (odds ratio=3.81, 95% confidence interval=[1.75-8.31], P < .001). The results showed that more side effects were observed in the uncapitonnage group than in the capitonnage group. The risk of side effects in the uncapitonnage group is 3.81 times higher than in the capitonnage group. The results showed that more prolonged air leak was seen in uncapitonnage group than in the capitonnage group (odds ratio=4.18, 95% confidence interval=[1.64-10.64], P=.003). The results show that more empyema was observed in uncapitonnage group than in the capitonnage group (odds ratio=4.76, 95% confidence interval=[1.29-17.57], P =0.020). An analysis of atelectasis and mean hospital stay revealed that there was no statistically significant difference between the capitonnage and uncapitonnage groups. The results reveal the advantages of capitonnage in the treatment of pulmonary hydatid cysts and that the capitonnage method is quite effective in reducing complications compared to the uncapitonnage method.

PMID:37916996 | DOI:10.5152/eurasianjmed.2023.22281

J Magn Reson Imaging. 2023 Nov 2. doi: 10.1002/jmri.29089. Online ahead of print.

ABSTRACT

BACKGROUND: Previous in vitro studies have described sub-linear longitudinal and heightened transverse H₂ O relaxivities of gadolinium-based contrast agents (GBCAs) in blood due to their extracellular nature. However, in vivo validation is lacking.

PURPOSE: Validate theory describing blood behavior of R₁ and R₂ * in an animal model.

STUDY TYPE: Prospective, animal.

ANIMAL MODEL: Seven swine (54-65 kg).

FIELD STRENGTH/SEQUENCE: 1.5 T; time-resolved 3D spoiled gradient-recalled echo (SPGR) and quantitative Look-Locker and multi-echo fast field echo sequences.

ASSESSMENT: Seven swine were each injected three times with 0.1 mmol/kg intravenous doses of one of three GBCAs: gadoteridol, gadobutrol, and gadobenate dimeglumine. Injections were randomized for rate (1, 2, and 3 mL/s) and order, during which time-resolved aortic 3D SPGR imaging was performed concurrently with aortic blood sampling via an indwelling catheter. Time-varying [GBCA] was measured by mass spectrometry of sampled blood. Predicted signal intensity (SI) was determined from a model incorporating sub-linear R₁ and R₂ * effects (whole-blood model) and simpler models incorporating linear R₁ , with and without R₂ * effects. Predicted SIs were compared to measured aortic SI.

STATISTICAL TESTS: Linear correlation (coefficient of determination, R² ) and mean errors were compared across the SI prediction models.

RESULTS: There was an excellent correlation between predicted and measured SI across all injections and swine when accounting for the non-linear dependence of R₁ and high blood R₂ * (regression slopes 0.91-1.04, R² ≥ 0.91). Simplified models (linear R₁ with and without R₂ * effects) showed poorer correlation (slopes 0.67-0.85 and 0.54-0.64 respectively, both R² ≥ 0.89) and higher averaged mean absolute and mean square errors (128.4 and 177.4 vs. 42.0, respectively, and 5506 and 11,419 vs. 699, respectively).

DATA CONCLUSION: Incorporating sub-linear R₁ and high first-pass R₂ * effects in arterial blood models allows accurate SPGR SI prediction in an in vivo animal model, and might be utilized when modeling MR blood SI.

LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 1.

PMID:37916957 | DOI:10.1002/jmri.29089

Int J Surg. 2023 Nov 2. doi: 10.1097/JS9.0000000000000828. Online ahead of print.

ABSTRACT

BACKGROUND: Stress urinary incontinence (SUI) is common among women, and surgical interventions have significantly improved patients’ symptoms. The long-term effectiveness of these surgeries is increasingly drawing attention, yet it remains sparsely documented in the literature.

OBJECTIVE: To compare the long-term effectiveness and safety of retropubic tension-free vaginal tape (TVT-RP), tension-free vaginal tape-obturator (TVT-O), transobturator tape (TOT), single-incision sling (SIS), Burch colposuspension, and pubovaginal sling (PVS).

METHODS: A comprehensive and systematic literature review was conducted in PubMed, EMBASE, MEDLINE, Cochrane Library, Medicine, and clinicaltrials.gov from inception to May 2023. Selected trials were evaluated for potential bias using the Cochrane tool. Treatment modalities were compared using network meta-analysis to assess objective success rate, subjective success rate, and complications as outcomes.

RESULTS: A total of 37 studies involving 5,720 patients were included. No significant statistical differences were found among the interventions regarding objective success rate. PVS had the highest surface under the cumulative ranking curve SUCRA value (93.1). For subjective success rate, TVT-RP, TVT-O, and PVS demonstrated superiority over SIS, with PVS having the highest SUCRA value (80.1). SIS had lower overall complication and pain rates compared to other methods, with statistical significance. There were no differences in reoperation rate, exposure rate, and urinary tract infection occurrence among the surgical approaches.

CONCLUSIONS: In terms of long-term effectiveness and safety, TVT-RP and TVT-O appear to be the preferred options for patients opting for synthetic slings, while for patients seeking non-synthetic slings, PVS may represent the optimal choice.

PMID:37916939 | DOI:10.1097/JS9.0000000000000828

Int J Surg. 2023 Nov 2. doi: 10.1097/JS9.0000000000000814. Online ahead of print.

ABSTRACT

BACKGROUND: Papillary thyroid cancer (PTC) is one of the most common endocrine malignancies with different risk levels. However, preoperative risk assessment of PTC is still a challenge in the worldwide. Here, we first report a Preoperative Risk Assessment Classifier for PTC (PRAC-PTC) by multidimensional features including clinical indicators, immune indices, genetic feature, and proteomics.

MATERIALS AND METHODS: The 558 patients collected from June 2013 to November 2020 were allocated to three groups: discovery set (274 patients, 274 FFPE), retrospective test set (166 patients, 166 FFPE) and prospective test set (118 patients, 118 FNA). Proteomic profiling was conducted by formalin-fixed paraffin-embedded (FFPE) and fine-needle aspiration (FNA) tissues from the patients. Preoperative clinical information and blood immunological indices were collected. The BRAFV600E mutation were detected by the amplification refractory mutation system (ARMS).

RESULTS: We developed a machine learning model of 17 variables based on multidimensional features of 274 PTC patients from a retrospective cohort. The PRAC-PTC achieved areas under the curve (AUC) of 0.925 in the discovery set and validated externally by blinded analyses in a retrospective cohort of 166 PTC patients (0.787 AUC) and a prospective cohort of 118 PTC patients (0.799 AUC) from two independent clinical centres. Meanwhile, the preoperative predictive risk effectiveness of clinicians was improved with the assistance of PRAC-PTC, and the accuracies reached at 84.4% (95% CI 82.9-84.4) and 83.5% (95% CI 82.2-84.2) in the retrospective and prospective test sets, respectively.

CONCLUSION: This study demonstrated that the PRAC-PTC that integrating clinical data, gene mutation information, immune indices, high-throughput proteomics and machine learning technology in multi-centre retrospective and prospective clinical cohorts can effectively stratify the preoperative risk of PTC and may decrease unnecessary surgery or overtreatment.

PMID:37916932 | DOI:10.1097/JS9.0000000000000814

J Magn Reson Imaging. 2023 Nov 2. doi: 10.1002/jmri.29109. Online ahead of print.

ABSTRACT

BACKGROUND: Programmed cell death ligand-1 (PD-L1) is a promising target for immune checkpoint blockade therapy in breast cancer. However, the preoperative evaluation of PD-L1 expression in breast cancer is rarely explored.

PURPOSE: To determine the ability of radiomics signatures based on preoperative dynamic contrast-enhanced (DCE) MRI to evaluate PD-L1 expression in breast cancer.

STUDY TYPE: Retrospective.

POPULATION: 196 primary breast cancer patients with preoperative MRI and postoperative pathological evaluation of PD-L1 expression, divided into training (n = 137, 28 PD-L1-positive) and test cohorts (n = 59, 12 PD-L1-positive).

FIELD STRENGTH/SEQUENCE: 3.0T; volume imaging for breast assessment DCE sequence.

ASSESSMENT: Radiomics features were extracted from the first phase of DCE-MRI by using the minimum redundancy maximum relevance method and least absolute shrinkage and selection operator algorithm. Three radiomics signatures were constructed based on the intratumoral, peritumoral, and combined intra- and peritumoral regions. The performance of the signatures was assessed using area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, and accuracy.

STATISTICAL TESTS: Univariable and multivariable logistic regression analysis, t-tests, chi-square tests, Fisher exact test or Yates correction, ROC analysis, and one-way analysis of variance. P < 0.05 was considered significant.

RESULTS: In the test cohort, the combined radiomics signature (AUC, 0.853) exhibited superior performance compared to the intratumoral (AUC, 0.816; P = 0.528) and peritumoral radiomics signatures (AUC, 0.846; P = 0.905) in PD-L1 status evaluation, although the differences did not reach statistical significance.

DATA CONCLUSION: Intratumoral and peritumoral radiomics signatures based on preoperative breast MRI showed some potential accuracy for the non-invasive evaluation of PD-L1 status in breast cancer.

LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 2.

PMID:37916918 | DOI:10.1002/jmri.29109

J Magn Reson Imaging. 2023 Nov 2. doi: 10.1002/jmri.29053. Online ahead of print.

ABSTRACT

BACKGROUND: Independent factors are needed to supplement vesical imaging-reporting and data system (VI-RADS) to improve its ability to identify muscle invasive bladder cancer (MIBC).

PURPOSE: To assess the correlation between MIBC and diffusion kurtosis imaging (DKI) ratio, VI-RADS, and other factors (such as tumor location).

STUDY TYPE: Retrospective.

POPULATION: Sixty-eight patients (50 males and 18 females; age: 70.1 ± 9.5 years) with bladder urothelial carcinoma.

FIELD STRENGTH/SEQUENCE: 1.5 T, conventional diffusion-weighted imaging (DWI), and DKI (single shot echo-planar sequence).

ASSESSMENT: Three radiologists independently measured the diffusion parameters of each bladder cancer (BCa) and obturator internus, including the mean apparent diffusion coefficient (ADCmean), mean kurtosis (MK), and mean diffusion (MD). And the ratio of diffusion parameters between BCa and obturator internus was calculated (diffusion parameter ratio = bladder cancer:obturator internus). Based on the VI-RADS, the target lesions were independently scored. Furthermore, the actual tumor-wall contact length (ACTCL) and absolute tumor-wall contact length (ABTCL) were measured.

STATISTICAL TESTS: Multicollinearity among independent variables was evaluated using the variance inflation factor (VIF). Multivariable logistic regression analysis was used to determine the independent risk factors of MIBC. The receiver operating characteristic curve was used to evaluate the efficacy of each variable in detecting MIBC. The DeLong test was used to compare the area under the curve (AUC). A P < 0.05 was considered statistically significant.

RESULTS: MKratio (median: 0.62) and VI-RADS were independent risk factors for MIBC. AUCs for MKratio, VI-RADS, and MKratio combined with VI-RADS in assessing MIBC were 0.895, 0.871, and 0.973, respectively. MKratio combined with VI-RADS was more effective in diagnosing MIBC than VI-RADS alone.

DATA CONCLUSIONS: MKratio has potential to assist the assessment of MIBC. MKratio can be used as a supplement to VI-RADS for detecting MIBC.

LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 2.

PMID:37916908 | DOI:10.1002/jmri.29053

Eur Rev Med Pharmacol Sci. 2023 Oct;27(20):9729-9737. doi: 10.26355/eurrev_202310_34144.

ABSTRACT

OBJECTIVE: The neutrophil-to-lymphocyte ratio (NLR) is used for the prognosis of diseases characterized by inflammatory processes. This study aims to discuss the long-term outcomes and NLR in pediatric traumatic brain injury cases.

PATIENTS AND METHODS: This study investigated traumatic brain injury patients younger than 18 years. Patients were grouped into 5 groups according to their Glasgow outcome scores (GOS). Initial admission Glasgow coma scale (GCS) values, neurological examinations, pupil conditions, cardiopulmonary resuscitation (CPR) administration, and seizure occurrence were recorded. Neutrophil counts and lymphocyte counts, derived from complete blood count (CBC) values taken during the patient’s first 8 hours of admission, were used to calculate the NLR value.

RESULTS: A total of 150 patients, 54 (36%) females and 96 (64%) males, were assessed in the study. The most frequent accident type was falling from a height [84 patients (56%)]. The GCS, CPR, pupillary reflex, anisocoria, surgical procedure, and neutrophil counts were significantly different between the GOS scores. There was no statistically significant difference between the GOS and the NLR (p=0.400). There was a significant difference in NLR value according to CPR, seizures, and brain injury type (p<0.05).

CONCLUSIONS: NLR values are not correlated with 1-year outcome scores in pediatric traumatic brain injury patients, unlike proven parameters such as initial GCS scores and neurological status.

PMID:37916336 | DOI:10.26355/eurrev_202310_34144

Eur Rev Med Pharmacol Sci. 2023 Oct;27(20):9710-9720. doi: 10.26355/eurrev_202310_34141.

ABSTRACT

OBJECTIVE: This study aimed to investigate the predictive role of admission serum glucose, baseline NIHSS score, and fibrinogen on hemorrhagic transformation after intravenous thrombolysis with alteplase in acute ischemic stroke.

PATIENTS AND METHODS: A total of 254 patients admitted with acute ischemic stroke who received intravenous thrombolysis with alteplase from January 2016 to December 2017 were selected to collect clinical data. Patients were divided into a hemorrhagic transformation group (n=70) and a no-hemorrhagic transformation group (n=184) based on repeat CT/magnetic resonance imaging (MRI) findings during the acute period. The demographic data, past medical history and laboratory examination indexes of the two groups were compared. Multivariate Logistic regression analysis was used to explore the influencing factors of hemorrhage transformation after intravenous thrombolysis in patients with acute ischemic stroke. ROC curve was used to plot the ability of blood glucose at admission, baseline NIHSS score and fibrinogen alone to predict bleeding transformation after intravenous thrombolysis of alteplase, and then the combined model of the three was constructed and the predictive ability of this model to bleeding transformation was evaluated.

RESULTS: Among 254 patients, 70% (27.55%) had hemorrhage transformation. Except for DNT, red blood cell count, platelet count, fibrinogen, smoking, atrial fibrillation, baseline NIHSS score and admission serum glucose, there were statistically significant differences between the hemorrhagic transformation group and the non-hemorrhagic transformation group (p<0.05), and there were no statistically significant differences in other indicators between the two groups (p>0.05). The combined model was better than the three models alone in predicting the risk of bleeding conversion (p<0.05). Compared with the group without hemorrhagic transformation, the 90d prognosis was worse in the hemorrhage transformation group (p<0.05).

CONCLUSIONS: Admission blood glucose, NIHSS score, and fibrinogen are independent risk factors for hemorrhage transformation after intravenous thrombolysis of alteplase in patients with acute ischemic stroke, and the combined model established by them has high predictive efficacy for hemorrhage transformation risk after intravenous thrombolysis of alteplase.

PMID:37916334 | DOI:10.26355/eurrev_202310_34141

J Neurointerv Surg. 2023 Nov 1:jnis-2023-020649. doi: 10.1136/jnis-2023-020649. Online ahead of print.

ABSTRACT

BACKGROUND: Vasospasm of the large cerebral arteries (CVS) after aneurysmatic subarachnoid hemorrhage (aSAH) reduces cerebral perfusion and causes delayed cerebral ischemia. Although endovascular spasmolysis shows convincing angiographic results, patients often do not improve in outcome. Delayed recognition of CVS contributes substantially to this effect. Therefore, this study aimed to confirm established and to identify unknown risk factors for CVS, which can be used for risk stratification.

METHODS: In this monocentric, retrospective cohort study of 853 patients with aSAH, we compared demographics, clinical, and radiographic parameters at the time of aneurysm occlusion between patients who developed CVS and those who did not. Significant cohort differences were included as predictors in a multivariate analysis to address confounding. Logistic regression models were used to determine odds ratios (ORs) for the presence of CVS for each predictor.

RESULTS: Of the 853 patients treated with aSAH, 304 (32%) developed CVS. In the univariable analysis, CVS was significantly associated with young age, female sex, aneurysm location, modified Fisher score, Barrow Neurological Institute (BNI) score, and surgical interventions. In the multivariable regression analysis, we identified BNI score (OR 1.33, 95% CI 1.11 to 1.58, p=0.002), decompressive craniectomy (OR 1.93, 95% CI 1.22 to 3.04, p=0.005), and aneurysm clipping (OR 2.22, 95% CI 1.50 to 3.29, p<0.001), as independent risk factors.

CONCLUSIONS: Young female patients with high BNI scores who undergo surgical interventions are more likely to develop CVS and should therefore be monitored most intensively after aneurysm occlusion.

PMID:37914393 | DOI:10.1136/jnis-2023-020649

Urol Pract. 2023 Nov 1:101097UPJ0000000000000490. doi: 10.1097/UPJ.0000000000000490. Online ahead of print.

ABSTRACT

INTRODUCTION: ChatGPT is an artificial intelligence (AI) platform available to patients seeking medical advice. Traditionally, urology patients consulted official provider-created materials, particularly the Urology Care Foundation (UCF). Today, men increasingly go online due to the rising costs of healthcare and the stigma surrounding sexual health. Online health information is largely inaccessible to laypersons as it exceeds the recommended American sixth-eighth grade reading level. We conducted a comparative assessment of patient education materials generated by ChatGPT versus UCF regarding men’s health conditions.

METHODS: All 6 UCF men’s health resources were identified. ChatGPT responses were generated using patient questions obtained from UCF. Adjusted ChatGPT (ChatGPT-a) responses were generated by prompting “Explain it to me like I am in sixth grade.” Textual analysis was performed using sentence, word, syllable, and complex word count. Six validated formulae were used for readability analysis. Two physicians independently scored responses for accuracy, comprehensiveness, and understandability. Statistical analysis involved Wilcoxon matched-pairs test.

RESULTS: ChatGPT responses were longer and more complex. Both UCF and ChatGPT failed official readability standards, although ChatGPT performed significantly worse across all 6 topics (all P < .001). Conversely, ChatGPT-a readability typically surpassed UCF, even meeting the recommended level for 2 topics. Qualitatively, UCF and ChatGPT had comparable accuracy, although ChatGPT had better comprehensiveness and worse understandability.

CONCLUSION: When comparing readability, ChatGPT-generated education is less accessible than provider-written content, although neither meets the recommended level. Our analysis indicates that specific AI prompts can simplify educational materials to meet national standards and accommodate individual literacy.

PMID:37914380 | DOI:10.1097/UPJ.0000000000000490