Nevin Manimala

J Neuroimaging. 2023 Nov 9. doi: 10.1111/jon.13170. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Thalamic hypometabolism is a consistent finding in brain PET with F-18 fluorodeoxyglucose (FDG) in patients with neurofibromatosis type 1 (NF1). However, the pathophysiology of this metabolic alteration is unknown. We hypothesized that it might be secondary to disturbance of peripheral input to the thalamus by NF1-characteristic peripheral nerve sheath tumors (PNSTs). To test this hypothesis, we investigated the relationship between thalamic FDG uptake and the number, volume, and localization of PNSTs.

METHODS: This retrospective study included 22 adult NF1 patients (41% women, 36.2 ± 13.0 years) referred to whole-body FDG-PET/contrast-enhanced CT for suspected malignant transformation of PNSTs and 22 sex- and age-matched controls. Brain FDG uptake was scaled voxelwise to the individual median uptake in cerebellar gray matter. Bilateral mean and left-right asymmetry of thalamic FDG uptake were determined using a left-right symmetric anatomical thalamus mask. PNSTs were manually segmented in contrast-enhanced CT.

RESULTS: Thalamic FDG uptake was reduced in NF1 patients by 2.0 standard deviations (p < .0005) compared to controls. Left-right asymmetry was increased by 1.3 standard deviations (p = .013). Thalamic hypometabolism was higher in NF1 patients with ≥3 PNSTs than in patients with ≤2 PNSTs (2.6 vs. 1.6 standard deviations, p = .032). The impact of the occurrence of paraspinal/paravertebral PNSTs and of the mean PNST volume on thalamic FDG uptake did not reach statistical significance (p = .098 and p = .189). Left-right asymmetry of thalamic FDG uptake was not associated with left-right asymmetry of PNST burden (p = .658).

CONCLUSIONS: This study provides first evidence of left-right asymmetry of thalamic hypometabolism in NF1 and that it might be mediated by NF1-associated peripheral tumors.

PMID:37942683 | DOI:10.1111/jon.13170

Pediatr Transplant. 2023 Nov 9:e14638. doi: 10.1111/petr.14638. Online ahead of print.

ABSTRACT

BACKGROUND: The study purpose was to add to limited literature assessing anti-HLA donor-specific antibody (DSA) appearance, clearance, specificity, and impact in intestinal/multivisceral (MV) transplant as well as the value of serial monitoring following an institutional protocol shift implementing serial monitoring.

METHODS: This single-center retrospective review included intestinal/MV recipients transplanted 1/1/15-9/31/17 with completed DSA testing. Patients were divided into groups based on DSA presence post-transplant. The primary outcome was biopsy-proven acute rejection (BPAR). Secondary outcomes included graft loss and death. Descriptive analysis of DSA was completed.

RESULTS: Of the 35 intestinal/MV recipients (60% pediatric) with DSA testing, 24 patients had post-transplant DSA. Fifteen patients in the DSA(+) group had T-cell-mediated BPAR versus five in the DSA(-) group (63% vs 45%, p = .47). Days to BPAR were 25 [IQR 19-165] (DSA(+) group) versus 232 [IQR 25.5-632.5] (DSA(-) group) (p = .066). There were no differences between groups for graft loss or death. One hundred and five DSA were identified in the DSA(+) group with 63% being class II, and 54% cleared during follow-up. DSA were directed against 50 different HLA alleles, with the most common being directed against HLA- DQ (35%). Time to first DSA and to clearance did not differ between class I and II.

CONCLUSION: Findings confirm previous data that suggest post-transplant DSA in this population may lead to increased BPAR or shorter time to BPAR, although not statistically significant. Most DSA were identified within the first month after transplant, and ahead of rejection identification on biopsy. DSA therefore may have utility as an early rejection biomarker and use may be considered in place of early protocol biopsies, particularly in pediatric patients. We identified novel findings of DSA directed against a large breadth of HLA in intestinal/MV patients.

PMID:37942670 | DOI:10.1111/petr.14638

Expert Rev Med Devices. 2023 Nov 9. doi: 10.1080/17434440.2023.2280685. Online ahead of print.

ABSTRACT

AIM: To evaluate the relevance of Incidental prostate [¹⁸F]FDG uptake (IPU) and to explore the potential of radiomics and machine learning (ML) to predict prostate cancer (PCa).

METHODS: We retrieved [¹⁸F]FDG PET/CT scans with evidence of IPU performed in 2 institutions between 2015-2021. Patients were divided in PCa and non-PCa, according to biopsy. Clinical and PET/CT derived information (comprehensive of radiomic analysis) were acquired. 5 ML models were developed and their performance in discriminating PCa vs non-PCa IPU was evaluated. Radiomic analysis was investigated to predict ISUP Grade.

RESULTS: Overall 56 IPU were identified and 31 patients performed prostate biopsy. Eighteen of those were diagnosed as PCa. Only PSA and radiomic features (8 from CT and 9 from PET images, respectively) showed statistically significant difference between PCa/non-PCa patients. Eight features resulted robust between the two institutions. CT-based ML models showed a good performance, especially in terms of negative predictive value (NPV 0.733-0.867). PET-derived ML models resulted less accurate except the Random Forest model (NPV = 0.933). Radiomics could not accurately predict ISUP grade.

CONCLUSIONS: Paired with PSA, radiomic analysis seems to be promising to discriminate PCa/non-PCa IPU. ML could be a useful tool to identify non-PCa IPU, avoiding further investigations.

PMID:37942630 | DOI:10.1080/17434440.2023.2280685

Vestn Oftalmol. 2023;139(5):36-42. doi: 10.17116/oftalma202313905136.

ABSTRACT

PURPOSE: The study comparatively evaluates the effectiveness of various approaches to acaricidal treatment in patients with chronic demodex blepharitis and meibomian gland dysfunctions.

MATERIAL AND METHODS: The study included 40 patients with chronic blepharitis (CB) of demodicosis etiology in conditions of meibomian gland dysfunction (MGD) and dry eye (DE). The 1^st group of patients (20 people) received acaricidal treatment as part of therapeutic eyelid hygiene (TEH; 2 times a day) involving the use of «Blefarogel ochishchenie», «Blefarolosion», «Blefarogel forte» (contains sulfur and metronidazole). Acaricidal treatment in the patients of the 2^nd group involved applications of a product containing metronidazole (2 times a day) without TEH. Control points: 1) at inclusion in the study; 2) after a course of therapy (45 days). Evaluation included: patient acarograms, symptoms and signs of CB (points); OSDI; tear film break-up time (TBUT, sec), severity of meibomian gland dysfunction (S-MGD, points). Statistical analysis: calculation of M±SD, Mann-Whitney, and Wilcoxon tests.

RESULTS: Acaricidal treatment was effective in both groups (reduction in demodex population, which was more pronounced in the 1^st group). Symptoms and signs of CB were significantly less pronounced in the patients of the 1^st group after therapy. The patients of the 1^st group showed a significant decrease in S-MGD, OSDI and an increase in TBUT, the 2^nd group – a significant decrease in OSDI and an increase in TBUT at the second control point. The positive OSDI and TBUT trends were significantly more pronounced in the 1^st group.

CONCLUSION: Acaricidal treatment as part of TEH showed a significantly more pronounced reduction in demodex population, relief of CB symptoms and sign, OSDI decrease and TBUT increase, compared to the 2^nd group. Apparently, this was associated with combined acaricidal effect and significant S-MGD decrease in the patients of the 1^st group.

PMID:37942595 | DOI:10.17116/oftalma202313905136

Vestn Oftalmol. 2023;139(5):27-35. doi: 10.17116/oftalma202313905127.

ABSTRACT

PURPOSE: The study assesses the potential influence of refractive errors in keratoconus (KC) on the results of tomographic methods of studying the structures of the posterior eye segment.

MATERIAL AND METHODS: The study included 30 patients with bilateral stabilized KC of stages I-IV in classification by M. Amsler. Spherical and cylindrical components of refractions were determined using automatic refractometry, keratometry measurements – based on scanning keratotopography with Scheimpflug analyzer. Aberrometry was performed to evaluate corneal wave front according to the following parameters: root mean square for lower order aberrations (RMS LOA), root mean square for higher order aberrations (RMS HOA), vertical trefoil, vertical coma, horizontal coma and spherical aberrations. Optical coherence tomography (OCT) and laser confocal scanning ophthalmoscopy (HRT 3) data was used in morphometric analysis of the optic nerve head and peripapillary retina. The following morphometric parameters were analyzed: optic nerve head (ONH) area, optic disc cup area, optic disc cup volume, ratio of optic disc cup area to ONH area, neuroretinal rim area, neuroretinal rim volume, peripapillary retinal nerve fiber layer (RNFL) thickness. All studies were performed first without correction, and 30 minutes after installing customized scleral hard contact lenses (SHCL).

RESULTS: Compensation of the refractive errors characteristic for KC was achieved as expected with contact correction. OCT revealed a general trend for reduction in the area and volume of the optic disc cupping, ratio of area to volume of the optic disc cupping, as well as an increase in other parameters. As such, with correction the values for area and volume of the neuroretinal rim according to OCT were 2.2 and 13%, HRT 3 – 18 and 51.6%; comparable increase in mean RNFL thickness – 2.8 and 28.5%, respectively (p<0.001). According to HRT 3 data, the area and volume of optic disc cupping statistically significantly decreased (by 21 and 28%, respectively), while OCT showed statistically significant decrease only in cupping area (by 5.7%). The ratio of cupping to ONH area decreased by 6.6 and 23% relative to the initial data obtained with OCT and HRT 3, respectively. Significant decrease in ONH area amid SHCL correction was observed only with HRT 3. The revealed changes in morphometric parameters were analyzed using the fundamental principles of physiological optics. Changes in interference pattern and, consequently, morphometric parameters of structures of the eye fundus in KC are of multifactorial nature, and are mostly associated with refractive and wave artefacts occurring when the rays pass through the irregular corneal surface and cannot be optically compensated by the device. The use of SHCL as means for making the optic system relatively regular can significantly decrease the artefacts in morphometric measurements.

CONCLUSION: The results obtained in this study demonstrate the practicality of tomographic examination in KC with contact correction. The optimal choice is custom-fit SHCL, which along with proper correction of refractive errors also ensures stable position of the lens on the cornea. In standard examination specialists should take into account the «false» decrease in parameters of the peripapillary retinal nerve fiber layer and increase in ONH cupping.

PMID:37942594 | DOI:10.17116/oftalma202313905127

Vestn Oftalmol. 2023;139(5):20-26. doi: 10.17116/oftalma202313905120.

ABSTRACT

Despite an obvious interest in the processes occurring in the lacrimal passages in their obstruction, there is few articles analyzing their biometric parameters.

PURPOSE: The study investigates the biometric characteristics of the lacrimal passages in healthy individuals and in patients with nasolacrimal duct obstruction.

MATERIAL AND METHODS: The study included 81 cases of partial nasolacrimal duct obstruction and 38 cases without tear drainage insufficiency. All patients underwent computed tomography with dacryocystography. Analysis of the biometric parameters involved calculation of the length, volume, and average sectional area of the nasolacrimal duct and the nasolacrimal bony canal. The ratio R⁴/16l was calculated (where R is the radius of the nasolacrimal duct; l is the length of the nasolacrimal duct). The normality of values was assessed using the Shapiro-Wilk test. Intergroup differences were assessed using the Mann-Whitney test and t-statistics for independent samples. Correlation analysis was performed according to the Spearman method. ROC analysis was carried out. Differences were considered significant at p≤0.05.

RESULTS: There were significant differences in the volume (p=0.004) and the average sectional area of the nasolacrimal duct (p=0.014), as well as in the length of the nasolacrimal canal (p=0.034). Relationships were established between the age of patients without tear drainage insufficiency and the length of the nasolacrimal canal (p=0.042); the length of the nasolacrimal canal and the volume of the nasolacrimal duct (p=0.034), as well as the volume of the nasolacrimal duct and the nasolacrimal canal in partial nasolacrimal duct obstruction (p=0.017). The AUC of the R⁴/16l ratio in the ROC analysis was 0.653 (p=0.007).

CONCLUSION: In addition to the obvious differences, it was found that the length of the nasolacrimal bony canal significantly differed in the subjects of both study groups. We considered the tear ducts as a hydrodynamic system obeying Poiseuille’s law, so we calculated the ratio R⁴/16l. The value of this ratio varied (p=0.016), and the ROC analysis showed high sensitivity and specificity of the criterion. This makes it possible to use this ratio as a diagnostic criterion for partial nasolacrimal duct obstruction.

PMID:37942593 | DOI:10.17116/oftalma202313905120

J Cutan Med Surg. 2023 Nov 9:12034754231211326. doi: 10.1177/12034754231211326. Online ahead of print.

ABSTRACT

Acneiform eruptions occur frequently and early in patients on epidermal growth factor receptor inhibitors (EGFRi). Identification of baseline patient risk factors would prompt earlier referral to dermatology to optimize prevention and management. The primary objective of this retrospective study is to determine the association between clinical and demographic characteristics and the development of acneiform eruptions. A retrospective chart review was conducted on patients diagnosed with colon and head and neck cancers who started EGFRi between January 2017 and December 2021. Patients were followed until death or September 2022. Baseline demographic and clinical parameters were documented and patients were followed from the time of diagnosis to most recent visit for the development and management of an acneiform eruption. Regression analyses were performed to determine the association between baseline characteristics and the development of acneiform eruptions. A total of 66 patients were treated with cetuximab or panitumumab between 2017-2021 were included in the analysis. Forty-seven of the sixty-six patients developed an acneiform eruption while on EGFRi therapy (71.2%). Combination cancer therapy with another chemotherapeutic agent was associated with a lower risk of acneiform eruption (OR 0.03, P = .027). No other baseline features were statistically associated with a lower risk of acneiform eruption. Acneiform eruptions are a common cutaneous adverse event of EGFRi therapy. Ongoing research is required to elucidate risk factors for the development of acneiform eruptions, to improve the quality of life of oncology patients.

PMID:37942582 | DOI:10.1177/12034754231211326

Comput Assist Surg (Abingdon). 2023 Dec;28(1):2275522. doi: 10.1080/24699322.2023.2275522. Epub 2023 Nov 9.

ABSTRACT

A system for performance assessment and quality assurance (QA) of surgical trackers is reported based on principles of geometric accuracy and statistical process control (SPC) for routine longitudinal testing. A simple QA test phantom was designed, where the number and distribution of registration fiducials was determined drawing from analytical models for target registration error (TRE). A tracker testbed was configured with open-source software for measurement of a TRE-based accuracy metric $\epsilon$ and Jitter ($J$). Six trackers were tested: 2 electromagnetic (EM – Aurora); and 4 infrared (IR – 1 Spectra, 1 Vega, and 2 Vicra) – all NDI (Waterloo, ON). Phase I SPC analysis of Shewhart mean ($\overline{x}$) and standard deviation ($s$) determined system control limits. Phase II involved weekly QA of each system for up to 32 weeks and identified Pass, Note, Alert, and Failure action rules. The process permitted QA in <1 min. Phase I control limits were established for all trackers: EM trackers exhibited higher upper control limits than IR trackers in $\epsilon$ (EM: ${\overline{x}}_{\epsilon }\sim$2.8-3.3 mm, IR: ${\overline{x}}_{\epsilon }\sim$1.6-2.0 mm) and Jitter (EM: ${\overline{x}}_{\mathrm{jitter}}\sim$0.30-0.33 mm, IR: ${\overline{x}}_{\mathrm{jitter}}\sim$0.08-0.10 mm), and older trackers showed evidence of degradation – e.g. higher Jitter for the older Vicra (p-value < .05). Phase II longitudinal tests yielded 676 outcomes in which a total of 4 Failures were noted – 3 resolved by intervention (metal interference for EM trackers) – and 1 owing to restrictive control limits for a new system (Vega). Weekly tests also yielded 40 Notes and 16 Alerts – each spontaneously resolved in subsequent monitoring.

PMID:37942523 | DOI:10.1080/24699322.2023.2275522

Technol Cancer Res Treat. 2023 Jan-Dec;22:15330338231212309. doi: 10.1177/15330338231212309.

ABSTRACT

Objective: The pathogenesis of leukemia is complex and there are no effective diagnostic and prognostic indicators. Previous studies showed that microRNA-22 (miR-22) has altered expression level in multiple leukemia subtypes, which is associated with the survival outcomes of leukemia. Methods: According to the constituted retrieval strategy, eligible studies were included from January 2010 to November 2022 by searching database. The pooled Risk Ratio (RR) and 95% confidence intervals (CI) were used to study the relationship between miR-22 and survival. Stata12.0 was used for meta-analysis. Differential expression analysis was conducted based on expression profile of miRNA. Results: Four English articles were included containing a total of 215 leukemia patients. Data showed that the pooled RR for overall survival (OS) was 1.558 (95% CI: 1.197-2.028, P < .01). Subgroup analysis for OS of acute myeloid leukemia patients and the RFS of plasma cell leukemia patients were statistically significant with different expression levels of miR-22 (RR:1.495, 95%CI:1.141-1.958, P < .01 and RR:1.517, 95%CI:1.114-2.065, P < .01, respectively). Moreover, all data included had no significant heterogeneity and publication bias. Conclusions: miR-22 is associated with the survival outcome of leukemia patients suggesting that miR-22 may be a promising prognostic biomarker for this patient population, and the expression level of miR-22 in ALL patients down-regulated.

PMID:37942522 | DOI:10.1177/15330338231212309

Transfusion. 2023 Nov 9. doi: 10.1111/trf.17587. Online ahead of print.

ABSTRACT

BACKGROUND: Red blood cell wastage occurs when blood is discarded rather than transfused, and ineffective ordering results in unnecessary crossmatch procedures. We describe how a multimodal approach to redesigning electronic ordering tools improved blood utilization in a pediatric inpatient setting and how using innovative application of time series data analysis provides insights into intervention effectiveness, which can guide future process improvement cycles.

METHODS: A multidisciplinary team used best practices and Toyota Production System methodology to redesign electronic blood ordering and improve administration processes. We analyzed crossmatch to transfusion ratio and red blood cell wastage time series data extracted from our laboratory information system and electronic health record. We used changepoint analysis to identify statistically discernible breaks in each time series, compatible with known interventions. We performed causal impact analysis on red blood cell wastage time series data to estimate blood wastage avoided due to the interventions.

RESULTS: Changepoint analysis estimated an 11% decrease in crossmatch to transfusion ratio and a 77% decrease in red blood cell monthly wastage rate during the intervention period. Causal impact analysis estimated a 61% reduction in expected wastage compared to the scenario if the interventions had not occurred.

DISCUSSION: Our results show that electronic health record design is an important factor in reducing waste and preventing unnecessary crossmatching, and that time series analysis can be a useful tool for evaluating the long-term impact of each stage of intervention in a longitudinal process redesign effort for the purpose of effectively targeting future improvement efforts.

PMID:37942518 | DOI:10.1111/trf.17587