Nevin Manimala

Turk J Gastroenterol. 2023 Sep 8. doi: 10.5152/tjg.2023.22679. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: Liver transplantation is an acceptable treatment for some selected hepatocellular carcinoma. We report our experience of 6 patients with liver transplantation for hepatocellular carcinoma with background inherited metabolic disease.

MATERIALS AND METHODS: This is a single-center retrospective, descriptive study. Consecutive patients who underwent liver transplantation for hepatocellular carcinoma with background inherited metabolic disease were included in the study. The record of the patients was accessed, and the following data were extracted: sociodemographic variables, type of metabolic disease, date of liver transplantation, tumor characteristics, laboratory parameters, Model for End-Stage Liver Disease score, immediate- and long-term outcome after transplantation, disease-free survival, and overall survival. Data were analyzed using Statistical Package for the Social Sciences version 25.0.

RESULTS: Six patients received liver transplantation for hepatocellular carcinoma with background inherited metabolic liver disease. The median age was 4.5 years. The median Model for End-Stage Liver Disease score was 29.30. The median maximum tumor diameter was 2.15 cm. Three patients had multiple tumor nodules. Half of the patients had microvascular invasion. Four of the patients had a moderately differentiated tumor. Progressive familial intrahepatic cholestasis type II is the commonest inherited metabolic disease seen in 3 patients. Median follow-up is 46.1 months. Half of the patients are currently more than 5 years post liver transplantation with no features of recurrence. The estimated survival rates at 1, 3, and 5 years are 100%, 83.3%, and 83.3%, respectively.

CONCLUSION: Liver transplant for these categories of patients is associated with good disease-free and overall survival, even in the presence of some seemingly poor prognostic features.

PMID:37681267 | DOI:10.5152/tjg.2023.22679

Eur J Rheumatol. 2023 Jul;10(3):97-100. doi: 10.5152/eurjrheum.2023.22086.

ABSTRACT

BACKGROUND: It has been estimated that about 1% of the US population is treated with long-term glucocorticoids. High doses of glucocorticoids particularly those used by rheumatologists and oth- ers for systemic autoimmune rheumatic disease result in bone loss, causing glucocorticoid-induced osteoporosis and an increase in the risk of fractures. The increased risk is related to both the daily dose and the cumulative dose of the glucocorticoids. Despite the availability of effective preventative and treatment options, glucocorticoid-induced osteoporosis is often not mitigated with the use of these preventive therapies. The risk of glucocorticoid-induced osteoporosis often also goes under- recognized, because it occurs in a different group of patients compared to age-related osteoporosis. As a result, glucocorticoid-induced osteoporosis is not always treated until after fractures may have occurred. Our objective is to determine if a structured health-care provider’s educational interven- tion with intermittent educational updates would lead to improvement in the identification, evalu- ation, and prevention of glucocorticoid-induced osteoporosisin those patients at the highest risk of glucocorticoid-induced osteoporosis.

METHODS: In this single-center, prospective study, patients over 40 years of age, receiving a total cumu- lative dose of glucocorticoids of >5 g or a single dose of >30 mg of prednisone or its equivalent was enrolled. All providers attended an academic Journal Club, where the current American College of Rheumatology guidelines regarding glucocorticoid-induced osteoporosiswas reviewed. All providers received monthly reminders during academic meetings within the department.

RESULTS: There was a statistically significant improvement between pre- and post-educational data, with increasing use of glucocorticoid-induced osteoporosis preventive measures, which was sus- tained over the 12-month duration of the study.

CONCLUSION: This research shows the importance of provider education as a means of disseminating information and improving the quality of patient care.

PMID:37681255 | DOI:10.5152/eurjrheum.2023.22086

Astrophys J. 2023 Apr 1;946(2):107. doi: 10.3847/1538-4357/acbe3b. Epub 2023 Apr 5.

ABSTRACT

It is well known that the power spectrum is not able to fully characterize the statistical properties of non-Gaussian density fields. Recently, many different statistics have been proposed to extract information from non-Gaussian cosmological fields that perform better than the power spectrum. The Fisher matrix formalism is commonly used to quantify the accuracy with which a given statistic can constrain the value of the cosmological parameters. However, these calculations typically rely on the assumption that the sampling distribution of the considered statistic follows a multivariate Gaussian distribution. In this work, we follow Sellentin & Heavens and use two different statistical tests to identify non-Gaussianities in different statistics such as the power spectrum, bispectrum, marked power spectrum, and wavelet scattering transform (WST). We remove the non-Gaussian components of the different statistics and perform Fisher matrix calculations with the Gaussianized statistics using Quijote simulations. We show that constraints on the parameters can change by a factor of ∼2 in some cases. We show with simple examples how statistics that do not follow a multivariate Gaussian distribution can achieve artificially tight bounds on the cosmological parameters when using the Fisher matrix formalism. We think that the non-Gaussian tests used in this work represent a powerful tool to quantify the robustness of Fisher matrix calculations and their underlying assumptions. We release the code used to compute the power spectra, bispectra, and WST that can be run on both CPUs and GPUs.

PMID:37681217 | PMC:PMC10482003 | DOI:10.3847/1538-4357/acbe3b

Front Pediatr. 2023 Aug 23;11:1097152. doi: 10.3389/fped.2023.1097152. eCollection 2023.

ABSTRACT

INTRODUCTION: Energy requirements are difficult to estimate in children with cerebral palsy (CP). Resting energy expenditure (REE), necessary to implement personalized nutritional interventions, is most commonly estimated using prediction formulae since indirect calorimetry, the reference method, is not available in all nutrition units. The aims of the present study were: (1) to evaluate the accuracy of the most commonly used REE prediction formulae developed for healthy children, in children with CP; (2) to assess the accuracy of the REE population-specific formula for CP children proposed in our preliminary report; (3) to develop new population-specific methods.

METHODS: REE was measured by indirect calorimetry in 100 children and adolescents with spastic quadriplegic cerebral palsy (SQCP) and estimated on the basis of predictive formulas selected by the clinicians [World Health Organization (WHO), Harris-Benedict, Schofield weight, Schofield weight & height, Oxford, Mifflin formulae and a population-specific formula for CP children developed in our preliminary report].

RESULTS: 100 children with SQCP (35 girls, 35%) classified as level V according to gross motor function classification system (GMFCS-V); 64% with oral nutrition, 29% total enteral nutrition (nasogastric tube feeding, percutaneous endoscopic gastrostomy, percutaneous endoscopic transgastric jejunostomy) and 7% mixed nutrition. The median (IQR) REE was 41.96 (17.5) kcal/kg/day.Statistical analysis highlighted a proportional bias between the indirect calorimetry and all considered predictive formulae for REE determination. By studying the relationship between the bias and the mean values of REE, specific conversion equations were obtained. With a pre-specified model having as predictors the variable weight and the variable Triceps Skinfold (TSF) and, as response the variable REE measured by indirect calorimetry, a predictive nomogram was developed to estimate the REE in this population of children.

CONCLUSIONS: We suggest using predictive formulae for healthy children with caution, and where possible carrying out indirect calorimetry to assess REE in children with CP. However, we propose a new tool which could be developed to become an additional help for assessment of REE in the clinical practice.Future objectives will be to obtain a larger sample size, in a multicenter perspective study, to build a specific predictive model for the REE of the studied population.

PMID:37681200 | PMC:PMC10481865 | DOI:10.3389/fped.2023.1097152

Proc Mach Learn Res. 2023 Apr;206:10343-10367.

ABSTRACT

Conditional randomization tests (CRTs) assess whether a variable $x$ is predictive of another variable $y$, having observed covariates $z$. CRTs require fitting a large number of predictive models, which is often computationally intractable. Existing solutions to reduce the cost of CRTs typically split the dataset into a train and test portion, or rely on heuristics for interactions, both of which lead to a loss in power. We propose the decoupled independence test (DIET), an algorithm that avoids both of these issues by leveraging marginal independence statistics to test conditional independence relationships. DIET tests the marginal independence of two random variables: $F_{x\mid z}(x\mid z)$ and $F_{y\mid z}(y\mid z)$ where $F_{\cdot \mid z}(\cdot \mid z)$ is a conditional cumulative distribution function (CDF) for the distribution $p(\cdot \mid z)$. These variables are termed “information residuals.” We give sufficient conditions for DIET to achieve finite sample type-1 error control and power greater than the type-1 error rate. We then prove that when using the mutual information between the information residuals as a test statistic, DIET yields the most powerful conditionally valid test. Finally, we show DIET achieves higher power than other tractable CRTs on several synthetic and real benchmarks.

PMID:37681192 | PMC:PMC10484293

Heliyon. 2023 Aug 28;9(9):e19411. doi: 10.1016/j.heliyon.2023.e19411. eCollection 2023 Sep.

ABSTRACT

The common disorder, Keratoconus (KC), is distinguished by cumulative corneal slimming and steepening. The corneal ring implantation has become a successful surgical procedure to correct the KC patient’s vision. The determination of suitable patients for the surgery alternative is among the paramount concerns of ophthalmologists. To reduce the burden on them and enhance the treatment, this research aims to previse the ocular condition of KC patients after the corneal ring implantation. It focuses on predicting post-surgical corneal topographic indices and visual characteristics. This study applied an efficacious artificial neural network approach to foretell the aforementioned ocular features of KC subjects 6 and 12 months after implanting KeraRing and MyoRing based on the accumulated data. The datasets are composed of sufficient numbers of corneal topographic maps and visual characteristics recorded from KC patients before and after implanting the rings. The visual characteristics under study are uncorrected visual acuity (UCVA), sphere (SPH), astigmatism (Ast), astigmatism orientation (Axe), and best corrected visual acuity (BCVA). In addition, the statistical data of multiple KC subjects were registered, including three effective indices of corneal topography (i.e., Ast, K-reading, and pachymetry) pre- and post-ring embedding. The outcomes represent the contribution of practical training of the introduced models to the estimation of ocular features of KC subjects following the implantation. The corneal topographic indices and visual characteristics were estimated with mean errors of 7.29% and 8.60%, respectively. Further, the errors of 6.82% and 7.65% were respectively realized for the visual characteristics and corneal topographic indices while assessing the predictions by the leave-one-out cross-validation (LOOCV) procedure. The results confirm the great potential of neural networks to guide ophthalmologists in choosing appropriate surgical candidates and their specific intracorneal rings by predicting post-implantation ocular features.

PMID:37681187 | PMC:PMC10480659 | DOI:10.1016/j.heliyon.2023.e19411

Heliyon. 2023 Aug 27;9(9):e19448. doi: 10.1016/j.heliyon.2023.e19448. eCollection 2023 Sep.

ABSTRACT

The aim of this study is to determine the relationships between some potentially toxic elements (PTE) (Cu, Mn, Ni, Zn) in human stomach and intestinal tissues and toxic element contents in soil, vegetables and fruits. This study was conducted in the eastern of Erciyes Strato volcano, an area of 2400 km² in Turkey. Tissue samples taken from the stomach and intestines of people living in the study area, soils, vegetables, and fruits were used as material. In the study, tissue samples of 26 people’s stomach and intestines, 576 soil samples from 192 points and 3 different depths (0-30 cm, 30-60 cm, and 60-90 cm) and vegetable and fruit samples from 137 sampling points were taken. Cu, Mn, Ni, and Zn contents of human tissue samples, soil samples, vegetable and fruit samples were determined. Artificial Neural Networks method (ANN) and Fuzzy Linear Regression Analysis (FLRA) methods were used to determine the relationships between PTE contents in human tissue samples and soils, vegetables, and fruits. Root Mean squared error (RMSE) and coefficient of determination (R²) indices were used as the test criteria for goodness of fit. When compared with ANN method, it was determined that PTE values in stomach and intestinal tissue estimated by FLRA method had the lowest error and high R² values. It was found that the most effective variable in estimating the average PTE value in stomach and intestinal tissue is PTE values in soil. It was determined that the FLRA regression analysis method has a better predictive power than the ANN method. Using FLRA and ANN regression methods, it was determined that there is a statistically high relationship between PTE contents in soils and stomach and intestinal tissues. It is recommended to make the study findings more meaningful with effective and reliable service planning by using different regression analysis methods in ecological and clinical studies.

PMID:37681186 | PMC:PMC10481309 | DOI:10.1016/j.heliyon.2023.e19448

Heliyon. 2023 Aug 21;9(9):e19277. doi: 10.1016/j.heliyon.2023.e19277. eCollection 2023 Sep.

ABSTRACT

There is no uniform regimen for refractory Langerhans cell histiocytosis (LCH). We retrospectively described patients with refractory multisystem and risk organ involvement LCH treated with the low-dose (Ara-c, 100 mg/m²/d × 5day; 2-CDA, 5 mg/m²/d × 5day) chemotherapy (LDC) and the intermediate-dose (Ara-c, 500 mg/m²/d × 5day; 2-CDA, 9 mg/m²/d × 5day) chemotherapy (IDC). 26 patients and 10 patients receiving the LDC and IDC regimen from January 2013 to December 2016 were included in the study. The overall response rate exhibited no significant difference between the LDC and IDC groups after four courses (76.9% vs 90%, P = 0.375) and eight courses (80.8% vs 100%, P = 0.135) of treatment. No statistical differences in the overall survival rate were observed between the two groups, but 5-year event-free survival rate of patients in the IDC group was higher than that in the LDC group at the median follow-up of 6.16 and 5.07 years (88.9% vs 52.9%, P = 0.033). The patients in the IDC group had more severe myelosuppression than those in the LDC group (grade 3/4 myelosuppression, 80% vs 19.2%, P = 0.001). The intermediate-dose regimen of 2CDA and Ara-c had a higher event-free survival rate and a similar overall survival rate compared with the low-dose regimen.

PMID:37681174 | PMC:PMC10481182 | DOI:10.1016/j.heliyon.2023.e19277

Heliyon. 2023 Aug 26;9(9):e19477. doi: 10.1016/j.heliyon.2023.e19477. eCollection 2023 Sep.

ABSTRACT

BACKGROUND: The goal of the present research was to employ CBCT imaging to assess the root and canal anatomy of maxillary second molars in a population from the Hail province of Saudi. The effects of gender and side were taken into account.

METHODS: The investigation included a sample size of 499 completely developed right and left untreated maxillary second molars obtained from 250 Saudi people. The root morphology of each tooth was evaluated. The examination also included an analysis of the canal morphology for each tooth, utilizing Vertucci’s categorization. The effect of genders as well as sides was recorded. Results were analyzed using the Chi-square test.

RESULTS: 464 teeth had three roots (93.0%), whereas 20 teeth (4.0%) had two roots. One root was recorded in 7 (1.4%) of the study sample, whilst 8 (1.6%) had four roots. Although there were no significant differences between the left and right sides (p = .075), gender had a significant influence on the number of roots (p = .030). 240 M (48.1%) had three canal orifices, and 247 (49.5%) had four root canal orifices. Eight molars (1.6%) had two canal orifices, while one and five canal orifices were found in 3 (0.6%) and one (0.2%), respectively. Gender had a significant impact on the number of root canal orifices (p = .039). The observed differences in the orifices of the root canals between the left and right sides were not statistically significant (p = .059). The prevalence of MB2 in maxillary second molars was found to be 49.7%. In the mesiobuccal root, the Vertucci type I configuration had the highest canal frequency (50.3%), followed by the Vertucci types II (14.4%), IV (13.8%), V (12.0%), and III (7.6%), and VI (1.8%). The prevalence of Vertucci type I canal configurations was found to be higher in the distobuccal root (99.4%) and palatal root (98.2%) of maxillary second molars.

CONCLUSIONS: Significant variations in root canal anatomy were observed within the Saudi population. The majority of the subjects from Saudi Arabia in this study exhibited the presence of maxillary second molars with three roots. Approximately half of the sample under investigation exhibited the presence of the four canals.

PMID:37681163 | PMC:PMC10481312 | DOI:10.1016/j.heliyon.2023.e19477

Heliyon. 2023 Aug 19;9(9):e19310. doi: 10.1016/j.heliyon.2023.e19310. eCollection 2023 Sep.

ABSTRACT

A zebra crossing is a form of pedestrian crossing provision point on roads that have significant volumes of traffic. It is one of the safety measures employed to reduce avoidable pedestrian-motorist conflicts and accidents on such roads. In the past several studies have been conducted on the behaviours of road users (pedestrians and motorists) especially on non-signal intersections. Although, various recommendations and solutions have been proffered to the many road-crossing challenges. But there has been little to no change in pedestrians’ perceptions and preferences of zebra crossing. Contemporary researches have tried to rectify this by applying several models to rate the use of pedestrian zebra crossing. This study uses a Regression Model Techniques to analyse factors influencing utilization rate of pedestrian zebra crossing. In this study, 450 samples were collected from 12 locations, covering school, public building, residential and business areas to examine the utilization rate of the zebra crossing by pedestrians. To examine the significance level on the crossing utilization rates by pedestrian at 95% confidence interval, a pedestrian utilization rate (PUR) was acting as the dependent variable and the remaining variables served as the independent variables. The Multiple Linear Regression (MLR) model was also used to determine the utilization rate needed to develop the zebra crossing utilization model. From the findings, the calibrated R2 value was discovered to be at 0.937 and the descriptive statistics of MLR test, t and p-values, were also found within an acceptable range. The result also showed that, out of all the variables which were used, only three have a significant effect on the utilization rates of pedestrian zebra crossing while the remaining variables have an insignificant effect. The study concluded that among the different variables, Guardrail, number of lanes and Width of zebra crossing were the most influential variables. It is believed that the conclusions drawn from this research are expected to be useful to improve the state of pedestrian facilities in Malaysia.

PMID:37681154 | PMC:PMC10480594 | DOI:10.1016/j.heliyon.2023.e19310