Nevin Manimala

Eur Radiol. 2023 Feb 1. doi: 10.1007/s00330-023-09393-7. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the clinical value of contrast-enhanced ultrasound (CEUS) with time-intensity curve (TIC) in distinguishing different types of hypovascular solid pancreatic lesions.

METHODS: A total of 89 patients with 90 pancreatic lesions (all confirmed by surgery or biopsy pathology) that manifested hypoenhancement on contrast-enhanced ultrasound (CEUS) were included in this study. Six peak enhancement patterns were proposed for differentiating hypovascular pancreatic lesions. CEUS qualitative and TIC-based quantitative parameters were analyzed, and each lesion was scored based on the statistically significant qualitative parameters to evaluate the diagnostic ability of CEUS for hypovascular solid pancreatic lesions.

RESULTS: Qualitative parameters such as peak enhancement pattern II/III/IV, penetrating vessels, centripetal enhancement, and early washout were reliable indicators of malignant lesions, and lesions scored based on these qualitative parameters, with a score ≥ 2, were highly suspected to be malignant lesions. Pattern I had an accuracy of 83.33% for predicting mass-forming pancreatitis (MFP), pattern V had an accuracy of 96.67% for predicting solid pseudopapillary tumors of the pancreas (SPTP), and pattern VI had an accuracy of 81.11% for predicting neuroendocrine tumors/carcinomas (NETs/NECs). For quantitative analysis, nodule/pancreatic parenchyma echo intensity reduction ratio was significantly greater in malignant lesions.

CONCLUSIONS: CEUS qualitative and TIC-based quantitative parameters have clinical value in distinguishing malignant from benign hypovascular pancreatic lesions.

KEY POINTS: • Contrast-enhanced ultrasound helps clinicians assess patients with pancreatic lesions. • Six peak enhancement patterns are proposed for differentiating pancreatic hypovascular lesions. • Qualitative parameters such as peak enhancement pattern II/III/IV, penetrating vessels, centripetal enhancement, early washout, and quantitative parameter nodule/pancreatic parenchyma echo intensity reduction ratio were important characteristics to discriminate malignant from hypovascular benign lesions.

PMID:36725721 | DOI:10.1007/s00330-023-09393-7

J Ocul Pharmacol Ther. 2023 Feb 1. doi: 10.1089/jop.2022.0102. Online ahead of print.

ABSTRACT

Purpose: To investigate the characteristics of sustained drug release systems established by an arginine-glycine-aspartic acid (RGD) peptide hydrogel and mitomycin C (MMC) in vitro, and verify their antiscar effects in rat ocular injury model. Methods: Low, medium, and high loading doses of MMC were added to 5 mL 0.25%, 0.5%, and 1% wt RGD peptide hydrogel, respectively, to prepare 9 ratios of MMC-RGD systems. Drug release characteristics of the systems in phosphate-buffered saline solution were investigated by plotting the drug release curves and fitting them with mathematical models in OriginPro8.0 software. Appropriate ratios of MMC-RGD systems were selected as treatment in rat ocular injury model. Scar formation was observed by Masson staining and immunohistochemical staining with alpha-smooth muscle actin (α-SMA) and fibronectin (FN). Results: Nine ratios of MMC-RGD systems could release drug slowly. The maximum drug release proportions of all systems were >80%, and the time to maximum release proportions statistically prolonged with the increase of drug loading. Fitting with mathematical models indicated that the mechanisms of drug release were mainly Fick diffusion at early stage and Anomalous Transport at later stage. Systems of 1% wt RGD hydrogel were evaluated in animal experiments, which could inhibit hyperplasia of collagen and expression of α-SMA and FN. Conclusions: The RGD peptide hydrogel could be used as the carrier of MMC to establish sustained drug release system, which could inhibit scar formation after rat’s ocular injury.

PMID:36724493 | DOI:10.1089/jop.2022.0102

Am Nat. 2023 Feb;201(2):287-301. doi: 10.1086/722504. Epub 2023 Jan 4.

ABSTRACT

AbstractTerrestrial mammals span seven orders of magnitude in body size, ranging from the <2-g Etruscan pygmy shrew (Suncus etruscus) to the >3,900-kg African elephant (Loxodonta africana). Although body size profoundly affects the behavior, physiology, ecology, and evolution of species, how investment in functional immune defenses changes with body size across species is unknown. Here, we (1) developed a novel 12-point dilution curve approach to describe and compare antibacterial capacity against three bacterial species among >160 terrestrial species of mammals and (2) tested published predictions about the scaling of immune defenses. Our study focused on the safety factor hypothesis, which predicts that broad, early-acting immune defenses should scale hypermetrically with body mass. However, our three statistical approaches demonstrated that antibacterial activity in sera across mammals exhibits isometry; killing capacity did not change with body size across species. Intriguingly, this result indicates that the serum of a large mammal is less hospitable to bacteria than would be predicted by its metabolic rates. In other words, if metabolic rates underlie the rates of physiological reactions as postulated by the metabolic theory of ecology, large species should have disproportionately lower antibacterial capacity than small species, but they do not. These results have direct implications for effectively modeling the evolution of immune defenses and identifying potential reservoir hosts of pathogens.

PMID:36724463 | DOI:10.1086/722504

Facts Views Vis Obgyn. 2022 Dec;14(4):309-315. doi: 10.52054/FVVO.14.4.043.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has had a significant effect on healthcare services, particularly affecting patients who suffer from chronic conditions. However, the pandemic’s effect on endometriosis surgery is not yet known.

OBJECTIVES: To determine the impact of the COVID-19 pandemic on surgery for severe endometriosis in the UK at a national, regional and centre-level.

MATERIALS AND METHODS: The British Society for Gynaecological Endoscopy (BSGE) collects data nationally on all operations for severe endometriosis which involve dissection of the pararectal space. Annual audits of this database were obtained from the BSGE. Publicly available data on COVID-19 cases and population were obtained from the UK Office for National Statistics.

MAIN OUTCOME MEASURES: Numbers of annual BSGE-registered endometriosis operations.

RESULTS: A total of 8204 operations were performed. The number of operations decreased by 49.4% between 2019 and 2020 and then increased in 2021, but remained 10.5% below average pre-pandemic levels, indicating at least 980 missed operations between 2019-2020. Median operations per centre decreased by 51.0% in 2020 (IQR 29.4% – 75.0%) and increased in 2021 but remained 33% below pre-pandemic levels. There was no change in the type of surgery performed. All 11 administrative regions of Great Britain had reduced numbers of operations in 2020 compared with the average for 2017-2019, with a median 44.2% decrease (range 13.3% – 67.5%). Regional reduction in operations was correlated with COVID-19 infection rates (r=0.54, 95% CI of r 0.022 – 1.00, p=0.043).

CONCLUSION: The number of operations performed annually in the UK for severe endometriosis fell dramatically during the COVID-19 pandemic and is yet to normalise.

WHAT’S NEW?: This study shows the dramatic effect that the COVID-19 pandemic has had on UK services for endometriosis surgery, which may continue to affect patients and clinicians for a considerable time to come.

PMID:36724422 | DOI:10.52054/FVVO.14.4.043

JCO Clin Cancer Inform. 2023 Jan;7:e2200099. doi: 10.1200/CCI.22.00099.

ABSTRACT

PURPOSE: Arkansas is one of only four known states that have linked All-Payer Claims Database (APCD) to state’s cancer registry (Arkansas Cancer Registry [ACR]). We evaluated the reporting consistency of radiation therapy (RT) between the two sources.

METHODS: Women age ≥ 18 years diagnosed in 2013-2017 with early-stage hormone receptor-positive breast cancer who received breast-conserving surgery were identified. Patients must have continuous insurance coverage (any private plans, Medicaid, and Medicare) in the 13 months (month of diagnosis and 12 months after). Receipt of RT was identified independently from ACR and APCD. We calculated sensitivity, specificity, positive predictive value, and negative predictive value for receipt of RT coded by the registry compared with APCD billing claims as the gold standard. We assessed the degree of concordance between the data sources by Cohen’s kappa statistics.

RESULTS: The final sample included 2,695 patients who were in both databases and satisfied our inclusion/exclusion criteria. Using APCD as the gold standard, there were high sensitivity (88.1%) and positive predictive value (87.7%) and moderate specificity (71.1%) and negative predictive value (71.8%). The overall agreement between the two sources was 83.0%, with a kappa statistic of 0.59 (95% CI, 0.56 to 0.63). Consistency measures varied by age, stage, and insurance type with Medicare fee-for-service coverage only having the best and private insurance only the worse consistency.

CONCLUSION: In patients with early-stage hormone receptor-positive breast cancer who received breast-conserving surgery, recording of RT receipt was moderately consistent between Arkansas APCD and ACR. Future studies are needed to identify factors affecting reporting consistency to better use this unique resource in addressing population health problems.

PMID:36724402 | DOI:10.1200/CCI.22.00099

Int Tinnitus J. 2022 Dec 1;26(2):143-146. doi: 10.5935/0946-5448.20220023.

ABSTRACT

The present study compared the Auditory Brainstem Response (ABR) of children with thalassemia major and typically developing children. A total of 16 children participated in this study. Group I included 8 children with thalassemia major regularly undergoing blood transfusions and chelating therapy. Group II included 8 age and gender-matched typically developing children. All children in both groups had hearing sensitivity within normal limits. The Auditory Brainstem Response (ABR) was recorded monaurally for click stimuli from both ears. Results showed that the mean latencies of peaks of ABR were similar in both groups. The mean peak amplitude of peaks I and V of the ABR were different between groups, but it was not statistically significant. The present study showed no abnormality in the latency and amplitude of peaks of the ABR in children with thalassemia major with hearing sensitivity within normal limits.

PMID:36724364 | DOI:10.5935/0946-5448.20220023

Int Tinnitus J. 2022 Dec 1;26(2):133-138. doi: 10.5935/0946-5448.20220021.

ABSTRACT

PURPOSE: The purpose of the present study is to find the functions of vestibular reflexes in individuals’ with normal hearing and tinnitus, to identify vestibular dysfunctions earlier, and helps with the management of the same.

METHOD: The present study aimed to administer cVEMP and oVEMP to all the participants having a normal hearing with tinnitus (experimental group) and without tinnitus (Control group) and compared p13, n23 latencies and peak-to-peak amplitude of cVEMP; n10, p15 latencies of oVEMP and peak-to-peak amplitude between two groups and within tinnitus group.

RESULTS: The present study stated that there is no statistically significant difference seen in cVEMP except n23 latency of bilateral tinnitus than control group. However, there is statistically significant difference in left ear p15 latency, left ear peak-to-peak amplitude, bilateral peak-to-peak amplitude between the two groups and Right Vs Left ear peak-to-peak amplitude in within the tinnitus group was seen in oVEMP. T-test was used to compare the latencies of p13, n23, and peak-to-peak amplitude of cVEMP and n10, p15 latencies and peak-to-peak amplitude of oVEMP between the experimental and control group and within the tinnitus group.

CONCLUSION: There is no significant difference seen in cVEMP except n23 latency of bilateral tinnitus than control group and However, there is statistically significant difference in left ear p15 latency, left ear peak-to-peak amplitude, bilateral peak-to-peak amplitude between the two groups and Right Vs Left ear peak-to-peak amplitude in within the tinnitus group was seen in oVEMP and the current study concluded that the significant results with several parameters and no significant results with other parameters in cVEMP and oVEMP recording might be Presymptomatic tinnitus is regarded to occur in ears with normal hearing and abnormal VEMP, while asymptomatic tinnitus may occur in ears with normal VEMP. Tinnitus may be the first signs of secondary or delayed endolymphatic hydrops. If this is demonstrated to be accurate, we should anticipate that such patients will gradually develop other endolymphatic hydrops symptoms like SNHL and clinical vestibular dysfunction.

PMID:36724362 | DOI:10.5935/0946-5448.20220021

Int Tinnitus J. 2022 Dec 1;26(2):122-126. doi: 10.5935/0946-5448.20220019.

ABSTRACT

BACKGROUND: There is many civilians and soldiers who exposed to explosions in Iraq each month and they need an otolaryngological and audiological assessment.

OBJECTIVE: To recognize the possible auditory insults and the recovery period of the acquired damages that may resulted from explosion and help for planning of optimal management strategies of otological manifestations and prevent undesirable consequences.

PATIENTS AND METHODS: A prospective, descriptive study included forty-seven patients who were exposed to blast injuries within two weeks came to otolaryngology unit in Basrah Teaching Hospital complaining from otological symptoms from July 2017 tell January 2019. Three periodic assessments were done for each patient. An initial evaluation was done in the 1st visit included a detailed history and examination to evaluate the symptoms and assess the associated non-otological injury. An otological examination were done for all patients in the three visits, included microscopic ear examination, photos for the perforated tympanic membrane were taken to grade the perforations depending on their surface area, Pure tone audiometry and tympanometry. Thirty-eight patients were available to follow up in the 2nd and 3rd visits.

RESULTS: All of the 47 patients were young and middle age male, hearing loss and tinnitus were the most presenting symptoms, which improved with time. Hearing impairment mostly in the high frequencies however there was improvement in the subsequent visits. The majority of patients (93.6%) presented with tympanic membrane perforation mostly grade I which usually healed spontaneously. There was a statistically significant associations between the degree of tympanic membrane perforation and associated nonotological injuries and with the explosions if occurred in closed space.

CONCLUSION: Blast related otological injury constitute the main cause of morbidity as the ear is the most sensitive organ to explosive blast injury. Hearing loss was the dominant symptoms at presentation mainly in high frequencies, but fortunately most of patients improved with time. Tympanic membrane perforation constituted the mostly seen sign, however spontaneous healing can be expected in the majority of cases.

PMID:36724360 | DOI:10.5935/0946-5448.20220019

Int Tinnitus J. 2022 Dec 1;26(2):101-106. doi: 10.5935/0946-5448.20220015.

ABSTRACT

INTRODUCTION: Cochlear Implantation (CI) surgery has long been used as an effective treatment for children with bilateral profound sensorineural hearing loss who failed to benefit from the use of hearing aids. Among other factors, the age at which implantation is done is thought to have an effect on the speech progression outcome of patients postoperatively.

OBJECTIVES: The Jordanian CI Program has limited resources, and Jordan has an underdeveloped early screening and intervention program for deafness. In this study, we aimed to explore the effect of age at time of implantation on receptive and expressive language outcomes in Jordan, to guide funding and focus efforts on patient groups who would benefit most, thus reducing unnecessary longterm morbidity and disability, and improving cost efficiency.

METHODS: Data was gathered from all major sectors in Jordan on patients who underwent CI from 2006 to 2018 (a total of 1815 patients). We compared the language outcome 2 to 4 years after implantation for patients aged below 3 years, 3 to under 6, 6 to under 9 years, and 9 and older at the time of implantation.

RESULTS AND CONCLUSION: We found a statistically significant difference in language outcomes between patients aged below 6 years vs those 6 and older, with better receptive and expressive language outcomes in the younger age groups.

PMID:36724356 | DOI:10.5935/0946-5448.20220015

Int Tinnitus J. 2022 Dec 1;26(2):79-88. doi: 10.5935/0946-5448.20220012.

ABSTRACT

OBJECTIVES: To examine the differences in auditory evoked cortical responses that may underlie the tendency of some people to perceive tinnitus. The study hypothesis is that the mean ALR and P300 amplitudes in normal hearing adults who perceive temporary tinnitus after exposure to sustained silence will be larger than the mean ALR and P300 amplitudes in normal hearing adults who do not perceive temporary tinnitus after exposure to sustained silence.

DESIGN: This was a prospective cross-sectional study. The approval for the study was obtained from the IRB and COVID ramp up committee of University of North Carolina Greensboro (UNCG). Participants completed comprehensive hearing screening and preand postsilence ALR and P300 recordings were obtained. After the first ALR/P300 recording participants were exposed to ten minutes of silence. Participants completed a Qualtrics questionnaire to report any tinnitus perception that emerged during silence exposure. Absolute N1, P2 and P300 waveform amplitudes and latencies were identified and were entered into an SPSS spreadsheet for data analysis.

RESULTS: Thirty adult females with normal pure tone hearing thresholds and no history of persistent tinnitus were included in the study. The mean age of the participants was 22.5 ± 3.9 years. When exposed to silence, eight (26.7%) participants perceived temporary tinnitus. N1 and P300 waveforms were smaller in amplitude and faster in latency in the tinnitus perception group; however, the ALR and P300 waveform latencies and amplitudes did not statistically differ significantly between the participants who perceived temporary tinnitus in silence and those who did not (p>0.05). The difference in waveform morphology between the tinnitus perception group and the non-tinnitus perception group revealed a greater difference in P300 amplitude after exposure to silence.

CONCLUSION: Differences in ALR and P300 latencies and amplitudes were observed between the tinnitus perception group and non-tinnitus perception group, with smaller P300 amplitudes appearing in the group perceiving tinnitus. While the results did not statistically significant, this pattern may reflect a mismatch between the neuronal response in the auditory cortex (N1 and P2 amplitudes and latencies) and the neuronal activity in the modulatory network regions (P300).

PMID:36724353 | DOI:10.5935/0946-5448.20220012