Nevin Manimala

Pain Ther. 2023 May 12. doi: 10.1007/s40122-023-00519-9. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aims to evaluate the efficacy of esketamine on postoperative recovery quality after laparoscopic bariatric surgery.

METHODS: Patients (n = 74) scheduled for laparoscopic bariatric surgery were randomly divided into two groups: the esketamine group (group E: 0.5 mg/kg/h infusion, i.e., 0.2 mL/kg/h) or the control group (group C: 0.2 mL/kg/h normal saline infusion). The infusions were stopped 20 min before the end of the procedure. The primary outcome was the Quality of Recovery-40 (QoR-40) score on postoperative day 1 (POD 1). The secondary outcomes included QoR-40 scores on PODs 2 and 7, Numeric Rating Scale (NRS) on PODs 1, 2, and 7, time to extubation, additional postoperative analgesic use, length of hospital stay, and time to first exhaust. Additonally, the safety indices were also recorded, including hemodynamic profile, perioperative anesthesia index (Ai), utilization of vasoactive drugs or urapidil, and side effects.

RESULTS: All in all, 70 of the 74 patients completed the study, 35 in each group. The difference of QoR-40 scores on POD 1 was both statistically and clinically significant [difference 7.21, 95% confidence interval (CI) 5.17, 9.25, p < 0.001]. The difference of QoR-40 on POD 2 was statistically significant but clinically insignificant (difference 4.81, 95% CI 2.69, 6.92, p < 0.001). The difference of NRS scores on POD 1 was statistically significant (difference -1.23, 95% CI -2.36, -0.10, p = 0.033). Compared with group C, group E had a lower utilization rate of phenylephrine and higher Ai values (p < 0.05). There was no statistical difference between the two groups on other measures.

CONCLUSION: Continuous ketamine infusion seems to be safe and well tolerated in laparoscopic bariatric surgery. It improved the quality of postoperative recovery and reduced pain on POD 1. In spite of the increased Ai value during the surgery, it also provided better hemodynamics with less usage of phenylephrine.

PMID:37171754 | DOI:10.1007/s40122-023-00519-9

Environ Sci Pollut Res Int. 2023 May 12. doi: 10.1007/s11356-023-27442-y. Online ahead of print.

ABSTRACT

Globally, as a renewable source of energy, biofuel, wind, solar, and hydro energy have been increasingly valued by a range of businesses. There is no denying the advantages of using renewable energy in terms of preventing climate change and protecting the environment. Therefore, this article investigates the relationship among hydro, solar, biofuel, wind, coal consumption, and CO₂ emissions in 19 G20 member countries between 2000 and 2019. The results of dynamic fixed effects and the system-generalized method of moments suggest that solar energy and biofuel usage have a negative and statistically significant influence on carbon emissions. On the other hand, the impact of wind energy consumption on carbon dioxide emissions is positive and statistically significant. However, hydro energy consumption is statistically insignificant. The significance of this study is to include wind energy, solar energy, and hydro energy as new indicators for a group of 19 G20 member countries. Furthermore, this research paper also includes coal consumption in the existing model to confirm that CO2 emissions may rise if more coal is consumed. Growing the solar-hydro-biofuel-wind industry can reduce nonrenewable energy consumption and has tremendous potential to diminish carbon dioxide emissions.

PMID:37171731 | DOI:10.1007/s11356-023-27442-y

Environ Sci Pollut Res Int. 2023 May 12. doi: 10.1007/s11356-023-27224-6. Online ahead of print.

ABSTRACT

Despite the high importance of coagulation process in drinking water treatment plant (DWTP), challenge remains in effectively linking raw water quality measured at the inlet of the DWTP with coagulant dosage rate. This study proposes an integral modelling framework using hybrid extreme learning machine and Bat metaheuristic algorithm (ELM-Bat) for modelling coagulant dosage rate using water temperature, pH, specific conductance, dissolved oxygen, and water turbidity. The aluminum sulphate (Al₂ (SO₄)₃.18H₂O) coagulant is determined using conventional Jar-Test procedure. Results obtained using the hybrid ELM-Bat were compared to those obtained using standalone ELM, outlier robust extreme learning machine (ORELM), online sequential extreme learning machine (OSELM), optimally pruned extreme learning machine (OPELM), and kernel extreme learning machine (KELM). First, the models have been calibrated during the training stage and in a second stage; they are validated using various statistical metrics, i.e., RMSE, MAE, the correlation coefficient (R), and the Nash-Sutcliffe model efficiency (NSE). We found that the hybrid ELM-Bat was significantly more accurate and it has yielded accuracy higher than all other models. During the validation stage, the R and NSE values calculated using the ELM-Bat were ≈0.959 and ≈0.918 exhibiting an improvement rates of approximately (≈15.26% and ≈33.82%), (≈10.35% and ≈21.92%), (≈14.98% and ≈31.89%), (≈7.63% and ≈16.35%), (≈10.99% and ≈23.05%), compared to the values obtained using the ELM, OPELM, OSELM, KELM and ORELM, respectively. Besides, the new ELM-Bat model has shown to have high predictive capabilities, which can be used optimally for calculating the optimal coagulant dosage with high accuracy.

PMID:37171728 | DOI:10.1007/s11356-023-27224-6

Invest New Drugs. 2023 May 12. doi: 10.1007/s10637-023-01351-w. Online ahead of print.

ABSTRACT

Talazoparib, a poly(ADP-ribose) polymerase inhibitor, has demonstrated efficacy in the treatment of advanced breast and prostate cancers in Western populations. This open-label, phase 1 study investigated the pharmacokinetics, safety, and antitumor activity of talazoparib monotherapy in Chinese patients with advanced solid tumors. Molecularly unselected patients (≥18 years) with advanced solid tumors resistant to standard therapy received talazoparib (oral, 1 mg once daily). Primary endpoint was characterization of single-dose and steady-state pharmacokinetics. Secondary endpoints evaluated safety, unconfirmed objective response rate (ORR), and duration of response. The safety population comprised 15 Chinese patients (median [range] age 53.0 [31.0-72.0] years). Single-dose median time to first occurrence of maximum observed concentration was 1.9 h; concentrations then declined with a mean terminal half-life (t_1/2) of 67 h. Following multiple dosing, median T_max was approximately 1.85 h with steady state generally achieved by Day 21. Treatment-related treatment-emergent adverse events (TEAEs) occurred in 86.7% (13/15) of patients (grade 3, 20.0%; grade 4, 13.3%). Two patients (13.3%) experienced serious treatment-related TEAEs. ORR (investigator-assessed) was 6.7% (95% CI: 0.2-31.9); one patient (6.7%) had a partial response. In patients with measurable disease at baseline, the ORR was 9.1% (1/11; 95% CI: 0.2-41.3; duration of response: 114 days); stable disease was achieved by 36.4% (4/11) of patients, and 54.5% (6/11) progressed by data cut-off. In Chinese patients with advanced solid tumors, the pharmacokinetic profile of talazoparib monotherapy (1 mg/day) was consistent with other patient populations. TEAEs were generally manageable with no unexpected safety findings. (ClinicalTrials.gov: NCT04635631 [prospectively registered November 19, 2020]).

PMID:37171721 | DOI:10.1007/s10637-023-01351-w

J Neurooncol. 2023 May 12. doi: 10.1007/s11060-023-04328-0. Online ahead of print.

ABSTRACT

BACKGROUND: The HIT-SKK protocol is used for low/standard-risk medulloblastomas in young children with the aim to eliminate cranial irradiation and its neuropsychological (NP) sequelae. This therapy includes IV and intraventricular (ITV) methotrexate (MTX) potentially responsible for leukoencephalopathy (LE) and neurocognitive disorders. This study describes the risk factors and course of LE, and investigates its correlation with neurocognitive impact.

METHODS: A retrospective, multicenter study was conducted in 35 children under 5 years old, with a median follow-up of 72 months (range 14 to 130). The main analysis was performed in 30 patients who received cumulative doses of MTX as per-protocol (group 1). Five patients who received higher cumulative doses of MTX were analyzed separately. All follow-up MRIs and NP assessments were centrally reviewed by experts.

RESULTS: Twenty patients in group 1 developed LE, grade 2 and 3 abnormalities did not correlate with higher cumulative doses of ITV-MTX (p = 0.698). Considering the most recent NP evaluation, the Full-Scale IQ (FSIQ) and Wechsler indices were in the average to lower average range. The FSIQ was deficient in 6/17 evaluable patients. Cumulative dose of ITV-MTX was almost associated with decreased processing speed competence (p = 0.055) which was the most frequently impaired neurocognitive domain. Neuropsychological assessment scores were not statistically lower in patients with persistent grade 2 LE at the end of follow-up.

CONCLUSION: This study described that the use of cumulative dose of MTX (IV and ITV) according to the HIT-SKK protocol resulted in LE that tented to decrease over time, without significant correlation with a decline in neuro-intellectual skills.

PMID:37171700 | DOI:10.1007/s11060-023-04328-0

Eur J Nucl Med Mol Imaging. 2023 May 12. doi: 10.1007/s00259-023-06240-1. Online ahead of print.

ABSTRACT

PURPOSE: To introduce a biomarker-based dosimetry method for the rational selection of a treatment activity for patients undergoing radioactive iodine ¹³¹I therapy (RAI) for metastatic differentiated thyroid cancer (mDTC) based on single-timepoint imaging of individual lesion uptake by ¹²⁴I PET.

METHODS: Patients referred for RAI therapy of mDTC were enrolled in institutionally approved protocols. A total of 208 mDTC lesions (in 21 patients) with SUV_max > 1 underwent quantitative PET scans at 24, 48, 72, and 120 h post-administration of 222 MBq of theranostic NaI-¹²⁴I to determine the individual lesion radiation-absorbed dose. Using a general estimating equation, a prediction curve for biomarker development was generated in the form of a best-fit regression line and 95% prediction interval, correlating individual predicted lesion radiation dose metrics, with candidate biomarkers (“predictors”) such as SUV_max and activity in microcurie per gram, from a single imaging timepoint.

RESULTS: In the 169 lesions (in 15 patients) that received ¹³¹I therapy, individual lesion cGy varied over 3 logs with a median of 22,000 cGy, confirming wide heterogeneity of lesion radiation dose. Initial findings from the prediction curve on all 208 lesions confirmed that a 48-h SUV_max was the best predictor of lesion radiation dose and permitted calculation of the ¹³¹I activity required to achieve a lesional threshold radiation dose (2000 cGy) within defined confidence intervals.

CONCLUSIONS: Based on MIRD lesion-absorbed dose estimates and regression statistics, we report on the feasibility of a new single-timepoint ¹²⁴I-PET-based dosimetry biomarker for RAI in patients with mDTC. The approach provides clinicians with a tool to select personalized (precision) therapeutic administration of radioactivity (MBq) to achieve a desired target lesion-absorbed dose (cGy) for selected index lesions based on a single 48-h measurement ¹²⁴I-PET image, provided the selected activity does not exceed the maximum tolerated activity (MTA) of < 2 Gy to blood, as is standard of care at Memorial Sloan Kettering Cancer Center.

TRIAL REGISTRATION: NCT04462471, Registered July 8, 2020. NCT03647358, Registered Aug 27, 2018.

PMID:37171634 | DOI:10.1007/s00259-023-06240-1

J Med Syst. 2023 May 12;47(1):62. doi: 10.1007/s10916-023-01947-y.

ABSTRACT

We aimed to assess the feasibility of developing three-dimensional (3D) models of pelvic organs using cross-sectional MRI images of patients with uterine fibroids and urinary symptoms and of obtaining anatomical information unavailable in 2D imaging modalities. We also aimed to compare two image processing applications. We performed a feasibility study analysing MRI scans from three women, aged 30 to 58 years old, with fibroids and urinary symptoms. Cross-sectional images were used to render 3D models of pelvic anatomy, including bladder, uterus and fibroids, using 3D Slicer and OsiriX. Dimensions, volumes and anatomical relationships of the pelvic organs were evaluated. Comparisons between anatomical landmarks and measurements obtained from the two image processing applications were undertaken. Rendered 3D pelvic models yielded detailed anatomical information and data on spatial relationships that were unobtainable from cross-sectional images. Models were rendered in sufficient resolution to aid understanding of spatial relationships between urinary bladder, uterus and fibroid(s). Measurements of fibroid volumes ranged from 5,336 to 418,012 mm³ and distances between the fibroid and urinary bladder ranged from 0.10 to 83.60 mm. Statistical analysis of measurements showed no significant differences in measurements between the two image processing applications. To date, limited data exist on the use of 3D volume reconstructions of routine MRI scans, to investigate pelvic pathologies such as fibroids in women with urinary symptoms. This study suggests that post-MRI image processing can provide additional information over standard MRI. Further studies are required to assess the role of these data in clinical practice, surgical planning and training. Three-dimensional reconstruction of routine two-dimensional magnetic resonance imaging provides additional anatomical information and may improve our understanding of anatomical relationships, their role in clinical presentations and possibly guide clinical and surgical management.

PMID:37171621 | DOI:10.1007/s10916-023-01947-y

Allergol Immunopathol (Madr). 2023 May 1;51(3):117-123. doi: 10.15586/aei.v51i3.820. eCollection 2023.

ABSTRACT

BACKGROUND: Urticaria is a common disorder, estimated to affect 2.1 to 6.7% of children and adolescents, and is a frequent cause of emergency department (ED) admissions.

METHODS: The aim of this study was to retrospectively characterize the clinical features of children and adolescents with a diagnosis of urticaria, evaluated in a tertiary care pediatric ED between 2015 and 2019. Statistical analysis was performed using IBM SPSS Statistics^®, version 27.0.

RESULTS: A total of 2254 episodes of urticaria were counted with 98.1% corresponding to acute urticaria (AU). A suspected trigger factor was identified in 51.6% of the episodes, namely infections (27.8%), drugs (9.9%) and food (7.6%). From these episodes, excluding infections, only 59.2% were referred to an Allergy Consultation for further study, with only 18.8% (drug) and 28.3% (food) confirmed as the AU trigger. Of the 43 episodes of chronic urticaria (CU), 79% were referred to consultation, with 23 being diagnosed with chronic spontaneous urticaria, 8 with inducible urticaria and 3 with both entities. Older age (p < 0.001), personal history of atopy (p = 0.019) and angioedema (p = 0.003) were factors associated with CU, while the presence of other accompanying symptoms (p = 0.007) was associated with AU. Older age (OR = 1.2; p < 0.001) and the presence of angioedema (OR = 2.7; p = 0.007) were identified as independent factors for CU.

CONCLUSION: The majority of episodes corresponded to AU. Infections were the main suspected trigger, followed by drugs and food, with an overall confirmation rate ranging from 18 to 30%, highlighting the importance of an allergologic follow-up evaluation.

PMID:37169569 | DOI:10.15586/aei.v51i3.820

Allergol Immunopathol (Madr). 2023 May 1;51(3):80-84. doi: 10.15586/aei.v51i3.790. eCollection 2023.

ABSTRACT

Lipid transfer protein (LTP) syndrome is an increasingly prevailing disease, especially in the young population, with severely affected quality of life. Since 2013, a specific treatment, called sublingual immunotherapy (SLIT), with peach extract (SLIT-peach^®) has been used, but with no long-term effectiveness studies. The main objective of the present study was to assess the long-term effectiveness of SLIT-peach^® and to relate the clinical evolution of patients. This was an ambispective study conducted for 3 years. A total of 25 patients with LTP syndrome were selected and treated with SLIT-peach^®. They underwent a provocation test in the first year with reintroduced foods that had produced symptoms in the past. Analytical determination of specific immunoglobulin E (IgE) and immunoglobulin G4 (IgG4) to peach (Pru p 3) was performed at the beginning of treatment, at the first year of initiation, and at the end of treatment. These data were compared with the control group comprising 14 patients with LTP syndrome without treatment. A statistically significant decrease in specific IgE to Pru p 3 at the end of the treatment and an increase in specific IgG4 to Pru p 3 1 year after treatment initiation were observed in the active group in relation to tolerance to foods with LTPs. These results indicate that food tolerance begins after the first year and is maintained after the end of 3 years of treatment. In conclusion, treatment with SLIT-peach^® for 3 years is effective for patients with LTP syndrome, preventing the evolution of the disease, allowing patients to restart a diet with plant foods, and improving their quality of life.

PMID:37169563 | DOI:10.15586/aei.v51i3.790

AJNR Am J Neuroradiol. 2023 May 11. doi: 10.3174/ajnr.A7865. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Surgical clipping and endovascular treatment are commonly used in patients with unruptured intracranial aneurysms. We compared the safety and efficacy of the 2 treatments in a randomized trial.

MATERIALS AND METHODS: Clipping or endovascular treatments were randomly allocated to patients with one or more 3- to 25-mm unruptured intracranial aneurysms judged treatable both ways by participating physicians. The study hypothesized that clipping would decrease the incidence of treatment failure from 13% to 4%, a composite primary outcome defined as failure of aneurysm occlusion, intracranial hemorrhage during follow-up, or residual aneurysms at 1 year, as adjudicated by a core lab. Safety outcomes included new neurologic deficits following treatment, hospitalization of >5 days, and overall morbidity and mortality (mRS > 2) at 1 year. There was no blinding.

RESULTS: Two hundred ninety-one patients were enrolled from 2010 to 2020 in 7 centers. The 1-year primary outcome, ascertainable in 290/291 (99%) patients, was reached in 13/142 (9%; 95% CI, 5%-15%) patients allocated to surgery and in 28/148 (19%; 95% CI, 13%-26%) patients allocated to endovascular treatments (relative risk: 2.07; 95% CI, 1.12-3.83; P = .021). Morbidity and mortality (mRS >2) at 1 year occurred in 3/143 and 3/148 (2%; 95% CI, 1%-6%) patients allocated to surgery and endovascular treatments, respectively. Neurologic deficits (32/143, 22%; 95% CI, 16%-30% versus 19/148, 12%; 95% CI, 8%-19%; relative risk: 1.74; 95% CI, 1.04-2.92; P = .04) and hospitalizations beyond 5 days (69/143, 48%; 95% CI, 40%-56% versus 12/148, 8%; 95% CI, 5%-14%; relative risk: 0.18; 95% CI, 0.11-0.31; P < .001) were more frequent after surgery.

CONCLUSIONS: Surgical clipping is more effective than endovascular treatment of unruptured intracranial aneurysms in terms of the frequency of the primary outcome of treatment failure. Results were mainly driven by angiographic results at 1 year.

PMID:37169541 | DOI:10.3174/ajnr.A7865