Nevin Manimala

Mod Pathol. 2023 Jan 11;36(4):100100. doi: 10.1016/j.modpat.2023.100100. Online ahead of print.

ABSTRACT

TP53 mutation is associated with primary endocrine resistance in luminal breast cancer (BC). Nuclear accumulation of p53, as determined by immunohistochemistry (IHC), is a surrogate marker for TP53 mutation. The immunohistochemical p53 index that defines a p53-positive status is not well established. This study determined the optimal p53 index cutoff to identify luminal BCs harboring TP53 mutations. In total, 364 luminal BCs from the West German Study Group ADAPT trial (NCT01779206) were analyzed for TP53 mutations by next-generation sequencing and for p53 expression by IHC (DO-7 antibody). P53 indices were determined by automated image analysis. All tumors were from patients treated with short-term preoperative endocrine therapy (pET; tamoxifen or aromatase inhibitor) before tumor resection. IHC evaluation included needle biopsies before therapy (baseline) and resections specimens after therapy (post-pET). Optimal p53 index cutoffs were defined with Youden statistics. TP53 mutations were detected in 16.3% of BC cases. The median p53 indices were significantly higher in TP53-mutated BCs compared to BCs harboring wild-type TP53 (baseline: 47.0% vs 6.4%, P < .001; post-pET: 50.1% vs 1.1%, P < .001). Short-term pET decreased p53 indices in BCs harboring wild-type TP53 (P < .001) but not in TP53-mutated BCs (P = .102). For baseline biopsies, the optimal p53 index cutoff was ≥34.6% (specificity 0.92, sensitivity 0.63, Youden index 0.54, accuracy: 0.87). For post-pET specimens, the optimal cutoff was ≥25.3% (specificity 0.95, sensitivity 0.65, Youden index 0.60, accuracy: 0.90). Using these cutoffs to define the p53 status, p53-positive BCs were >2-fold more common in pET nonresponders compared to pET responders (baseline: 37/162, 22.8% vs 18/162, 11.1%, P = .007; post-pET: 36/179, 20.1% vs 16/179, 8.9%, P = .004). In summary, IHC for p53 identifies TP53-mutated luminal BCs with high specificity and accuracy. Optimal cutoffs are ≥35% and ≥25% for treatment-naïve and endocrine-pretreated patients, respectively.

PMID:36788081 | DOI:10.1016/j.modpat.2023.100100

Mod Pathol. 2023 Jan;36(1):100037. doi: 10.1016/j.modpat.2022.100037.

NO ABSTRACT

PMID:36788072 | DOI:10.1016/j.modpat.2022.100037

Physiol Meas. 2023 Feb 14. doi: 10.1088/1361-6579/acbc07. Online ahead of print.

ABSTRACT

Assessment of heartbeat dynamics provides a promising framework for non-invasive monitoring of cardiovascular and autonomic states. Nevertheless, the non-specificity of such measurements among clinical populations and healthy conditions associated with different autonomic states severely limits their applicability and exploitation in naturalistic conditions. This limitation arises specially when pathological or postural change-related sympathetic hyperactivity is compared to autonomic changes across age and experimental conditions. In this frame, we investigate the intrinsic irregularity and complexity of cardiac sympathetic and vagal activity series in different populations, which are associated with different cardiac autonomic dynamics. Sample entropy, fuzzy entropy, and distribution entropy are calculated on the recently proposed sympathetic and parasympathetic activity indices (SAI and PAI) series, which are derived from publicly available heartbeat series of congestive heart failure patients, elderly and young subjects watching a movie in the supine position, and healthy subjects undergoing slow postural changes. Results show statistically significant differences between pathological/old subjects and young subjects in the resting state and during slow tilt, with interesting trends in SAI- and PAI-related entropy values. Moreover, while CHF patients and healthy subjects in upright position show the higher cardiac sympathetic activity, elderly and young subjects in resting state showed higher vagal activity. We conclude that quantification of intrinsic cardiac complexity from sympathetic and vagal dynamics may provide new physiology insights and improve on the non-specificity of heartbeat-derived biomarkers.

PMID:36787644 | DOI:10.1088/1361-6579/acbc07

Addiction. 2023 Feb 14. doi: 10.1111/add.16167. Online ahead of print.

ABSTRACT

AIMS: To estimate the efficacy of multiple psychosocial interventions for opioid dependent persons receiving methadone maintenance treatment (MMT).

METHODS: Systematic review and network meta-analysis of randomized controlled trials (RCTs) reporting the effect of psychosocial intervention for opioid dependent persons receiving MMT in outpatient clinics. We searched multiple data sources (Medline, Embase, Web of Science, PsycINFO and Cochrane Library) from inception to January 2022, finding 21 RCTs evaluating a total of 2862 persons with opioid dependence receiving MMT. The primary outcome was the opioid positive rate (assessed by urinalysis) and the secondary outcome was treatment discontinuation (the number of patients who terminated the study for any reason). We performed random effects Bayesian meta-analysis. We used relative ranking using surface under the cumulative ranking method and certainty of evidence using grading of recommendations, assessment, development, and evaluations.

RESULTS: Cognitive-behavioral therapy (CBT) [Odds Ratio (OR): 0.66, 95% Credibility Interval (CI): 0.66 to 0.96; low certainty] and educational and behavioral counseling (EBC) (OR: 0.28, 95% CI: 0.12 to 0.25; high certainty) were more effective than treatment as usual (TAU) in efficacy. In terms of treatment discontinuation, at the end of the follow-up period there was no statistical significance among psychosocial interventions. According to the ranking probabilities, EBC might be the best treatment in terms of efficacy and behavioral couple therapy (BCT) might be the best treatment in terms of treatment discontinuation.

CONCLUSIONS: Educational and behavioral counseling and cognitive-behavioral therapy appear to be the most effective psychosocial interventions for opioid dependent persons receiving methadone maintenance treatment.

PMID:36787637 | DOI:10.1111/add.16167

Cir Cir. 2023;91(1):28-33. doi: 10.24875/CIRU.21000624.

ABSTRACT

BACKGROUND: Management of breast cancer is increased by late diagnoses.

OBJECTIVE: To analyse direct costs of breast cancer in early and advanced stage in a third level medical facility at Mexican Social Security Institute.

METHOD: Observational study, direct costs of care in breast cancer in initial and advanced clinical stages are compared. Variables analysed were laboratory and diagnostic imaging studies, drugs, as well as hospitalization costs. The evaluated period included from the first care to the completion of the treatment. Costs were determined according to the table of Unit Costs by Level of Medical Care for the year 2019 of the Mexican Social Security Institute. Student’s t test was used to determinate differences between groups, as well as descriptive statistics.

RESULTS: The advanced stage compared to the initial stage, causes a greater number of laboratory-cabinet studies, surgeries, day/bed and interconsultations. The average cost of breast cancer care per patient is $99,280.36 (US$5,230.78) and $148,023.60 (US$7,789.92) for the initial and advanced stages, respectively (p = 0.024).

CONCLUSIONS: Cost of medical attention in the initial stage is lower than that of the advanced stage.

PMID:36787613 | DOI:10.24875/CIRU.21000624

Cir Cir. 2023;91(1):9-14. doi: 10.24875/CIRU.22000490.

ABSTRACT

OBJECTIVE: The present study aims to investigate the relationship between bile reflux (BR) and diameter of the common bile duct (CBD) in patients after cholecystectomy.

MATERIALS AND METHODS: In our case series analysis, according to the endoscopy results, the patients who underwent cholecystectomy were divided into two groups as those with BR and those non-BR. Age, sex, CBD diameter measured on ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, and endoscopic biopsy results of the patients were statistically analyzed.

RESULTS: In a total of 188 patients included in the study, BR was detected in 93 patients, it was not observed in 95 patients. The CBD diameter of the patients was observed to be 7 mm or less in 70.9% (n = 66) in the BR group, and 23% (n = 22) in the non-BR group. The statistical analysis revealed that while there was a significant difference between the two groups in terms of CBD diameter and intestinal metaplasia, the results were similar in both groups in terms of inflammation, activity, atrophy, and Helicobacter pylori.

CONCLUSION: We believe that CBD diameter may be a predictive factor in the detection of BR after cholecystectomy.

PMID:36787612 | DOI:10.24875/CIRU.22000490

Cir Cir. 2023;91(1):87-93. doi: 10.24875/CIRU.20001361.

ABSTRACT

OBJECTIVE: To evaluate the preoperative tomographic characteristics of the nose and paranasal sinuses of children with chronic dacryocystitis.

METHOD: Prospective, observational, cross-sectional, and descriptive study. CT scans of the paranasal sinuses of patients candidates for endoscopic dacryocystorhinostomy were evaluated for two years. Demographic characteristics, radiological findings, inflammatory processes and anatomical variants were identified using the Lund-Mackay classification. Statistic analysis. Stata 10.0, descriptive analysis, Student’s t: mean difference and χ². Logistic studies to estimate the probability between variables.

RESULTS: 27 men and 11 women (n = 38) were included. Of these, 22 had unilateral and 16 bilateral nasolacrimal duct involvement. Lund-Mackay score range: 2-20. Eleven patients had associated pathology. The most affected were anterior and maxillary ethmoidal sinus (69%), osteomeatal complex (68%), posterior ethmoidal (51%). Patients with severe rhinosinusitis are 12 times more likely to develop dacryocystitis than patients with < 12 points. Men presented greater severity, affectation, and clinical repercussion.

CONCLUSIONS: There is radiological rhinosinusal involvement in dacryocystitis, which must be evaluated and treated preoperatively to avoid postoperative complications or reinfections.

PMID:36787607 | DOI:10.24875/CIRU.20001361

Cir Cir. 2023;91(1):79-86. doi: 10.24875/CIRU.21000470.

ABSTRACT

BACKGROUND: Papillary thyroid cancer is the most common endocrine neoplasia. There are prognostic factors that establish risk of recurrence and mortality; however, patients considered low risk may have a less favorable evolution and hence the importance of finding new markers.

OBJECTIVE: To assess whether the mean platelet volume (MPV) and the platelet-lymphocyte index (PLI) show a relationship with the clinical staging in papillary thyroid cancer.

METHOD: Retrospective, observational and analytical study. Preoperative MPV and PLI were recorded, its relationship with TNM and MACIS systems was sought, as well as locally advanced invasion and tumor focality.

RESULTS: 107 cases treated from November 2017 to February 2020. No statistically significant difference was observed in these two preoperative parameters with advanced and initial stages, risk groups or tumor focality. The statistical analysis used was one-way ANOVA with SPSS 25, a 95% confidence interval and p < 0.05.

CONCLUSIONS: Despite the logical reasoning of tumor pathophysiology, our study did not find a relationship between papillary thyroid carcinoma with MPV and PLI, and should be complemented with more extensive studies.

PMID:36787604 | DOI:10.24875/CIRU.21000470

Cir Cir. 2023;91(1):107-112. doi: 10.24875/CIRU.21000720.

ABSTRACT

PURPOSE: To evaluate the stability and the refractive error of the different intraocular lens (IOL) after cataract surgery.

METHOD: Retrospective, observational and single-center study. Patients diagnosed with cataract and myopia who underwent a phacoemulsification surgery with intraocular lens placement without complications were included. All patients underwent a complete ophthalmological examination, ultrasound biomicroscopy was performed at 2 weeks, 1 and 3 months after surgery. Descriptive statistics were performed using measures of central tendency and comparative analyzes. A value of p < 0.05 was considered significant.

RESULTS: Thirty-one subjects with a diagnosis of axial myopia and senile cataract were included, 20 women (64.5%) and 11 men (35.5%), with a mean age was 62.8 ± 13.14 years. The IOL displacement were not different for the upper, lower, temporal and nasal quadrants; however, we observed a tendency to inclination to the temporal sector (p = 0.054) between the first and third postoperative month. Therefore, the were no significant differences in spherical equivalent between groups postoperatively.

CONCLUSIONS: The inclination of the IOL did not change over time after surgery, the changes were similar with the different three types of IOL.

PMID:36787599 | DOI:10.24875/CIRU.21000720

Clin Lab. 2023 Feb 1;69(2). doi: 10.7754/Clin.Lab.2022.220526.

ABSTRACT

BACKGROUND: There are studies showing associations between hypovitaminosis D and obesity, obesity and depression, and hypovitaminosis D and depression. This study aims to investigate the relationship between vitamin D levels and depression status of patients followed in an obesity center.

METHODS: This retrospective study included 107 obesity patients followed up and treated at an obesity center. Patients were divided into two groups as serum 25(OH)D level < 20 ng/mL (deficient) and ≥ 20 ng/mL (not deficient) and compared in terms of Beck Depression Inventory scores. Patients were also divided into two groups according to BDI scores < 17 and ≥ 17, and serum 25(OH)D levels were evaluated.

RESULTS: Patients at higher risk for depression (BDI score ≥ 17) had statistically significantly higher weight (p = 0.003) and BMI (p < 0.001), but had significantly lower serum 25(OH)D levels (p < 0.001). The BDI scores were found to be moderately positively related with the BMI (r = 0.404, p < 0.001), weakly negatively related with vitamin D levels (r = -0.383, p < 0.001), weakly positively related with weight (r = 0.293, p = 0.002). The BDI score me-dians (12 and 8, respectively) were found to be statistically significantly higher in patients with serum 25(OH)D levels of < 20 ng/mL compared to those with ≥ 20 ng/mL (p < 0.001). The increased BMI and decreased serum 25(OH)D levels have been found to independently increase the risk of depression in multivariate logistic regression analysis. The ROC analysis performed to evaluate the discriminative performance of serum 25(OH)D levels in predicting the risk of depression. The analysis showed that the serum 25(OH)D parameter was likely to reveal patients who were at higher risk for depression. For the cutoff point of 25(OH)D ≤ 19.21 level determined by Youden index, the sensitivity was found as 92.86% and the selectivity as 68.82%.

CONCLUSIONS: In our study, the BMIs were higher and serum 25(OH)D levels were lower in obese individuals at risk for depression. Understanding or explaining the relationship between vitamin D deficiency and depression will contribute to revealing the preventive or therapeutic role of vitamin D supplementation for depression.

PMID:36787573 | DOI:10.7754/Clin.Lab.2022.220526