Nevin Manimala

Nucl Med Commun. 2023 Apr 10. doi: 10.1097/MNM.0000000000001695. Online ahead of print.

ABSTRACT

AIM OF WORK: To determine the predictive value of initial [18F]FDG PET/computed tomography (CT) volumetric and radiomics-derived analyses in patients with head and neck squamous cell carcinoma (HNSCC).

METHODS: Forty-six adult patients had pathologically proven HNSCC and underwent pretherapy [18F]FDG PET/CT were enrolled. Semi-quantitative PET-derived volumetric [(maximum standardized uptake value (SUVmax) and mean SUV (SUVmean), total lesion glycolysis (TLG) and metabolic tumor volume (MTV)] and radiomics analyses using LIFEx 6.73.3 software were performed.

RESULTS: In the current study group, the receiver operating characteristic curve marked a cutoff point of 21.105 for primary MTV with area under the curve (AUC) of 0.727, sensitivity of 62.5%, and specificity of 86.8% (P value 0.041) to distinguish responders from non-responders, while no statistically significant primary SUVmean or max or primary TLG cut off points could be determined. It also marked the cutoff point for survival prediction of 10.845 for primary MTV with AUC 0.728, sensitivity of 80%, and specificity of 77.8% (P value 0.026). A test of the synergistic performance of PET-derived volumetric and textural features significant parameters was conducted in an attempt to develop the most accurate and stable prediction model. Therefore, multivariate logistic regression analysis was performed to detect independent predictors of mortality. With a high specificity of 97.1% and an overall accuracy of 89.1%, the combination of primary tumor MTV and the textural feature gray-level co-occurrence matrix correlation provided the most accurate prediction of mortality (P value < 0.001).

CONCLUSION: Textural feature indices are a noninvasive method for capturing intra-tumoral heterogeneity. In our study, a PET-derived prediction model was successfully generated with high specificity and accuracy.

PMID:37038954 | DOI:10.1097/MNM.0000000000001695

Nucl Med Commun. 2023 Apr 10. doi: 10.1097/MNM.0000000000001693. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study is to evaluate the prognostic role of Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and quantitative 68Ga-DOTATATE PET/computed tomography parameters such as maximum standardized uptake value (SUVmax), mean SUV (SUVmean), DOTATATE tumor volume (DTV), total lesion DOTATATE (TLD) in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) treated with 177Lu-DOTATATE.

MATERIAL AND METHOD: Our retrospective study included 21 patients with GEP-NETs treated with 177Lu-DOTATATE between January 2017 and January 2022. SUVmax, SUVmean, SUVmax/spleenSUVmax (SUVmax/Sx), DTV, TLD, SUVmean/spleenSUVmean (SUVmean/Sm), TLD/Sm values were calculated and recorded for all patients before and after 177Lu-DOTATATE treatment.

RESULTS: A total of 319 metastases were detected in the patients included in the study, and a total of 68 target lesions were selected. In univariant Cox regression analysis, TLD/Sm percent change (∆TLD/Sm) was found to be statistically significant on overall survival (OS) (P = 0.044). The 3-year survival in nonresponders was 50% (P = 0.034) based on ∆SUVmax/Sx values, 50% (P = 0.002) based on RECIST values, 50% based on ∆TDTV + new lesion values (P = 0.033), and according to ∆TTLD + new lesion values, it was 66% (P = 0.030).

CONCLUSION: In our study, we showed that SUVmax/Sx, RECIST, ∆TDTV + new lesion, and ∆TTLD + new lesion parameters can predict OS in the evaluation of response to treatment.

PMID:37038931 | DOI:10.1097/MNM.0000000000001693

Crit Rev Clin Lab Sci. 2023 Apr 11:1-15. doi: 10.1080/10408363.2023.2195496. Online ahead of print.

ABSTRACT

Reference intervals (RIs) are the cornerstone for evaluation of test results in clinical practice and are invaluable in judging patient health and making clinical decisions. Establishing RIs based on clinical laboratory data is a branch of real-world data mining research. Compared to the traditional direct method, this indirect approach is highly practical, widely applicable, and low-cost. Improving the accuracy of RIs requires not only the collection of sufficient data and the use of correct statistical methods, but also proper stratification of heterogeneous subpopulations. This includes the establishment of age-specific RIs and taking into account other characteristics of reference individuals. Although there are many studies on establishing RIs by indirect methods, it is still very difficult for laboratories to select appropriate statistical methods due to the lack of formal guidelines. This review describes the application of real-world data and an approach for establishing indirect reference intervals (iRIs). We summarize the processes for establishing iRIs using real-world data and analyze the principle and applicable scope of the indirect method model in detail. Moreover, we compare different methods for constructing growth curves to establish age-specific RIs, in hopes of providing laboratories with a reference for establishing specific iRIs and giving new insight into clinical laboratory RI research. (201 words).

PMID:37038925 | DOI:10.1080/10408363.2023.2195496

J Int Med Res. 2023 Apr;51(4):3000605231166222. doi: 10.1177/03000605231166222.

ABSTRACT

OBJECTIVE: There is a lack of established biological, psychological, social, and digital markers for the prediction, identification, and stratification of patients with major depressive disorder (MDD). We therefore aimed to evaluate serum nerve growth factor (NGF) in MDD patients.

METHODS: In this case-control study, we recruited MDD patients and age- and sex-matched healthy controls (HCs). A qualified psychiatrist evaluated study participants according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Serum NGF levels were analyzed using a commercially available enzyme-linked immunosorbent assay kit.

RESULTS: We analyzed data from 106 MDD patients and 88 HCs. Mean serum NGF concentrations were significantly higher in MDD patients (104.70 ± 6.43 pg/mL) than in HCs (72.09 ± 7.69 pg/mL). Receiver operating characteristic curve analysis revealed the good diagnostic performance of serum NGF in MDD.

CONCLUSIONS: Higher serum NGF levels might be involved in MDD pathophysiology, and altered NGF levels may be an early warning sign of depression. The present findings will aid in the development of new and improved therapies for depressive patients. Further interventional studies are recommended to explore the underlying mechanisms, risk factors, disease course, and treatment responses of NGF in MDD.

PMID:37038918 | DOI:10.1177/03000605231166222

Pediatrics. 2023 Apr 11:e2022059839. doi: 10.1542/peds.2022-059839. Online ahead of print.

ABSTRACT

BACKGROUNDS: This study aimed to determine the best educational application of a respiratory function monitor and a video laryngoscope.

METHODS: This study was a randomized controlled simulation-based trial, including 167 medical students. Participants had to execute ventilation and intubation maneuvers on a newborn manikin. Participants were randomized into 3 groups. In group A (no-access), the feedback devices were not visible but recording. In group B (supervisor-access), the feedback devices were visible to the supervisor only. In group C (full-access), both the participant and the supervisor had visual access.

RESULTS: The two main outcome variables were the percentage of ventilations within the tidal volume target range (4-8mL/kg) and the number of intubation attempts. Group C achieved the highest percentage of ventilations within the tidal volume target range (full-access 63.6%, supervisor-access 51.0%, no-access 31.1%, P < .001) and the lowest mask leakage (full-access 34.9%, supervisor-access 46.6%, no-access 61.6%; A to B: P < .001, A to C: P < .001, B to C: P = .003). Overall, group C achieved superior ventilation quality regarding primary and secondary outcome measures. The number of intubation attempts until success was lowest in the full-access group (full-access: 1.29, supervisor-access: 1.77, no-access: 2.43; A to B: P = .001, A to C: P < .001, B to C: P = .015).

CONCLUSIONS: Our findings confirm that direct visual access to feedback devices for supervisor and trainees alike considerably benefits outcomes and can contribute to the future of clinical education.

PMID:37038898 | DOI:10.1542/peds.2022-059839

Tuberc Respir Dis (Seoul). 2023 Apr 11. doi: 10.4046/trd.2022.0048. Online ahead of print.

ABSTRACT

BACKGROUND: : Surgical resection is the standard treatment for early-stage lung cancer. Since postoperative lung function is related to mortality, predicted postoperative lung function is used to determine the treatment modality. The aim of this study was to evaluate the predictive performance of linear regression and machine learning models.

METHODS: We extracted data from the Clinical Data Warehouse (CDW) and developed 3 sets: set Ⅰ, the linear regression model; set Ⅱ, machine learning models omitting the missing data: and set Ⅲ, machine learning models imputing the missing data. Six machine learning models, the least absolute shrinkage and selection operator (LASSO), ridge regression, ElasticNet, Random Forest, eXtreme gradient boosting (XGBoost), and the light gradient boosting machine (LightGBM) were implemented. The forced expiratory volume in one second (FEV1) measured 6 months after surgery was defined as the outcome. Five-fold cross-validation was performed for hyperparameter tuning of the machine learning models. The dataset was split into training and test datasets at a 70:30 ratio. Implementation was done after dataset splitting in set Ⅲ. Predictive performance was evaluated by R2 and mean squared error (MSE) in the 3 sets.

RESULTS: A total of 1,487 patients were included in sets Ⅰ and Ⅲ and 896 patients were included in set Ⅱ. In set Ⅰ, the R2 value was 0.27 and in set Ⅱ, LightGBM was the best model with the highest R2 value of 0.5 and the lowest MSE of 154.95. In set Ⅲ, LightGBM was the best model with the highest R2 value of 0.56 and the lowest MSE of 174.07.

CONCLUSION: The LightGBM model showed the best performance in predicting postoperative lung function.

PMID:37038881 | DOI:10.4046/trd.2022.0048

JACC Cardiovasc Imaging. 2023 Feb 7:S1936-878X(23)00032-3. doi: 10.1016/j.jcmg.2022.12.027. Online ahead of print.

ABSTRACT

BACKGROUND: Left ventricular (LV) diastolic function is primarily assessed by means of echocardiography, which has limited utility in detecting fibrosis. Cardiac magnetic resonance (CMR) readily detects and quantifies fibrosis.

OBJECTIVES: In this study, the authors sought to determine the association of LV diastolic function by to echocardiography with CMR-determined global fibrosis burden and the incremental value of fibrosis with diastolic function grade in prediction of total mortality and heart failure hospitalizations.

METHODS: A total of 549 patients underwent comprehensive echocardiography and CMR within 30 days. Echocardiography was used to assess LV diastolic function, and CMR was used to determine LV volumes, mass, ejection fraction, replacement fibrosis, and percentage extracellular volume fraction (ECV).

RESULTS: Normal diastolic function was present in 142 patients; the rest had diastolic dysfunction grades I to III, except for 18 (3.3%) with indeterminate results. The event rate was higher in patients with diastolic dysfunction compared with patients with normal diastolic function (33.4% vs 15.5; P < 0.001). The model including LV diastolic function grades II and III predicted composite outcome (C-statistic: 0.71; 95% CI: 0.67-0.76), which increased by adding global fibrosis burden (C-statistic: 0.74, 95% CI: 0.70-0.78; P = 0.02). For heart failure hospitalizations, the competing risk model with LV diastolic function grades II and III was good (C-statistic: 0.78; 95% CI: 0.74-0.83) and increased significantly with the addition of global fibrosis burden (C-statistic: 0.80; 95% CI: 0.76-0.85; P = 0.03).

CONCLUSIONS: Higher grades of diastolic dysfunction are seen in patients with replacement fibrosis and increased ECV. Fibrosis burden as determined with the use of CMR provides incremental prognostic information to echocardiographic evaluation of LV diastolic function.

PMID:37038874 | DOI:10.1016/j.jcmg.2022.12.027

Eur J Paediatr Dent. 2023 Mar 28. doi: 10.23804/ejpd.2023.1817. Online ahead of print.

ABSTRACT

AIM: This study aimed to determine the impact of laser surgical tongue-tie, lip-tie, buccal-tie release on bottle-feeding and gastroesophageal reflux disease (GERD) after functional assessment of tongue and lip movement in a prospective cohort study conducted from June 2019 to June 2020 in a private general dental practice.

METHODS: Preoperative, one-week and one-month postoperative surveys were completed, using the Revised Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R). All study participants were bottle-feeding dyads (0-12 weeks of age) with untreated ankyloglossia and/or tethered maxillary/buccal frena.

RESULTS: The study had 40 bottle feeding infants enrolled. Posterior :tongue-tie was noted in 67.5% of this cohort. Statistically significant improvement in I-GERQ-R scores was reported between preoperative (16.6, SD: 6.1; min-max: 8-28), 1 week (14.1, SD: 4.2; min-max: 6-24) and 1 month I-GERQ-R total scores (9.1, SD: 4.5; min-max:3-27) (ANOVA test – P <.001).

CONCLUSION: This study confirms the need for functional assessment of tongue and lip movement for this significantly affected cohort when surgical release is proposed. Laser surgical release (frenotomy) of tongue-tie, lip-tie, buccal-tie resulted in significant improvement in I-GERQ-R outcomes were found for cohorts of the classically recognised anterior tongue-tie and the less obvious (without functional assessment) and less diagnosed posterior tongue tie were found.

PMID:37038872 | DOI:10.23804/ejpd.2023.1817

Risk Anal. 2023 Apr 10. doi: 10.1111/risa.14127. Online ahead of print.

ABSTRACT

Networks like those of healthcare infrastructure have been a primary target of cyberattacks for over a decade. From just a single cyberattack, a healthcare facility would expect to see millions of dollars in losses from legal fines, business interruption, and loss of revenue. As more medical devices become interconnected, more cyber vulnerabilities emerge, resulting in more potential exploitation that may disrupt patient care and give rise to catastrophic financial losses. In this paper, we propose a structural model of an aggregate loss distribution across multiple cyberattacks on a prototypical hospital network. Modeled as a mixed random graph, the hospital network consists of various patient-monitoring devices and medical imaging equipment as random nodes to account for the variable occupancy of patient rooms and availability of imaging equipment that are connected by bidirectional edges to fixed hospital and radiological information systems. Our framework accounts for the documented cyber vulnerabilities of a hospital’s trusted internal network of its major medical assets. To our knowledge, there exist no other models of an aggregate loss distribution for cyber risk in this setting. We contextualize the problem in the probabilistic graph-theoretical framework using a percolation model and combinatorial techniques to compute the mean and variance of the loss distribution for a mixed random network with associated random costs that can be useful for healthcare administrators and cybersecurity professionals to improve cybersecurity management strategies. By characterizing this distribution, we allow for the further utility of pricing cyber risk.

PMID:37038249 | DOI:10.1111/risa.14127

J Health Popul Nutr. 2023 Apr 10;42(1):31. doi: 10.1186/s41043-023-00362-w.

ABSTRACT

BACKGROUND: The aim of this study was to examine the relationship between dietary intake of folate and niacin and diabetes risk in Chinese adults.

METHODS: This is a cross-sectional study. Demographic and anthropometric data along with information on dietary intake of vitamins were collected, and eligible participants were recruited to complete the questionnaire. A binary logistic regression analysis was conducted to examine the association between dietary intake of vitamins and diabetes risk, with adjustment for potential confounders. Non-linear dose-response relationships between dietary intake of folate and niacin and diabetes risk were also evaluated using adjusted restricted cubic splines.

RESULTS: Of the 3106 eligible participants, 15.9% had diabetes. Median folate was significantly higher in diabetic patients than in controls (32.030 vs. 27.600 gμ), while median niacin was significantly lower (7.000 vs. 7.900 mg). After controlling for potential confounders, binary logistic regression analysis showed that each unit increase in folate intake was associated with a 1.002-fold increase in the risk of developing diabetes (odds ratio (OR) = 1.002; 95% confidence interval (CI) 1.000-1.004; P = 0.022), while each unit increase in niacin intake was associated with a 3.5% reduction in diabetes risk (OR = 0.965; 95% CI 0.944-0.986; P = 0.001). The plots of restricted cubic splines presented an atypical inverted U-shaped association between dietary intake of folate and diabetes risk.

CONCLUSIONS: Diabetic patients had a low intake of vitamins, especially the B vitamins. Dietary intake of folate and niacin tended to be independently associated with the risk of diabetes. Nevertheless, this study is observational and a large-scale randomized controlled trial is yet to be conducted, which will add to the evidence of the study results.

PMID:37038237 | DOI:10.1186/s41043-023-00362-w