Nevin Manimala

Dermatitis. 2022 Sep-Oct 01;33(5):362-367. doi: 10.1097/DER.0000000000000806. Epub 2021 Dec 10.

ABSTRACT

BACKGROUND: The use of palladium (Pd) is increasing in metal objects after the banning of nickel in items in prolonged contact with the skin. The properties of Pd make this metal useful in various industrial fields.

OBJECTIVE: The aim of the study was to evaluate the prevalence of Pd sensitization in patients who underwent patch tests for suspected allergic contact dermatitis in the Triveneto region from 2013 to 2018.

METHODS: A total of 4816 patients with symptoms and/or signs of suspected contact allergic dermatitis were patch tested. Individual characteristics were assessed using a standardized questionnaire.

RESULTS: The overall prevalence of Pd sensitization was 7.6% and 10.8% using PdCl2 1% or 2% petrolatum, respectively, with a higher prevalence in women (odds ratio, 2.6; 95% confidence interval, 1.9-3.7) and in 26- to 55-year-old patients. Monosensitization occurred in 1%-1.5% of the patients tested. Health care workers and technicians were more sensitized to Pd than clerks, but the data did not reach statistical significance.

CONCLUSIONS: Palladium sensitization was high, but it was mainly associated with nickel sensitization. A possible occupational role was found for workers with potential contact with Pd-containing objects, but more data are needed to reach statistical significance.

PMID:36113001 | DOI:10.1097/DER.0000000000000806

Med Phys. 2022 Sep 16. doi: 10.1002/mp.15982. Online ahead of print.

ABSTRACT

PURPOSE: Task automation is essential for efficient and consistent image segmentation in radiation oncology. We report on a deep learning architecture, comprised of a U-Net and a variational autoencoder (VAE) for automatic contouring of the prostate gland incorporating inter-observer variation for radiotherapy treatment planning. The U-Net/VAE generates an ensemble set of segmentations for each image CT slice. A novel outlier mitigation (OM) technique was implemented to enhance the model segmentation accuracy.

METHODS: The primary source dataset (source_prim) consisted of 19,200 CT slices (from 300 patient planning CT image datasets) with manually contoured prostate glands. A smaller secondary source dataset (source_sec) was comprised of 640 CT slices (from 10 patient CT datasets), where prostate glands were segmented by five independent physicians on each dataset to account for inter-observer variability. Data augmentation via random rotation (< five degrees), cropping, and horizontal flipping was applied to each dataset to increase sample size by a factor of 100. A probabilistic hierarchical U-Net with VAE was implemented and pre-trained using the augmented source_prim dataset for 30 epochs. Model parameters of the U-Net/VAE were fine-tuned using the augmented source_sec dataset for 100 epochs. After the first round of training, outlier contours in the training dataset were automatically detected and replaced by the most accurate contours (based on Dice similarity coefficient, DSC) generated by the model. The U-Net/OM-VAE was re-trained using the revised training dataset. Metrics for comparison included DSC, Hausdorff distance (HD, mm), normalized cross-correlation coefficient (NCC), and center-of-mass distance (COM, mm).

RESULTS: Results for U-Net/OM-VAE with outliers replaced in the training dataset versus U-Net/VAE without outlier mitigation were as follows: DSC = 0.82±0.01 vs 0.80±0.02 (p = 0.019), HD = 9.18±1.22 vs 10.18±1.35 mm (p = 0.043), NCC = 0.59±0.07 vs. 0.62±0.06 and COM = 3.36±0.81 vs. 4.77±0.96 mm over the average of 15 contours. For the average of 15 highest accuracy contours, values were: DSC = 0.90±0.02 vs 0.85±0.02, and HD = 5.47±0.02 vs 7.54±1.36 mm, COM = 1.03±0.58 vs 1.46±0.68 mm (p < 0.03 for all metrics). Results for the U-Net/OM-VAE with outliers removed were: DSC = 0.78±0.01, HD = 10.65±1.95 mm, NCC = 0.46±0.10, COM = 4.17±0.79 mm for the average of 15 contours, and DSC = 0.88±0.02, HD = 7.00±1.17 mm, COM = 1.58±0.63 mm for the average of 15 highest accuracy contours. All metrics for U-Net/VAE trained on the source_prim and source_sec datasets via pre-training, followed by fine-tuning, show statistically significant improvement over that trained on the source_sec dataset only. Finally, all metrics for U-Net/VAE with or without outlier mitigation showed statistically significant improvement over those for the standard U-Net.

CONCLUSIONS: A VAE combined with a hierarchical U-Net and an outlier mitigation strategy (U-Net/OM-VAE) demonstrates promise towards capturing inter-observer variability and produces accurate prostate auto-contours for radiotherapy planning. The availability of multiple contours for each CT slice enables clinicians to determine trade-offs in selecting the “best fitting” contour on each CT slice. Mitigation of outlier contours in the training dataset improves prediction accuracy but one must be wary of reduction in variability in the training dataset. This article is protected by copyright. All rights reserved.

PMID:36112996 | DOI:10.1002/mp.15982

Cancer Control. 2022 Jan-Dec;29:10732748221125561. doi: 10.1177/10732748221125561.

ABSTRACT

BACKGROUND: Comorbid depression and anxiety in men with localised prostate cancer (CaP) largely go undiagnosed and untreated and their effects on health-related quality of life (HRQOL) in men with CaP should not be underestimated. We examined the prevalence of depression and anxiety and its association with HRQOL in men about to commence treatment for CaP and the differences between treatment groups, radical prostatectomy (RP) and radiation therapy (RT).

METHOD: One hundred and seven participants from a longitudinal prospective observational study assessing depression, anxiety and HRQOL in men with localised CaP (DAHCaP), were used in this cross-sectional analysis. Data were collected shortly before participants were scheduled to receive their treatment. The Centre for Epidemiologic Studies Depression Scale (CES-D), the State Trait Anxiety Inventory (STAI), the Memorial Anxiety Scale for Prostate Cancer (MAX-PC), the European Organisation for Research and Treatment in Cancer Quality of Life questionnaire (EORTC QLQ-C30) and (EORTC QLQ-PR25) were used in this analysis.

RESULTS: Symptoms of depression pre-treatment were noted in 39.3%, state anxiety 28%, trait anxiety 31.4% and prostate cancer anxiety in 12.1% of participants. Statistically significant correlations (P ≤ .05) with the CES-D and a cluster of symptoms on the EORTC QLQ-C30 domains for Global Health (r_s = -.35), fatigue (r_s = .38), pain (r_s = .32), dyspnoea (r_s = .28), insomnia (r_s = .30) and finance (r_s = .26) and EORTC QLQ-PR25 domains for urinary symptoms (r_s = .43), bowel (r_s = .43) and hormone replacement therapy (HRT) (r_s = .41) were observed.Statistically significant correlations were also noted between the STAI-S and EORTC QLQ-C30 and EORTC QLQ-PR25. No statistically significant difference was noted between treatments.

CONCLUSION: More men were depressed than anxious with significant associations with HRQOL prior to commencement of treatment. CaP treatments should focus not only on the prevailing indisposition but include a psychooncological and HRQOL assessment at pre-treatment in high-risk individuals.

PMID:36112984 | DOI:10.1177/10732748221125561

Ann Med. 2022 Dec;54(1):2470-2476. doi: 10.1080/07853890.2022.2121419.

ABSTRACT

OBJECTIVE: Patients with type 2 diabetes mellitus (T2DM) are often immunosuppressed and susceptible to infectious diseases. We investigated the mortality and related risk factors of active TB disease in patients with T2DM in Taiwan.

MATERIALS AND METHODS: The data of 1258 patients diagnosed with both T2DM and active TB disease from January 1 to December 31, 2002 (T2DM-TB group) were retrieved from the Taiwan National Health Insurance Research Database. Patients in the T2DM-TB group were matched by age, sex, and comorbidities to a control group of 10,064 T2DM patients without TB disease (T2DM group). Patients were followed up since TB diagnosis until death or 31 December 2011. Cox proportional-hazards regression analysis was employed to compare the risk of death between the T2DM group and the T2DM-TB group.

RESULTS: A total of 101,837 potentially eligible patients were included in the study. After 1:10 propensity score matching, 1,258 patients were classified in the T2DM-TB group and 10,064 patients in the T2DM group. After adjustment for age, sex and comorbidities, the T2DM-TB group showed a 2.16-fold higher mortality risk than the T2DM group (95% CI = 1.83-2.56, p < .001). The mortality risk remained higher after stratification by year. The log-rank test indicated that male sex, age ≥60 years, hypertension and heart failure were independent risk factors.

CONCLUSIONS: TB increases mortality risk in patients with T2DM on long-term follow-up. The independent risk factors for mortality in patients with concurrent T2DM and TB disease include male sex, age ≥60 years, hypertension and heart failure.KEY MESSAGESThe co-presentation of T2DM and TB is an important emerging issue, especially in Asia.This study showed mortality risk was significantly higher in the T2DM-TB group compared with the T2DM group on long-term follow-up.Increased medical attention is necessary for patients with T2DM and a history of TB disease.

PMID:36111539 | DOI:10.1080/07853890.2022.2121419

Vet Comp Oncol. 2022 Sep 16. doi: 10.1111/vco.12858. Online ahead of print.

ABSTRACT

Extracellular vesicles (EVs) are cell-derived membrane-bound vesicles involved in many biological processes such as tumour progression. For years, ultracentrifugation (UC) has been considered the gold standard for EV isolation but limited purity and integrity allowed the diffusion of alternative techniques. In this study, EVs were isolated from a canine mammary tumour cell line using UC and size exclusion chromatography (SEC) and analysed for size and concentration by nanoparticle tracking analysis (NTA) and for protein expression by western blot (WB). EV autocrine effect on cell proliferation, migration and invasiveness was then evaluated in vitro. In all samples, particles were in the EV size range (50-1000 nm), with a higher concentration in UC than in SEC samples (10¹¹ and 10¹⁰ particles/ml respectively), and expressed EV markers (Alix, CD9). Functional assays did not show statistically significant difference among conditions, but EV treatment slightly increased cell proliferation and invasiveness and treatment with SEC-isolated EVs slightly enhanced cell migration compared to UC-isolated EVs. In conclusion, the main differences between the two isolation techniques are the quantity of the final EV-product and slight differences on EV functionality, which should be further explored to better highlight the real autocrine effect of tumoral EVs. This article is protected by copyright. All rights reserved.

PMID:36111535 | DOI:10.1111/vco.12858

Int Wound J. 2022 Sep 16. doi: 10.1111/iwj.13956. Online ahead of print.

ABSTRACT

This meta-analysis aims to systemically evaluate the efficacy of vacuum sealing drainage (VSD) combined with autologous platelet-rich plasma (PRP) in the treatment of diabetic foot ulcers (DFU). The China HowNet, China Biomedical Literature, VIP periodical resource integration service platform, Wanfang, Embase, Cochrane Central, and PubMed databases were retrieved using the computer. The retrieval period was up to July 2021. Randomised controlled trials on VSD combined with PRP in the treatment of DFU were collected. Those trials that met the inclusion criteria were included for meta-analysis using RevMan 5.3 software. A total of 13 articles were included. In the trial group, 477 patients with DFU were treated with VSD combined with PRP, while in the control group, 482 patients with DFU were treated with conventional dressings and/or VSD. The meta-analysis showed that, compared with the control group, VSD combined with PRP has significant advantages in shortening healing time (standardised mean difference [SMD] = -0.87, 95% confidence interval [CI]: -1.07 to -0.67, P < .00001), improving ulcer healing rates (odds ratio = 4.01, 95% CI: 2.95 ~ 5.46, P < .00001), and reducing hospital stays (mean difference = -15.29, 95% CI: -16.05 to -14.54, P < .00001), but the differences in dressing change times (SMD = -1.27, 95% CI: -2.71 to 0.17, P = .08) and hospitalisation expenses (SMD = -0.16, 95% CI: -13.40 to 13.07, P = .98) were not statistically significant. VSD combined with autologous PRP has good curative efficacy in the treatment of DFU and is a better treatment option. However, this treatment is limited in patients with platelet dysfunction, thrombocytopenia, leukaemia, and poor general condition.

PMID:36111514 | DOI:10.1111/iwj.13956

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022 Sep 15;36(9):1126-1131. doi: 10.7507/1002-1892.202204011.

ABSTRACT

OBJECTIVE: To compare the effectiveness between three-dimensional (3D) printed porous titanium alloy cage (3D Cage) and poly-ether-ether-ketone cage (PEEK Cage) in the posterior lumbar interbody fusion (PLIF).

METHODS: A total of 66 patients who were scheduled to undergo PLIF between January 2018 and June 2019 were selected as the research subjects, and were divided into the trial group (implantation of 3D Cage, n=33) and the control group (implantation of PEEK Cage, n=33) according to the random number table method. Among them, 1 case in the trial group did not complete the follow-up exclusion study, and finally 32 cases in the trial group and 33 cases in the control group were included in the statistical analysis. There was no significant difference in gender, age, etiology, disease duration, surgical segment, and preoperative Japanese Orthopaedic Association (JOA) score between the two groups (P>0.05). The operation time, intraoperative blood loss, complications, JOA score, intervertebral height loss, and interbody fusion were recorded and compared between the two groups.

RESULTS: The operations of two groups were completed successfully. There was 1 case of dural rupture complicated with cerebrospinal fluid leakage during operation in the trial group, and no complication occurred in the other patients of the two groups. All incisions healed by first intention. There was no significant difference in operation time and intraoperative blood loss between groups (P>0.05). All patients were followed up 12-24 months (mean, 16.7 months). The JOA scores at 1 year after operation in both groups significantly improved when compared with those before operation (P<0.05); there was no significant difference between groups (P>0.05) in the difference between pre- and post-operation and the improvement rate of JOA score at 1 year after operation. X-ray film reexamination showed that there was no screw loosening, screw rod fracture, Cage collapse, or immune rejection in the two groups during follow-up. At 3 months and 1 year after operation, the rate of intervertebral height loss was significantly lower in the trial group than in the control group (P<0.05). At 3 and 6 months after operation, the interbody fusion rating of trial group was significantly better in the trial group than in the control group (P<0.05); and at 1 year after operation, there was no significant difference between groups (P>0.05).

CONCLUSION: There is no significant difference between 3D Cage and PEEK Cage in PLIF, in terms of operation time, intraoperative blood loss, complications, postoperative neurological recovery, and final intervertebral fusion. But the former can effectively reduce vertebral body subsidence and accelerate intervertebral fusion.

PMID:36111476 | DOI:10.7507/1002-1892.202204011

Epidemiol Psychiatr Sci. 2022 Sep 16;31:e65. doi: 10.1017/S204579602200049X.

ABSTRACT

AIMS: Lithium has long been believed to reduce the risk of suicide and suicidal behaviour in people with mood disorders. Previous meta-analyses appeared to support this belief, but excluded relevant data due to the difficulty of conducting meta-analysis of rare events. The current study is an updated systematic review and meta-analysis that includes all eligible data, and evaluates suicide, non-fatal suicidal behaviour (including suicidal ideation) and suicide attempts.

METHODS: We searched PubMed, PsycINFO and Embase and some trial registers. We included all randomised trials comparing lithium and placebo or treatment as usual in mood disorders published after 2000, to ensure suicide was reliably reported. Trial quality was assessed using the Cochrane Risk of Bias tool. Pooled data were analysed using Fisher’s Exact test. In addition, meta-analysis was conducted using various methods, prioritizing the Exact method. All trials were included in the analysis of suicide initially, regardless of whether they reported on suicide or not. We conducted a sensitivity analysis with trials that specifically reported on suicides and one that included trials published before 2000. Pre-specified subgroup analyses were performed involving suicide prevention trials, trials excluding people already taking lithium, trials involving people with bipolar disorder exclusively and those involving people with mixed affective diagnoses. Non-fatal suicidal behaviour and suicide attempts were analysed using the same methods, but only trials that reported these outcomes were included. PROSPERO registration: CRD42021265809.

RESULTS: Twelve eligible studies involving 2578 participants were included. The pooled suicide rate was 0.2% for people randomised to lithium and 0.4% with placebo or treatment as usual, which was not a statistically significant difference; odds ratio (OR) = 0.41 (95% confidence interval 0.03-2.49), p = 0.45. Meta-analysis using the Exact method produced an OR of 0.42 (95% confidence interval 0.01-4.5). The result was not substantially different when restricted to 11 trials that explicitly reported suicides and remained statistically non-significant when including 15 trials published before 2000 (mostly in the 1970s). There were no significant differences in any subgroup analysis. There was no difference in rates of all non-fatal suicidal behaviour in seven trials that reported this outcome, or in five trials that reported suicide attempts specifically. Meta-analyses using other methods also revealed no statistically significant differences.

CONCLUSIONS: Evidence from randomised trials is inconclusive and does not support the idea that lithium prevents suicide or suicidal behaviour.

PMID:36111461 | DOI:10.1017/S204579602200049X

Infect Control Hosp Epidemiol. 2022 Sep 16:1-7. doi: 10.1017/ice.2022.66. Online ahead of print.

ABSTRACT

OBJECTIVE: From January 1, 2018, until July 31, 2020, our hospital network experienced an outbreak of vancomycin-resistant enterococci (VRE). The goal of our study was to improve existing processes by applying machine-learning and graph-theoretical methods to a nosocomial outbreak investigation.

METHODS: We assembled medical records generated during the first 2 years of the outbreak period (January 2018 through December 2019). We identified risk factors for VRE colonization using standard statistical methods, and we extended these with a decision-tree machine-learning approach. We then elicited possible transmission pathways by detecting commonalities between VRE cases using a graph theoretical network analysis approach.

RESULTS: We compared 560 VRE patients to 86,684 controls. Logistic models revealed predictors of VRE colonization as age (aOR, 1.4 (per 10 years), with 95% confidence interval [CI], 1.3-1.5; P < .001), ICU admission during stay (aOR, 1.5; 95% CI, 1.2-1.9; P < .001), Charlson comorbidity score (aOR, 1.1; 95% CI, 1.1-1.2; P < .001), the number of different prescribed antibiotics (aOR, 1.6; 95% CI, 1.5-1.7; P < .001), and the number of rooms the patient stayed in during their hospitalization(s) (aOR, 1.1; 95% CI, 1.1-1.2; P < .001). The decision-tree machine-learning method confirmed these findings. Graph network analysis established 3 main pathways by which the VRE cases were connected: healthcare personnel, medical devices, and patient rooms.

CONCLUSIONS: We identified risk factors for being a VRE carrier, along with 3 important links with VRE (healthcare personnel, medical devices, patient rooms). Data science is likely to provide a better understanding of outbreaks, but interpretations require data maturity, and potential confounding factors must be considered.

PMID:36111457 | DOI:10.1017/ice.2022.66

Pharmacoepidemiol Drug Saf. 2022 Sep 16. doi: 10.1002/pds.5541. Online ahead of print.

ABSTRACT

PURPOSE: Our objective was to describe differences in telemedicine use among women with metastatic breast cancer (mBC) by race, age and geographic region.

METHODS: This was a retrospective cohort study of women with recurrent or de novo mBC treated in U.S. community cancer practices that initiated a new line of therapy between March 2020 and February 2021. Multivariable modified Poisson regression models were used to calculate adjusted rate ratios (OR) and robust 95% confidence intervals (CI) associated with telemedicine visits within 90 days of therapy initiation.

RESULTS: Overall, among 3412 women with mBC, 751 (22%) patients had telemedicine visits following therapy initiation, with lower risks observed among older women (<50 years: 24%; 50-64 years: 22%; 65-74 years: 21%; ≥75 years: 20%). Greater telemedicine use was observed among Asian women (35%) compared to White (21%), Black (18%) and Hispanic (21%) women. Fewer telemedicine visits occurred in Southern (12%) and Midwestern (17%) states versus Northeastern (37%) or Western (36%) states. In multivariable models, women ages ≥75 years had significantly lower risks of telemedicine visits (RR=0.76, 95% CI 0.62-0.95) compared to ages <50 years. Compared to patients in Northeastern states, women in Midwestern (RR=0.46, 95% CI 0.37-0.57) and Southern (RR=0.31, 95% CI 0.26-0.37) states had significantly lower risks of telemedicine visits; but not women in Western states (RR=0.96, 95% CI 0.83-1.12). No statistically significant differences in telemedicine use were found between racial groups in overall multivariable models.

CONCLUSIONS: In this study of community cancer practices, older mBC patients and those living in Southern and Midwestern states were less likely to have telemedicine visits. Preferences for communication and delivery of care may have implications for measurement of exposures and endpoints in pharmacoepidemiologic studies of cancer patients.

PMID:36111444 | DOI:10.1002/pds.5541