Nevin Manimala

Oral Surg Oral Med Oral Pathol Oral Radiol. 2022 Jul 16:S2212-4403(22)01055-0. doi: 10.1016/j.oooo.2022.07.008. Online ahead of print.

ABSTRACT

OBJECTIVE: The introduction of minimally invasive surgical procedures has significantly reduced the rate of major salivary gland removal. This study aimed to assess these procedures in relieving patients’ complaints and their impact on quality of life using the newly introduced Multidisciplinary Salivary Gland Society questionnaire.

STUDY DESIGN: Between January 2021 and October 2021, a case series was treated with minimally invasive surgical procedures. Data such as stone size, number and location, surgical approach, symptoms relief, and improvement of quality of life were collected and analyzed. Thirty-six patients were included (22 males and 14 females); 28 had stones in the submandibular gland and 8 in the parotid gland with largest stone diameter ranging from 0.2 to 2.8 cm. The approach was selected according to stone size and location, so 17 patients were treated with sialendoscopy (alone or using a combined approach), and 19 patients were treated without sialendoscopy using a transoral approach.

RESULTS: After a 6-month follow-up, the questionnaire scores showed a statistically significant difference in comparison to preoperative ones.

CONCLUSIONS: Minimally invasive surgical procedures present an excellent option for sialolithotomy, after which the relief of symptoms, restoration of gland function, and a significant improvement in quality of life are achieved.

PMID:36089488 | DOI:10.1016/j.oooo.2022.07.008

J Plast Reconstr Aesthet Surg. 2022 Jun 22:S1748-6815(22)00386-2. doi: 10.1016/j.bjps.2022.06.069. Online ahead of print.

ABSTRACT

BACKGROUND: Melanoma is a common cancer that causes a severe socioeconomic burden. Patients usually turn to plastic surgeons to determine their prognosis after surgery.

METHODS: Data from hundreds of thousands of real-world patients were downloaded from the Surveillance, Epidemiology, and End Results database. Nine mainstream machine learning models were applied to predict 5-year survival probability and three survival analysis models for overall survival prediction. Models that outperformed were deployed online.

RESULTS: After manual review, 156,154 real-world patients were included. The deep learning model was chosen for predicting the probability of 5-year survival, based on its area under the receiver operating characteristic curve (0.915) and its accuracy (84.8%). The random survival forest model was chosen for predicting overall survival, with a concordance index of 0.894. These models were deployed at www.make-a-difference.top/melanoma.html as an online calculator with an interactive interface and an explicit outcome for everyone.

CONCLUSIONS: Users should make decisions based on not only this online prognostic application but also multidimensional information and consult with multidiscipline specialists.

PMID:36089473 | DOI:10.1016/j.bjps.2022.06.069

HPB (Oxford). 2022 Aug 25:S1365-182X(22)01556-8. doi: 10.1016/j.hpb.2022.08.009. Online ahead of print.

ABSTRACT

BACKGROUND: Anastomotic leak (AL) after bilioenteric reconstruction (BR) is a feared complication after bile duct resection, especially in combination with liver resection. Literature on surgical outcome is sparse. This study aimed to determine the incidence and risk factors for AL after combined liver and bile duct resection with a focus on operative or endoscopic reinterventions.

METHODS: Data from consecutive patients who underwent liver resection and BR between 2004 and 2018 in 11 academic institutions in Europe were collected from prospectively maintained databases.

RESULTS: Within 921 patients, AL rate was 5.4% with a 30d mortality of 9.6%. Pringle maneuver (p<0.001),postoperative external biliary (p=0.007) and abdominal drainage (p<0.001) were risk factors for clinically relevant AL. Preoperative biliary drainage (p<0.001) was not associated with a higher rate of AL. AL was more frequent in stented patients (76.5%) compared to PTCD (17.6%) or PTCD+stent (5.9%,p=0.017). AL correlated with increased incidence of postoperative liver failure (p=0.036), cholangitis, hemorrhage and sepsis (all p<0.001).

CONCLUSION: This multicenter data provides the largest series to date of LR with BR and could help in the management of these patients which are often challenging and hampering the patients’ postoperative course negatively.

PMID:36089466 | DOI:10.1016/j.hpb.2022.08.009

Heart Lung Circ. 2022 Sep 8:S1443-9506(22)01007-1. doi: 10.1016/j.hlc.2022.07.007. Online ahead of print.

ABSTRACT

AIM: The Occlutech duct occluder (ODO) with a novel design has been available for closure of patent ductus arteriosus (PDA) since 2011. Available data on initial experience with the ODO have shown that operators continue to choose device sizes based on their experience with conventional duct occluders (CDO). This study postulated that occlusion of the pulmonary arterial (PA) end of the ductus should achieve satisfactory PDA closure without additional complications. Accordingly, the size of the ODO was chosen such that the larger PA diameter in the new design exceeded the PA end of the ductus by 2-3 mm and 2-4 mm for normotensive and hypertensive ducts, respectively. It sought to examine the feasibility and safety of such an approach, and compared ODO and CDO devices with respect to device sizes deployed, to ascertain if the newer design had any advantages.

METHODS: This prospective study enrolled 105 infants, children and a few adults with various duct morphologies and PA pressures for ductal closure using the ODO from 2018-2020. The control group consisted of 105 ducts closed with CDO. A comparison of the two groups with respect to duct diameter and implanted device sizes was performed using appropriate statistical software.

RESULTS: The study found that 40% of the ducts had moderate-to-severe pulmonary hypertension. Most ducts measured between 3-4 mm in both groups. The mean weight of the subjects in both groups was 12 kg. Although there was no change in the way that duct occluders were chosen in both groups (2-3 mm over the pulmonary artery diameter), ODO could be significantly downsized in most ducts measuring between 2.5-6.4 mm in diameter (p<0.05).

CONCLUSIONS: This study found successful closure of relatively larger PDA in infants and children using smaller ODO compared with CDO, without embolisation or aortic narrowing. It also demonstrated that a different device size selection technique may be safely employed with the ODO.

PMID:36089464 | DOI:10.1016/j.hlc.2022.07.007

Aust Crit Care. 2022 Sep 9:S1036-7314(22)00094-7. doi: 10.1016/j.aucc.2022.07.004. Online ahead of print.

ABSTRACT

BACKGROUND: Despite a growing body of research into end-of-life care (EOLC) in intensive care units (ICUs), few studies have concurrently explored the perspectives of families and clinicians.

OBJECTIVE: The objective of this study was to identify the characteristics of high-quality EOLC in the ICU from family and clinician perspectives and by examining the care documented in medical records.

METHODS: A convergent mixed-methods study incorporating electronic health record audits (n = 20), structured interview surveys with families (n = 20), clinician surveys (n = 189), and focus groups (n = 10) was undertaken at a 30-bed, level 3 ICU at a metropolitan public adult teaching hospital in Australia. Descriptive statistics were calculated from quantitative data, and inductive thematic analysis was used to analyse qualitative data.

RESULTS: Overall, families were very satisfied with EOLC and the quality of communication yet, felt that earlier, clearer communication that the patient was dying was required. Families spoke of the attentiveness, or lack thereof, by ICU clinicians and the opportunity to be present for the patient’s death. The majority of ICU clinicians felt EOLC could be improved. Nurses highlighted communication challenges when family meetings were delayed. Some nurses expressed a lack of clarity of how to withdraw care, resulting in hesitancy to cease potentially inappropriate care, and to provide EOLC outside ICU practice norms. In many instances, observations, invasive monitoring, and interventions were documented after EOLC commenced. A lack of documented personal cares was also noted.

CONCLUSIONS: This study provides new insights into EOLC from the dual perspectives of families and clinicians. There is a need for institutional guidelines to support ICU clinicians’ EOLC practices and education to improve clinician confidence with communication.

PMID:36089461 | DOI:10.1016/j.aucc.2022.07.004

Risk Anal. 2022 Sep 11. doi: 10.1111/risa.14018. Online ahead of print.

ABSTRACT

In this study, a new approach of machine learning (ML) models integrated with the analytic hierarchy process (AHP) method was proposed to develop a holistic flood risk assessment map. Flood susceptibility maps were created using ML techniques. AHP was utilized to combine flood vulnerability and exposure criteria. We selected Quang Binh province of Vietnam as a case study and collected available data, including 696 flooding locations of historical flooding events in 2007, 2010, 2016, and 2020; and flood influencing factors of elevation, slope, curvature, flow direction, flow accumulation, distance from river, river density, land cover, geology, and rainfall. These data were used to construct training and testing datasets. The susceptibility models were validated and compared using statistical techniques. An integrated flood risk assessment framework was proposed to incorporate flood hazard (flood susceptibility), flood exposure (distance from river, land use, population density, and rainfall), and flood vulnerability (poverty rate, number of freshwater stations, road density, number of schools, and healthcare facilities). Model validation suggested that deep learning has the best performance of AUC = 0.984 compared with other ensemble models of MultiBoostAB Ensemble (0.958), Random SubSpace Ensemble (0.962), and credal decision tree (AUC = 0.918). The final flood risk map shows 5075 ha (0.63%) in extremely high risk, 47,955 ha (5.95%) in high-risk, 40,460 ha (5.02%) in medium risk, 431,908 ha (53.55%) in low risk areas, and 281,127 ha (34.86%) in very low risk. The present study highlights that the integration of ML models and AHP is a promising framework for mapping flood risks in flood-prone areas.

PMID:36088657 | DOI:10.1111/risa.14018

BJU Int. 2022 Sep 11. doi: 10.1111/bju.15891. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the strength of the evidence indicative of prostate cancer (PCa) progression as the adjudicated cause of death, according to age at death and PCa risk category.

MATERIALS AND METHODS: Using data from the Prostate Cancer data Base Sweden, we identified a study frame of 5,543 men with PCa registered as the cause of death according to the Cause of Death Register. We assessed the evidence of PCa progression through a review of health care records for a stratified sample of 495/5,543. We extracted data on prostate-specific antigen levels, presence of metastases on imaging, and PCa treatments, and quantified the evidence of disease progression using a points system.

RESULTS: Both no evidence and moderate evidence for PCa progression was more common in men aged above 85 years at death than those below 85 years (29% vs. 14%). Among the latter, the proportion with no evidence or moderate evidence for PCa progression was 21% for low-risk, 14% for intermediate-risk, 8% for high-risk, and 0% for metastatic PCa. In contrast, in men above 85 years, there was little difference in the proportion with no evidence or moderate evidence of PCa progression between PCa risk categories; 31% for low-risk, 29% for intermediate-risk, 29% for high-risk, and 21% for metastatic PCa. Of the 5543 men who died of PCa, 13% (95% CI: 5%-19%) were estimated to have either no evidence or moderate evidence of PCa progression.

CONCLUSIONS: Weak evidence for PCa progression as cause of death was more common in older men with PCa and in those with low-risk PCa. This has implications for interpretation of mortality statistics especially when assessing screening and early treatment of PCa because the beneficial effect of earlier diagnosis could be masked by erroneous adjudication of PCa as cause of death in older men, particular those with localized disease at diagnosis.

PMID:36088648 | DOI:10.1111/bju.15891

J Med Radiat Sci. 2022 Sep 11. doi: 10.1002/jmrs.617. Online ahead of print.

ABSTRACT

INTRODUCTION: In this study, we aimed to investigate the feasibility of gadoxetate low-temporal resolution (LTR) DCE-MRI for voxel-based hepatic extraction fraction (HEF) quantification for liver sparing radiotherapy using a deconvolution analysis (DA) method.

METHODS: The accuracy and consistency of the deconvolution implementation in estimating liver function was first assessed using simulation data. Then, the method was applied to DCE-MRI data collected retrospectively from 64 patients (25 normal liver function and 39 cirrhotic patients) to generate HEF maps. The normal liver function patient data were used to measure the variability of liver function quantification. Next, a correlation between HEF and ALBI score (a new model for assessing the severity of liver dysfunction) was assessed using Pearson’s correlation. Differences in HEF between Child-Pugh score classifications were assessed for significance using the Kruskal-Wallis test for all patient groups and Mann-Whitney U-test for inter-groups. A statistical significance was considered at a P-value <0.05 in all tests.

RESULTS: The results showed that the implemented method accurately reproduced simulated liver function; root-mean-square error between estimated and simulated liver response functions was 0.003, and the coefficient-of-variance of HEF was <20%. HEF correlation with ALBI score was r = -0.517, P < 0.0001, and HEF was significantly decreased in the cirrhotic patients compared to normal patients (P < 0.0001). Also, HEF in Child-Pugh B/C was significantly lower than in Child-Pugh A (P = 0.024).

CONCLUSION: The study demonstrated the feasibility of gadoxetate LTR-DCE MRI for voxel-based liver function quantification using DA. HEF could distinguish between different grades of liver function impairment and could potentially be used for functional guidance in radiotherapy.

PMID:36088635 | DOI:10.1002/jmrs.617

Proteins. 2022 Sep 11. doi: 10.1002/prot.26420. Online ahead of print.

ABSTRACT

Antibodies are key proteins produced by the immune system to target pathogen proteins termed antigens via specific binding to surface regions called epitopes. Given an antigen and the sequence of an antibody the knowledge of the epitope is critical for the discovery and development of antibody based therapeutics. In this work, we present a computational protocol that uses template-based modeling and docking to predict epitope residues. This protocol is implemented in three major steps. First, a template-based modeling approach is used to build the antibody structures. We tested several options, including generation of models using AlphaFold2. Second, each antibody model is docked to the antigen using the FFT based docking program PIPER. Attention is given to optimally selecting the docking energy parameters depending on the input data. In particular, the van der Waals energy terms are reduced for modeled antibodies relative to X-ray structures. Finally, ranking of antigen surface residues is produced. The ranking relies on the docking results, i.e., how often the residue appears in the docking poses’ interface, and also on the energy favorability of the docking pose in question. The method, called PIPER-Map, has been tested on a widely used antibody-antigen docking benchmark. The results show that PIPER-Map improves upon the existing epitope prediction methods. An interesting observation is that epitope prediction accuracy starting from antibody sequence alone does not significantly differ from that of starting from unbound (i.e., separately crystallized) antibody structure.

PMID:36088633 | DOI:10.1002/prot.26420

Colorectal Dis. 2022 Sep 11. doi: 10.1111/codi.16328. Online ahead of print.

ABSTRACT

The management of malignant polyps is a treatment dilemma in selecting between polypectomy and colorectal resection. To assist clinicians, guidelines have been developed by the Association of Coloproctology of Great Britain and Ireland (ACPGBI) to provide treatment recommendations.

METHODS: This study compared management strategy based on the ACPGBI risk categorisation for malignant polyps. Univariate and multivariable statistical analysis was undertaken to assess the factors predicting management strategy. A population wide analysis was performed of 1,646 malignant polyps, and the factors which predicted their management strategy, from Queensland, Australia from 2011-2019.

RESULTS: Overall 31.55% of patients with very-low or low risk disease proceeded to resection. Of those with high or very-high risk disease, 36.69% did not proceed to resection. In very-low and low risk polyps, age (p=0.003) and polyp location (p<0.001) were significantly different between the colorectal resection group and the polypectomy alone group. In those with very-high or high risk polyps age (p<0.001), type of facility (public or private) for the colonoscopy (p=0.037), right colonic polyps compared to left colonic (p=0.015) and rectal polyps (p<0.001) and mismatch repair mutations present (p=0.027) were predictive of resection in high risk disease using a multivariable model.

CONCLUSION: Over 30% of patients with very-low and low risk malignant polyps proceeded to resection, against the advice of guidelines. Furthermore, over 35% of patients with very-high or high risk malignant polyps did not proceed to resection. Education strategies may improve management decision choices. Furthermore, improvements in data collation will improve understanding management choices into the future.

PMID:36088629 | DOI:10.1111/codi.16328