Nevin Manimala

Phys Med Biol. 2021 Nov 10. doi: 10.1088/1361-6560/ac383f. Online ahead of print.

ABSTRACT

Breathing interplay effects in Intensity Modulated Proton Therapy (IMPT) arise from the interaction between target motion and the scanning beam. Assessing the detrimental effect of interplay and the clinical robustness of several mitigation techniques requires statistical evaluation procedures that take into account the variability of breathing during dose delivery. In this study, we present such a statistical method to model intra-fraction respiratory motion based on breathing signals and assess clinical relevant aspects related to the practical evaluation of interplay in IMPT such as how to model irregular breathing, how small breathing changes affect the final dose distribution, and what is the statistical power (number of different scenarios) required for trustworthy quantification of interplay effects. First, two data-driven methodologies to generate artificial patient-specific breathing signals are compared: a simple sinusoidal model, and a precise probabilistic deep learning model generating very realistic samples of patient breathing. Second, we investigate the highly fluctuating relationship between interplay doses and breathing parameters, showing that small changes in breathing period result in large local variations in the dose. Our results indicate that using a limited number of samples to calculate interplay statistics introduces a bigger error than using simple sinusoidal models based on patient parameters or disregarding breathing hysteresis during the evaluation. We illustrate the power of the presented statistical method by analyzing interplay robustness of 4DCT and Internal Target Volume (ITV) treatment plans for a 8 lung cancer patients, showing that, unlike 4DCT plans, even 33 fraction ITV plans systematically fail to fulfill robustness requirements.

PMID:34757958 | DOI:10.1088/1361-6560/ac383f

J Neural Eng. 2021 Nov 10. doi: 10.1088/1741-2552/ac387f. Online ahead of print.

ABSTRACT

OBJECTIVE: The efficacy of an adopted feature extraction method directly affects the classification of the electromyographic (EMG) signals in myoelectric control applications. Most methods attempt to extract the dynamics of the multi-channel EMG signals in the time domain and on a channel-by-channel, or at best pairs of channels, basis. However, considering multi-channel information to build a similarity matrix has not been taken into account.

APPROACH: Combining methods of long and short-term memory (LSTM) and dynamic temporal warping (DTW), we developed a new feature, called spatio-temporal warping (STW), for myoelectric signals. This method captures the spatio-temporal relationships of multi channels EMG signals.

MAIN RESULTS: Across four online databases, we show that in terms of average classification error and standard deviation values, the STW feature outperforms traditional features by 5% to 17%. In comparison to the more recent deep learning models, e.g. convolutional neural networks (CNN), STW outperformed by 5% to 18%. Also, STW showed enhanced performance when compared to the CNN+LSTM model by 2% to 14%. All differences were statistically significant with a large effect size.

SIGNIFICANCE: This feasibility study provides evidence supporting the hypothesis that spatio-temporal warping of the EMG signals can enhance the classification accuracy in an explainable way when compared to recent deep learning methods. Future work includes real-time implementation of the method and testing for prosthesis control.

PMID:34757954 | DOI:10.1088/1741-2552/ac387f

J Am Vet Med Assoc. 2021 Dec 15:1-6. doi: 10.2460/javma.20.07.0420. Online ahead of print.

ABSTRACT

OBJECTIVE: To characterize the signalment, clinical signs, clinical pathological and histologic findings, and outcome in 8 related Bracchi Italiani with proteinuric kidney disease.

ANIMALS: 8 client-owned Bracchi Italiani.

PROCEDURES: Health records submitted to the Bracco Italiano Health Foundation and the Bracco Italiano Club of America between 2012 and 2019 were reviewed for dogs with evidence of nephropathy for which histologic diagnoses were obtained. Pedigree, signalment, clinical signs, diagnostic test results (including microscopic examination of kidney tissue samples collected ante- or postmortem), and outcome were acquired. Results were presented as descriptive statistics.

RESULTS: The most common clinical sign in affected dogs was inappetence. All dogs were proteinuric, and 4 dogs were azotemic. Seven dogs developed clinical signs of kidney disease and were euthanized a median of 75 days postdiagnosis. Six dogs had glomerular amyloidosis, and 1 dog each had nephrosclerosis and nonamyloidotic fibrillar glomerulopathy.

CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that the clinical presentation may vary in affected dogs, and proteinuria in young or middle-aged Bracchi Italiani should raise the concern for hereditary nephropathy. Prognosis is likely poor once clinical signs are noted.

PMID:34757934 | DOI:10.2460/javma.20.07.0420

J Am Vet Med Assoc. 2021 Dec 15:1-5. doi: 10.2460/javma.20.05.0291. Online ahead of print.

ABSTRACT

OBJECTIVE: To characterize features of myxomatous mitral valve disease (MMVD) in Miniature Schnauzers and Yorkshire Terriers.

ANIMALS: 69 Miniature Schnauzers and 65 Yorkshire Terriers, each with MMVD.

PROCEDURES: Medical record data for each dog were collected; the study period was January 2007 through December 2016. If available, radiographic data were evaluated, and a vertebral heart scale score was assigned for each dog. Statistical analysis was performed with Student t and Fisher exact tests.

RESULTS: Compared with Yorkshire Terriers, the prevalence of MMVD was significantly higher in Miniature Schnauzers and affected dogs were significantly younger at the time of diagnosis. Miniature Schnauzers were significantly more likely to have mitral valve prolapse and syncope, compared with Yorkshire Terriers. Yorkshire Terriers were significantly more likely to have coughing and have had previous or current treatment with cardiac medications, compared with Miniature Schnauzers. There was no statistical difference between breeds with regard to abnormally high vertebral heart scale scores or radiographic evidence of congestive heart failure.

CONCLUSIONS AND CLINICAL RELEVANCE: With regard to MMVD, features of the disease among Miniature Schnauzers and Yorkshire Terriers were similar, but there were also a few discernable differences between these 2 breeds and from historical findings for dogs with MMVD of other breeds. Clinical signs at the time of diagnosis differed between the 2 breeds, which may have reflected concurrent breed-specific conditions (sick sinus syndrome or airway disease [eg, tracheal collapse]). Future work should include prospective studies to provide additional information regarding the natural progression of MMVD in these dog breeds.

PMID:34757932 | DOI:10.2460/javma.20.05.0291

IEEE J Biomed Health Inform. 2021 Nov 10;PP. doi: 10.1109/JBHI.2021.3127080. Online ahead of print.

ABSTRACT

Transcranial direct and alternating current stimulation (tDCS and tACS, respectively) can modulate human brain dynamics and cognition. However, these modalities have not been compared using multiple imaging techniques concurrently. In this study, 15 participants participated in an experiment involving two sessions with a gap of 10 d. In the first and second sessions, tACS and tDCS were administered to the participants. The anode for tDCS was positioned at point FpZ, and four cathodes were positioned over the left and right prefrontal cortices (PFCs) to target the frontal regions simultaneously. tDCS was administered with 1 mA current. tACS was supplied with a current of 1 mA (zero-to-peak value) at 10 Hz frequency. Stimulation was applied concomitantly with functional near-infrared spectroscopy and electroencephalography acquisitions in the resting-state. The statistical test showed significant alteration (p < 0.001) in the mean hemodynamic responses during and after tDCS and tACS periods. Between-group comparison revealed a significantly less (p < 0.001) change in the mean hemodynamic response caused by tACS compared with tDCS. As hypothesized, we successfully increased the hemodynamics in both left and right PFCs using tDCS and tACS. Moreover, a significant increase in alpha-band power (p < 0.01) and low beta band power (p < 0.05) due to tACS was observed after the stimulation period. Although tDCS is not frequency-specific, it increased but not significantly (p > 0.05) the powers of most bands including delta, theta, alpha, low beta, high beta, and gamma. These findings suggest that both hemispheres can be targeted and that both tACS and tDCS are equally effective in high-definition configurations, which may be of clinical relevance.

PMID:34757916 | DOI:10.1109/JBHI.2021.3127080

J Intensive Care Med. 2021 Nov 10:8850666211053548. doi: 10.1177/08850666211053548. Online ahead of print.

ABSTRACT

Background: Severe coronavirus disease 2019 (COVID-19) can boost the systematic inflammatory response in critically ill patients, causing a systemic hyperinflammatory state leading to multiple complications. In COVID-19 patients, the use of inhaled corticosteroids (ICS) is surrounded by controversy regarding their impacts on viral infections. This study aims to evaluate the safety and efficacy of ICS in critically ill patients with COVID-19 and its clinical outcomes. Method: A multicenter, noninterventional, cohort study for critically ill patients with COVID-19 who received ICS. All patients aged ≥ 18 years old with confirmed COVID-19 and admitted to intensive care units (ICUs) between March 1, 2020 and March 31, 2021 were screened. Eligible patients were classified into two groups based on the use of ICS ± long-acting beta-agonists (LABA) during ICU stay. Propensity score (PS)-matched was used based on patient’s Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, systemic corticosteroids use, and acute kidney injury (AKI) within 24 h of ICU admission. We considered a P-value of < 0.05 statistically significant. Results: A total of 954 patients were eligible; 130 patients were included after PS matching (1:1 ratio). The 30-day mortality (hazard ratio [HR] [95% confidence interval [CI]]: 0.53 [0.31, 0.93], P-value = 0.03) was statistically significant lower in patients who received ICS. Conversely, the in-hospital mortality, ventilator-free days (VFDs), ICU length of stay (LOS), and hospital LOS were not statistically significant between the two groups. Conclusion: The use of ICS ± LABA in COVID-19 patients may have survival benefits at 30 days. However, it was not associated with in-hospital mortality benefits nor VFDs.

PMID:34757869 | DOI:10.1177/08850666211053548

Assay Drug Dev Technol. 2021 Nov 10. doi: 10.1089/adt.2021.078. Online ahead of print.

ABSTRACT

Microstructure of a semisolid system is greatly influenced by the formulation composition and the processing parameters. Different polymers exhibit different three-dimensional structure and these have a great impact on the drug release properties. The current research focuses on studying the impact of hydroxypropyl cellulose gel microstructure on the release properties of chlorhexidine gluconate (CHX G). The two main investigating methods of microstructure were used namely, rheology and texture analysis to determine the differences in the formulations studied. The CHX G drug release study was performed using a developed and validated in vitro release test method, which is reproducible, discriminative, and robust to detect the formulation differences. The drug release results showed that there was appreciable difference in the release rates of the different formulations. The rheology and texture analysis data correlated well with the difference in the release rates. The formulations differences were further confirmed by a statistical approach using analysis of variance.

PMID:34757828 | DOI:10.1089/adt.2021.078

Telemed J E Health. 2021 Nov 9. doi: 10.1089/tmj.2021.0157. Online ahead of print.

ABSTRACT

Background: Faced with the coronavirus disease 2019 (COVID-19) pandemic, Korea has allowed telemedicine use for a limited time. This study examined whether the surge in COVID-19 cases led to increased telemedicine use and the associated factors. Methods: Data from the electronic medical records of 929,753 outpatient episodes between March 4 and September 4, 2020, in a tertiary hospital in Korea were used. A comparison group was chosen by matching, adjusting for age and sex because only a small portion (1.0%) of the sample used telemedicine. The final sample comprised 57,972 episodes. Multivariable logistic regression analyses were performed to examine the association of independent variables with the dichotomous dependent variable (i.e., telemedicine visit/in-person visit). Results: The surge in confirmed COVID-19 cases led to significantly increased telemedicine use (101-300 new cases odds ratio [OR]: 3.00; 301-500 new cases OR: 5.82; and ≥501 new cases OR: 42.18; all p < 0.0001). Telemedicine use was also statistically associated with sex (female patients OR: 2.08), age ˃19 years, distance from the hospital (Incheon, Gyeonggi, region, OR: 1.30; and other regions, OR: 4.33), and the number of days from diagnosis (3-6 months OR: 1.21; 6-12 months OR: 1.56; 12-36 months OR: 1.98; and ≥36 months OR: 2.49). Medical Aid patients (OR: 0.83) were less likely to use telemedicine than those with National Health Insurance. Conclusions: Telemedicine can be effective in delivering health services during an outbreak. Policymakers and health care organizations are encouraged to use the results of this study to tailor telemedicine to meet the needs of patients.

PMID:34757827 | DOI:10.1089/tmj.2021.0157

OMICS. 2021 Nov 10. doi: 10.1089/omi.2021.0097. Online ahead of print.

ABSTRACT

The Slit-Robo family of axon guidance molecules works in concert, playing important roles in organ development and cancer. Expressions of individual Slit-Robo genes have been used in calculating univariable hazard ratios (HR_uni) for predicting cancer prognosis in the literature. However, Slit-Robo members do not act independently; hence, hazard ratios from multivariable Cox regression (HR_multi) on the whole gene set can further lead to identification of cancer-specific, novel, and independent prognostic gene pairs or modules. Herein, we obtained mRNA expressions of the Slit-Robo family consisting of four Robos (ROBO1/2/3/4) and three Slits (SLIT1/2/3), along with four types of survival outcome across cancers found in the Cancer Genome Atlas (TCGA). We used cluster heat maps to visualize closely associated pairs/modules of prognostic genes across 33 different cancers. We found a smaller number of significant genes in HR_multi than in HR_uni, suggesting that the former analysis was less redundant. High ROBO4 expression emerged as relatively protective within the family, in both types of HR analyses. Multivariable Cox regression, on the other hand, revealed significantly more HR signatures containing Slit-Robo pairs acting in opposing directions than those containing Slit-Slit or Robo-Robo pairs for disease-specific survival. Furthermore, we discovered, through the online app SmulTCan’s lasso regression, Slit-Robo gene subsets that significantly differentiated between high- versus low-risk prognosis patient groups, particularly for renal cancers and low-grade glioma. The statistical pipeline reported herein can help test independent and significant pairs/modules within a codependent gene family for cancer prognostication, and thus should also prove useful in personalized/precision medicine research.

PMID:34757814 | DOI:10.1089/omi.2021.0097

Minerva Dent Oral Sci. 2021 Nov 10. doi: 10.23736/S2724-6329.21.04561-7. Online ahead of print.

ABSTRACT

INTRODUCTION: A successful endodontic treatment can be achieved by proper cleaning, shaping and disinfection and obturation of the root canal system. Mandibular molars requiring endodontic therapy have several variations. A mandibular molar usually has two roots but occasionally, it might have additional roots also. The purpose of this article is to determine the regional predilection of Radix Entomolaris in permanent mandibular first molar in India and its comparison to rest of world.

EVIDENCE ACQUISITION: A search was undertaken to identify published research articles related to radix entomolaris in mandibular first molars. Sixty four research articles were analyzed.

EVIDENCE SYNTHESIS: Articles were assessed in relation to demographic location of radix entomolaris. Also the type of study and the analytic tool employed for its assessment was evaluated. Results were tabulated and statistically analyzed. Statistical test revealed a significant variation between the India and rest of world.

CONCLUSIONS: This research reported that regional predilection of radix entomolaris in mandibular first molar varies significantly. In India the highest incidence of radix entomolaris was observed in north India with 24%, whereas in world China reported the highest prevalence of 32% and the minimum was observed in Africa at 0%. India relied on conventional radiography for its diagnosis whereas rest of the world primarily utilized in vitro studies and advanced radiography for its diagnosis.

PMID:34755993 | DOI:10.23736/S2724-6329.21.04561-7