Nevin Manimala

JNCI Cancer Spectr. 2021 Dec 8;5(6):pkab090. doi: 10.1093/jncics/pkab090. eCollection 2021 Dec.

ABSTRACT

BACKGROUND: Recreational physical activity (RPA) is associated with improved survival after breast cancer (BC) in average-risk women, but evidence is limited for women who are at increased familial risk because of a BC family history or BRCA1 and BRCA2 pathogenic variants (BRCA1/2 PVs).

METHODS: We estimated associations of RPA (self-reported average hours per week within 3 years of BC diagnosis) with all-cause mortality and second BC events (recurrence or new primary) after first invasive BC in women in the Prospective Family Study Cohort (n = 4610, diagnosed 1993-2011, aged 22-79 years at diagnosis). We fitted Cox proportional hazards regression models adjusted for age at diagnosis, demographics, and lifestyle factors. We tested for multiplicative interactions (Wald test statistic for cross-product terms) and additive interactions (relative excess risk due to interaction) by age at diagnosis, body mass index, estrogen receptor status, stage at diagnosis, BRCA1/2 PVs, and familial risk score estimated from multigenerational pedigree data. Statistical tests were 2-sided.

RESULTS: We observed 1212 deaths and 473 second BC events over a median follow-up from study enrollment of 11.0 and 10.5 years, respectively. After adjusting for covariates, RPA (any vs none) was associated with lower all-cause mortality of 16.1% (95% confidence interval [CI] = 2.4% to 27.9%) overall, 11.8% (95% CI = -3.6% to 24.9%) in women without BRCA1/2 PVs, and 47.5% (95% CI = 17.4% to 66.6%) in women with BRCA1/2 PVs (RPA*BRCA1/2 multiplicative interaction P = .005; relative excess risk due to interaction = 0.87, 95% CI = 0.01 to 1.74). RPA was not associated with risk of second BC events.

CONCLUSION: Findings support that RPA is associated with lower all-cause mortality in women with BC, particularly in women with BRCA1/2 PVs.

PMID:34950851 | PMC:PMC8692829 | DOI:10.1093/jncics/pkab090

J Frailty Sarcopenia Falls. 2021 Dec 1;6(4):209-217. doi: 10.22540/JFSF-06-209. eCollection 2021 Dec.

ABSTRACT

OBJECTIVES: The health and well-being of older women may be influenced by frailty and low socioeconomic status (SES). This study examined the association between frailty and SES, healthcare utilisation and quality of life (QOL) among older women in regional Australia.

METHODS: Cross-sectional analysis of the Geelong Osteoporosis Study was conducted on 360 women (ages ≥60yr) in the 15-year follow up. Frailty was identified using modified Fried’s phenotype. Individual SES measures and healthcare utilisation were documented by questionnaire. Area-based SES was determined by cross-referencing residential addresses with the Australian Bureau of Statistics Index of Relative Socio-economic Advantage and Disadvantage (IRSAD). QOL was measured using the Australian World Health Organisation Quality of Life Instrument (WHOQoL-Bref). Multinomial logistic regression was conducted with frailty groupings as outcome.

RESULTS: Sixty-two (17.2%) participants were frail, 199 (55.3%) pre-frail and 99 (27.5%) robust. Frail participants were older with higher body mass index. Frailty was associated with lower education but not marital status, occupation or IRSAD. Strong associations with frailty were demonstrated for all WHOQoL-Bref domains. Frailty was associated with more primary care doctor visits (p<0.001).

CONCLUSIONS: This population-based study highlights the significant impact of frailty on older women, indicating reduced QOL and increased primary care doctor visits.

PMID:34950811 | PMC:PMC8649863 | DOI:10.22540/JFSF-06-209

Bone Rep. 2021 Dec 9;16:101157. doi: 10.1016/j.bonr.2021.101157. eCollection 2022 Jun.

ABSTRACT

BACKGROUND: Pseudoarthrosis or non-union is a complication with an incidence of 5-10% of bone fractures, most frequently located in the diaphysis of long bones. The management of this complication is addressed by means of complex surgical procedures and is a concern for orthopaedic and trauma surgeons nowadays. The use of biomarkers for diagnosing patients at risk of non-union would help us to establish special measures for early corrective treatment.

METHODS: Prospective exploratory pilot study with a cohort of 20 patients diagnosed of non-hypertrophic pseudoarthrosis of long bones who were treated surgically with either autologous bone graft or a Tissue Engineering Product composed of bone marrow-derived Mesenchymal Stromal Cells. Patients were followed for 12 months and plasma blood samples were obtained to determine circulating levels of Transforming Growth Factor Beta 1 and Beta 2 (TGF-β1 and TGF-β2, respectively) at inclusion, and at 1 week, 2 weeks, and months 1, 2, 3, 6 and 12 after surgery. Radiological bone healing was evaluated by the Tomographic Union Score (TUS).

RESULTS: Basal levels of TGF-β1 and TGF-β2 were determined in the twenty patients (26,702 ± 14,537 pg/mL and 307.8 ± 83.1 pg/mL, respectively). Three of them withdrew from the study, so complete follow-up was conducted on 17 patients (9 successfully healed vs. 8 that did not heal). Statistically significant differences between the bone healing group and the non-union group were found at month 12 for both TGF-β1 (p = 0.005) and TGF-β2 (p = 0.02).

CONCLUSIONS: TGF-β1 and TGF-β2 are biomarkers that correlate with clinical evidence of bone regeneration and may be used to monitor patients, although early predictive value after intervention needs to be further studied in combination with other molecules.

PMID:34950754 | PMC:PMC8671858 | DOI:10.1016/j.bonr.2021.101157

J Med Imaging (Bellingham). 2021 Nov;8(6):067501. doi: 10.1117/1.JMI.8.6.067501. Epub 2021 Dec 20.

ABSTRACT

Purpose: Recent advances in computational image analysis offer the opportunity to develop automatic quantification of histologic parameters as aid tools for practicing pathologists. We aim to develop deep learning (DL) models to quantify nonsclerotic and sclerotic glomeruli on frozen sections from donor kidney biopsies. Approach: A total of 258 whole slide images (WSI) from cadaveric donor kidney biopsies performed at our institution ( n=123 ) and at external institutions ( n=135 ) were used in this study. WSIs from our institution were divided at the patient level into training and validation datasets (ratio: 0.8:0.2), and external WSIs were used as an independent testing dataset. Nonsclerotic ( n=22767 ) and sclerotic ( n=1366 ) glomeruli were manually annotated by study pathologists on all WSIs. A nine-layer convolutional neural network based on the common U-Net architecture was developed and tested for the segmentation of nonsclerotic and sclerotic glomeruli. DL-derived, manual segmentation, and reported glomerular count (standard of care) were compared. Results: The average Dice similarity coefficient testing was 0.90 and 0.83. And the F1 , recall, and precision scores were 0.93, 0.96, and 0.90, and 0.87, 0.93, and 0.81, for nonsclerotic and sclerotic glomeruli, respectively. DL-derived and manual segmentation-derived glomerular counts were comparable, but statistically different from reported glomerular count. Conclusions: DL segmentation is a feasible and robust approach for automatic quantification of glomeruli. We represent the first step toward new protocols for the evaluation of donor kidney biopsies.

PMID:34950750 | PMC:PMC8685284 | DOI:10.1117/1.JMI.8.6.067501

Open Forum Infect Dis. 2021 Dec 21;8(12):ofab303. doi: 10.1093/ofid/ofab303. eCollection 2021 Dec.

ABSTRACT

[This corrects the article DOI: 10.1093/ofid/ofaa589.].

PMID:34950745 | PMC:PMC8691156 | DOI:10.1093/ofid/ofab303

Prim Care Companion CNS Disord. 2021 Dec 23;23(6):21m02941. doi: 10.4088/PCC.21m02941.

ABSTRACT

Objective: To investigate the frequency of suicidal ideation and its correlation with other clinical variables in patients with pulmonary arterial hypertension.

Methods: Fifty patients with pulmonary arterial hypertension who presented to the cardiology department between 2018 and 2019 and 50 healthy controls were included in the study. A sociodemographic and clinical data form was completed by both the patients and controls, and the Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), Rosenberg Self-Esteem Scale (RSE), and Suicide Probability Scale (SPS) were administered. SPSS version 22 software was used in the statistical analysis.

Results: The mean ± SD systolic pulmonary pressure of the patients was 47.48 ± 18.86 and the pulmonary artery pressure was 33.32 ± 19.69. BHS, BDI, and SPS total scores were statistically significantly higher in the patient group compared to the control group (P < .001, P = .001, P = .026, respectively). RSE scores were also higher in the patient group compared to the control group (P = .017).

Conclusions: It is important to identify pulmonary arterial hypertension patients with intense feelings of hopelessness and depressive symptoms and to provide psychiatric treatment and psychotherapeutic interventions to improve their self-esteem.

PMID:34942065 | DOI:10.4088/PCC.21m02941

Eur J Dent Educ. 2021 Dec 23. doi: 10.1111/eje.12760. Online ahead of print.

ABSTRACT

OBJECTIVES: Some dental schools depend on the students’ academic performance for admission purposes. This research aimed at investigating the correlations between dental students’ performance in specific academic courses and their preclinical and clinical counterparts, and the correlations between students’ performance in the pre-clinical practical courses and the clinical courses.

METHODS: Academic and practical preclinical and clinical grades were retrieved for 811 students who graduated from the School of Dentistry, the University of Jordan between 2016 and 2018. Ten courses (five academic and five practical) were selected. Pearson’s rho test was used to calculate the correlations between the courses.

RESULTS: Statistically significant weak to moderate positive correlations were found between each academic course and its preclinical or clinical counterparts and between preclinical and clinical courses. A statistically significant positive moderate correlation (P<0.001) was found between students’ performance in fourth and fifth year restorative clinics.

CONCLUSION: The results of this study suggest that the academic performance could partially predict the practical performance in both the pre-clinical and clinical courses and that the clinical performance could partially be predicted from the pre-clinical practical performance. Moreover, students who can successfully perform the required clinical procedures in fourth year will successfully perform the required clinical procedures in fifth year. However, other confounding factors should be taken into consideration such as manual dexterity and artistic skills even though their intellectual abilities are average.

PMID:34942060 | DOI:10.1111/eje.12760

Hematol Oncol. 2021 Dec 23. doi: 10.1002/hon.2958. Online ahead of print.

ABSTRACT

The prognosis of patients with multiple myeloma (MM) with extramedullary disease (EMD) remains poor. A high overall response rate (ORR) has been reported following anti-B-cell maturation antigen (BCMA) chimeric antigen receptor (CAR)-T cell therapy in relapsed/ refractory (R/R) patients with MM; however, data on patients with EMD remain limited. Herein, we compared and analyzed the efficacy and long-term follow-up of anti-BCMA CAR-T cell therapy in R/R MM patients with extramedullary-extraosseous (EM-E), extramedullary-bone related (EM-B), and without extramedullary disease. No difference in the ORR was observed between the three groups. The long-term efficacy of anti-BCMA CAR-T cell therapy in the EM-E group was worse than that in patients without EMD and with EM-B. In the EM-E group, disease progression was the reappearance of extramedullary lesions without an increase in the MM cell percentage or M protein level. Although no difference in the proportion of CAR-T cells was detected among the three groups, the EM-E group might exhibit a relatively high grade of cytokine release syndrome following anti-BCMA CAR-T therapy. Interleukin-6 levels in the without EMD group were lower than those in the EM-E and EM-B groups. However, given the small number of cases in the three groups, statistical analysis was not performed. This article is protected by copyright. All rights reserved.

PMID:34942032 | DOI:10.1002/hon.2958

New Microbiol. 2021 Dec 19;44(4). Online ahead of print.

ABSTRACT

Type 1 diabetes (T1DM) ethiopathogenesis is still being studied, since the role of environmental factors , especially viruses, is not yet clear. This study was conducted on 31 paediatric patients with T1DM at onset. We analysed: Coxsackieviruses A (CoxA), Coxsackieviruses B (CoxB), Echoviruses (Echo); Influenzavirus A and B (IV-A and IV-B); Adenovirus (AdV); Parainfluenza viruses 1-2 and 3 ( PiV 1-2-3); Cytomegalovirus (CMV) and Respiratory Syncytial Virus (RSV). Enteroviruses, especially CoxB and Echo, are most represented. Unexpectedly, Parainfluenza viruses were detected in seasonal subgroups, with peaks in autumn and spring, and spread homogeneously in different age groups.

PMID:34942009

Interact Cardiovasc Thorac Surg. 2021 Dec 23:ivab354. doi: 10.1093/icvts/ivab354. Online ahead of print.

ABSTRACT

OBJECTIVES: Obesity may increase the risk of vascular complications in transfemoral (TF) transcatheter aortic valve replacement (TAVR) procedures. The transcarotid (TC) approach has recently emerged as an alternative access in TAVR. We sought to compare vascular complications and early clinical outcomes in obese patients undergoing TAVR either by TF or TC vascular access.

METHODS: Multicentre registry including obese patients undergoing TF- or TC-TAVR in 15 tertiary centres. All patients received newer-generation transcatheter heart valves. For patients exhibiting unfavourable ileo-femoral anatomic characteristics, the TC approach was favoured in 3 centres with experience with it. A propensity score analysis was performed for overcoming unbalanced baseline covariates. The primary end point was the occurrence of in-hospital vascular complications (Valve Academic Research Consortium-2 criteria).

RESULTS: A total of 539 patients were included, 454 (84.2%) and 85 (15.8%) had a TF and TC access, respectively. In the propensity-adjusted cohort (TF: 442 patients; TC: 85 patients), both baseline and procedural valve-related characteristics were well-balanced between groups. A significant decrease in vascular complications was observed in the TC group (3.5% vs 12% in the TF group, odds ratio: 0.26, 95% CI: 0.07-0.95, P = 0.037). There were no statistically significant differences between groups regarding in-hospital mortality (TC: 2.8%, TF: 1.5%), stroke (TC: 1.2%, TF: 0.4%) and life-threatening/major bleeding events (TC: 2.8%, TF: 3.8%).

CONCLUSIONS: In patients with obesity undergoing TAVR with newer-generation devices, the TC access was associated with a lower rate of vascular complications. Larger randomized studies are warranted to further assess the better approach for TAVR in obese patients.

PMID:34942005 | DOI:10.1093/icvts/ivab354