Nevin Manimala

Eur Radiol. 2022 Apr 5. doi: 10.1007/s00330-022-08732-4. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Transarterial ⁹⁰Y radioembolization (TARE) is increasingly being used for hepatocellular carcinoma (HCC) treatment. However, tumor response assessment after TARE may be challenging. We aimed to assess the diagnostic performance of gadoxetate disodium MRI for predicting complete pathologic necrosis (CPN) of HCC treated with TARE, using histopathology as the reference standard.

METHODS: This retrospective study included 48 patients (M/F: 36/12, mean age: 62 years) with HCC treated by TARE followed by surgery with gadoxetate disodium MRI within 90 days of surgery. Two radiologists evaluated tumor response using RECIST1.1, mRECIST, EASL, and LI-RADS-TR criteria and evaluated the percentage of necrosis on subtraction during late arterial, portal venous, and hepatobiliary phases (AP/PVP/HBP). Statistical analysis included inter-reader agreement, correlation between radiologic and pathologic percentage of necrosis, and prediction of CPN using logistic regression and ROC analyses.

RESULTS: Histopathology demonstrated 71 HCCs (2.8 ± 1.7 cm, range: 0.5-7.5 cm) including 42 with CPN, 22 with partial necrosis, and 7 without necrosis. EASL and percentage of tumor necrosis on subtraction at the AP/PVP were independent predictors of CPN (p = 0.02-0.03). Percentage of necrosis, mRECIST, EASL, and LI-RADS-TR had fair to good performance for diagnosing CPN (AUCs: 0.78 – 0.83), with a significant difference between subtraction and LI-RADS-TR for reader 2, and in specificity between subtraction and other criteria for both readers (p-range: 0.01-0.04). Radiologic percentage of necrosis was significantly correlated to histopathologic degree of tumor necrosis (r = 0.66 – 0.8, p < 0.001).

CONCLUSIONS: Percentage of tumor necrosis on subtraction and EASL criteria were significant independent predictors of CPN in HCC treated with TARE. Image subtraction should be considered for assessing HCC response to TARE when using MRI.

KEY POINTS: • Percentage of tumor necrosis on image subtraction and EASL criteria are significant independent predictors of complete pathologic necrosis in hepatocellular carcinoma treated with⁹⁰Y radioembolization. • Subtraction, mRECIST, EASL, and LI-RADS-TR have fair to good performance for diagnosing complete pathologic necrosis in hepatocellular carcinoma treated with⁹⁰Y radioembolization.

PMID:35380226 | DOI:10.1007/s00330-022-08732-4

Eur Radiol. 2022 Apr 5. doi: 10.1007/s00330-022-08709-3. Online ahead of print.

ABSTRACT

OBJECTIVES: To analyze the response in the management of both radiological emergencies and continuity of care in oncologic/fragile patients of a radiology department of Sant’Andrea Academic Hospital in Rome supported by a dedicated business analytics software during the COVID-19 pandemic.

METHODS: Imaging volumes and workflows for 2019 and 2020 were analyzed. Information was collected from the hospital data warehouse and evaluated using a business analytics software, aggregated both per week and per quarter, stratified by patient service location (emergency department, inpatients, outpatients) and imaging modality. For emergency radiology subunit, radiologist workload, machine workload, and turnaround times (TATs) were also analyzed.

RESULTS: Total imaging volume in 2020 decreased by 21.5% compared to that in 2019 (p < .001); CT in outpatients increased by 11.7% (p < .005). Median global TAT and median code-blue global TAT were not statistically significantly different between 2019 and 2020 and between the first and the second pandemic waves in 2020 (all p > .09). Radiologist workload decreased by 24.7% (p < .001) during the first pandemic wave in 2020 compared with the same weeks of 2019 and showed no statistically significant difference during the second pandemic wave, compared with the same weeks of 2019 (p = 0.19).

CONCLUSIONS: Despite the reduction of total imaging volume due to the COVID-19 pandemic in 2020 compared to 2019, management decisions supported by a dedicated business analytics software allowed to increase the number of CT in fragile/oncologic outpatients without significantly affecting emergency radiology TATs, and emergency radiologist workload.

KEY POINTS: • During the COVID-19 pandemic, management decisions supported by business analytics software guaranteed efficiency of emergency and preservation of fragile/oncologic patient continuity of care. • Real-time data monitoring using business analytics software is essential for appropriate management decisions in a department of radiology. • Business analytics should be gradually introduced in all healthcare institutions to identify strong and weak points in workflow taking correct decisions.

PMID:35380224 | DOI:10.1007/s00330-022-08709-3

Osteoporos Int. 2022 Apr 5. doi: 10.1007/s00198-022-06376-0. Online ahead of print.

ABSTRACT

Data are contradictory regarding the relationship between osteoarthritis (OA) and osteoporosis (OP) with some studies showing the increased risk of OP in OA. The study was conducted to determine whether OP prevalence is increased in patients with OA, compared to age and sex-matched population. MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library (inception-2019) were searched for studies reporting the frequency, rate, prevalence, incidence, risk, or excess risk of OP in patients with OA compared to age and sex-matched population. Estimates were combined using a random effects model. Consistency was evaluated using the I² statistic. Articles with fewer than 200 participants were excluded. Of 2772 articles, 49 had full article screening, and 8 articles met the inclusion criteria. Other articles reporting mean BMD and not OP were excluded. In women, 998 participants with OA were compared with 1903 controls. The pooled estimate of the odds ratio for prevalence of OP vs general matched population was not statistically different. In men, 136 participants with OA were compared with 682 controls. The results did not show a statistically significant difference in the frequency of OP in OA in men. According to the site of bone mineral density measurement, a higher prevalence of OP at lumbar spine was found in both men and women. The frequency of OP overall in participants with OA was not different, except for a higher prevalence of OP in lumbar spine in both men and women compared to the matched controls.

PMID:35380214 | DOI:10.1007/s00198-022-06376-0

Quintessence Int. 2022 Apr 5;0(0):2-9. doi: 10.3290/j.qi.b2887673. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate functional and esthetic clinical outcomes and patient satisfaction with narrow-diameter implants in comparison to standard-diameter implants in the anterior zone of the maxilla in a follow-up examination after 1 to 6 years.

METHOD AND MATERIALS: The study was designed as a retrospective cohort study investigation including 27 patients receiving a 3.3-mm diameter single implant (NDI, n = 14) or a standard-diameter 4.1-mm single implant in the anterior zone of the maxilla (SDI, n = 16). Descriptive and analytical statistics were performed comparing both groups with regard to clinical examination including esthetic outcome, sulcus fluid flow-rate, crown esthetics, patients’ satisfaction on visual analog scales, occurrence of biologic or technical complication, probing pocket depths (Fisher exact test), pink esthetic score (PES) and Periotest (Mann-Whitney U test). The level of significance was set at α = .05.

RESULTS: The mean observation period was 4.8 years after crown insertion in the NDI group, and 4.9 years in the SDI group. Significant differences were observed for Periotest values in favor of the 4.1-mm implants (P = .014). No differences were found with regards to esthetics (PES; P = .27) or sulcus fluid flow-rate (P = 0.73) and probing pocket depths (P = .35). Overall patient satisfaction was high for both groups with visual analog scale scores of 9.3 ± 1.1 for NDI and 9.4 ± 1.0 for SDI (P = .39).

CONCLUSION: Clinical outcome with narrow-diameter implants was comparable to standard-diameter implants in the anterior zone of the maxilla with similar esthetic assessments and patients’ satisfaction.

PMID:35380207 | DOI:10.3290/j.qi.b2887673

J Neurosurg Sci. 2022 Apr 5. doi: 10.23736/S0390-5616.22.05606-5. Online ahead of print.

ABSTRACT

BACKGROUND: In our experience, we encountered more blood vessels during deep brain stimulation (DBS) surgeries in epilepsy. In this study, we have quantified and compared the cerebral vascularization in epilepsy, Parkinson’s Disease (PD) and Obsessive-Compulsive Disorder (OCD).

METHODS: A retrospective observational study in 15 epilepsy and 15 PD patients was performed. The amount, location and size of blood vessels within 5 millimeter (mm) of all DBS electrode trajectories (n=120) for both targets (anterior nucleus of the thalamus: ANT and subthalamic nucleus: STN) in both patient groups were quantified and compared on a Medtronic workstation. Additionally, blood vessels in the trajectories (n=120) of another group of 15 PD (STN) and 15 OCD (Ventral Capsule-Ventral Striatum, VC-VS) patients were quantified and compared (trajectories n=120), also to the first group. Statistical analyses were performed with SPSS version 27.0 (descriptive statistics, independent samples T-tests, Mann Whitney U tests, ANOVA test and post-hoc Tukey test). A P-value < 0.05 was considered statistically significant.

RESULTS: Our results showed a significant greater amount of cerebral blood vessels in epilepsy patients (10 SD ± 4) compared to PD (PD1 6 SD ± 1 and PD2 5 SD ± 3) and OCD (5 SD ± 1) with P <0.0001. Also, all other subanalyses showed more vascularization in the epilepsy group.

CONCLUSIONS: Our results show that the brain of epilepsy patients seems to be more vascularized compared to PD and OCD patients. This can make the surgical planning for DBS more challenging and the use of multiple trajectories limited.

PMID:35380200 | DOI:10.23736/S0390-5616.22.05606-5

J Neurosurg Sci. 2022 Apr 5. doi: 10.23736/S0390-5616.22.05553-9. Online ahead of print.

ABSTRACT

BACKGROUND: Degenerative disc disease (DDD) is a prevalent disorder that brings great incapacity and morbidity to the world’s population. Its pathophysiology is not fully understood. DNA damage can influence this process, but so far, there have been few studies to evaluate this topic and its true importance in DDD, as well as whether there is a relation between degeneration grade and DNA damage. The objective of this study is to evaluate the degree of damage to the DNA and the relation to the severity of DDD and measure its response to this insult compared to live/dead cell parameters and reactive oxygen species activity in human discs.

METHODS: An experimental study was performed with 15 patients with grade IV or V Pfirrmann classification who underwent spinal surgery. Five patients were operated on two levels, resulting in 20 samples that were submitted to the comet assay to measure DNA damage. Of these, six samples were submitted to flow cytometry, and apoptosis, necrosis, cell membrane integrity, intracellular esterase activity, reactive oxygen species (ROS), caspase 3 and mitochondrial membrane potential were evaluated.

RESULTS: All samples had DNA damage, and the average of index damage (ID) was 78.1 (SD ± 65.11) and frequency damage (FD) was 49.3% (SD ± 26,05%). There was no statistical difference between the Pfirrmann grades and genotoxic damage. Likewise, all samples that underwent flow cytometry showed apoptosis and ROS to many different degrees.

CONCLUSIONS: DNA damage occurs in high-grade degeneration of human discs and contributes to activation of the apoptosis pathway and ROS production that can accelerate disc degeneration.

PMID:35380199 | DOI:10.23736/S0390-5616.22.05553-9

Swiss Med Wkly. 2022 Mar 28;152:w30151. doi: 10.4414/smw.2022.w30151. eCollection 2022 Mar 28.

ABSTRACT

OBJECTIVES: The aim is to investigate whether and why over-indebted individuals in German-speaking Switzerland have poorer mental health than the general population.

METHODS: A cross-sectional study among over-indebted people in the canton of Zurich was conducted in 2019. The study population (n = 219) was compared to the cantonal subsample of the general adult population selected from the nationally representative sample of the Swiss Health Survey 2017 (n = 1,997). Bivariate and multivariate statistical analyses were used to examine associations between over-indebtedness, mastery and health outcomes like mental stress and depression.

RESULTS: Over-indebted people have poorer mental health and weaker mastery than the general population. Low mastery is the strongest predictor of poor mental health (beta coefficient = 0.58/-0.62 for mental stress/depression respectively) among the over-indebted, followed by the perception of one’s health being affected by over-indebtedness (beta coefficient = -0.19/0.15). The amount of debt, anticipated time until repayment of debt and duration of indebtedness had no predictive effects.

CONCLUSION: Surprisingly, traditional debt parameters cannot explain the poor mental health of the over-indebted, in contrast to a strong sense of mastery, which was identified as a highly protective factor.

PMID:35380186 | DOI:10.4414/smw.2022.w30151

Swiss Med Wkly. 2022 Mar 22;152:w30136. doi: 10.4414/smw.2022.w30136. eCollection 2022 Mar 14.

ABSTRACT

PURPOSE: To compare in-hospital treatment costs of aquablation and transurethral resection of the prostate (TURP) in the treatment of benign prostatic enlargement.

PATIENTS AND METHODS: Patient data and procedural details were derived from a prospective database. In-hospital costs were calculated using detailed expenditure reports provided by the hospital accounts department. Total costs including those arising from surgical procedures, consumables, personnel and accommodation were analysed for 24 consecutive patients undergoing aquablation and compared with 24 patients undergoing TURP during the same period. Mean total costs and mean costs for individual expense items were compared between treatment groups with t-tests.

RESULTS: Mean total costs per patient (± standard deviation) were higher for aquablation at EUR 10,994 ± 2478 than for TURP at EUR 7445 ± 2354. The mean difference of EUR 3549 was statistically significant (p <0.001). Although the mean procedural costs were significantly higher for aquablation (mean difference EUR 3032; p <0.001), costs apart from the procedure were also lower for TURP, but the mean difference of EUR 1627 was not significant (p <0.327). Medical supplies were mainly responsible (mean difference EUR 2057; p <0.001) for the difference in procedural costs.

CONCLUSIONS: In-hospital costs are significantly higher for aquablation than for TURP, mainly due to higher costs of medical supplies for the procedure. This difference should be taken into consideration, at least in patients for whom the different side effect profiles of both treatments are irrelevant.

PMID:35380182 | DOI:10.4414/smw.2022.w30136

Int Marit Health. 2022;73(1):32-42. doi: 10.5603/IMH.2022.0004.

ABSTRACT

BACKGROUND: Yacht tourism is a developing sector in the world and in Turkey as well. Yacht masters are the most important components of this sector. This study aims to investigate the factors affecting the fatigue, job satisfaction, and burnout levels of yacht masters, offer solutions according to the findings, and eliminate this deficiency in the literature.

MATERIALS AND METHODS: The Maslach Burnout Scale (MBI), Minnesota Job Satisfaction Scale (MSQ) and Piper Fatigue Scale (PFS) were applied to yacht masters who are still actively working on yachts operating in the Bodrum district. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) software.

RESULTS AND CONCLUSIONS: According to the results of the analysis, yacht masters have high emotional burnout perceptions and very high personal success perceptions. In addition, their depersonalisation levels are low and their overall job satisfaction is high. The general fatigue levels of the masters are moderate. As their job satisfaction rate increases, their perceived fatigue level decreases. As their age increases, their fatigue level decreases. As their fatigue level increases, their burnout level also increases.

PMID:35380171 | DOI:10.5603/IMH.2022.0004

Math Med Biol. 2022 Apr 3:dqab021. doi: 10.1093/imammb/dqab021. Online ahead of print.

ABSTRACT

We propose a mathematical model to study the antibody-dependent enhancement (ADE) phenomenon. Here, we explore the interaction between macrophages, dengue virus and plasma cells, especially the effect of a limitation on plasma cell proliferation, which occurs due to immunological memory. The model has up to three equilibrium points: one virus-free equilibrium and two virus-presence equilibrium, depending on the value of two thresholds. We determine the existence regions for the model equilibrium points and their stability, a sensitivity analysis was performed in the model thresholds. Numerical simulations illustrate that ADE can occur even when the basic reproduction number is less than one.

PMID:35380162 | DOI:10.1093/imammb/dqab021