Nevin Manimala

Arch Endocrinol Metab. 2021 May 18;64(6):758-763. doi: 10.20945/2359-3997000000287.

ABSTRACT

OBJECTIVE: The aim of the present study was to examine the influence of body composition and insulin resistance on the magnitude of postprandial lipemia in patients with Turner’s syndrome receiving oral versus transdermal estrogen replacement.

METHODS: Twenty-five patients with Turner’s syndrome receiving oral or transdermal estrogen replacement were evaluated for body mass index, waist-to-hip and waist-to-height ratios, fasting glycemia, insulin, body composition (dual-energy X-ray absorptiometry), and postprandial lipid metabolism. For statistical analysis, we used parametric tests to compare numeric variables between the two subgroups.

RESULTS: We observed no difference in postprandial triglyceride levels between patients receiving oral versus transdermal hormone replacement therapy. The postprandial triglycerides increment correlated positively with the percentage of total fat mass (p=0.02) and android fat mass (p=0.02) in the transdermal group. In the oral estrogen group, a positive correlation was observed between the increment in postprandial triglycerides and waist-to-hip (p=0.15) and waist-to-height (p=0.009) ratios. No association was observed between the estrogen replacement route and insulin resistance evaluated by the homeostatic model assessment-insulin resistance (HOMA-IR) index (p=0.19 and p=0.65 for the oral and transdermal groups, respectively).

CONCLUSION: We concluded that body composition and anthropometric characteristics possibly affect the extent of postprandial lipemia independently from the route of estrogen replacement.

PMID:34033286 | DOI:10.20945/2359-3997000000287

Arch Endocrinol Metab. 2021 May 18;64(6):735-742. doi: 10.20945/2359-3997000000283.

ABSTRACT

OBJECTIVE: Ultrasonography (US) is the most accurate and cost-effective imaging method in diagnosis of thyroid nodules. A practical thyroid imaging reporting and data system (TIRADS) for thyroid nodules has been proposed to classify nodules of the thyroid gland to solve the problem of nodule selection for fine needle aspiration cytology (FNAC). Real-time elastography and strain ratio (SR) is a method used to assess the stiffness and predict the malignancy of thyroid nodules. The objective of this study was to assess the role of elastography and SR and the TIRADS scoring system in discriminating malignant from benign thyroid nodules.

METHODS: From 2015 to 2018 at Cairo University Hospital, a series of 409 patients with thyroid nodules was referred to undergo thyroid ultrasound. Categorization of each nodule according to the TIRADS ranged from 1 to 5. The qualitative elastography score and semiquantitative SR of the nodules were evaluated. Final diagnosis was done by either post-thyroidectomy histopathological examination or US-guided FNAC.

RESULTS: Our study included 409 patients with thyroid nodules. Their mean age was 39 ± 10 SD; 36 were males and 373 were females. There were 22 malignant nodules and 387 benign nodules. There were statistical differences between benign and malignant nodules regarding TIRADS classification, SR, anteroposterior/transverse ratio, degree of echogenicity, border, presence of calcification, and absence of halo sign (P < 0.001). The elastic properties of thyroid nodules proved to be a good discriminator between malignant and benign nodules (P- < 0.001) at a cut off value of > 2.32 with 95.2% sensitivity and 86.5% specificity. For every unit increase in SR, the risk of malignancy increased by nearly 2 times. Patients with irregular borders had nearly 17 times increased risk of malignancy than those with regular borders.

CONCLUSION: Elastography and SR proved to be of high significant value in discriminating benign from malignant nodules, so we recommend adding it to the TIRADS classification.

PMID:34033283 | DOI:10.20945/2359-3997000000283

Arch Endocrinol Metab. 2021 May 18;64(6):726-734. doi: 10.20945/2359-3997000000281.

ABSTRACT

OBJECTIVE: To determine the prevalence of vitamin D deficiency (VDD) in exclusively breastfed infants at the Aga Khan University Hospital Nairobi, Kenya (AKUHN). The relationships between 25-hydroxyvitamin D; 25OHD, parathyroid hormone (PTH), maternal vitamin D supplementation, and sunlight exposure were also determined.

METHODS: Blood from 98 infants was assayed for 25OHD, calcium, phosphate, and PTH. Socio-demographic and clinical characteristics were analyzed using descriptive statistics and inferential analysis (p < 0.05).

RESULTS: The prevalence of VDD (25OHD <12 ng/mL), vitamin D insufficiency (VDI, 25OHD 12-20 ng/mL) and vitamin D sufficiency (VDS, 25OHD >20 ng/mL) was 11.2% (95% CI 8.0%-14.4%), 12.2% (95% CI 8.9%-15.5%), and 76.5% (95% CI 72.3%-80.8%) respectively. There was no difference in the mean age, head circumference, length, or weight of infants in VDD, VDI, and VDS groups. PTH was elevated when 25OHD was <12 ng/mL and normal when 25OHD was between 12-20 ng/mL. 25OHD and PTH were normal in infants whose mothers received vitamin D supplements. Infants who received <30 minutes/day of exposure to sunlight were 5 times more likely to have VDI than infants who received ≥30 minutes/day (p = 0.042).

CONCLUSION: The prevalence of VDD in exclusively breastfed infants at AKUHN is low. The current national policy that recommends exclusive breastfeeding of infants in the first 6 months of life appears to be effective in staving off vitamin D deficiency but those infants with < 30 minutes sunlight exposure may benefit from low dose supplemental vitamin D during times of low sunlight exposure.

PMID:34033282 | DOI:10.20945/2359-3997000000281

Int J Older People Nurs. 2021 May 25:e12382. doi: 10.1111/opn.12382. Online ahead of print.

ABSTRACT

BACKGROUND: Ageist and helping attitudes among undergraduate homecare students are a concern for educators, healthcare professionals and home care workers due to their potential to increase the marginalisation of older people and negatively impact quality of care.

OBJECTIVES: The current study evaluated the effect of extended contact with community-dwelling older adults on the ageist and helping attitudes of home care students.

METHODS: Fifty-five students attending a public university in Turkey were randomly assigned to the intervention group (n = 27) or control group (n = 28). The intervention group received positive theoretical education and had extended contact with community-dwelling older adults, while the control group only received positive theoretical education. Before and after the intervention, the students’ ageist attitudes were evaluated with Kogan’s Attitudes towards Old People scale (KAOP) and helping attitudes were evaluated with the Helping Attitude Scale (HAS).

RESULTS: There were statistically significant differences between pre- and post-test mean KAOP total, positive ageism and negative ageism subscale scores in the intervention group (p < 0.05) and in KAOP negative ageism score in the control group (p < 0.05). HAS scores showed no significant post-intervention change in helping attitudes in either group.

CONCLUSION: Extended contact with community-dwelling older adults had a favourable influence on undergraduate health students’ ageism attitudes. These results suggest that contact with older adults may be an effective strategy to reduce ageism but may not increase helping behaviours.

IMPLICATIONS FOR PRACTICE: Positive contact experiences with community-dwelling older adults can be used to reduce ageism in home care students.

PMID:34032387 | DOI:10.1111/opn.12382

J Magn Reson Imaging. 2021 May 25. doi: 10.1002/jmri.27741. Online ahead of print.

ABSTRACT

BACKGROUND: Non-small cell lung cancer (NSCLC) is the most common tumor entity spreading to the brain and up to 50% of patients develop brain metastases (BMs). Detection of BMs on MRI is challenging with an inherent risk of missed diagnosis.

PURPOSE: To train and evaluate a deep learning model (DLM) for fully automated detection and 3D segmentation of BMs in NSCLC on clinical routine MRI.

STUDY TYPE: Retrospective.

POPULATION: Ninety-eight NSCLC patients with 315 BMs on pretreatment MRI, divided into training (66 patients, 248 BMs) and independent test (17 patients, 67 BMs) and control (15 patients, 0 BMs) cohorts.

FIELD STRENGTH/SEQUENCE: T₁ -/T₂ -weighted, T₁ -weighted contrast-enhanced (T₁ CE; gradient-echo and spin-echo sequences), and FLAIR at 1.0, 1.5, and 3.0 T from various vendors and study centers.

ASSESSMENT: A 3D convolutional neural network (DeepMedic) was trained on the training cohort using 5-fold cross-validation and evaluated on the independent test and control sets. Three-dimensional voxel-wise manual segmentations of BMs by a neurosurgeon and a radiologist on T₁ CE served as the reference standard.

STATISTICAL TESTS: Sensitivity (recall) and false positive (FP) findings per scan, dice similarity coefficient (DSC) to compare the spatial overlap between manual and automated segmentations, Pearson’s correlation coefficient (r) to evaluate the relationship between quantitative volumetric measurements of segmentations, and Wilcoxon rank-sum test to compare the volumes of BMs. A P value <0.05 was considered statistically significant.

RESULTS: In the test set, the DLM detected 57 of the 67 BMs (mean volume: 0.99 ± 4.24 cm³ ), resulting in a sensitivity of 85.1%, while FP findings of 1.5 per scan were observed. Missed BMs had a significantly smaller volume (0.05 ± 0.04 cm³ ) than detected BMs (0.96 ± 2.4 cm³ ). Compared with the reference standard, automated segmentations achieved a median DSC of 0.72 and a good volumetric correlation (r = 0.95). In the control set, 1.8 FPs/scan were observed.

DATA CONCLUSION: Deep learning provided a high detection sensitivity and good segmentation performance for BMs in NSCLC on heterogeneous scanner data while yielding a low number of FP findings. Level of Evidence 3 Technical Efficacy Stage 2.

PMID:34032344 | DOI:10.1002/jmri.27741

Prostate. 2021 May 25. doi: 10.1002/pros.24171. Online ahead of print.

ABSTRACT

BACKGROUND: Current preclinical models of metastatic prostate cancer (PCa) require sophisticated technologies and/or genetically engineered cells for the noninvasive monitoring of tumors in remote sites, such as bone. Recent developments in circulating tumor DNA (ctDNA) analysis provide an alternative method for noninvasive tumor monitoring at a low cost. Here, we sought to evaluate human Alu and LINE-1 ctDNA for the longitudinal measurement of subcutaneous and intratibial human PCa xenograft growth and response to ionizing radiation (IR) through comparison with standard slide caliper and bioluminescence measurements.

MATERIAL AND METHODS: Intratibial and subcutaneous xenografts were established in male athymic nude mice using LNCaP cells that stably express firefly luciferase. A subset of tumors was treated with a single dose of IR (CT-guided focal IR, 6 Gy). Tumor measurements were simultaneously taken by slide caliper (subcutaneous only), in vivo bioluminescence imaging, and quantitative real-time PCR (qPCR) of human-specific Alu and LINE-1 ctDNA for several weeks.

RESULTS: Levels of ctDNA and bioluminescence increased concordantly with subcutaneous and intratibial tumor growth. A statistically significant correlation (Spearman) was observed between ctDNA and subcutaneous tumor volume (LINE-1, r = .94 and Alu, r = .95, p < .0001), ctDNA and bioluminescence (LINE-1, r = .66 and Alu, r = .60, p < .002), and bioluminescence and tumor volume (r = .66, p = .0003). Bioluminescence and ctDNA were also significantly correlated in intratibial tumors (LINE-1, r = .82 and Alu, r = .81, p < .0001). Following external beam IR, the tumor responses varied briefly by method of measurement, but followed a similar trend. Statistically significant correlations were maintained between ctDNA and slide caliper measurement in irradiated subcutaneous tumors (LINE-1, r = .64 and Alu, r = .44, p < .02), and ctDNA and bioluminescence in intratibial tumors (LINE-1, r = .55, p = .018).

CONCLUSIONS: Real-time qPCR of circulating human Alu and LINE-1 DNA provides an accurate measurement of subcutaneous and intratibial xenograft burden that is comparable with conventional bioluminescence imaging and slide caliper measurement. Transient differences in measurements were observed following tumor-targeted IR, but overall all measurements mirrored tumor growth and response.

PMID:34032307 | DOI:10.1002/pros.24171

J Oral Rehabil. 2021 May 25. doi: 10.1111/joor.13209. Online ahead of print.

ABSTRACT

BACKGROUND: The current diagnostic criteria for temporomandibular disorders (TMD) do not require imaging for the diagnosis of degenerative joint disease (DJD) of the temporomandibular joint (TMJ) condyle and there is a lack of data investigating the effectiveness of imaging modalities in predicting long-term TMJ DJD prognosis.

OBJECTIVES: To verify the association between initial bone scintigraphy results and long-term DJD bone changes occurring in the TMJ condyle on cone beam computed tomography (CBCT).

METHODS: Initial bone scintigraphy, panoramic radiography, and CBCT results were analyzed in relation to long-term (12 months) TMJ DJD bone change on CBCTs in 55 TMD patients (110 joints). Clinical and radiographic indices were statistically analyzed among 3 groups (improves, no change, worsened) based on long-term TMJ DJD prognosis calculated by destructive change index (DCI).

RESULTS: Neither the uptake ratio nor visual assessment results from initial bone scintigraphy showed a significant difference according to long-term condylar bone change groups. The cut-off value of bone scintigraphy uptake ratio was 2.53 for long-term worsening of TMJ DJD. Worsening of TMJ DJD was significantly associated with the diagnosis based on panoramic radiography(P=0.011) and CBCT(P<0.001). Initial DCI (β=-0.291, P=0.046) had a significant association with long-term worsening of TMJ DJD.

CONCLUSION: Initial bone scintigraphy results do not show sufficiently close associations with long-term TMJ DJD prognosis. This should be considered in the selection process of imaging modalities for TMJ DJD patients. Future studies are needed to develop prognostic indices that comprise both clinical and imaging contents for improved predictive ability.

PMID:34032306 | DOI:10.1111/joor.13209

J Sci Food Agric. 2021 May 25. doi: 10.1002/jsfa.11334. Online ahead of print.

ABSTRACT

Soy contains many bioactive phytochemicals, such as isoflavones, which have the effect of preventing many cancers. Some studies have shown the beneficial effect of soy-based food and isoflavone intake on gastric cancer (GC), while others claimed no effect. Therefore, whether the beneficial effect of soy-based food is related to its fermentation or whether its protective effect comes from isoflavones still remains inconclusive. Our aim was to investigate the relationship between total soybean, fermented soybean, non-fermented soybean, and isoflavone intake and the risk of GC. Ten cohort studies and 21 case-control studies involving 916 354 participates were included. The association between soy-based food and isoflavone intake and the risk of GC was calculated with the pooled RRs for the highest versus lowest intake categories. The results showed that isoflavone intake might be a protective factor to GC, but the result was not statistically significant (RR = 0.92, 95%CI: 0.79-1.07). However, total soybean intake could significantly decrease the risk of GC by 36% (RR = 0.64, 95%CI: 0.51-0.80), which might credit to non-fermented soybean products (RR = 0.79, 95%CI: 0.71-0.87). In contrast, high intake of fermented soybean products could increase the risk of GC (RR = 1.19, 95%CI: 1.02-1.38). High intake of total soybean and non-fermented soybean products could reduce the risk of GC, and high intake of fermented soybean products could increase the risk, which indicated that the beneficial effect of soy-based food might be related to its non-fermentation. However, high intake of isoflavones may not be associated with the incidence of GC. This article is protected by copyright. All rights reserved.

PMID:34032287 | DOI:10.1002/jsfa.11334

J Physiol. 2021 May 25. doi: 10.1113/JP281691. Online ahead of print.

ABSTRACT

KEY POINTS: Healthy older adults exhibit lower cardiorespiratory fitness (VO₂ peak) than young in the absence of any age-related difference in skeletal muscle mitochondrial capacity, suggesting central hemodynamics plays a larger role in age-related declines in VO₂ peak. Total physical activity did not differ by age, but moderate-to-vigorous physical activity was lower in older compared to young adults. Moderate-to-vigorous physical activity is associated with VO₂ peak and muscle oxidative capacity, but physical inactivity cannot entirely explain the age-related reduction in VO₂ peak.

ABSTRACT: Declining fitness (VO₂ peak) is a hallmark of aging and believed to arise from decreased oxygen delivery and reduced muscle oxidative capacity. Physical activity is a modifiable lifestyle factor that is critical when evaluating the effects of age on parameters of fitness and energy metabolism. The objective was to evaluate the effects of age and sex on VO₂ peak, muscle mitochondrial physiology, and physical activity in young and older adults. An additional objective was to assess the contribution of skeletal muscle oxidative capacity to age-related reductions in VO₂ peak and determine if age-related variation in VO₂ peak and muscle oxidative capacity could be explained on the basis of physical activity levels. 23 young and 52 older men and women completed measurements of VO₂ peak, mitochondrial physiology in permeabilized muscle fibers, and free-living physical activity by accelerometry. Regression analyses were used to evaluate associations between age and VO₂ peak, mitochondrial function, and physical activity. Significant age-related reductions were observed for VO₂ peak (P<0.001), but not muscle mitochondrial capacity. Total daily step counts did not decrease with age, but older adults showed lower moderate-to-vigorous physical activity, which was associated with VO₂ peak (R² = 0.323, P<0.001) and muscle oxidative capacity (R² = 0.086, P = 0.011). After adjusting for sex and physical activity, age was negatively associated with VO₂ peak but not muscle oxidative capacity. Healthy older adults exhibit lower VO₂ peak but preserved mitochondrial capacity compared to young. Physical activity, particularly moderate-to-vigorous, is a key factor in observed age-related changes in fitness and muscle oxidative capacity, but cannot entirely explain the age-related reduction in VO₂ peak. This article is protected by copyright. All rights reserved.

PMID:34032280 | DOI:10.1113/JP281691

J Chemother. 2021 May 25:1-10. doi: 10.1080/1120009X.2021.1923153. Online ahead of print.

ABSTRACT

The main objective is to define the mortality of patients with cancer admitted to our hospital, their clinical and demographic characteristics, investigate the risk of COVID-19 for patients with cancer, and determine factors that affect the mortality rates of patients with cancer dying of COVID-19. A total of 2401 patients were admitted to our hospital with the diagnosis of COVID-19 from March 11th, 2020, to May 31st, 2020. Ninety-two out of a total of 112 cancer patients were included in this study based on the planned inclusion/exclusion criteria. The clinical, demographic, and laboratory features and treatments provided were studied, and their effect on mortality rates was analyzed. In our study the median age of the patients was 67 years, and 55.4% were male. More than half (56.5%) of our patients had metastasis. The mortality rate was 6.2% in the overall population with COVID-19, whereas it was 23.9% in patients with cancer. The mortality rate in patients with metastasis was statistically significantly higher compared with those without metastasis (34.0% vs. 10.3% P = 0.008). The mortality rate in patients still smoking was statistically significantly higher than in non-smokers (37.5% vs. 12.5% P = 0.033). The mortality rates of patients with high average C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), and D-dimer levels were statistically significantly higher than in those without, and the mortality rates of patients with lower average albumin and hemoglobin levels were statistically significantly higher than those without (P < 0.001, P = 0.006, P = 0.041, P < 0.001, P < 0.001, and P = 0.028, respectively). Having metastases concurrent with COVID-19 was a statistically significant factor predictive of prognosis. Also, high CRP, ferritin, LDH, and D-dimer, and low albumin and hemoglobin were related to increased mortality rates. The predictive and prognostic role of possible factors related to prognosis is still unknown and further large, multicenter prospective studies are needed to confirm these results.

PMID:34032198 | DOI:10.1080/1120009X.2021.1923153