Nevin Manimala

Diagn Interv Radiol. 2021 Jul;27(4):580-586. doi: 10.5152/dir.2021.20438.

ABSTRACT

PURPOSE: We aimed to retrospectively correlate 18F-fluorodeoxyglucose (18F-FDG) metabolic activity with lumbar spine magnetic resonance imaging (MRI) findings and epidural steroid injection sites in patients with symptomatic degenerative disease of the lumbar spine.

METHODS: A database search was conducted for patients receiving epidural injections <12 months after a positron emission tomography/computed tomography (PET/CT). Maximum standard uptake values (SUVmax) were measured at the facet joints, neural foramina, and spinal canal. Severity of facet arthrosis, disc degeneration, neuroforaminal, and canal stenosis was determined on MRI using previously described grading scales. Spearman rank coefficient assessed association between PET/CT FDG uptake and severity of MRI findings. The SUVmax was also compared with injection sites.

RESULTS: Twenty-five patients were included, comprising MRI (n=19) and injection (n=22 patients; 18 interlaminar, 8 transforaminal) groups. Injections were performed an average of 2.6 months after PET/CT. The greatest SUVmax occurred at the L5-S1 spinal canal (mean SUVmax = 2.25). A statistically significant, positive correlation between uptake and grade of spinal canal stenosis was seen only at L4-L5 (r=0.60, p = 0.007). No other significant association was found with spinal canal or neuroforaminal stenosis, or grade of facet joint or disc degeneration. All patients reported symptomatic improvement after injections with mean pain score improvement of 4.4 on a 10-point scale (SD, 2.9). There was moderate agreement between sites of epidural injection and highest SUVmax (κ= 0.591, p < 0.001).

CONCLUSION: 18F-FDG metabolic activity on PET/CT corresponds with MRI findings about the lumbar spinal column, but there is no significant correlation between severity of MRI findings and radiotracer uptake. Given the moderate agreement between metabolic activity and levels of symptomatic spinal stenosis, further studies are warranted to fully evaluate the diagnostic potential of FDG PET/CT as a surrogate for guiding epidural injections.

PMID:34313246 | DOI:10.5152/dir.2021.20438

Diagn Interv Radiol. 2021 Jul;27(4):534-541. doi: 10.5152/dir.2021.20042.

ABSTRACT

PURPOSE: We aimed to evaluate the diagnostic accuracy and safety profile of computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) in patients with primary malignancy suspected of lung metastasis and assess possible factors associated with nondiagnostic results.

METHODS: All PTNBs with core needle performed in our hospital from January 2014 to January 2019 were retrospectively reviewed. Overall, 108 cases were found to have a history of primary malignancy with suspected lung metastasis. Patient demographics, lesion characteristics, procedure techniques and complications were evaluated as predictors of overall diagnosis, final diagnosis of lung metastasis, and nondiagnostic results. Statistical analysis was performed using univariate analysis.

RESULTS: The overall diagnostic accuracy of PTNB was 83.3%. Lung metastasis was found in 52.8% of PTNBs (57 of 108) and nondiagnostic results were present in 27.6% (18 of 108). Of the 18 cases with nondiagnostic results, 11 cases had a final diagnosis of lung metastasis (61.1%), yielding PTNB a sensitivity of 83.8% and specificity of 100% for the detection of lung metastasis. Smaller lesion size (p = 0.014), pneumothorax (p = 0.026), and hemoptysis (p = 0.014) were significantly associated with overall nondiagnostic results. Similarly, smaller lesion size (p = 0.047), pneumothorax (p = 0.019), high-grade pulmonary hemorrhage (p = 0.019), and hemoptysis (p = 0.012) were significantly correlated with unsuccessful biopsies in the diagnosis of lung metastasis.

CONCLUSION: CT-guided core needle biopsy of the lung in patients with primary malignancy suspected of lung metastasis has a high diagnostic accuracy with acceptable complication rates. Small lesion size, pneumothorax, high-grade pulmonary hemorrhage, and hemoptysis are significantly associated with nondiagnostic results in the final diagnosis of lung metastasis. Repeat biopsy and clinical/radiological follow-up should be considered in cancer patients with nondiagnostic results due to the high probability of lung metastasis.

PMID:34313240 | DOI:10.5152/dir.2021.20042

Diagn Interv Radiol. 2021 Jul;27(4):529-533. doi: 10.5152/dir.2021.20059.

ABSTRACT

PURPOSE: We aimed to assess the association between complication rate and time to feeding in a cohort of patients undergoing radiologically guided placement of gastrostomy tubes.

METHODS: A retrospective study was conducted of all patients receiving pull-type and push-type gastrostomy tubes placed by interventional radiologists between January 1st, 2017 and December 31st, 2018 at a single institution. Primary outcomes included procedural and tube-related complications per medical chart review with a follow-up interval of 30 days. Exclusion criteria were enteral nutrition delayed more than 48 hours, no feeding information, and tubes placed for venting (n=20). Overall, 303 gastrostomy tubes (pull-type, n=184; push-type, n=119) were included. The most common indications for placement included head and neck carcinoma for push-type tubes (n=76, 63.9%) and cerebral vascular accident for pull-type tubes (n=78, 42.4%).

RESULTS: In a multiple regression analysis, there was no statistically significant association between complications and time to feeding (p = 0.096), age (p = 0.758), gender (p = 0.127), indication for tube placement (p = 0.206), or type of tube placed (p = 0.437). Average time to initiation of enteral nutrition was 12.3 hours for the pull-type and 21.7 hours for the push-type cohort (p < 0.001). Additional multiple regression analyses of pull-type tubes and push-type tubes separately also did not find any significant association between complications and the above factors (p > 0.05).

CONCLUSION: There was no statistically significant correlation between time to feed and complications, suggesting that there is no clinical difference between early and late feeding following gastrostomy tube placement.

PMID:34313239 | DOI:10.5152/dir.2021.20059

Elife. 2021 Jul 27;10:e65099. doi: 10.7554/eLife.65099. Online ahead of print.

ABSTRACT

Sleep is essential in maintaining physiological homeostasis in the brain. While the underlying mechanism is not fully understood, a ‘synaptic homeostasis’ theory has been proposed that synapses continue to strengthen during awake, and undergo downscaling during sleep. This theory predicts that brain excitability increases with sleepiness. Here, we collected transcranial magnetic stimulation (TMS) measurements in 38 subjects in a 34-hour program, and decoded the relationship between cortical excitability and self-report sleepiness using advanced statistical methods. By utilizing a combination of partial least squares (PLS) regression and mixed-effect models, we identified a robust pattern of excitability changes, which can quantitatively predict the degree of sleepiness. Moreover, we found that synaptic strengthen occurred in both excitatory and inhibitory connections after sleep deprivation. In sum, our study provides supportive evidence for the synaptic homeostasis theory in human sleep and clarifies the process of synaptic strength modulation during sleepiness.

PMID:34313218 | DOI:10.7554/eLife.65099

Curr Rheumatol Rev. 2021 Jul 26. doi: 10.2174/1573397117666210726143757. Online ahead of print.

ABSTRACT

BACKGROUND: GPA is a necrotizing inflammation of the small vessels with granulomas. Kidney involvement deteriorated its prognosis.

OBJECTIVE: Comparison of GPA patients with kidney (KI) and without kidney involvement (nKI).

MATERIAL AND METHODS: We conducted a cross-sectional study of 50 consecutive adult GPA patients, 25 KI from Nephrology and 25 nKI from Rheumatology Department of Central Clinical Hospital Ministry of Interior in Warsaw. We analyzed clinical features, organ involvement, laboratory, serological, imaging, histopathological data, BVAS, treatment.

RESULTS: The mean age of KI patients was statistically older then nKI (67.3±9.5 vs 55.1±15.9, p=0.002). Generalized, severe, resistance disease was observed respectively in 92% vs 44%, p<0.001. The number of red blood cells (3.47 vs 4.41T/l, p<0.001), hemoglobin (10.0 vs 12.9g/dl, p<0.001) was lower in KI, higher mean serum creatinine (3.95 vs. 0.89mg/dl, p<0.001), lower GFR (20.1 vs. 79.3, p<0.001), higher CRP (median: 43.4 vs 2.0mg/l, p<0.001), BVAS (16.6±4.4 vs 10.1±6.2, p<0.001), c-ANCA (median: 119.0 vs 15.2CU, p=0.017). Nodules in 28% KI, in 4% nKI (p=0.048) in chest X-ray, infiltration in 43.5% KI, in 15% nKI (p=0.042) in HRCT were observed. Skin granulomas were found in 61.5% nKI vs 18.2% KI, (p=0.047). Renal biopsy revealed in KI patients focal segmental glomerulonephritis in 11.8%, crescentic glomerulonephritis in 17.6%, pauci-immune crescentic glomerulonephritis in 70.6%.

CONCLUSIONS: In patients with KI more frequently we found generalized, severe, resistant GPA, higher BVAS in comparison in patients without KI. The results of laboratory parameters, were worse in patients with KI. Aggressive immunosuppressive treatment is often used in KI group.

PMID:34313202 | DOI:10.2174/1573397117666210726143757

Curr Rheumatol Rev. 2021 Jul 26. doi: 10.2174/1573397117666210726125632. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies demonstrated that MicroRNA-146a (miR-146a) plays an important role in the regulation of autoinflammatory diseases including primary gout. The G/C polymorphism (rs2910164) in the precursor sequence of miR-146a caused its stem region to change from G: U to C: U，which can contribute to the susceptibility of human diseases. however, no genetic relevance studies of miR-146a gene polymorphisms to gout have been reported by now.

OBJECTIVE: The purpose of this study was to analyze the association between the miR-146a rs2910164 genetic polymorphism and the susceptibility of Chinese Han population to primary gout. Method：1130 Chinese Han participants (including 606 primary gout patients and 524 gender and age-matched healthy control subjects) were recruited and the 5’exonuclease TaqMan® technology was used to perform miR-146a rs2910164 genotyping.

RESULT: After statistical analysis, no significant differences were observed between gout patients and healthy controls in genotype and allele frequency.

CONCLUSION: Our results indicate that there is no evidence for the involvement of the miR-146a rs2910164 polymorphisms in susceptibility to primary gout in the Chinese Han population.

PMID:34313201 | DOI:10.2174/1573397117666210726125632

Technol Cancer Res Treat. 2021 Jan-Dec;20:15330338211035260. doi: 10.1177/15330338211035260.

ABSTRACT

OBJECTIVE: The purpose of this meta-analysis was to study the prognostic effects of androgen receptor splicing variant 7 (AR-V7) on metastatic castration-resistant prostate cancer (mCRPC) under different treatment options (chemotherapy, hormone therapy).

METHODS: We conducted a systematic search of PubMed, EMBASE and Cochrane databases for clinical studies up to June 4, 2021, and used prostate-specific antigen (PSA) progression free-survival (PSA-PFS), radiologic PFS (r-PFS), overall survival (OS) and PSA response rate (PSA RR) as the main endpoints. Subgroup analyses were conducted based on the source of the specimens. STATA v.15 software was used for data analysis.

RESULTS: Twenty-one studies were included in this meta-analysis, with a total of 1578 samples. In the abiraterone (AA)/enzalutamide (E) treatment group, AR-V7 positive patients had worse PSA-PFS (hazard ratio [HR] = 3.40; 95% confidence interval [95%CI] 2.56-4.51; P < 0.05) and worse r-PFS (HR = 2.69; 95%CI 1.70-4.24; P < 0.05) and OS (HR = 3.02; 95%CI 1.73-5.30; P < 0.05). Multivariate Cox regression results showed that AR-V7 positive status was an independent risk factor for OS in the AA/E treatment group. In the taxane treatment group, AR-V7-positive and negative patients had similar PSA-PFS (HR = 0.87; 95%CI 0.46-1.63; P = 0.657), r-PFS (HR = 1.01; 95%CI 0.53-1.96; P = 0.965) and OS (HR = 1.50; 95%CI 0.89-2.52; P = 0.127). For AR-V7-positive patients, the difference in OS between taxane and AA/E treatment was not statistically significant (HR = 1.03; 95%CI 0.52-2.06; P = 0.930). However, multivariate Cox regression results suggested that for AR-V7-positive patients, taxane therapy was a protective factor for OS (HR = 0.35; 95%CI 0.20-0.60; P < 0.05).

CONCLUSION: The expression of AR-V7 indicates a poor prognosis and is an independent risk factor for OS in AA/E-treated mCRPC patients. However, AR-V7 positive status does not play the same role in taxane-treated patients. In addition, compared to AA/E, taxane treatment is a protective factor for OS in AR-V7-positive patients. AR-V7 may thus be an effective biomarker for treatment prognosis in patients with mCRPC.

PMID:34313171 | DOI:10.1177/15330338211035260

Eur J Contracept Reprod Health Care. 2021 Jul 27:1-6. doi: 10.1080/13625187.2021.1957093. Online ahead of print.

ABSTRACT

Objective: Domestic violence against women is a violation of women’s rights and is a public health issue. Knowledge by all society sectors about the clinical and social characteristics of women who suffer violence is fundamental for the development of preventive actions.Methods: Data on clinical, perinatal, and socioeconomic characteristics of women attended in the municipal hospital of São Bernardo do Campo, Brazil, in 2018 and 2019 who reported ever suffering domestic violence collected and compared with to women who denied exposure to violence.Results: Marital status, schooling level, evangelical religion, drug, and tobacco use were more prevalent in women who suffered violence than those who did not. The likelihood of suffering violence was lower among pregnant women who had planned (OR 0.71), desired (OR 0.64), and accepted (0.43) pregnancy compared to those who had not planned, desired, or accepted. The average per capita income of women’s neighbourhoods of origin showed an inverse correlation (R=-0.795) with the number of violence cases.Conclusion: Statistic associations suggest that the historical of having suffered from violence is more prevalent among women who planned, desired, and accepted their pregnancy, in comparison to women who denied exposure to violence. The type of religion, clinical, and social conditions of more significant vulnerability showed different levels of domestic violence.

PMID:34313163 | DOI:10.1080/13625187.2021.1957093

Acute Crit Care. 2021 Jul 26. doi: 10.4266/acc.2021.00234. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with sepsis are at risk for developing sepsis-induced cardiomyopathy (SIC). Previous studies offer inconsistent results regarding the association of SIC and mortality. This study sought to assess whether SIC is linked to mortality in patients with sepsis and to evaluate predictors of the development of SIC.

METHODS: In this retrospective study, patients admitted to the medical intensive care unit with a diagnosis of sepsis in the absence of acute coronary syndrome were included. SIC was identified using transthoracic echocardiogram and was defined by a new-onset decline in left ventricular ejection fraction (LVEF) of up to 50% or a decline of at least 10% in LVEF relative to baseline in patients with a history of heart failure with reduced EF. Multivariable logistic regression analysis was performed using the R software program (R Foundation for Statistical Computing).

RESULTS: Of the 359 patients in the final analysis, 19 (5.3%) had SIC, and eight (42.1%) of these 19 patients and 60 (17.6%) of the 340 patients in the non-SIC group died. SIC was associated with an increased risk for all-cause in-hospital mortality (odds ratio [OR], 4.46; 95% confidence interval [CI], 1.15-18.69; P=0.03). Independent predictors for the development of SIC were albumin level (OR, 0.47; 95% CI, 0.23-0.93; P=0.03) and culture positivity (OR, 8.47; 95% CI, 2.24-55.61; P=0.006). Concomitant right ventricular hypokinesis was noted in 13 (68.4%) of the 19 SIC patients.

CONCLUSION: SIC was associated with an increased risk for all-cause in-hospital mortality. Low albumin level and culture positivity were independent predictors of SIC.

PMID:34311515 | DOI:10.4266/acc.2021.00234

Pediatr Allergy Immunol. 2021 Jul 26. doi: 10.1111/pai.13604. Online ahead of print.

ABSTRACT

BACKGROUND: The Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ-PF) is widely used to assess food allergy-specific health-related quality of life (FAQL), but cannot be used directly in cost-utility analyses, which require health state utility (HSU) scores. Currently, limited evidence is available regarding the HSU of food allergic children/adolescents. This study aimed to develop mapping algorithms from the FAQLQ-PF onto HSU scores generated by generic, preference-based, health-related quality-of-life (HRQL) instruments.

METHODS: Caregivers of children aged 7 to 17 years with a clinician diagnosis of IgE-mediated food allergy, recruited via Allergy & Anaphylaxis Australia, completed an online FAQLQ-PF questionnaire and proxy generic preference-based pediatric instruments (Assessment of Quality of Life [AQoL]-6D Adolescent version and Child Health Utility 9D [CHU9D]). Optimal statistical methods were based on series of goodness-of-fit statistics.

RESULTS: Mean FAQLQ-PF total score, AQoL-6D, and CHU9D utility scores of 238 food-allergic children/adolescents were 3.49 (SD: 1.41), 0.78 (SD: 0.22), and 0.74 (SD: 0.22), respectively. Spearman correlation coefficients of FAQLQ-PF with AQoL-6D and CHU9D were rho=-0.56 and rho=-0.45, respectively. Optimal mapping algorithms were generated from selected FAQLQ-PF items, mapped onto AQoL-6D or CHU9D utility scores, with AQoL-6D demonstrating better performance.

CONCLUSIONS: This study generated mapping algorithms to help facilitate the use of FAQLQ-PF for cost-utility analyses, which are essential for health economic evaluation. External validation of the reported mapping algorithms is warranted.

PMID:34311507 | DOI:10.1111/pai.13604