Nevin Manimala

Head Neck Pathol. 2021 Oct 16. doi: 10.1007/s12105-021-01384-8. Online ahead of print.

ABSTRACT

Tumour heterogeneity in oral cancer is attributed to the presence of cancer stem cells (CSCs). CSCs are the most migratory and metastatic cellular subpopulation within tumours. Assessment of CSC markers as significant predictors of lymph node metastasis may prove valuable in the clinical setting. Furthermore, analysis of this panel of putative stem cell markers in oral dysplasia may additionally inform of the likelihood for oral potentially malignant disorders (OPMDs) to progress to oral squamous cell carcinoma (OSCC). The present study aims to assess the significance of CSC markers in the progression of OPMDs to OSCC and assessment of lymph node metastasis in OSCC. CD44 and ALDH1 were assessed immunohistochemically in 25 normal, 30 OPMDs, and 24 OSCCs. CD44 is a membranous marker and ALDH1 is a cytoplasmic marker. The immunohistochemical expression of these markers were compared between OPMDs with and without dysplasia, as well as between low-risk and high-risk dysplasias. Similarly, expression was compared between OSCC with and without lymph node metastasis and among grades of OSCC. Positive CD44 expression was seen in all normal mucosal tissues. The expression decreased from normal epithelium to OPMDs but increased in OSCC. CD44 expression was positive in 21 cases of OSCC (87.5%) and reduced from well-differentiated to poorly differentiated OSCC. CD44 staining index was higher in OSCC without lymph node metastasis (3.59) when compared with OSCC with lymph node metastasis (1.33). There was a statistically significant difference observed in the ALDH1 staining index among three groups (p < 0.05), with highest expression seen in OSCC. Within OPMDs, the ALDH1 staining index was statistically higher in OPMDs with dysplasia as compared to OPMDs without dysplasia. Furthermore, the expression was higher in OPMDs with high-risk dysplasia when compared with low-risk dysplasia, but this was not statistically significant (p = 0.82). In conclusion, The CD44 positive population possesses properties of CSCs in head and neck carcinoma, and continuous shedding could be found after CD44 down-regulation. The present study reports differences in ALDH1 expression between OPMDs with and without dysplasia, dysplastic and non-dysplastic epithelia, and low-risk and high-risk dysplasia. These findings may suggest ALDH1 as a specific marker for dysplasia. CD44 demonstrated a difference in staining index in OSCC without lymph node metastasis versus OSCC with lymph node metastasis. These findings may suggest CD44 as a marker for lymph node metastasis. Both proteins may play key roles in the tumorigenicity of CSCs in OPMDs and OSCC.

PMID:34655409 | DOI:10.1007/s12105-021-01384-8

Mol Biol Rep. 2021 Oct 16. doi: 10.1007/s11033-021-06791-2. Online ahead of print.

ABSTRACT

BACKGROUND: The brinjal shoot and fruit borer, Leucinodes orbonalis is a destructive pest of Solanum melongena. The control of L. orbonalis with extensive application of synthetic chemical insecticides resulted in the development of resistance with known genetic heterogeneity among populations. Understanding the genetic diversity of their populations is important in developing strategies for their management. The present investigation was performed to characterize populations of L. orbonalis for their genetic diversity in the entire region of Tamil Nadu, South India using random amplified polymorphic DNA (RAPD) primers as a tool of the molecular marker.

METHODS AND RESULTS: Among 60 random 10-mer primers, only ten primers generated reproducible and scorable banding profile. Among the ten different random primers, the primers namely OPG 7, OPG 8, OPS 2 and OPS 7 generated the highest genetic variation with over 80% genetic polymorphism. Phylogram analysis produced 18 clusters with eight major and ten minor clusters. Cluster analysis, statistical fitness, population structure and analysis of molecular variance confirmed the significant genetic variation among different populations. A trait specific marker obtained through RAPD was cloned, sequenced and used to develop a stable diagnostic SCAR marker for DNA fingerprinting to distinguish the populations. Amplification of this locus in the samples of 20 different populations indicated recognition of the trait for pesticide resistance in 12 populations.

CONCLUSIONS: The results suggest that the biochemical nature of host plant varieties of this insect pest and variation in the application of different insecticides are essential contributing factors for the genotypic variations observed among populations of L. orbonalis.

PMID:34655405 | DOI:10.1007/s11033-021-06791-2

Ir J Med Sci. 2021 Oct 16. doi: 10.1007/s11845-021-02812-y. Online ahead of print.

ABSTRACT

BACKGROUND: Virtual fracture clinics (VFC) have been widely adopted worldwide as part of the changes in healthcare delivery during the COVID-19 pandemic. They have been shown to be a safe and effective method of delivering trauma care for injuries which do not require immediate intervention or specialist management, whilst maintaining high levels of patient satisfaction.

AIMS: Our aim was to evaluate whether VFCs reduce the volume of X-rays performed for common fractures of the wrist and ankle.

METHODS: A retrospective cohort review was performed. The pre-VFC group consisted of 168 wrist and 108 ankle referrals from March to September 2019. The VFC group included 75 wrist and 68 ankle referrals, during the period March to September 2020. The total number of X-ray images, carried out within a 3-month period for each fracture was summated, with statistical analysis performed following fracture pattern classification.

FINDINGS: A statistically significant decrease in mean X-rays was observed for isolated stable fracture patterns, such as non-displaced distal radius, – 0.976 (p = 0.00025), and Weber A ankle fractures, – 0.907 (p = 0.000013). A reduction was also observed for more complex fracture patterns such as dorsally displaced distal radius, – 0.701 (p = 0.129) and Weber B ankle fractures, – 0.786 (p = 0.235), though not achieving statistical significance.

CONCLUSIONS: Virtual fracture clinics can reduce X-ray frequency for common stable wrist and ankle fractures, with resultant benefits for both patients and healthcare systems. These benefits may be sustained in patient care beyond the current COVID-19 pandemic.

PMID:34655402 | DOI:10.1007/s11845-021-02812-y

Int Urol Nephrol. 2021 Oct 16. doi: 10.1007/s11255-021-03003-5. Online ahead of print.

ABSTRACT

PURPOSE: This study was aimed to compare lymphatic complications of bipolar vessel sealing system with silk ligation of lymphatic vessels among renal transplant recipients.

METHODS: This was a prospective randomized controlled trial done among 68 patients undergoing renal transplantation in Tribhuvan University Teaching Hospital. They were randomly assigned to either silk ligation or Enseal bipolar vessel sealing lymphatic dissection. Postoperative drain volume and duration of drain placement were measured in all patients. Ultrasound was used to find lymphocele formation in six and 12 weeks.

RESULTS: Total of 30 patients in silk ligation group and 28 patients in bipolar vessel sealing group were analyzed. The baseline characteristics of the patients in each group were similar. Overall, lymphatic complications (either lymphorrhea or lymphocele formation) were in 16 cases (27.58%), 7 (25%) in the bipolar group, and 9 (30%) in the silk ligation group (p = 0.67). A total of 13 patients (22.41%) had lymphorrhea, 6 (21.4%) patients in the bipolar group, and 7 (23.3%) patients in the silk ligation group. Median drain volume was 415 ml (Q1 275 ml, Q3 675 ml) in the bipolar group and 542 ml (Q1 290, Q3 775) in silk group (p = 0.72). Median drain removal day was 5 in each bipolar and silk group with Q1 and Q3 being 5 days in each arm (p = 0.95). A total of five patients (8.62%) developed symptomatic lymphocele, two (7.1%) in the bipolar group, and three (10%) in the silk ligation group, but the difference was not statistically significant. In univariate analysis, double renal arteries in the donor’s kidney (p = 0.03) and graft rejection (p = 0.04) were risk factors for the development of lymphatic complications. However, in multivariable analysis, these factors were not statistically significant.

CONCLUSIONS: This study did not find any significant differences in lymphatic complications between bipolar vessel sealing system and silk ligation. However, large sample multi-centric studies should be done to add evidences on lymphatic complications differences between these two techniques.

TRIAL REGISTRATION NUMBER: UMIN000039354, Date of registration-2020, Feb 01.

PMID:34655393 | DOI:10.1007/s11255-021-03003-5

Environ Sci Pollut Res Int. 2021 Oct 16. doi: 10.1007/s11356-021-16912-w. Online ahead of print.

ABSTRACT

The balanced amelioration of mechanical characteristics of fat clay with an additive refers to the attainment of high strength without compromising ductility, which is unattainable by solitary usage of a cementing additive. For this purpose, an amalgamated binary admixture (ABA) is proposed by assimilating shredded face mask (FM) waste, which is posing serious environmental concerns these days, with a cementitious waste material, i.e., silica fume (SF). However, for such ABA, the optimization of mix design is desirable because an excessive amount of one component could disturb the required balance. To address this issue, response surface methodology (RSM) is used in the current study, which is a strong technique used during the process of production to develop, improve, and optimize product inputs. Several experiments are designed and conducted to evaluate mechanical responses, i.e., unconfined compressive strength (q_u), brittleness index (I_B), deformability index (I_D), and California bearing ratio (CBR) value, of treated fat clay by varying mix designs of ABA. Based on the test results, mathematical models are developed which are found to be statistically valid to predict the subjected responses using SF and FM as inputs. Afterward, an optimized mix design is determined by integrating developed models with a desirability function model and setting maximization of strength and ductility as the optimization goals. An ABA having 7.9% SF and 1.2% FM is observed to provide the highest strength and ductility for multiple applications, i.e., road and buildings, with desirability factor close to unity; responses of which are also validated by performing tests. Furthermore, analysis of cleaning aspect shows that the use of optimized ABA in place of cement for subgrade improvement of 1 km two-lane road could avoid CO₂ emission of around 79,032 kg of C, save 42,720 kWh and 1174.8 GJ of electrical and thermal energy, respectively, and clean 43 Mg of FM waste; however, astute protocols of COVID-19 FM waste handling and disinfection are needed to be established and followed.

PMID:34655381 | DOI:10.1007/s11356-021-16912-w

J Patient Rep Outcomes. 2021 Oct 16;5(1):107. doi: 10.1186/s41687-021-00384-0.

ABSTRACT

BACKGROUND: Patient-reported outcome measures are increasingly used by clinicians to support communication in telephone- or face-to-face consultations with patients. A renal disease questionnaire has been developed, but not sufficiently evaluated through clinimetrics in clinical setting. Hence, we aimed to evaluate the content validity, construct validity and the test-retest reliability of a renal disease questionnaire to be used for clinical decision-making.

METHODS: A content, construct validity and test-retest reliability study was conducted in 3 nephrology outpatient clinics in Central Denmark Region, Denmark. Content validity (face validity, comprehensibility and relevance) was assessed among 8 patients and 6 clinicians. Reliability was assessed by asking outpatients with chronic kidney disease to complete the questionnaire twice. Reliability was assessed by kappa statistics and agreement by percentage. Construct validity was determined using 4 a priori defined hypotheses and comparing 2 known groups.

RESULTS: Five new domains emerged, 6 items were rephrased and 3 items were removed following the content validity test. A total of 160 patients completed the questionnaire with median 8 days (IQR 2 days) between assessments. The test-retest reliability parameters of the single items in the questionnaire were substantial to almost perfect as all the observed weighted kappa values ranged from 0.61 to 0.91, 95% CI (0.34 to 0.95). In total, 61% of the single items showed almost perfect agreement. In total, 3 of the 4 hypotheses were accepted and 44% of the items showed satisfying known-group discriminative validity.

CONCLUSION: A renal disease questionnaire used for clinical decision-making in outpatient follow-up showed acceptable content validity and substantial to almost perfect reliability. Sufficient construct validity was not established. Incorporating the questionnaire into routine clinical practice may improve the evaluation of disease burden in patients with chronic kidney disease. We ask patients with chronic kidney disease (CKD) in Central Region Denmark to complete a questionnaire before each outpatient visit. The answers they provide are used to support communication with their health care provider. A questionnaire requires testing to ensure it can accurately capture important information about patient’s symptoms and quality of life. When questionnaires are used to support communication between patients and health care professionals, they need to have good measurement properties. This means they need to be: (1) trustworthy, (2) relevant to a patient’s health condition, (3) consistent and produce stable results every time. We explored the measurement properties of a questionnaire designed to be used in the face-to face outpatient visits for patients with CKD. We found that the questionnaire captured consistent and stable results. Using this questionnaire may help health care professionals to assess the patients´ burden of symptoms with a more patient-centered approach. Potentially, the use of the questionnaire will increase the patients´ ability to cope with their symptoms and strengthen patients´ involvement in the clinical decisions concerning their treatment.

PMID:34655365 | DOI:10.1186/s41687-021-00384-0

Eur J Health Econ. 2021 Oct 16. doi: 10.1007/s10198-021-01384-z. Online ahead of print.

ABSTRACT

Cost-effective threshold (CET) is essential for health technology assessment and decision-making based on health economic evaluations. Recently, it has been argued that the commonly used once and three times of gross domestic product (GDP) per capita CETs of a quality-adjusted life year (QALY) are not necessarily empirically supported in all countries. Therefore, we aimed to estimate the CET of a QALY as times of GDP per capita in China, of which the reimbursement coverage decisions are increasingly engaging economic evaluations. Estimates on the value of statistical life (VSL) in China were identified from several studies in the literature and converted to times of GDP per capita, the weighted average of which was used for subsequent calculation. By pooling data on population mortality, health utility, and age distribution, we estimated the value of a statistical QALY (VSQ) from VSL using an established mathematical process, which represented the theoretical upper bound of CET. The corresponding point estimate and theoretical lower bound were obtained using their numerical relationships with the upper bound. Scenarios analyses were also conducted. The estimated CET, its upper bound, and its lower bound were 1.45, 2.90, and 1.16 times of GDP per capita in China, respectively. In different scenarios, the estimated CET varied but was greater than once GDP per capita in most cases. As such, the CET of a QALY in China is close to 1.5 times of GDP per capita, which should be benchmarked for future ICER-based coverage decisions.

PMID:34655364 | DOI:10.1007/s10198-021-01384-z

Int J Cardiovasc Imaging. 2021 Oct 16. doi: 10.1007/s10554-021-02438-2. Online ahead of print.

ABSTRACT

Hypo-attenuated leaflet thickening (HALT) of transcatheter aortic valves is detected on multidetector computed tomography (MDCT) and reflects leaflet thrombosis. Whether HALT affects left ventricular (LV) reverse remodeling, a favorable effect of LV afterload reduction after transcatheter aortic valve implantation (TAVI) is unknown. The aim of this study was to examine the association of HALT after TAVI with LV reverse remodeling. In this multicenter case-control study, patients with HALT on MDCT were identified, and patients without HALT were propensity matched for valve type and size, LV ejection fraction (LVEF), sex, age and time of scan. LV dimensions and function were assessed by transthoracic echocardiography before and 12 months after TAVI. Clinical outcomes (stroke or transient ischemic attack, heart failure hospitalization, new-onset atrial fibrillation, all-cause mortality) were recorded. 106 patients (age 81 ± 7 years, 55% male) with MDCT performed 37 days [IQR 32-52] after TAVI were analyzed (53 patients with HALT and 53 matched controls). Before TAVI, all echocardiographic parameters were similar between the groups. At 12 months follow-up, patients with and without HALT showed a significant reduction in LV end-diastolic volume, LV end-systolic volume and LV mass index (from 125 ± 37 to 105 ± 46 g/m², p = 0.001 and from 127 ± 35 to 101 ± 27 g/m², p < 0.001, respectively, p for interaction = 0.48). Moreover, LVEF improved significantly in both groups. In addition, clinical outcomes were not statistically different. Improvement in LVEF and LV reverse remodeling at 12 months after TAVI were not limited by HALT.

PMID:34655348 | DOI:10.1007/s10554-021-02438-2

Support Care Cancer. 2021 Oct 16. doi: 10.1007/s00520-021-06555-5. Online ahead of print.

ABSTRACT

PURPOSE: Patients with primary malignant brain tumors have high symptom burden and commonly rely on family caregivers for practical and emotional support. This can lead to negative mental and physical consequences for caregivers. We investigated effectiveness of an 8-week nurse-led online needs-based support program (SmartCare^©) with and without online self-guided cognitive behavioral therapy (CBT) for depression compared to enhanced care as usual (ECAU) on depressive symptoms, caregiving-specific distress, anxiety, mastery, and burden.

METHODS: Family caregivers scoring ≥ 6 on a depressive symptoms inventory were randomized to three groups: ECAU plus self-guided CBT and SmartCare^©; ECAU plus SmartCare^©; ECAU only. Primary outcomes (depressive symptoms; caregiving-specific distress) and secondary outcomes (anxiety, caregiver mastery, and caregiver burden) were assessed online. Intention to treat (ITT) and per protocol (PP) analyses of covariance corrected for baseline scores were performed for outcomes at 4 months.

RESULTS: In total, 120 family caregivers participated. Accrual and CBT engagement were lower than expected, therefore intervention groups were combined (n = 80) and compared to ECAU (n = 40). For depressive symptoms, no statistically significant group differences were found. Caregiving-specific distress decreased in the intervention group compared with ECAU (ITT: p = 0.01, partial ɳ² = 0.08; PP: p = 0.02, partial ɳ² = 0.08). A trend towards improvement in mastery for the intervention group compared with ECAU was identified (ITT: p = 0.08, partial ɳ² = 0.04; PP: p = 0.07, partial ɳ² = 0.05).

CONCLUSIONS: SmartCare^©, with or without self-guided CBT, reduced caregiving-specific distress with a trend towards improving mastery. SmartCare^© has the potential to improve the lives of families coping with a brain tumor diagnosis.

TRIAL REGISTRATION NUMBER: NCT02058745; 10 February 2014.

PMID:34655326 | DOI:10.1007/s00520-021-06555-5

Health Econ. 2021 Oct 15. doi: 10.1002/hec.4442. Online ahead of print.

ABSTRACT

In light of skilled-labor shortage, the effect of a change in the wage of nurses on their labor supply is intensely discussed in recent literature. Using extensive data of German 14- to 15-year-olds, I analyze the role of the beliefs about a nurse’s wage in the decision to become one. To estimate a partial effect, I select controls and their functional form using post-double-selection, which is a data-driven selection method based on regression shrinkage. Highlighting the importance of wages at the extensive margin of labor supply, the wage beliefs play a positive and statistically significant role. Although information is publicly available, educational choices knowingly suffer from misinformation. I find that especially those who do not become a nurse understate the wage. The results lead to two important policy implications. First, increasing the wage may help to overcome the shortage observed in many countries. Second, providing more information on the (relative) wage may be a successful strategy to attract more individuals into this profession. To assess the sensitivity of the results regarding omitted variable bias, I apply a novel approach. It turns out that potential unobserved confounders would have to be strong to overrule the conclusions.

PMID:34655140 | DOI:10.1002/hec.4442