Nevin Manimala

J Environ Manage. 2021 Aug 28;299:113594. doi: 10.1016/j.jenvman.2021.113594. Online ahead of print.

ABSTRACT

Nowadays, releasing the Emerging Pollutants (EPs) in the nature is one of the main reasons for many health and environmental disasters. Amoxicillin as an antibiotic is one of the EPs and categorized as the Endocrine Disrupting Compounds (EDCs) in hazardous materials. Accumulation of amoxicillin in the soil bulk increases the cancer risk, drug resistances and other epidemiological diseases. Hence, the soil bioremediation of antibiotics can be a solution for this problem which is more environmental-friendly system. This study technically creates a bio-engine setup in soil bulk for remediation of amoxicillin based on Aspergillus Flavus (AF) activities and Removal Percentage (RP) of amoxicillin with Aflatoxin B1 Generation (AG) controls. The main novelty is to propose a hybrid computational intelligence approach to do optimization for mechanical and biological aspects and to predict the behavior of bio-engine’s effective mechanical and biological features in an intelligent way. The optimization model is formulated by the Central Composite Design (CCD) which is set by the Response Surface Methodology (RSM). The prediction model is formulated by the Random Forest (RF), Adaptive Neuro Fuzzy Inference System (ANFIS) and Random Tree (RT) algorithms. According to the experimental practices from real soil samples in different times and places, concentration of amoxicillin and Aflatoxin B1 are set equal to 25 mg/L (ppm) and 15 μg/L (ppb). Likewise, the outcomes of experiments in CCD-RSM computations are evaluated by curve fitting comparisons between linear, 2FI, quadratic and cubic polynomial equations with considering to regression coefficient and predicted regression coefficient values, ANOVA and optimization by sequential differentiation. Based on the results of CCD-RSM, the RP performance in the optimum conditions is measured around 86% and in 25 days after runtime, the RP and AG are balanced in the safe mode. The proposed hybrid model achieves the 0.99 accuracy. The applicability of the research is done using real field evaluations from drug industrial park in Mashhad city in Iran. Finally, a broad analysis is done and managerial insights are concluded. The main findings of the present research are: (I) with application of bioremediation from fungus activities, amoxicillin amounts can be control in soil resources with minimum AG, (II) ANFIS model has the best accuracy for smart monitoring of amoxicillin bioremediation in soil environments and (III) based on the statistical assessments Aeration Intensity and AF/Biological Waste ratio are most effective on the amoxicillin removal percentage.

PMID:34467868 | DOI:10.1016/j.jenvman.2021.113594

Pediatr Dent. 2021 Jul 15;43(4):290-295.

ABSTRACT

Purpose: The purpose of this study was to evaluate the treatment outcomes of multisurface caries in primary molars treated with intracoronal restorations versus stainless steel crowns (SSCs) through a retrospective split-mouth study. Methods: Dental records were screened for patients who had treatment of one primary molar with a multisurface restoration and one primary molar with an SSC. Teeth were followed until a loss to follow-up, exfoliation, or failure. Results: A total of 988 primary molars were evaluated, with a mean follow-up time of 22 months. The survival probabilities for: SSCs were 95.5 percent at one year of service and 92.8 percent at two years of service; and for intracoronal restorations were 92.0 percent at one year of service and 80.0 percent at two years of service. Overall survival analysis showed SSCs to be significantly more successful than restorations (P<0.001), particularly in children treated at ages four years and younger (P<0.001). No statistically significant difference (P=0.10) was found for children treated at ages five years and older. Conclusions: Stainless steel crowns have a higher survival probability versus restorations for multisurface caries. In children ages four years and younger, more aggressive treatment of multi-surface caries with SSCs should be considered, as conservative treatment leads to an increased need for retreatment.

PMID:34467846

Pediatr Dent. 2021 Jul 15;43(4):276-281.

ABSTRACT

Purpose: Childhood caries is a highly prevalent disease that is intricately connected to diet and other social and behavioral factors. While it has been established that breastfeeding confers many health benefits for children, previous research found no consensus on the relationship between breastfeeding and caries. The purpose of this study was to examine the relationship between early childhood caries (ECC) and the length of time breastfeeding using the National Health and Nutrition Examination Survey (NHANES). Methods: Four cycles of NHANES (2011 to 2018) were analyzed, including 3,234 children ages two to five years. The association between breastfeeding duration and incidence of ECC and severe earlychildhood caries (S-ECC) was evaluated using logistic regression, adjusting for age, ethnicity, education, income, last dental visit, and sugar-sweetened beverages. Results: In the study population, 16.9 percent had ECC and 12.2 percent had S-ECC. Breastfeeding six months to one year, one to two years, or over two years was not associated with higher odds of ECC or S-ECC than breastfeeding for zero to six months after adjusting for covariates. Conclusions: There was no statistically significant relationship between breastfeeding and early childhood caries, and breastfeeding duration was not associated with increased caries risk. More research from well-controlled analytical studies is needed to establish or refute a relationship between breastfeeding and ECC.

PMID:34467843

Pediatr Dent. 2021 Jul 15;43(4):270-275.

ABSTRACT

Purpose: The purpose of this study was to evaluate the prevalence, severity, and distribution of molar incisor hypomineralization (MIH) and its association with socioeconomic characteristics among eight-year-old students from public schools in Petrópolis, Rio de Janeiro, Brazil. Methods: This cross-sectional study evaluated 450 eight-year-old Brazilian children. A questionnaire was used to assess socioeconomic factors (family income, maternal education, and person per household). MIH was diagnosed based on European Academy of Paediatric Dentistry criteria. The severity of MIH was evaluated at patient and tooth levels. The examinations were conducted in school environments. Descriptive analysis, chi-square, Fisher’s exact, and Kruskal-Wallis tests were performed. Results: The prevalence of MIH was 28.7 percent. The average of affected molars and incisors was 2.25 (standard deviation [SD] equals 1.03) and 0.84 (1.22 SD). The maxillary molars were the most affected, but mandibular molars showed greater severity. The majority of MIH-children had white-creamy opacities (51.9 percent). There was no association between MIH and socioeconomic factors. MIH was more prevalent in boys (P=0.025). The number of incisors with MIH rose with the increasing number of affected molars (P=0.02). A significant association between severity and the mean number of affected molars was observed (P=0.004). Conclusions: The prevalence of molar incisor hypomineralization was 28.7 percent. MIH severity at the individual level was significantly associated with the number of affected teeth and the occurrence of affected incisors.

PMID:34467841

Semergen. 2021 Aug 29:S1138-3593(21)00226-4. doi: 10.1016/j.semerg.2021.07.010. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the adequacy of vitamin D treatment based on clinic evidence in a Primary Care Center as well as to analyze some characteristics of the prescriptions made.

MATERIALS AND METHODS: Descriptive cross-sectional study. Primary Care. Patients above 14 years old with vitamin D prescription. Main variable was the therapeutic adequacy with vitamin D compounds (adequacy was considered when there was a clinical indication for treatment and blood vitamin D levels below 20ng/ml). Other clinical variables were collected. Frequency and association measures were used for statistical analysis. Level of statistical significance was considered <0.05.

RESULTS: 430 patients, 346 women (80.5%, 95% CI=77-84). Record of vitamin D values in 216 (50.2%, 95% CI=45-55). Screening/treatment indications in 219 patients (50.9%, 95% CI=46-56), of those in 150 patients vitamin D values were recorded (68.5%, 95% CI=62-75), average (±SD) was 21.22±12ng/ml, deficiency criteria in 86 (57.3%, 95% CI=51-64), insufficiency in 37 (24.7%, 95% CI=19-30) and sufficiency in 27 (18%, 95% CI=13-23). 86 patients (20%, 95% CI=16-24) had treatment indications plus vitamin D deficiency with no differences between genders.

CONCLUSIONS: Only 20% of the patients had treatment indications plus vitamin D deficiency. Female predominance. Just over half had indications for screening of serological vitamin D values and/or indications for treatment with vitamin D compounds.

PMID:34465546 | DOI:10.1016/j.semerg.2021.07.010

Urol Oncol. 2021 Aug 28:S1078-1439(21)00366-5. doi: 10.1016/j.urolonc.2021.08.007. Online ahead of print.

ABSTRACT

PURPOSE: Robust prediction of progression on active surveillance (AS) for prostate cancer can allow for risk-adapted protocols. To date, models predicting progression on AS have invariably used traditional statistical approaches. We sought to evaluate whether a machine learning (ML) approach could improve prediction of progression on AS.

PATIENTS AND METHODS: We performed a retrospective cohort study of patients diagnosed with very-low or low-risk prostate cancer between 1997 and 2016 and managed with AS at our institution. In the training set, we trained a traditional logistic regression (T-LR) classifier, and alternate ML classifiers (support vector machine, random forest, a fully connected artificial neural network, and ML-LR) to predict grade-progression. We evaluated model performance in the test set. The primary performance metric was the F1 score.

RESULTS: Our cohort included 790 patients. With a median follow-up of 6.29 years, 234 developed grade-progression. In descending order, the F1 scores were: support vector machine 0.586 (95% CI 0.579 – 0.591), ML-LR 0.522 (95% CI 0.513 – 0.526), artificial neural network 0.392 (95% CI 0.379 – 0.396), random forest 0.376 (95% CI 0.364 – 0.380), and T-LR 0.182 (95% CI 0.151 – 0.185). All alternate ML models had a significantly higher F1 score than the T-LR model (all p <0.001).

CONCLUSION: In our study, ML methods significantly outperformed T-LR in predicting progression on AS for prostate cancer. While our specific models require further validation, we anticipate that a ML approach will help produce robust prediction models that will facilitate individualized risk-stratification in prostate cancer AS.

PMID:34465541 | DOI:10.1016/j.urolonc.2021.08.007

J Heart Lung Transplant. 2021 Aug 6:S1053-2498(21)02446-3. doi: 10.1016/j.healun.2021.07.027. Online ahead of print.

ABSTRACT

BACKGROUND: Heart transplant programs and regulatory entities require highly accurate performance metrics to support internal quality improvement activities and national oversight of transplant programs, respectively. We assessed the accuracy of publicly reported performance measures.

METHODS: We used the United Network for Organ Sharing registry to study patients who underwent heart transplantation between January 1, 2016 and June 30, 2018. We used tests of calibration to compare the observed rate of 1-year graft failure to the expected risk of 1-year graft failure, which was calculated for each recipient using the July 2019 method published by the Scientific Registry of Transplant Recipients (SRTR). The primary study outcome was the joint test of calibration, which accounts for both the total number of events predicted (calibration-in-the-large) and dispersion of risk predictions (calibration slope).

RESULTS: 6,528 heart transplants were analyzed. The primary test of calibration failed (p <0.0001), indicating poor accuracy of the SRTR model. The calibration-in-the-large statistic (0.63, 95% confidence interval [CI] 0.58-0.68, p < 0.0001) demonstrated overestimation of event rates while the calibration slope statistic (0.56, 95% CI 0.49-0.62, p <0.0001) indicated over-dispersion of event rates. Pre-specified subgroup analyses demonstrated poor calibration for all subgroups (each p <0.01). After recalibration, program-level observed/expected ratios increased by a median of 0.14 (p <0.0001).

CONCLUSIONS: Risk models employed for publicly-reported graft survival at U.S. heart transplant centers lack accuracy in general and in all subgroups tested. The use of disease-specific models may improve the accuracy of program performance metrics.

PMID:34465530 | DOI:10.1016/j.healun.2021.07.027

J Foot Ankle Surg. 2021 Aug 6:S1067-2516(21)00289-1. doi: 10.1053/j.jfas.2021.07.022. Online ahead of print.

ABSTRACT

The current study aimed to assess the outcomes of sliding oblique metatarsal osteotomy fixated with a K-wire without cheilectomy for hallux rigidus. Pre- and postoperative variables, including dorsiflexion angle, visual analog scale score, and Japanese Society for Surgery of the Foot scale score, were assessed using the Wilcoxon signed-rank test. In addition, the surgical effects among the four grades were compared using the Kruskal-Wallis test. In total, 43 patients, including 11, 11, 15, and 6 with grade 1, 2, 3, and 4 hallux rigidus, respectively, were enrolled in this analysis. The mean age of the participants was 56.2 years, and the mean follow-up period was 3.0 years. Mean pre- and postoperative dorsiflexion angles were as follows: overall, 53.0° to 66.5° (p < .001); grade 1, 66.8° to 79.1°; grade 2, 59.1° to 68.6°; grade 3, 43.3° to 61.0°; and grade 4, 40.8° to 53.3°. Mean pre- and postoperative visual analog scale scores were as follows: overall, 70.1 to 6.5 (p < .001); grade 1, 74.2 to 3.0; grade 2, 66.4 to 7.6; grade 3, 69.5 to 8.4; and grade 4, 71.2 to 6.0. Finally, mean pre- and postoperative Japanese Society for Surgery of the Foot scale scores were as follows: overall, 61.2 to 86.6 (p < .001); grade 1, 63.8 to 93.6; grade 2, 68.3 to 85.9; grade 3, 54.4 to 83.1; and grade 4, 60.5 to 83.5. There was no statistically significant difference in the surgical effects among the four grades. Decompressive metatarsal osteotomy without cheilectomy was found to be effective. Moreover, the procedure could be performed for all grades of hallux rigidus.

PMID:34465523 | DOI:10.1053/j.jfas.2021.07.022

Cytotherapy. 2021 Aug 28:S1465-3249(21)00745-3. doi: 10.1016/j.jcyt.2021.07.010. Online ahead of print.

ABSTRACT

BACKGROUND AIMS: The high genetic diversity of HLA across populations significantly confines the effectiveness of a donor or umbilical cord blood search for allogeneic hematopoietic stem cell transplantation (HSCT). This study aims to probe the HLA immunogenetic profile of the population of Crete, a Greek region with specific geographic and historical characteristics, and to investigate potential patterns in HLA distribution following comparison with the Deutsche Knochenmarkspenderdatei (DKMS) donor registry. It also aims to highlight the importance of regional public cord blood banks (PCBBs) in fulfilling HSCT needs, especially in countries with significant genetic diversity.

METHODS: A cohort of 1835 samples representative of the Cretan population was typed for HLA class I (HLA-A, HLA-B, HLA-C) and class II (HLA-DRB1, HLA-DQB1, HLA-DPB1) loci by high-resolution second field next-generation sequencing. Data were compared with the respective HLA profiles of 12 DKMS populations (n = 20 032). Advanced statistical and bioinformatics methods were employed to assess specific intra- and inter-population genetic indexes associated with the regional and geographic distribution of HLA alleles and haplotypes.

RESULTS: A considerable HLA allelic and haplotypic diversity was identified among the Cretan samples and between the latter and the pooled DKMS cohort. Even though the HLA allele and haplotype frequency distribution was similar to regions of close geographic proximity to Crete, a clinal distribution pattern from the northern to southern regions was identified. Significant differences were also observed between Crete and the Greek population of DKMS.

CONCLUSIONS: This study provides an in-depth characterization of the HLA immunogenetic profile in Crete and reveals the importance of demographic history in HLA heterogeneity and donor selection. The novel HLA allele and haplotype frequency comparative data between the Cretan and other European populations signify the importance of regional PCBBs in prioritizing HLA diversity to efficiently promote the HSCT program at the national level and beyond.

PMID:34465516 | DOI:10.1016/j.jcyt.2021.07.010

Eur Urol. 2021 Aug 28:S0302-2838(21)01946-1. doi: 10.1016/j.eururo.2021.08.002. Online ahead of print.

ABSTRACT

BACKGROUND: Multiparametric magnetic resonance imaging (MRI) is validated for the detection of clinically significant prostate cancer (csPCa), although patients with negative/equivocal MRI undergo biopsy for false negative concerns. In addition, ⁶⁸Ga-PSMA-11 positron emission tomography/computed tomography (prostate-specific membrane antigen [PSMA]) may also identify csPCa accurately.

OBJECTIVE: This trial aimed to determine whether the combination of PSMA + MRI was superior to MRI in diagnostic performance for detecting csPCa.

DESIGN, SETTING, AND PARTICIPANTS: A prospective multicentre phase II imaging trial was conducted. A total of 296 men were enrolled with suspected prostate cancer, with no prior biopsy or MRI, recent MRI (6 mo), and planned transperineal biopsy based on clinical risk and MRI. In all, 291 men underwent MRI, pelvic-only PSMA, and systematic ± targeted biopsy.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Sensitivity, specificity, and predictive values (negative predictive value [NPV] and positive predictive value) for csPCa were determined for MRI, PSMA, and PSMA + MRI. PSMA + MRI was defined as negative for PSMA negative Prostate Imaging Reporting and Data System (PI-RADS) 2/3 and positive for either MRI PI-RADS 4/5 or PSMA positive PI-RADS 2/3; csPCa was any International Society of Urological Pathology (ISUP) grade group ≥2 malignancy.

RESULTS AND LIMITATIONS: Of the patients, 56% (n = 162) had csPCa; 67% had PI-RADS 3-5, 73% were PSMA positive, and 81% were combined PSMA + MRI positive. Combined PSMA + MRI improved NPV compared with MRI alone (91% vs 72%, test ratio = 1.27 [1.11-1.39], p < 0.001). Sensitivity also improved (97% vs 83%, p < 0.001); however, specificity was reduced (40% vs 53%, p = 0.011). Five csPCa cases were missed with PSMA + MRI (four ISUP 2 and one ISUP 3). Of all men, 19% (56/291) were PSMA + MRI negative (38% of PI-RADS 2/3) and could potentially have avoided biopsy, risking delayed csPCa detection in 3.1% men with csPCa (5/162) or 1.7% (5/291) overall.

CONCLUSIONS: PSMA + MRI improved NPV and sensitivity for csPCa in an MRI triaged population. Further randomised studies will determine whether biopsy can safely be omitted in men with a high clinical suspicion of csPCa but negative combined imaging.

PATIENT SUMMARY: The combination of magnetic resonance imaging (MRI) + prostate-specific membrane antigen positron emission tomography reduces false negatives for clinically significant prostate cancer (csPCa) compared with MRI, potentially allowing a reduction in the number of prostate biopsies required to diagnose csPCa.

PMID:34465492 | DOI:10.1016/j.eururo.2021.08.002