Nevin Manimala

Spectrochim Acta A Mol Biomol Spectrosc. 2021 Aug 6;264:120255. doi: 10.1016/j.saa.2021.120255. Online ahead of print.

ABSTRACT

For the estimation of some co-administered antimicrobials, two highly accurate and precise spectrofluorimetric methods were developed. Fluconazole (FLZ) is co-administered with either ciprofloxacin (CPR) or ofloxacin (OFX) for the treatment of certain microbial infections. On the other hand, another antimicrobial drug, vancomycin (VNC) is co-administered with ciprofloxacin (CPR) for peritonitis treatment. In method I, conventional spectrofluorimetry has been introduced for the concurrent quantitative estimation of FLZ in presence of OFX or CPR. While in method II, a first derivative synchronous spectrofluorimetric technique was adapted for quantitation of VNC and CPR co-administered combination. Both of them were utilized for estimation of the considered drugs in raw materials, laboratory prepared mixtures, dosage forms, and biological fluids. Method I was relied on simultaneous measuring of the native fluorescence of FLZ and OFX or CPR without any overlapping between the emission spectra of each binary mixture (FLZ / OFX) and (FLZ / CPR). Fluorescence intensities were measured at 283.0, 483.0 and 436.0 nm after excitation at 262.0, 292.0 and 275.0 nm for FLZ, OFX and CPR, respectively. Method II was utilized the synchronous fluorescence intensity of VNC and CPR in methanol at Δλ = 40 nm. The first derivative synchronous spectra were calibrated at 297.0 nm for VNC and at 379.5 nm for CPR. Different variables influencing conventional and synchronous fluorescence intensities of the four antimicrobials under investigation were precisely optimized. Both methods were successfully investigated for the determination of the studied drugs in plasma. The linear data analysis for the calibration curves reveals a good relationship in the ranges of 1.0-10.0, 0.25-2.5 and 0.06-0.6 μg/mL for FLZ, OFX and CPR for method I with limits of detection 0.144, 0.038 and 0.007 μg/mL and limits of quantitation of 0.437, 0.114 and 0.021 μg/mL for FLZ, OFX and CPR, respectively. Linearity range for method II was 0.5 -10.0 μg/mL for VNC and CPR with detection limits of 0.127 and 0.110 μg/mL and quantitation limits of 0.380 and 0.334 μg/mL for VNC and CPR, respectively. International Council on Harmonization ICH Q2 (R1) Guidelines were followed in the developed methods validation. The achieved outcomes were statistically compared with those found by the reported ones, and no significant difference was observed.

PMID:34464919 | DOI:10.1016/j.saa.2021.120255

Eur J Radiol. 2021 Aug 26;143:109936. doi: 10.1016/j.ejrad.2021.109936. Online ahead of print.

ABSTRACT

PURPOSE: To compare the image quality, presence of artifacts and apparent diffusion coefficient (ADC) values of reduced field-of-view (rFOV) and large FOV (lFOV) single-shot spin-echo echo-planar diffusion-weighted imaging (DWI) in the evaluation of solid pancreatic lesion.

METHOD: The 3T MR examinations of 60 patients with solid pancreatic lesions were examined. Two Readers independently performed qualitative analysis and quantitative measurements of the ADC values of the solid pancreatic lesions in both rFOV and lFOV DWI sequence. The qualitative analysis parameters included: 1) Sharpness, 2) Distortion, Ghosting, Motion and Susceptibility artifacts, 3) Lesion Conspicuity and 4) Overall Image Quality. These parameters were evaluated using a 4-point scale. The T-test for paired data was used to compare qualitative scores and the ADC values of the rFOV and lFOV DWI sequences, and to assess inter-reader agreement.

RESULTS: The qualitative analysis yielded scores for the rFOV DWI sequence, which were better for sharpness, artifacts, and overall image quality as compared to the lFOV DWI sequence according to the only Reader 2 (the most experienced) (p ≤ 0.001). As to lesion conspicuity, no significant difference was found by either Reader (p ≥ 0.245). As to quantitative analysis, both Readers found no significant difference between the two sequences in the ADC values of various solid pancreatic lesions (p ≥ 0.156).

CONCLUSIONS: The rFOV DWI sequence of the pancreas provides better anatomic structure visualization, reduced artifacts, and better overall image quality as compared to the lFOV DWI sequence according to the Reader with the more experience in abdominal MRI. The ADC values were not significantly different in the two sequences. The rFOV DWI sequence could be included in the standard MRI protocol for the pancreas.

PMID:34464906 | DOI:10.1016/j.ejrad.2021.109936

J Surg Res. 2021 Aug 28;268:595-605. doi: 10.1016/j.jss.2021.07.014. Online ahead of print.

ABSTRACT

BACKGROUND: Timely identification and management of sepsis in surgical patients is crucial, and transfer status may delay optimal treatment of these patients. The objective of this study was to compare in-house and 90-day mortality between patients primarily admitted or transferred into the surgical ICU (SICU) at a tertiary referral center.

MATERIAL AND METHODS: All patients admitted to the SICU with a diagnosis of sepsis (Sepsis III) were reviewed at a single institution between 2014 to 2019 (n = 1489). Demographics, comorbidities, and sepsis presentation were compared between transferred (n = 696) and primary patients (n = 793). Primary outcomes evaluated were in-house and 90 day mortality in an unmatched and propensity score matched cohorts. A P value < 0.05 was considered statistically significant.

RESULTS: Transfer patients were more likely to have obesity (60% versus 49%, P < 0.005), a higher median SOFA (6 (4-8) versus 5 (3-8), P = 0.007), and require vasopressors on admission (42% versus 35%, P = 0.004). Compared to primary patients, transfer patients exhibited higher rates of respiratory failure (76% versus 69%, P = 0.003), in-house (30% versus 17%, P < 0.005), and 90 day mortality (36% versus 24%, P < 0.005). After matching, transferred patients were associated with 75% and 83% increased odds of in-house and 90 day mortality after controlling for age, sex, race, comorbidities, BMI, and sepsis severity.

CONCLUSIONS: Transfer status is associated with an over 80% increase in the odds of 90 day mortality for patients admitted to the SICU with sepsis. Aggressive patient identification and earlier transfer of those at higher risk of death may reduce this effect.

PMID:34464897 | DOI:10.1016/j.jss.2021.07.014

J Surg Res. 2021 Aug 28;268:562-569. doi: 10.1016/j.jss.2021.06.076. Online ahead of print.

ABSTRACT

BACKGROUND: Thyroid nodules are common; up to 67% of adults will show nodules on high-quality ultrasound, and 95% of these nodules are benign. FNA cytology is a crucial step in determining the risk of malignancy, and a false negative diagnosis at this stage delays cancer treatment. The purpose of this study is to develop a predictive model using machine learning which can identify false negative FNA results based on less-invasive clinical data.

MATERIALS AND METHODS: We conducted a retrospective medical record review at one academic and one community center. Inclusion criteria were thyroid nodules evaluated by ultrasound and FNA with a Bethesda II (benign) result or malignancy detected on pathology or FNA. Linear, non-linear, and ensemble models were generated with scikit-learn using 10-fold cross validation with repetition and compared with AUROC. The classification task was the prediction of malignancy using information acquired from less-invasive ultrasound and FNA.

RESULTS: A total of 604 subjects met inclusion criteria; 38 were diagnosed with malignancy. Of all algorithms tested, a Random Forest method achieved the best AUROC (0.64) in separating benign and malignant nodules, though the improvement over other tested algorithms was not statistically significant.

CONCLUSIONS: A Random Forest model performed better than random chance using readily available data obtained via standard evaluation of thyroid nodules. The diagnostic probability threshold of this model can be varied to minimize false positives at the cost of increasing the number of false negatives. Future studies will prospectively evaluate the model’s performance.

PMID:34464894 | DOI:10.1016/j.jss.2021.06.076

Int Immunopharmacol. 2021 Aug 28;100:108087. doi: 10.1016/j.intimp.2021.108087. Online ahead of print.

ABSTRACT

Cytochromes P450 (CYPs) are a large superfamily of heme-containing enzymes that are essential for the metabolism of a variety of endogenous and xenobiotic compounds. The role and the possible diagnostic or prognostic value of the occurrence of anti-CYP autoantibodies (aAbs) in cancer patients are essentially unclear. Recently we reported the monitoring of aAbs against CYP4Z1 and CYP19A1 in breast cancer patients and healthy controls. In the present study, we extended this investigation by screening the sera of 47 lung cancer patients (17 female and 30 male; age range 49-84) and 119 healthy controls (60 female and 59 male; age range 21-72) for the presence of aAbs directed against CYP2D6, CYP4Z1, or CYP17A1, respectively. Determination of anti-CYP aAb levels was done using our previously established ELISA method. Most sera gave low signals while a small fraction showed stronger responses; however, there were no statistically significant differences between the different test groups. Also, there was no significant difference in aAb signals between the various subtypes of lung cancer. Unexpectedly, sera from two female lung cancer patients (age 67 (adenocarcinoma) and 70 (small cell carcinoma)) and from four healthy controls (one female and three male; age range 34-48) showed significantly elevated signals for more than one of the three CYPs tested. These findings corroborate earlier reports that anti-CYP aAbs occur with low frequency in the general population and, moreover, suggest that the simultaneous presence of multiple aAbs targeting different CYPs should be taken into consideration when evaluating anti-CYP aAbs as biomarkers.

PMID:34464888 | DOI:10.1016/j.intimp.2021.108087

Accid Anal Prev. 2021 Aug 28;161:106357. doi: 10.1016/j.aap.2021.106357. Online ahead of print.

ABSTRACT

It is widely believed that with higher levels of vehicle automation and especially with the advent of fully automatic vehicles, the currently typical forward-facing, upright position will give way to a more relaxed and reclined seating posture. Therefore, the current study investigates the influence of a reclined sitting position on crash injury severity by analyzing real-world crash data from the German in-depth accident study (GIDAS). We compared reclined to upright occupants and focused on effect sizes regarding odds ratios at different injury severity levels. We used the abbreviated injury scale (AIS 2015) for injury scaling and the maximum AIS (MAIS) at the levels 2+, 3+, and 4+ to convert injury severity into a dichotomous metric. Two different analyses were conducted, one looking at the occupant MAIS and one focusing on selected body regions. The body regions investigated are head/face/neck (HFN), thorax, abdomen, pelvis/hip/lower extremities (PHL), and upper extremities. We computed odds ratios greater than one indicating a higher odds of injury at a given injury severity level in the reclined group compared to the upright group. The odds ratios for belted, reclined occupants compared to belted, upright sitting occupants are 2.07, 3.09, and 3.66 for the injury severity levels MAIS2+, MAIS3+, and MAIS4+, respectively. When looking at the body regions, the spread of the odds ratios is wider: At the MAIS2+ level, the odds ratios range between 1.6 and 7.1; at the MAIS3+ level, the odds ratios span from 1.5 to 8.7, with the latter value representing the PHL region. No odds ratio could be computed for the upper extremity injuries at this level. At the MAIS4+ injury severity level, only the HFN odds ratio was statistically significant with a value of 5.6. This study is among the first to show an association between body posture and injury severity at MAIS3+ and MAIS4+ injury level in real-world crashes for reclined seating postures.

PMID:34464840 | DOI:10.1016/j.aap.2021.106357

World Neurosurg. 2021 Aug 28:S1878-8750(21)01274-2. doi: 10.1016/j.wneu.2021.08.097. Online ahead of print.

ABSTRACT

INTRODUCTION: Prone transpsoas lateral lumbar interbody fusion (PTP-LLIF) is a recently introduced modification to standard-LLIF. To date, no study has compared the radiographic outcomes of standard-LLIF and PTP-LLIF. This study aimed to perform a radiographic parameter-based propensity score-matched analysis to compare postoperative clinical and radiographic outcomes between PTP-LLIF and standard-LLIF for degenerative lumbar spine disease.

METHODS: A total of 30 consecutive patients met the inclusion : riteria. Preoperative standing scoliosis x-rays were retrospectively reviewed for global and segmental sagittal alignment. Propensity matching was calculated using baseline radiographic parameters. One-to-one matching of patients who had undergone PTP-LLIF with those who had a similar propensity score but had undergone standard-LLIF was performed to compare radiographic (primary) and clinical (secondary) outcomes.

RESULTS: Propensity score matching resulted in 10 pairs of PTP-LLIF and standard-LLIF patients. The PTP-LLIF group had significantly better improvement in lumbar lordosis (p=0.047). Improvement in pelvic incidence minus lumbar lordosis mismatch approached statistical significance in that group (p=0.05). This led to better improvement in short form-12 physical score (SF12-PS) (p=0.03) and Oswestry disability index (p=0.1) in the PTP-LLIF group. There were no significant differences between groups in other clinical and radiographic outcomes. PTP-LLIF had non-significantly shorter operative time (p=0.4) and hospital stay (p=0.1) as well as less radiation exposure time (p=0.5). Standard-LLIF had non-significantly less intraoperative bleeding (p=0.3). Mean follow-up was 10.2±5.2 months in the PTP-LLIF group versus 30.9±17.2 months in the standard-LLIF group (p<0.05).

CONCLUSION: PTP-LLIF showed significantly better improvement in lumbar lordosis and SF12-PS.

PMID:34464774 | DOI:10.1016/j.wneu.2021.08.097

World Neurosurg. 2021 Aug 28:S1878-8750(21)01273-0. doi: 10.1016/j.wneu.2021.08.096. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: The term early onset scoliosis (EOS) refers to spinal deformities that develop before the age of 10. The aim of surgical treatment for EOS is stopping the progression of the curvature, maintaining the correction, ensuring the maximum growth of the vertebrae and ensuring that the vertebrae remain mobile. Using MCGR in the treatment of EOS is intended to protect the patient from negative effects of repetitive surgeries, increase the patient’s compliance and satisfaction, and increase the speed of return to normal social life.

PURPOSE: Our aim is to report early radiological evaluation and detect changes in the quality of life of patients and their parents after diagnosis of early onset scoliosis (EOS) and treatment with magnetically controlled growing rods (MCGR).

STUDY DESIGN/SETTING: Retrospective clinical study (Level 4 case series) OUTCOME MEASURES: Cobb angle, thoracic kyphosis, spinal height, thoracic height, sagittal balance, coronal balance, shoulder balance and pelvic balance were measured. All patients received preoperative and final follow-up respiratory function tests, and the parents of every patient completed the Turkish version of the EOSQ-24 questionnaire PATIENT SAMPLE: Twenty patients with surgical indication for treatment of EOS METHODS: A total of 20 patients who were treated with MCGR and had lengthening procedures at 3-month intervals between August 2014 and August 2016 were included in the study. The mean age at the time of surgery was 7.9 years (4-10) and the mean length of follow-up was 14.9 months (6-30). Preoperative, early postoperative and final follow-up x-rays of all patients were obtained. From the x-rays, Cobb angle, thoracic kyphosis, spinal height, thoracic height, sagittal balance, coronal balance, shoulder balance, and pelvic balance were measured. All patients received preoperative and final follow-up respiratory function tests, and all patients completed the Early Onset Scoliosis Questionnaire (EOSQ-24) RESULTS: Preoperative, early postoperative and final follow-up mean Cobb angles were 56.6 degrees (38-93), 30.5 degrees (13-80) and 33.5 degrees (14-86), respectively. These findings showed statistically significant improvement in Cobb angle (p<0.05). Thoracic height was also significantly increased; the preoperative mean was 181 mm (123-224), the early postoperative mean was 200 mm (164-245) and the final follow-up mean was 212 mm (167-248; p<0.05). Measurements for spinal height also increased significantly with preoperative, early postoperative, and final follow-up values of 219 mm (213-366), 315 mm (260-402), and 338 mm (261-406), respectively (p<0.05). Thoracic kyphosis measurements was 41 degrees (5-65) preoperatively, and this value decreased significantly to 32.5 degrees (0-53) in the final follow-up (p<0.05). Our measurements showed no statistically significant differences in coronal and sagittal balance, pelvic balance, or shoulder balance. There were no significant differences between preoperative and postoperative respiratory function tests. Assessment using the EOSQ-24 questionnaire demonstrated significant improvements in mean scores at final follow-up (p<0.05). When different categories in the questionnaire were evaluated separately, there were no statistically significant differences between preoperative and final follow-up scores of general health, pain/discomfort, respiratory function, movement capability, physical function or effects on daily life (p>0.05). However, exhaustion and energy levels, emotional state, effect of the disease on parents and the patient, and parent satisfaction scores increased significantly from preoperative assessment to final follow-up (p<0.05). Financial effect decreased significantly in final follow-up compared to preoperative values (p<0.05). Four patients developed complications requiring further treatment, and none of the patients developed infection that required surgical intervention.

CONCLUSIONS: Our study showed that insertion of a MCGR is a safe procedure for treatment of EOS to correct deformity and improve function in daily life. This method reduces the need for repetitive surgery and the likelihood of complications associated with other treatments. As a result, treatment with MCGR increases patient satisfaction and facilitates patient compliance.

PMID:34464772 | DOI:10.1016/j.wneu.2021.08.096

Comput Methods Programs Biomed. 2021 Aug 18;210:106354. doi: 10.1016/j.cmpb.2021.106354. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Magnetic drug targeting (MDT) is a promising technology to improve cancer therapy. MDT describes the accumulation of drug loaded superparamagnetic iron oxide nanoparticles (SPIONs) at a desired location, e. g. a tumor, by application of a magnetic field. Here, we evaluate the effectivity of MDT for an endoscopic placement of two different configurations of magnet arrays, i. e. six magnets with same poles facing each other and a Halbach array. Compared to conventional magnet setups outside the body, this endoscopic placement gives the possibility to achieve higher magnetic field gradients inside the tumor.

METHODS: For such a MDT concept, we present FEM based simulations of MDT tracing single SPIONs in a 3D geometry of eight multibranched vessels with sizes in the range of capillaries. In these simulations, the effect of the magnetic field gradient as well as of magnet distance to the vessel geometry, magnetic flux density of the magnets, SPIONs hydrodynamic diameter and magnetic moment on the MDT effectivity is calculated. The blood flow is modelled as an incompressible Newtonian fluid and the SPIONs are suspended in the blood flow. Statistical significance of the targeting effectivity results is tested with the Mann-Whitney-U-Test.

RESULTS: The results show that the magnetic targeting effectivity is up to 32 % higher than the one calculated without the presence of a magnetic field. In the investigated vessel network, this effect on the targeting effectivity is dependent on the number of local magnetic field maxima that are approached with a high gradient and is noticeable up to 200 µm distance of the magnet to the vessel geometry.

CONCLUSIONS: We conclude that for an effective application of MDT, the magnet configuration needs to be placed close to the tumor and should yield a large number of magnetic field maxima that are approached with a high gradient.

PMID:34464768 | DOI:10.1016/j.cmpb.2021.106354

Hand Surg Rehabil. 2021 Aug 28:S2468-1229(21)00249-8. doi: 10.1016/j.hansur.2021.08.010. Online ahead of print.

ABSTRACT

Acute peripheral nerve injuries are common and can cause physical disabilities with sensory and functional sequelae; they therefore require surgery. The aim of this study was to conduct a systematic review to assess the clinical applicability of end-to-side neurorrhaphy in peripheral nerve reconstruction, based on available evidence. We carried out a systematic review of the literature using MEDLINE/PubMed, EMBASE, Cochrane Library, Web of Science, Scielo and Scopus through March 16, 2021. Most of the selected studies were qualitative and employed nonrandomized groups of patients, without standardized scales for assessing outcomes, which made statistical analysis difficult. Efficacy varied from 24% to 81%. Factors for better outcome included the type of injury, type of injured nerve (sensory, motor or mixed), presence of an epineural window, topography, injury extension <1.3 cm, and intervention within 2 weeks of injury. Clinical studies so far lack scientific evidence on end-to-side neurorrhaphy in peripheral nerve lesions.

PMID:34464758 | DOI:10.1016/j.hansur.2021.08.010