Nevin Manimala

J Appl Clin Med Phys. 2021 Jul 7. doi: 10.1002/acm2.13325. Online ahead of print.

ABSTRACT

PURPOSE: Eye plaques are widely used for ocular melanoma and provide an effective alternative to enucleation with adequate tumor control. A COMS plaque utilizes a Silastic insert for precise positioning of the radioactive seeds with respect to the scleral surface of the eye; however, due to manufacturing variability, the insert may unintentionally increase or decrease the distance between the sources and tumor. The purpose of this work is to provide guidance in measuring and identifying outliers in Silastic inserts. The importance of regular quality assurance (QA) is illustrated in an experience where a systematic problem was detected and the manufacturer’s 22-mm mold was corrected.

METHODS: A detailed description of the molds and manufacturing process used to produce Silastic inserts is provided, including photographs of the process steps. The variability in Silastic insert production was evaluated by measuring the thickness of 124 Silastic inserts. An estimate of how the observed Silastic thickness discrepancies impact the dose to the tumor and critical eye structures was performed using homogeneous dose calculations. A standard QA protocol was developed to guide the clinical user.

RESULTS: Thickness of the measured Silastic inserts ranged from 1.22 to 2.67 mm, demonstrating variation from the 2.25 mm standard. Six of the 22-mm inserts were outliers (Δthickness >3 standard deviations) and were excluded from the statistics. The outliers were investigated with the help of the manufacturer, who discovered that a systematic error was accidentally introduced into the 22-mm mold.

CONCLUSIONS: Due to manufacturing errors or variability, the Silastic inserts used in COMS eye plaques may be thicker or thinner than the design standard. Such variations may impact tumor control or increase the risk of normal tissue side effects. A standardized QA program is recommended to detect variations and communicate unusual findings to the manufacturer.

PMID:34231949 | DOI:10.1002/acm2.13325

Helicobacter. 2021 Jul 7:e12832. doi: 10.1111/hel.12832. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effectiveness of using WeChat platform to manage the patients with H. pylori infection.

METHODS: 566 patients were randomly divided into two groups: The control group was treated with traditional management method, and the experimental group established WeChat group and implemented the informatization management. The two groups were given a unified plan to eradicate H. pylori. After the treatment, the C14 breath test was reexamined. The follow-up rate and H. pylori eradication rate of the two groups were counted.

RESULTS: In the experimental group, 289 patients were enrolled and 271 patients were followed up. The follow-up rate was 93.8%. The number of H. pylori-negative patients was 244, and the eradication rate was 90.0%. In the control group, 277 patients were enrolled in the study, and 215 patients were followed up. The follow-up rate was 77.6%. 169 cases of H. pylori-negative conversion were found, and the eradication rate was 78.6%.

CONCLUSION: Through WeChat management, the medication adherence, regular follow-up, and H.pylori infection eradication rate of the patients with H.pylori infection in the experimental group were better than that in control group, during the treatment of eradicating H.pylori, and the difference was statistically significant.

PMID:34231948 | DOI:10.1111/hel.12832

Pathol Int. 2021 Jul 7. doi: 10.1111/pin.13144. Online ahead of print.

ABSTRACT

CD163 is one of the scavenger receptors expressed on macrophages. However, several immunohistochemical studies have demonstrated that CD163 is also detected on cancer cells, and is associated with a poor prognosis. In the present study, we detected CD163 staining on cancer cells in lung adenocarcinoma and squamous cell carcinoma (SCC), and investigated the relationship between CD163 on cancer cells and the clinical prognosis. CD163 staining was seen in 128 of 342 adenocarcinoma cases and 35 of 103 SCC cases. Among the lung adenocarcinoma cases, the progression-free survival and overall survival were significantly shorter in the CD163 high group than the CD163 low group. A similar trend was observed among the SCC cases, but the difference was not statistically significant. Additionally, a higher number of macrophages was detected in areas with CD163-positive cancer cells when compared to areas with CD163-negative cancer cells. In summary, we found that CD163-positive cancer cells are a predictor of a worse clinical course in lung adenocarcinoma and SCC.

PMID:34231937 | DOI:10.1111/pin.13144

J Neuroimaging. 2021 Jul 7. doi: 10.1111/jon.12903. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Glioblastoma (GBM) is an aggressive primary CNS neoplasm with poor overall survival (OS) despite standard of care. On MRI, GBM is usually characterized by an enhancing portion (CET) (surgery target) and a nonenhancing surrounding (NET). Extent of resection is a long debated issue in GBM, with recent evidence suggesting that both CET and NET should be resected in <65 years old patients, regardless of other risk factors (i.e., molecular biomarkers). Our aim was to test a radiomic model for patient survival stratification in <65 years old patients, by analyzing MRI features of NET, to aid tumor resection.

METHODS: Sixty-eight <65 years old GBM patients, with extensive CET resection, were selected. Resection was evaluated by manually segmenting CET on volumetric T1-weighted MRI pre and postsurgery (within 72 h). All patients underwent the same treatment protocol including chemoradiation. NET radiomic features were extracted with a custom version of Pyradiomics. Feature selection was performed with principal component analysis (PCA) and its effect on survival tested with Cox regression model. Twelve months OS discrimination was tested by t-test followed by logistic regression. Statistical significance was set at p<0.05. The most relevant features were identified from the component matrix.

RESULTS: Five PCA components (PC1-5) explained 90% of the variance. PC5 resulted significant in the Cox model (p = 0.002; exp(B) = 0.686), at t-test (p = 0.002) and logistic regression analysis (p = 0.006). Apparent diffusion coefficient (ADC)-based features were the most significant for patient survival stratification.

CONCLUSIONS: ADC radiomic features on NET predict survival after standard therapy and could be used to improve patient selection for more extensive surgery.

PMID:34231927 | DOI:10.1111/jon.12903

Cereb Cortex. 2021 Jul 7:bhab209. doi: 10.1093/cercor/bhab209. Online ahead of print.

ABSTRACT

The study of states of arousal is key to understand the principles of consciousness. Yet, how different brain states emerge from the collective activity of brain regions remains unknown. Here, we studied the fMRI brain activity of monkeys during wakefulness and anesthesia-induced loss of consciousness. We showed that the coupling between each brain region and the rest of the cortex provides an efficient statistic to classify the two brain states. Based on this and other statistics, we estimated maximum entropy models to derive collective, macroscopic properties that quantify the system’s capabilities to produce work, to contain information, and to transmit it, which were all maximized in the awake state. The differences in these properties were consistent with a phase transition from critical dynamics in the awake state to supercritical dynamics in the anesthetized state. Moreover, information-theoretic measures identified those parameters that impacted the most the network dynamics. We found that changes in the state of consciousness primarily depended on changes in network couplings of insular, cingulate, and parietal cortices. Our findings suggest that the brain state transition underlying the loss of consciousness is predominantly driven by the uncoupling of specific brain regions from the rest of the network.

PMID:34231843 | DOI:10.1093/cercor/bhab209

Dental Press J Orthod. 2021 Jun 30;26(3):e2119288. doi: 10.1590/2177-6709.26.3.e2119288.oar. eCollection 2021.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate characteristics of African-Brazilians young adults with excellent dental occlusion, including bimaxillary protrusion; compare them to European-American Caucasian standards, and determine whether there is sexual dimorphism in the display of this phenotype.

METHODS: Lateral cephalometric radiographs were obtained from 43 African-Brazilians within military personnel (28 males and 15 females, average age 22.4 ± 3.4 years) with normal occlusion, selected from a group of 394 volunteers. Thirty-one angular and linear measurements were evaluated. Student’s t-test for independent samples was used to compare results with those established by European-American standards, previously described in the literature.

RESULTS: Considering the dentoalveolar pattern, seven angular and six linear measurements showed statistically significant differences (p< 0.001) when compared to Caucasian cephalometric standards. African-Brazilians’ subjects showed lower cranial base angle (SNAr = 119.87 ± 5.66º) and anterior cranial base length (SN-distance = 68.63 ± 4.50 mm) (p< 0.001). The maxilla (SNA = 88.51 ± 3.23º) and the mandible (SNB = 85.06 ± 3.24º) were protruded in relation to the SN line (p< 0.001). Sexual dimorphism was significant for L1.NB (degrees) (p< 0.01), and interincisal angle (U1.L1) (p< 0.05).

CONCLUSION: African-Brazilian young adults presented differences regarding dental and craniofacial characteristics, when compared to European-American norms. It can be stated that Caucasian cephalometric norms should not be applied to African-Brazilian faces.

PMID:34231833 | DOI:10.1590/2177-6709.26.3.e2119288.oar

Dental Press J Orthod. 2021 Jun 30;26(3):e2119251. doi: 10.1590/2177-6709.26.3.e2119251.oar. eCollection 2021.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the dimensional stability and maintenance of details of conventional and high stability alginates up to 5-day storage.

METHODS: Two types of alginates were selected (n=10) for this study, conventional (Hydrogum) and high stability alginates (Hydrogum 5), which were produced with the aid of a cylindrical metal block and a ring-shaped metal mold (Specifications 18, 19, and 25, ANSI/ADA). Ten images were obtained from the molds for the dimensional stability test, which were taken immediately after their production and at each different storage periods (15 min, 24 h, 48 h, 72 h, 96 h, and 120 h) by a digital camera. The specimens were kept hermetically sealed in plastic bags (23°C) and then used to obtain 140 (n=70) dental stone models, used in the detail reproduction test, in which the angular accuracy of three grooves (20 µm, 50 µm, and 75 µm) was observed at each period. The details reproduction accuracy was classified using a predetermined score classification. Measurements of dimensional changes were made in the Corel DRAW X6 program. The data were submitted to the Student’s t-test (α?#8197;= 0.05).

RESULTS: A statistically significant difference concerning the size of the matrix was observed after 24h for both alginates, and a statistically significant negative linear dimensional change (contraction) was verified after 24 h of storage (1.52% for the high stability alginate, and 1.32% for the conventional alginate). The high stability alginate kept the full details for 72 hours, while the conventional alginate, for 24 h. Both alginates reproduced the 75 µm groove at all storage periods.

CONCLUSION: Impressions made with both alginates presented satisfactory clinical results when the alginates were immediately poured.

PMID:34231832 | DOI:10.1590/2177-6709.26.3.e2119251.oar

Rev Bras Epidemiol. 2021 Jun 30;24:e210025. doi: 10.1590/1980-549720210025. eCollection 2021.

ABSTRACT

OBJECTIVE: To assess mortality during the COVID-19 pandemic according to social vulnerability by areas of Belo Horizonte (BH), aiming at strategies for vaccination.

METHODS: Ecological study with mortality analysis according to census tracts classified by the Health Vulnerability Index, a composite indicator that includes socioeconomic and sanitation variables. Deaths by natural causes and by COVID-19 were obtained from the “Mortality Information System”, between the 10th and 43rd epidemiological weeks (EW) of 2020. Excess mortality was calculated in a time series model, considering observed and expected deaths per EW, between 2015 and 2019, per census tracts. Mortality rates (MR) were calculated and age-standardized using population estimates from the 2010 census, by the Brazilian Institute of Geography and Statistics (IBGE).

RESULTS: Excess mortality in BH was 16.1% (n = 1,524): 11, 18.8 and 17.3% in low, intermediate and high vulnerability areas, respectively. The differences between observed and expected age-standardized MR by natural causes were equal to 59/100,000 inhabitants in BH, increasing from 31 to 77 and 95/100,000 inhabitants in the areas of low, intermediate and high vulnerability, respectively. There was an aging gradient in MR by COVID-19, ranging from 4 to 611/100,000 inhabitants among individuals aged 20-39 years and 75+ years. The COVID-19 MR per 100,000 older adults (60+ years) was 292 in BH, increasing from 179 to 354 and 476, in low, intermediate and high vulnerability areas, respectively.

CONCLUSION: Inequalities in mortality, particularly among older adults, combined with the limited supply of doses, demonstrate the importance of prioritizing socially vulnerable areas during vaccination against COVID-19.

PMID:34231827 | DOI:10.1590/1980-549720210025

Rev Bras Ter Intensiva. 2021 Apr-Jun;33(2):304-311. doi: 10.5935/0103-507X.20210039.

ABSTRACT

For extubation in pediatric patients, the evaluation of readiness is strongly recommended. However, a device or practice that is superior to clinical judgment has not yet been accurately determined. Thus, it is important to conduct a review on the techniques of choice in clinical practice to predict extubation failure in pediatric patients. Based on a search in the PubMed®, Biblioteca Virtual em Saúde, Cochrane Library and Scopus databases, we conducted a survey of the predictive variables of extubation failure most commonly used in clinical practice in pediatric patients. Of the eight predictors described, the three most commonly used were the spontaneous breathing test, the rapid shallow breathing index and maximum inspiratory pressure. Although the disparity of the data presented in the studies prevented statistical treatment, it was still possible to describe and analyze the performance of these tests.

PMID:34231812 | DOI:10.5935/0103-507X.20210039

Rev Bras Ter Intensiva. 2021 Apr-Jun;33(2):290-297. doi: 10.5935/0103-507X.20210037.

ABSTRACT

OBJECTIVE: To analyze the impact of Resolution 2.173/2017 of the Federal Council of Medicine on results from the Central Estadual de Transplantes de Santa Catarina.

METHODS: This was a cross-sectional observational study of medical records of all patients (1,605) with suspected brain death notified to the Central Estadual de Transplantes de Santa Catarina; for this study, procedures to confirm this diagnosis were initiated between July 2016 and December 2017 and between January 2018 and June 2019. The median duration of the protocol in each period was considered for the comparison between the intervals. The collected data were transformed into rates (per million population). The mean rates for the periods before and after the implementation of the protocol were analyzed by Student’s t-test, and qualitative variables were analyzed by Pearson’s chi-squared test.

RESULTS: The mean duration of brain death confirmation procedures decreased more than 1 hour in the second period compared to the first period, with statistical significance (p = 0.001). The rates of harvested livers and transplanted pancreas, the number of notifications by hospital size and the rate of cardiac arrest in the macro-region of the Itajaí Valley were significantly different between the two periods.

CONCLUSION: In the period after the new resolution on brain death, there was a reduction in the duration for diagnosis. However, other indicators did not change significantly, providing evidence for the multidimensional nature of the organ transplantation process in Santa Catarina and the need for further studies to better understand and optimize the process.

PMID:34231810 | DOI:10.5935/0103-507X.20210037