Nevin Manimala

Cancer Treat Res Commun. 2021 Apr 18;27:100374. doi: 10.1016/j.ctarc.2021.100374. Online ahead of print.

ABSTRACT

INTRODUCTION: Renal cell carcinoma (RCC) accounts for 2-3% of all tumors being the most frequent solid lesion in the kidney.

OBJECTIVE: To determine what genetic alterations and immunohistochemical (IHC) of clear cell renal carcinoma (ccRCC) are associated with prognosis and tumor aggressiveness.

PATIENTS AND METHODS: Experimental analytical study with 57 patients who underwent radical and partial nephrectomy between 2005 and 2011, all with diagnosis of ccRCC and minimum post-operative follow-up of 36 months. The pathological study included IHC determination of biomarkers associated (CAIX, CAM 5.2, CD10, c-erbB-2, EGFR, HIF-1a, Ki67, MDM2, PAX-2 y 8, p53, survivin and VEGFR 1 and 2). Genetic analysis was carried out using multiplex ligation-dependent probe amplification (MLPA). Clinical data were collected and summarized using an access-type database, adding genetic analysis and IHC data of each patient’s tumor sample. IHC statistical analysis included Chi-square, Kruskal-Wallis and multivariate analysis. The genetic analysis was performed using multivariate logistic regression (normal/deletion-duplication). Significance level p<0.05.

RESULTS: Pathologic stage was: pT1 (61.8%), pT2 (32.7%); pT3-T4 (5.4%); 16.3% were pN+ and 19.3% M1. 23.6% recurred being predominantly to distance in 83.3%. 27.3% of patients died (73.3% ccCCR). CAIX (Carbonic anhydrase IX) and tumor size were associated with worse Fuhrman grade (p = 0.035; p = 0.001 respectively). Deletion-duplication of genes increased the likelihood: of death (APC, Bcl-2 and CDKN2A by 11, 7 and 4 respectively and SMAD4 reduced the probability by 88%); tumor recurrence (CDKN2A by fifteen fold and VHL reduced the probability by 87%); pT greater than 2 (CCND2, MDM2 and WT1 multiplied by 6, 7 and 9); risk of N+ (CDK4 and EBF1 by 13); distant metastases (BRCA2 and DLEU1 by 5); Fuhrman grade ≥3 (BRCA1, BRCA2 and p53 by 40, 75 and 34 respectively, while that FHIT reduced by 96%). Deletion-duplication of CDK4 and DCC increased survival by a factor of 13 and 16, while that DLEU1 and RUNX1 decreased survival time by 80%.

CONCLUSION: CAIX and tumor size are associated with increased aggressiveness. The mutations to level 5q, 9p, 11p, 12, 13q, 17, 18q and 21q are associated with more aggressive tumors and with worse survival rate.

PMID:33932757 | DOI:10.1016/j.ctarc.2021.100374

J Forensic Leg Med. 2021 Apr 27;80:102174. doi: 10.1016/j.jflm.2021.102174. Online ahead of print.

ABSTRACT

SUBJECT: The objective of this study is to determine the violence experienced by women who presented to the Emergency Department (ED) due to Intimate Partner Violence (IPV) and their previous experiences of violence.

METHOD: The descriptive study was conducted with 96 women. The data was analyzed in SPSS 17.0 statistics package program.

FINDINGS: The average age of the women is X = 35.33 ± 11.72, 35.4% of them are in the 31-40 age group, 69.6% are married, 44.8% are high school graduates, 60.4% are unemployed. It was determined that women who were IPV victims were exposed to violence by being beaten (punching, kicking etc.) at the highest rate (82.3%), and nearly half of them (47.9%) were injured in the head and neck regions. The vast majority of women (86.5%) have been subjected to violence before, only %13.5 of them stated that they experienced violence for the first time. It was found that the majority of women (69.8%) continued to live with the perpetrator after violence. Only three of the women (3.4%) attempted to initiate legal action, and the majority (76.5%) did not intend to take legal action.

CONCLUSIONS: Healthcare professionals should be aware that most woman presenting to the ED with IPV has a history of violence before it, and that this will probably not be the last. Healthcare professionals should also consider the fact that the victims may be exposed to different types of violence at the same time. It is also recommended that healthcare professionals be trained on policies regarding IPV management and equipped to provide women with the right way out.

PMID:33932741 | DOI:10.1016/j.jflm.2021.102174

Int J Law Psychiatry. 2021 Apr 28;76:101686. doi: 10.1016/j.ijlp.2021.101686. Online ahead of print.

ABSTRACT

The attribution of criminal responsibility in the context of substance intoxication is a matter of controversy in forensic psychiatry. In 2011, the Supreme Court of Canada ruled that Tommy Bouchard-Lebrun was guilty in the straightforward case of a crime committed while in a state of substance-induced psychosis by an individual without a history of mental disorder. However, the ruling may since have served as a precedent also for settling cases where an offence is committed while in a certain state of intoxication and where there is much more diagnostic uncertainty. The goal of our research was to study the impact of the Bouchard-Lebrun Supreme Court decision on rates of criminal responsibility judgements and toxic psychosis diagnosis in the context of such cases. Applying a time-trend ecological study design, we conducted a chart review of every patient treated at the forensic unit of the Malartic Psychiatric Hospital in northern Quebec in the short periods pre- and post-ruling. We then determined the proportion of patients judged not criminally responsible and the proportion diagnosed with substance-induced psychosis. We ran chi-squared tests on the two sets of dichotomous variables. In the period following the Bouchard-Lebrun ruling, a statistically significant decrease was observed in the proportion of individuals judged not criminally responsible, as was a statistically significant increase in the proportion of individuals diagnosed with substance-induced psychosis. The findings suggest that the Bouchard-Lebrun ruling may have had an impact on subsequent forensic psychiatry decision-making and treatment at the Malartic Hospital.

PMID:33932740 | DOI:10.1016/j.ijlp.2021.101686

Gen Hosp Psychiatry. 2021 Apr 22;71:43-46. doi: 10.1016/j.genhosppsych.2021.04.005. Online ahead of print.

ABSTRACT

OBJECTIVE: The goal is to assess the feasibility of conducting unattended (type II) sleep studies before surgical aortic valve replacement (SAVR) to examine the relationship between baseline sleep measures and postoperative delirium.

METHODS: This single-site study recruited 18 of 20 study referrals with aortic stenosis undergoing first lifetime SAVR. Subjects completed a home-based type II sleep study. Delirium was assessed postoperative days 1-5. Exact logistic regression was used to determine whether sleep efficiency or apnea/hypopnea index predicts delirium.

RESULTS: Of 18 study participants, 15 successfully completed a home sleep study (mean age: 71.7 +/- 8.1 years old; 10 male subjects). Five subjects (33.3%) developed delirium. Preliminary analyses found that greater sleep efficiency was associated with a large reduction in delirium odds but was not statistically significant (OR = 0.31, 95% CI: 0.06, 1.03, p = 0.057). The point estimate of the relationship between apnea/hypopnea index and delirium was not similarly sizeable (OR 1.10, 95% CI: 0.35, 3.37, p = 0.85).

CONCLUSIONS: Our findings suggest that home type II sleep studies before SAVR are feasible, and they support adequately powered studies investigating type II home sleep studies as a predictor of postoperative delirium and other important postsurgical outcomes.

PMID:33932735 | DOI:10.1016/j.genhosppsych.2021.04.005

J Clin Anesth. 2021 Apr 28;72:110310. doi: 10.1016/j.jclinane.2021.110310. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE: To clarify whether intraoperative hypotension contributes to the development of postoperative cognitive dysfunction.

DESIGN: A systematic review of prospective studies reporting on intraoperative hypotension and postoperative cognitive dysfunction in elective, non-cognitive impaired, adult surgical patients. PubMed, EMBASE and the Cochrane Library were searched up to the 1st of January 2021.

SETTING: Studies had to use a clear definition of hypotension, although differing definitions were accepted. Neurocognitive tests to determine postoperative cognitive dysfunction had to be done pre- and postoperatively, with a minimum follow-up of seven days postoperatively.

MEASUREMENTS: Risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0 for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies.

MAIN RESULTS: Out of 941 studies screened, five randomized controlled trials and four cohort studies were included for qualitative analysis. Extensive methodological differences between studies were present hindering proper quantitive analysis. No studies reported statistically significant differences in incidence of postoperative cognitive dysfunction in hypo- compared to normotensive patients. Five studies reported exact incidences of postoperative cognitive dysfunction.

CONCLUSIONS: This systematic review showed no conclusive association between intraoperative hypotension and the development of postoperative cognitive dysfunction. Given the vast methodological differences of the included studies, the role of intraoperative hypotension in the development of postoperative cognitive dysfunction remains uncertain. Future research into the association between intraoperative hypotension and postoperative cognitive dysfunction should be conducted in a standardized manner.

PMID:33932723 | DOI:10.1016/j.jclinane.2021.110310

Appl Radiat Isot. 2021 Apr 24;174:109744. doi: 10.1016/j.apradiso.2021.109744. Online ahead of print.

ABSTRACT

¹³³Ba has been standardised by direct measurements for the first time in the laboratory using two counting systems: (i) the 4πβ (plastic scintillator) -γ coincidence, (ii) the 4πβ (proportional counter) -γ coincidence. Furthermore, this standardisation experiment demonstrates the performance and applicability of the recently developed 4πβ (plastic scintillator)-γ coincidence system for radionuclides decaying with complex decay schemes as well as for e, X-γ emitters. Additionally, ¹³³Ba solution standards were prepared to calibrate the pressurized 4π γ ionisation chamber and determination of the calibration coefficient. The E_n score is a statistical indicator of the agreement between two independent estimations. Thus, the performance of the PS system was compared to the result obtained with the PC system using the E_n score as specified in the ISO13528:2015. The results of measurements are acceptable if E_n ≦ 1.0. An E_n score of 0.2 was obtained which indicates that, the ¹³³Ba activity concentration obtained by the 4πβ (plastic scintillator) -γ coincidence and 4πβ (proportional counter) -γ coincidence systems are in agreement. This paper presents the standardisation procedure, the results obtained by the measurements and their comparison.

PMID:33932690 | DOI:10.1016/j.apradiso.2021.109744

Comput Biol Med. 2021 Apr 15;133:104403. doi: 10.1016/j.compbiomed.2021.104403. Online ahead of print.

ABSTRACT

The quality of magnetic resonance (MR) images obtained with different instruments and imaging parameters varies greatly. A large number of heterogeneous images are collected, and they suffer from acquisition variation. Such imaging quality differences will have a great impact on the radiomics analysis. The main differences in MR images include modality mismatch (M), intensity distribution variance (I), and layer-spacing differences (L), which are referred to as MIL differences in this paper for convenience. An MIL normalization system is proposed to reconstruct uneven MR images into high-quality data with complete modality, a uniform intensity distribution and consistent layer spacing. Three radiomics tasks, including tumor segmentation, pathological grading and genetic diagnosis of glioma, were used to verify the effect of MIL normalization on radiomics analysis. Three retrospective glioma datasets were analyzed in this study: BraTs (285 cases), TCGA (112 cases) and HuaShan (403 cases). They were used to test the effect of MIL on three different radiomics tasks, including tumor segmentation, pathological grading and genetic diagnosis. MIL normalization included three components: multimodal synthesis based on an encoder-decoder network, intensity normalization based on CycleGAN, and layer-spacing unification based on Statistical Parametric Mapping (SPM). The Dice similarity coefficient, areas under the curve (AUC) and six other indicators were calculated and compared after different normalization steps. The MIL normalization system can improved the Dice coefficient of segmentation by 9% (P < .001), the AUC of pathological grading by 32% (P < .001), and IDH1 status prediction by 25% (P < .001) when compared to non-normalization. The proposed MIL normalization system provides high-quality standardized data, which is a prerequisite for accurate radiomics analysis.

PMID:33932645 | DOI:10.1016/j.compbiomed.2021.104403

J Anxiety Disord. 2021 Apr 19;81:102406. doi: 10.1016/j.janxdis.2021.102406. Online ahead of print.

ABSTRACT

The Adjustment Disorder New Module (ADNM) is a self-report instrument for assessing Adjustment disorder (AjD), but uncertainties remain in evaluating factor structure and psychometric properties of ADNM in previous studies. Three studies were conducted to examine the factor structure, psychometrics properties, and clinical utility of the 20-item version of ADNM (ADNM-20) and 4-item version (ADNM-4) among samples of Hong Kong Chinese (N = 1,415). Confirmatory factor analysis demonstrated good model fitness with a bifactor model. Statistical indices indicated unidimensionality of AjD. The model-based reliability showed that the total score of ADNM-20 should be used in scoring and interpretation for capturing the construct of AjD. ADNM-4 model demonstrated full invariance between women and men and partial invariance between age groups. Receiver operating characteristic analysis revealed a cutoff score of 10 for probable AjD. The prevalence of probable AjD was 20.5 % excluding cases with probable depression among a population-representative sample of Hong Kong Chinese amid civil unrest in Hong Kong in July 2019. Cutoff scores of ADNM-20 (49) and ADNM-4 (9) were established for clinically significant common psychiatric conditions, namely PTSD, depression, and anxiety. Both ADNM-20 and ADNM-4 were reliable and valid to assess probable AjD. Implications for clinical research and practice are discussed.

PMID:33932632 | DOI:10.1016/j.janxdis.2021.102406

Med Phys. 2021 May 1. doi: 10.1002/mp.14916. Online ahead of print.

ABSTRACT

PURPOSE: This study assesses the accuracy of effective atomic number (Z_eff ) and electron density measurements acquired from dual energy CT and characterizes the response to clinically-relevant variables representative of challenges in patient imaging, including: phantom size, material position within the phantom, variation over time, off-center positioning, and large cone beam angle.

METHODS: The Gammex Multi-Energy CT head and body phantom was used to measure Z_eff and electron density from 35 rod inserts that mimic tissues and varying concentrations of iodine and calcium. Scans were performed on a Canon Aquilion ONE Genesis CT scanner over a period of 6 months using default dual-energy protocols appropriate for each phantom size. Theoretical Z_eff and electron density values were calculated using data provided by the phantom manufacturer and compared to the measurements. Sources of variance were separated and quantified to identify the influences of random photon statistics, ROI placement, and variation over time. A subset of measurements were repeated with the phantom shifted in the vertical and horizontal directions, and over all slices in the volumetric scan.

RESULTS: All measurements showed strong correlation (r > 0.98) with their corresponding theoretical values; however, the system did demonstrate a bias of -0.58 atomic units in the body phantom and 0.28 atomic units in the head phantom for Z_eff measurements. The mean absolute percent error (MAPE) was 6.3% for the body phantom and 3.2% for the head phantom. Electron density measurements of the body and head phantoms gave MAPE values of 4.6% and 1.0%, respectively. Z_eff and electron density measurements significantly varied within the solid water background, showing a positional dependence within the phantom that dominated the total standard deviation in measurements. Z_eff values dropped by 0.2 atomic units when the phantom was off-center; electron density measurements were less affected by phantom position. Along the z-axis, the accuracy drops off markedly at more than 50-60 mm from the central slice.

CONCLUSION: The Canon dual energy system offers an accurate way of measuring the Z_eff and electron density of clinically-relevant materials. Accuracy could be improved further by calibration to remove bias, careful attention to centering within the FOV, and avoiding measurements at the edges of the cone beam.

PMID:33932301 | DOI:10.1002/mp.14916

J Med Virol. 2021 May 1. doi: 10.1002/jmv.27058. Online ahead of print.

ABSTRACT

PROBLEM: Timing of detection of IgG, IgA and IgM antibodies against SARS-CoV-2, and their use to support the diagnosis are of increasing interest.

METHODS: We used the Gold Standard Diagnostics ELISA to evaluate the kinetics of SARS-CoV-2 IgG, IgA and IgM antibodies in sera of 82 hospitalized patients with PCR-confirmed COVID-19. Serum samples were collected 1-59 days post onset of symptoms (PoS) and we examined the association of age, sex, disease severity and symptoms’ duration with antibody levels. We also tested sera of 100 ambulatory hospital employees with PCR-confirmed COVID-19 and samples collected during convalescence, 35-57 days PoS.

RESULTS: All but 4 of the admitted patients (95.1%) developed antibodies to SARS-CoV-2. Antibodies were detected within seven days PoS; IgA in 60.0%, IgM in 53.3% and IgG in 46.7% of samples. IgG positivity increased to 100% at day 21. We did not observe significant differences in the rate of antibody development in regard to age and sex. IgA levels were highest in patients with severe and critical illness. In multiple regression analyses, only IgA levels were statistically significant correlated with critical disease (p=0.05) regardless of age, sex and duration of symptoms. Among 100 ambulatory hospital employees who had antibody testing after 4 weeks PoS only 10% had positive IgA antibodies. The most frequently isolated isotype in sera of employees after 30 days PoS was IgG (88%).

CONCLUSIONS: IgA was the predominant immunoglobulin in early disease and correlated independently with critical illness. IgG antibodies remained detectable in almost 90% on samples collected up to two months after infection. This article is protected by copyright. All rights reserved.

PMID:33932299 | DOI:10.1002/jmv.27058