Tag: nevin manimala

J Cancer Res Clin Oncol. 2023 Apr 8. doi: 10.1007/s00432-023-04736-9. Online ahead of print.

ABSTRACT

PURPOSE: Immune checkpoint inhibitors (ICIs) are increasingly used in the treatment of certain cancers but cause immune-related adverse events (irAEs). Gastrointestinal irAEs may necessitate extended periods of steroid use and the initiation of selective immunosuppressive therapy (SIT) which could theoretically counteract the effect of ICIs. In this study, we aim to explore the impact of immunosuppression use and duration on cancer progression and progression-free survival (PFS).

METHODS: This is a single-center retrospective review exploring cancer outcomes in patients taking ICIs who developed gastrointestinal irAEs within 1 year of ICI initiation. Cancer outcome and progression free survival (PFS) were measured and compared by using IBM SPSS Statistics 26.

RESULTS: Of the 116 patients included in this study, 69 received immunosuppression to treat irAEs. The occurrence of colitis and use of immunosuppression for colitis were associated with less cancer progression by later assessment (p < 0.05). Shorter durations of steroids with or without SIT for colitis were associated with less cancer progression within the study window than no immunosuppression (p < 0.05). Immunosuppression has no effect on PFS (p < 0.05).

CONCLUSION: Our study reported shorter duration of steroid treatment for colitis may be associated with less cancer progression. Though the use of immunosuppression was not found to impact PFS, this may be confounded by the presence of colitis, which is known to improve cancer outcomes and could mask any negative impact of immunosuppression on survival. It may be preferable to limit long-term immunosuppression in the treatment of immune-mediated colitis to minimize potential complications. Prospective studies are needed to clarify this relationship, and treatments that abrogate the need for immunosuppression in these patients such as fecal microbiota transplantation.

PMID:37029815 | DOI:10.1007/s00432-023-04736-9

Eur Spine J. 2023 Apr 8. doi: 10.1007/s00586-023-07662-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Endoscopic techniques are becoming popular among spine surgeons because of their advantages. Though the advantages of endoscopic spine surgery are evident and patients can be discharged home within hours of surgery, readmissions can be sought for incomplete relief of leg pain, recurrent disc herniation, and recurrent leg pain. We aim to find out the factors related to the readmission of patients treated for lumbar pathologies.

MATERIALS AND METHODS: This is a retrospective analysis of the data between the time duration of 2012 and 2022. Patients in the age group of 18-85 years, with lumbar disc herniation treated by transforaminal endoscopic lumbar procedures, were included. The patients who were readmitted within 90 days were included in the R Group and those who were not were included in the NR group. Univariable and multivariable logistic regression analyses were used to find the risk factors for 90-day readmission.

RESULTS: There were a total of 1542 patients enrolled in this study. Sex, number of episodes before admission, hypertension, smoking, BMI, migration, disc height, disc height index, spondylolisthesis, instability, pelvic tilt (PT), and disc cross-sectional area (CSA) were found significant on univariable analysis. Age, spondylolisthesis, instability and muscle CSA were the only variables that were found to be statistically significant on multivariable analysis.

CONCLUSIONS: This study shows that the elderly age group, presence of spondylolisthesis, segmental instability and decreased muscle cross-sectional area are independent risk factors for 90-day hospital readmissions. Patients having the above risk factors should be carefully counseled regarding the possibility of readmission in the future.

PMID:37029807 | DOI:10.1007/s00586-023-07662-z

World J Surg. 2023 Apr 8. doi: 10.1007/s00268-023-06990-x. Online ahead of print.

ABSTRACT

BACKGROUND: The shortage of trained surgeons, anesthesiologists, and obstetricians is a major contributor to the unmet need for surgical care in low- and middle-income countries, and the shortage is aggravated by migration to higher-income countries.

METHODS: We performed a cross-sectional observational study, combining individual-level data of 43,621 physicians from the Health Professions Council of South Africa with data from the registers of 14 high-income countries, and international statistics on surgical workforce, in order to quantify migration to and from South Africa in both absolute and relative terms.

RESULTS: Of 6670 surgeons, anesthesiologists, and obstetricians in South Africa, a total of 713 (11%) were foreign medical graduates, and 396 (6%) were from a low- or middle-income country. South Africa was an important destination primarily for physicians originating from low-income countries; 2% of all surgeons, anesthesiologists, and obstetricians from low- and middle-income countries were registered in South Africa, and 6% in the other 14 recipient countries. A total of 1295 (16%) South African surgeons, anesthesiologists, and obstetricians worked in any of the 14 studied high-income countries.

CONCLUSION: South Africa is an important regional hub for surgical migration and training. A notable proportion of surgical specialists in South Africa were medical graduates from other low- or middle-income countries, whereas migration out of South Africa to high-income countries was even larger.

PMID:37029798 | DOI:10.1007/s00268-023-06990-x

Eur J Trauma Emerg Surg. 2023 Apr 8. doi: 10.1007/s00068-023-02267-z. Online ahead of print.

ABSTRACT

PURPOSE: As blunt thoracic aortic injury (BTAI) treatment has shifted from open to thoracic endovascular aortic repair (TEVAR), logistical challenges exist in creating and maintaining inventories of appropriately sized stent-grafts, including storage demands, shelf-life management and cost. We hypothesized that most injured aortas can be successfully repaired with a narrow range of stent-graft sizes and present a value-based anatomic approach to optimizing inventory.

METHODS: CT-scans of all patients with BTAI admitted to our Level I trauma center from Apr 2010-Dec 2018 were reviewed. Patients with anatomy incompatible with TEVAR were excluded. For each patient, after aortic sizing a set of two stent-grafts most likely to be utilized was selected from a list of twenty commercially available GORE conformable TAG endografts based on manufacturer instructions. Stent-graft sizes were then ranked based on the number of cases they would be suitable for. MATLAB was utilized to determine the combinations of stent-grafts which would cover the most patients.

RESULTS: Twenty-eight patients with BTAI were identified and three were excluded based on iliac diameter. Most patients were male (68%), mean age 42.3 ± 20.2 years, mean ISS 37.0 ± 9.8. Overall mortality was 25%. Of the 20 available stent-graft options, a combination of four stent-grafts would successfully treat 100% of the patients in this series.

CONCLUSIONS: Based on actual CT-scan aortic measurements, we demonstrated that an inventory of four sent-graft sizes was sufficient to treat 100% of patients with BTAI. These data can be utilized as a value-based anatomic approach to aortic stent-graft institutional inventory creation and maintenance.

PMID:37029792 | DOI:10.1007/s00068-023-02267-z

Diabet Med. 2023 Apr 8:e15108. doi: 10.1111/dme.15108. Online ahead of print.

ABSTRACT

AIMS: The contemporary prescription patterns of antidiabetic drugs following guideline changes recommending metformin as first-line gestational diabetes (GDM) pharmacotherapy is underexplored. We aimed to examined use of metformin and insulin during pregnancy among women with GDM over 20 years in the United Kingdom.

METHODS: We conducted a population-based cohort study using linked data from the Clinical Practice Research Datalink, its pregnancy register, and Hospital Episode Statistics from 1998-2017. We included pregnancies of women without prior diabetes history who received GDM diagnosis or initiated an antidiabetic drug after 20 weeks gestation. Patient-level and practice-level characteristics were compared between metformin initiators and insulin initiators. We described trends of initiating metformin as first-line treatment and described time to initiation of rescue insulin overall, and by body mass index among metformin initiators.

RESULTS: Our cohort included 5,633 pregnancies from 5,393 women with GDM, of whom 39.6% initiated pharmacotherapy (41% insulin, 59% metformin). Metformin prescriptions (as opposed to insulin) increased substantially, from < 5% of pregnancies before 2007 to 42.5%. Since 2008. Over 85% of pregnancies that were prescribed a pharmacotherapy were prescribed metformin as first-line treatment in 2015. Among metformin initiators, 16% initiated rescue insulin, typically occurring within 40 days of metformin initiation. Choice of GDM pharmacotherapy varied by characteristics, including smoking, obesity, race/ethnicity, and general practice regions.

CONCLUSIONS: Metformin was the most prescribed medication for GDM, with large increases over the past 2 decades. The increasing use of oral-antidiabetic drugs during pregnancy, consistent with other regions, highlights the need for future studies examining effectiveness and safety of antidiabetic drug use during pregnancy.

PMID:37029772 | DOI:10.1111/dme.15108

Photochem Photobiol. 2023 Apr 8. doi: 10.1111/php.13805. Online ahead of print.

ABSTRACT

Far-UVC, from filtered Krypton-Chloride lamps, is promising for reducing airborne transmission of disease. Whilst significant research has been undertaken to investigate skin safety of these lamps, less work has been undertaken on eye safety. There is limited data on human eye safety or discomfort from the deployment of this germicidal technology. In this pilot study, immediate and delayed eye discomfort were assessed in a simulated office environment with deployment of Krypton-Chloride lamps, located on the ceiling and directed downwards into the occupied room. Discomfort was assessed immediately post-exposure and several days after exposure using validated, Standard Patient Evaluation Eye Dryness (SPEED) and Ocular Surface Disease Index (OSDI) questionnaires. Our results show no significant eye discomfort or adverse effects from the deployment of Far-UVC in this simulated office environment, even when lamps were operated continuously with participants receiving head exposures of up to 50 mJcm^-2 . In addition, a statistically significant reduction in bacteria and fungi of 52% was observed. Far-UVC in this simulated office environment did not cause any clinically significant eye discomfort and was effective at reducing pathogens in the room. These results contribute an important step to further investigation of the interaction of Far-UVC with the human eye.

PMID:37029739 | DOI:10.1111/php.13805

Med Phys. 2023 Apr 8. doi: 10.1002/mp.16404. Online ahead of print.

ABSTRACT

BACKGROUND: Age-Related macular degeneration (AMD) is a major cause of irreversible central vision loss. The main reason for lost vision due to AMD is choroidal neovascularization (CNV). In the clinic, current treatments for CNV include photodynamic therapy, laser photocoagulation, and anti-vascular endothelial growth factor (VEGF) therapy.

PURPOSE: This study evaluates a novel treatment technique combining synchronized nanosecond laser pulses and ultrasound bursts, namely photo-mediated ultrasound therapy (PUT) as a potential treatment method for CNV, for its efficacy and safety in treatment of CNV via the experiments in a clinically-relevant rabbit model in vivo.

METHODS: CNV was created by subretinal injection of Matrigel and vascular endothelial growth factor (M&V) in 10 New Zealand white rabbits. Six rabbits were used in the PUT group. In the control groups, two rabbits were treated by laser-only, and two rabbits were treated by ultrasound-only. The treatment efficacy was evaluated through fundus photography and fluorescein angiography (FA) longitudinally for up to 4 weeks. Rabbits were sacrificed for histopathology at 3 months after treatment to examine the safety of PUT.

RESULTS: The fluorescein leakage on FA was quantified to longitudinally evaluate treatment outcome. Compared with baseline, the relative intensity index was reduced by 26.57% ± 8.66% at 3 days after treatment, 27.24% ± 6.21% at 1 week after treatment, 27.79% ± 2.61% at 2 weeks after treatment, and 32.12% ± 3.23% at 4 weeks after treatment, all with a statistically significant difference of P < 0.01. The comparison between the relative intensity indexes from the two control groups (laser-only treatment and ultrasound-only treatment) did not show any statistically significant difference at all time points. Safety evaluation at 3 months with histopathology demonstrated that the PUT did not result in morphologic changes to the neurosensory retina.

CONCLUSIONS: This study introduces PUT for the first time for the treatment of CNV. The results demonstrated good efficacy and safety of PUT to treat CNV in a clinically-relevant rabbit model. With a single session of treatment, PUT can safely reduce the leakage of CNV for at least 1 month after treatment. This article is protected by copyright. All rights reserved.

PMID:37029733 | DOI:10.1002/mp.16404

Am J Biol Anthropol. 2023 Apr 8. doi: 10.1002/ajpa.24746. Online ahead of print.

ABSTRACT

OBJECTIVES: The level of fluctuating asymmetry is suggested as a putative signal of developmental stability, thus according to this theoretical framework more symmetric individuals should be in better biological condition and have greater reproductive potential. Here we hypothesize that women with more symmetric faces have more successful reproduction.

METHODS: Data were collected from 164 postmenopausal Polish women. Facial photographs were taken and the overall facial asymmetry (OFA) was calculated. The associations between the OFA and reproductive parameters were analyzed using multiple regression models. Furthermore, the mediation analysis was conducted to test for the indirect effects of the OFA on reproductive success.

RESULTS: There was a statistically significant relationship between the OFA and the number of children born, which was mediated by the age at first reproduction (p = 0.03), however, the size of the effect was rather low. Women with more symmetric faces had an earlier age at first reproduction and, in consequence, a greater number of children.

DISCUSSION: As fluctuating asymmetry is suggested to be established in utero, these findings shed light on the possible life-long importance of developmental conditions in shaping women’s reproductive potential and performance.

PMID:37029695 | DOI:10.1002/ajpa.24746

IEEE Trans Pattern Anal Mach Intell. 2023 Mar 6;PP. doi: 10.1109/TPAMI.2023.3253390. Online ahead of print.

ABSTRACT

Highly realistic imaging and video synthesis have become possible and relatively simple tasks with the rapid growth of generative adversarial networks (GANs). GAN-related applications, such as DeepFake image and video manipulation and adversarial attacks, have been used to disrupt and confound the truth in images and videos over social media. DeepFake technology aims to synthesize high visual quality image content that can mislead the human vision system, while the adversarial perturbation attempts to mislead the deep neural networks to a wrong prediction. Defense strategy becomes difficult when adversarial perturbation and DeepFake are combined. This study examined a novel deceptive mechanism based on statistical hypothesis testing against DeepFake manipulation and adversarial attacks. Firstly, a deceptive model based on two isolated sub-networks was designed to generate two-dimensional random variables with a specific distribution for detecting the DeepFake image and video. This research proposes a maximum likelihood loss for training the deceptive model with two isolated sub-networks. Afterward, a novel hypothesis was proposed for a testing scheme to detect the DeepFake video and images with a well-trained deceptive model. The comprehensive experiments demonstrated that the proposed decoy mechanism could be generalized to compressed and unseen manipulation methods for both DeepFake and attack detection.

PMID:37028044 | DOI:10.1109/TPAMI.2023.3253390

IEEE Trans Neural Syst Rehabil Eng. 2023 Mar 6;PP. doi: 10.1109/TNSRE.2023.3253051. Online ahead of print.

ABSTRACT

Complementary Linear Filter (CLF) is a common techinque employed for estimating the ground projection of body Centre of Mass starting from ground reaction forces. This method fuses centre of pressure position and double integration of horizontal forces, selecting best cut-off frequencies for low-pass and high-pass filters. Classical Kalman filter is a substantially equivalent approach, as both methods rely on an overall quantification of error/noise and don’t analyze its origin and time-dependence. In order to overcome such limitations, a Time-Varying Kalman Filter (TVKF) is proposed in this paper: the effect of unknown variables is directly taken into account by employing a statistical description which is obtained from experimental data. To this end, in this paper we have employed a dataset of 8 walking healthy subjects: beside supplying gait cycles at different speeds, it deals with subjects in age of development and provides a wide range of body sizes, allowing therefore to assess the observers’ behaviour under different conditions. The comparison carried out between CLF and TVKF appears to highlight several advantages of the latter method in terms of better average performance and smaller variability. Results presented in this paper suggest that a strategy which incorporates a statistical description of unknown variables and a time-varying structure can yield a more reliable observer. The demonstrated methodology sets a tool that can undergo a broader investigation to be carried out including more subjects and different walking styles.

PMID:37028027 | DOI:10.1109/TNSRE.2023.3253051