Tag: nevin manimala

Med Dosim. 2022 May 19:S0958-3947(22)00038-3. doi: 10.1016/j.meddos.2022.04.002. Online ahead of print.

ABSTRACT

Volumetric modulated arc therapy (VMAT) and 3D dynamic conformal arc therapy (DCAT) are 2 methods proven useful for the clinical implementation of stereotactic body radiation therapy (SBRT) for lung lesions however, similar comparisons of SBRT liver lesions are lacking. The purpose of this study was to determine if the conformity of dose, irradiated volume, and dose to organs at risk (OAR) are equivalent or improved with the use of DCAT as an alternative treatment method when compared to standard VMAT for SBRT delivery of palliative and early-stage liver lesions. Twenty patients with liver lesions sized 2.0 to 5.0 cm were selected for this study. Plans were created with both DCAT and VMAT techniques for each patient. Metrics evaluated included the mean heart, kidney, large bowel, small bowel, esophagus, and stomach doses, the lung volume receiving 20 Gy (V₂₀), the volume of the normal liver receiving 15 Gy (V₁₅), conformity index (CI), heterogeneity index (HI), and the irradiated volume or volume receiving 25 Gy (V₂₅). The p-values for the mean dose to kidneys, small bowel, esophagus, and the lung V₂₀ were greater than 0.05, and no statistical difference could be determined between DCAT and VMAT. The p-values for the mean heart, large bowel, stomach, and liver V₁₅ were less than 0.05, indicating statistical significance and superiority of VMAT for minimizing dose to these organs, especially V₁₅ of the liver. The DCAT technique produced CI greater than 1.0 for all patients proving superior coverage, while standard VMAT produced significantly improved V₂₅ with p-values less than 0.0001, and consequently higher HI.

PMID:35599177 | DOI:10.1016/j.meddos.2022.04.002

Neuromodulation. 2022 May 19:S1094-7159(22)00646-8. doi: 10.1016/j.neurom.2022.03.009. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to demonstrate the feasibility of using motor evoked responses to intraoperative double-train stimulation to guide lead placement and matching of intraoperative contacts with postoperative electrode programming in spinal cord stimulation for pain performed under general anesthesia.

MATERIALS AND METHODS: The study included a series of 20 consecutive patients with refractory pain operated on under general anesthesia. Either percutaneous or paddle leads were implanted and positioned according to the intraoperative mapping results. Neurophysiologic mapping was performed with a double-train stimulation paradigm (intertrain interval of 60 milliseconds, three to five cathodal pulses with 0.5-millisecond pulse duration, and within-train interstimulus intervals of 2-4 milliseconds). The sites where dorsal column responses of the targeted dermatomes were detected were considered optimal for lead placement (intraoperative best contacts). Following spinal cord stimulator (SCS) lead placement, blinded postoperative programming of electrode contacts was matched with the intraoperative best contacts and the pain-paresthesia overlap for the trial phase. A binominal test was used as a statistical method; pre- and postoperative numeric rating scale (NRS) after three months was obtained.

RESULTS: A total of 15 patients underwent spinal cord stimulation trial for intractable pain. Of these, ten patients (66%) had a successful trial and received permanent implants; one patient had a successful trial but was never intended to be implanted because of her poor health condition; four patients (26%) had an unsuccessful trial, leading to trial electrode explantation; and five patients had already had an implant with percutaneous leads and therefore underwent electrode revision, of whom four patients received paddle leads. In 18 of the 20 operated patients (90%), we found a match between the best intraoperative contacts and the postoperatively programmed contacts (significantly better than chance, p = 8.2 × 10^-15). In 90% of the patients, a pain-paresthesia overlap of 100% was found. In the remaining two patients (10%), the postoperatively best programmed contacts were one contact away from the intraoperative neurophysiologic best contact. A mean preoperative NRS score of 8.2 (variance) and a mean follow-up NRS score after three months of 3.6 (variance) were obtained for all patients with implants.

CONCLUSION: In this proof-of-concept study, we were able to demonstrate that SCS lead placement using a double-train stimulation paradigm performed under general anesthesia is a safe and feasible technique, offering reliable prediction of contacts for postoperative programming and excellent pain-paresthesia coverage.

PMID:35599160 | DOI:10.1016/j.neurom.2022.03.009

J Intern Med. 2022 May 22. doi: 10.1111/joim.13523. Online ahead of print.

ABSTRACT

BACKGROUND: The Bacillus Calmette-Guérin (BCG) vaccine may confer cross-protection against viral diseases in adults. This study evaluated BCG vaccine cross-protection in adults with convalescent coronavirus disease 2019 (COVID-19).

METHOD: This was a multicenter, prospective, randomized, placebo-controlled, double-blind phase III study (ClinicalTrials.gov: NCT04369794).

SETTING: University Community Health Center and Municipal Outpatient Center in South America.

PATIENTS: A total of 378 adult patients with convalescent COVID-19 were included.

INTERVENTION: Single intradermal BCG vaccine (n = 183) and placebo (n = 195).

MEASUREMENTS: The primary outcome was clinical evolution. Other outcomes included adverse events and humoral immune responses for up to six months.

RESULTS: A significantly higher proportion of BCG patients with anosmia and ageusia recovered at the 6-week follow-up visit than placebo (anosmia: 83.1% vs. 68.7% healed, p = 0.043, number needed to treat [NNT] = 6.9; ageusia: 81.2% vs. 63.4% healed, p = 0.032, NNT = 5.6). BCG also prevented the appearance of ageusia in the following weeks: seven in 113 (6.2%) BCG recipients versus 19 in 126 (15.1%) placebos, p = 0.036, NNT = 11.2. BCG did not induce any severe or systemic adverse effects. The most common and expected adverse effects were local vaccine lesions, erythema (n = 152; 86.4%), and papules (n = 111; 63.1%). Anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) humoral response measured by N protein immunoglobulin G (IgG) titer and seroneutralization by interacting with the angiotensin-converting enzyme 2 (ACE2) receptor suggest that the serum of BCG-injected patients may neutralize the virus at lower specificity; however, the results were not statistically significant.

CONCLUSION: BCG vaccine is safe and offers cross-protection against COVID-19 with potential humoral response modulation.

LIMITATIONS: No severely ill patients were included. This article is protected by copyright. All rights reserved.

PMID:35599154 | DOI:10.1111/joim.13523

Semergen. 2022 May 19:S1138-3593(22)00077-6. doi: 10.1016/j.semerg.2022.02.006. Online ahead of print.

ABSTRACT

This fourth in a series of five articles on systematic reviews demonstrates how to compile and summarize the results of the studies included in a review. The synthesis of the extracted data consists of tabulating the characteristics, and the quality of the included studies, with the effects or the magnitude of the associations found in them. Statistical methods can be used to explore the differences between studies and the reasons for the inconsistencies. The magnitude of this heterogeneity influences whether it is feasible to perform an overall or subgroup meta-analysis. Finally, information is provided both to assessment of clinical and methodological reasons for heterogeneity.

PMID:35599147 | DOI:10.1016/j.semerg.2022.02.006

J Cardiol. 2022 May 19:S0914-5087(22)00102-2. doi: 10.1016/j.jjcc.2022.04.011. Online ahead of print.

ABSTRACT

BACKGROUND: Current guidelines provide recommendation for transcatheter aortic-valve replacement (TAVR) in severe aortic stenosis without emphasis on valve systems. The comparative performances of balloon-expandable valves (BEV) and self-expanding valves (SEV) remain unclear. We aim to compare the early (30-day) and midterm (1-year) mortality and cardiovascular outcomes of BEV with SEV.

METHODS: PubMed, CENTRAL, and EMBASE were searched from inception to February 13, 2020 for randomized controlled trials (RCTs) and propensity-score matched (PSM) studies. Odds ratios (ORs) for binary outcomes and mean differences for continuous outcomes were pooled using random-effect models (DerSimonian-Laird method) with Hartung-Knapp-Sidik-Jonkman variance correction. Primary outcomes were early and midterm all-cause mortality.

RESULTS: We included 3 RCTs (1418 patients) and 12 PSM studies (36,540 patients). Compared with SEV, BEV was associated with significantly lower mortality at 30 days (OR 0.76, 95% CI 0.67-0.85, p < 0.001, I2 = 0) and 1 year (OR 0.87, 95% CI 0.77-0.99, p = 0.04, I2 = 20.4%) in PSM studies, but not RCTs with insufficient power. Similar findings were found in subgroups analysis based on valve generations and SEV types. The 30-day and 1-year cardiovascular mortality, 30-day incidences of moderate to severe paravalvular leak, procedural contrast agent volume, and procedure time were lower, but transvalvular pressure gradient was higher in BEV than SEV in PSM studies. The 30-day incidences of permanent pacemaker implantation (PPI), acute kidney injury, stroke, major bleeding, major vascular complications, and rehospitalization were not statistically different between BEV and SEV. Early-generation SEV was associated with a higher 30-day PPI risk than corresponding BEV comparators. PPI risk was lower in ACURATE neo (Boston Scientific, Natick, MA) but higher in Evolut R SEV (Medtronic Inc., Minneapolis, MN), both compared with SAPIEN 3 BEV (Edwards Lifesciences, Irvine, CA).

CONCLUSIONS: PSM studies suggest lower early and midterm mortality in BEV than SEV, but the contribution of unmeasured confounders cannot be excluded. Results from adequately powered RCTs with long-term follow-up are critically needed to confirm these findings.

PMID:35599108 | DOI:10.1016/j.jjcc.2022.04.011

J Foot Ankle Surg. 2022 Apr 29:S1067-2516(22)00115-6. doi: 10.1053/j.jfas.2022.04.005. Online ahead of print.

ABSTRACT

Adult acquired flat foot deformity (AAFD) is a progressive, tri-planar deformity involving collapse of the medial longitudinal arch, valgus deformity of the rear foot, and abduction of the mid-foot on the rear foot. There are a wide variety of surgical treatment options for this deformity, including lateral column lengthening (LCL) which results in tri-planar correction of AAFD. We retrospectively reviewed weightbearing preoperative radiographs and weight-bearing 6-week postoperative radiographs of 34 patients with stage II AAFD who underwent LCL (with and without concurrent procedures) with a minimum of 1-year of follow up. Outcomes, including complications and postoperative differences in 6 types of angle measurements were evaluated. Radiographic evaluation showed statistically significant differences in preoperative and postoperative measures in the following angles: calcaneal inclination, Meary’s, Simmons, talocalcaneal, and metatarsus adductus (each p ≤ .05). Postoperative Engel’s angle difference did not reach statistical significance (p = .07). Paired t tests showed TN coverage angles increased greater with LCL plus a Cotton osteotomy as compared to isolated LCL. Additionally, there was no significant difference in TN coverage angle based on LCL graft size (p = .20). Furthermore, the distance of the osteotomy from the calcaneocuboid joint on anteroposterior and lateral radiographs did not significantly predict TN coverage angle change. Our study suggests that LCL corrects AAFD in three planes while decreasing the metatarsus adductus angle. LCL appears to be more effective when performed with a Cotton osteotomy. Wedge size (6 mm, 8 mm, 10 mm) and osteotomy location did not demonstrate a relationship with postoperative TN coverage angle or incidence of lateral column overload.

PMID:35599073 | DOI:10.1053/j.jfas.2022.04.005

Physiotherapy. 2022 May 19:S0031-9406(21)00389-8. doi: 10.1016/j.physio.2021.12.003. Online ahead of print.

NO ABSTRACT

PMID:35599069 | DOI:10.1016/j.physio.2021.12.003

Brief Bioinform. 2022 May 23:bbac179. doi: 10.1093/bib/bbac179. Online ahead of print.

ABSTRACT

Sex-biased gene flow has been common in the demographic history of modern humans. However, the lack of sophisticated methods for delineating the detailed sex-biased admixture process prevents insights into complex admixture history and thus our understanding of the evolutionary mechanisms of genetic diversity. Here, we present a novel algorithm, MultiWaverX, for modeling complex admixture history with sex-biased gene flow. Systematic simulations showed that MultiWaverX is a powerful tool for modeling complex admixture history and inferring sex-biased gene flow. Application of MultiWaverX to empirical data of 17 typical admixed populations in America, Central Asia, and the Middle East revealed sex-biased admixture histories that were largely consistent with the historical records. Notably, fine-scale admixture process reconstruction enabled us to recognize latent sex-biased gene flow in certain populations that would likely be overlooked by much of the routine analysis with commonly used methods. An outstanding example in the real world is the Kazakh population that experienced complex admixture with sex-biased gene flow but in which the overall signature has been canceled due to biased gene flow from an opposite direction.

PMID:35598333 | DOI:10.1093/bib/bbac179

Dermatol Ther. 2022 May 22:e15593. doi: 10.1111/dth.15593. Online ahead of print.

ABSTRACT

BACKGROUND: Pustular psoriasis of pregnancy (PPP) can lead to life-threatening complications.

OBJECTIVES: To report clinical and genetic spectrum, prognostic factors and management options.

METHODS: We designed a retrospective study including 8 PPP patients. We collected clinical data, and performed genetic and statistical analysis to identify factors associated with fetal complications, resistance to treatment and post-partum flare extension. A systematic review of the literature was also carried out.

RESULTS: Eight Tunisian patients, with a mean age of 23±3.3 years, were included. They presented 14 flares (F) during pregnancies and 1 flare after delivery. Additional GPP flares outside pregnancy periods were noted in 2/8 of patients. The mean duration of PPP flares was 16.66±7.8 weeks. The first flare occurred at a gestational age of 26±5 weeks. Only 2/8 studied patients presented a homozygous mutation c.80T>C (p.L27P) in IL36RN gene. Used treatments were: Topical steroids (n=12F), systemic steroids (n=5F), Ciclosporin (n=1F), UVB (n=1F) and Acitretin (in post-partum n=6F). Complications were: oligoamnios (n=2), intra-uterine growth retardation (n=1), fetal death in utero (n=1), prematurity (n=3), low weight at birth (n=2). A significant association was found between: i- occurrence of fetal complications and early gestational age at the onset (p=0.036), ii- resistance to topical steroids and body surface affected area (p=0.008), iii- presence of mutation c.80T>C in PPP flares and low serum levels of calcium (p=0.01). Our systematic review of the literature identified 39 patients with 41 flares of PPP. Only 7/39 patients presented a causative mutation in IL36RN and CARD14 genes.

CONCLUSION: PPP is characterized by a phenotypic heterogeneity and can be associated to IL36RN mutations. Its early onset can be associated with fetal complications. Systemic steroids and cyclosporine remain the most used therapies. This article is protected by copyright. All rights reserved.

PMID:35598320 | DOI:10.1111/dth.15593

Brief Bioinform. 2022 May 23:bbac171. doi: 10.1093/bib/bbac171. Online ahead of print.

ABSTRACT

Many statistical methods for pathway analysis have been used to identify pathways associated with the disease along with biological factors such as genes and proteins. However, most pathway analysis methods neglect the complex nonlinear relationship between biological factors and pathways. In this study, we propose a Deep-learning pathway analysis using Hierarchical structured CoMponent models (DeepHisCoM) that utilize deep learning to consider a nonlinear complex contribution of biological factors to pathways by constructing a multilayered model which accounts for hierarchical biological structure. Through simulation studies, DeepHisCoM was shown to have a higher power in the nonlinear pathway effect and comparable power for the linear pathway effect when compared to the conventional pathway methods. Application to hepatocellular carcinoma (HCC) omics datasets, including metabolomic, transcriptomic and metagenomic datasets, demonstrated that DeepHisCoM successfully identified three well-known pathways that are highly associated with HCC, such as lysine degradation, valine, leucine and isoleucine biosynthesis and phenylalanine, tyrosine and tryptophan. Application to the coronavirus disease-2019 (COVID-19) single-nucleotide polymorphism (SNP) dataset also showed that DeepHisCoM identified four pathways that are highly associated with the severity of COVID-19, such as mitogen-activated protein kinase (MAPK) signaling pathway, gonadotropin-releasing hormone (GnRH) signaling pathway, hypertrophic cardiomyopathy and dilated cardiomyopathy. Codes are available at https://github.com/chanwoo-park-official/DeepHisCoM.

PMID:35598329 | DOI:10.1093/bib/bbac171