Tag: nevin manimala

Rev Assoc Med Bras (1992). 2021 Jun;67(6):845-850. doi: 10.1590/1806-9282.20210114.

ABSTRACT

OBJECTIVE: The aim of this study was to examine the characteristics of patients admitted to our hospital with a diagnosis of breast cancer who reached pathological complete response after being operated following eight cycles of neoadjuvant chemotherapy.

METHODS: Between 2015-2020, patients with pathological complete response who were operated on after neoadjuvant chemotherapy and sent to our clinic for radiotherapy were evaluated.

RESULTS: The median age of the patients was 51 years. The most common histological type was invasive ductal cancer. The number of pathological complete response patients was 74 (28%), and the number of non-pathological complete response patients was 188 (72%). Patients with pathological complete response had a smaller tumor diameter than the non-pathological complete response group (p=0.001). For pathological complete response, T1 stage, N1 stage, NG 3, Ki-67 >20%, negative estrogen receptor, negative progesterone receptor, positive Cerb-B2, and adding trastuzumab to chemotherapy were statistically significant (p<0.05). Before neoadjuvant chemotherapy, stage T1-T2 (p=0.036), LN0-1 (p=0.026), Cerb-B2 positivity (p=0.025), and an initial nuclear grade of three (p=0.001) were found to be the factors affecting pathological complete response.

CONCLUSIONS: With neoadjuvant chemotherapy, the size of locally advanced tumors decreases, allowing breast conserving surgery. The neoadjuvant chemotherapy response can be used as an early indicator of the prognosis of patients with breast cancer. Today, neoadjuvant chemotherapy is also used for patients with early-stage, operable breast cancer because it has been shown in many studies that reaching pathological complete response is associated with positive long-term results. If we can identify patients who have reached pathological complete response before neoadjuvant chemotherapy, we think we can also determine a patient-specific treatment plan at the beginning of treatment.

PMID:34709328 | DOI:10.1590/1806-9282.20210114

Eur J Endocrinol. 2021 Oct 1:EJE-21-0510.R2. doi: 10.1530/EJE-21-0510. Online ahead of print.

ABSTRACT

OBJECTIVE: Adrenocortical carcinoma (ACC) has an aggressive but variable clinical course. Prognostic stratification based on ENSAT tumour stage and Ki67 index is limited. We aimed to demonstrate the prognostic role of a points-based score (S-GRAS) in a large cohort of patients with ACC.

DESIGN: Multicentre retrospective study on ACC patients who underwent adrenalectomy.

METHODS: The S-GRAS score was calculated as a sum of the following points: tumour Stage (1-2=0; 3=1; 4=2), Grade (Ki67 index 0-9%=0; 10-19%=1; ≥20%=2 points), Resection (R)-status (R0=0; RX=1; R1=2; R2=3), Age (<50yr=0; ≥50yr=1), Symptoms (no=0; yes=1), and categorised, generating four groups (0-1, 2-3, 4-5, and 6-9). Endpoints were progression-free survival (PFS) and disease-specific survival (DSS). The discriminative performance of S-GRAS and its components was tested by Harrell’s C-index and Royston-Sauerbrei’s R2D statistic.

RESULTS: We included 942 ACC patients. The S-GRAS score showed superior prognostic performance for both PFS and DSS, with best discrimination obtained using the individual scores (0-9) (C-index=0.73, R2D=0.30, and C-index=0.79, R2D=0.45, respectively, all P<0.01 vs each component). The superiority of S-GRAS score remained when comparing patients treated or not with adjuvant mitotane (n=481 vs 314). In particular, the risk of recurrence was significantly reduced as a result of adjuvant mitotane only in patients with S-GRAS 4-5.

CONCLUSION: The prognostic performance of S-GRAS is superior to tumour stage and Ki67 in operated ACC patients, independently from adjuvant mitotane. S-GRAS score provides a new important guide for personalised management of ACC (i.e. radiological surveillance and adjuvant treatment).

PMID:34709200 | DOI:10.1530/EJE-21-0510

Rev Assoc Med Bras (1992). 2021 Jun;67(6):806-810. doi: 10.1590/1806-9282.20201015.

ABSTRACT

OBJECTIVE: This study aims to investigate the association between the immunohistochemical expression of matrix metalloproteinase-2 and matrix metalloproteinase-9 and plasma zinc in women with fibroadenoma.

METHODS: This cross-sectional study included 37 premenopausal women with fibroadenoma. Waist circumference and body mass index of the participants were measured. Plasma zinc concentrations were determined using atomic flame absorption spectrophotometry. Fragments of breast tissue were fixed and incubated with primary mouse monoclonal antibodies (monoclonal antibodies matrix metalloproteinase -2 -507 and monoclonal antibodies matrix metalloproteinase -9-439). Semi-quantitative analysis of matrix metalloproteinase-2 and matrix metalloproteinase-9 immunoreactivity was performed. Spearman’s test and Friedman’s test were used for statistical analyses. The p<0.05 were considered statistically significant.

RESULTS: The average age of the participants was 32.81±9.51 years. The body mass index and waist circumference values were within the normal range. The mean plasma zinc concentration was 42.73±13.84 µg/dL, with 94.6% inadequacy. A statistically significant difference was found between the positive expression of matrix metalloproteinase-2 and matrix metalloproteinase-9 (p=0.0184). There was no significant correlation between the matrix metalloproteinase expression and the plasma zinc levels.

CONCLUSIONS: Women with fibroadenoma had hypozincemia and positive expression of metalloproteinases.

PMID:34709321 | DOI:10.1590/1806-9282.20201015

J Med Internet Res. 2021 Oct 28;23(10):e28924. doi: 10.2196/28924.

ABSTRACT

BACKGROUND: Comprehensive multi-institutional patient portals that provide patients with web-based access to their data from across the health system have been shown to improve the provision of patient-centered and integrated care. However, several factors hinder the implementation of these portals. Although barriers and facilitators to patient portal adoption are well documented, there is a dearth of evidence examining how to effectively implement multi-institutional patient portals that transcend traditional boundaries and disparate systems.

OBJECTIVE: This study aims to explore how the implementation approach of a multi-institutional patient portal impacted the adoption and use of the technology and to identify the lessons learned to guide the implementation of similar patient portal models.

METHODS: This multimethod study included an analysis of quantitative and qualitative data collected during an evaluation of the multi-institutional MyChart patient portal that was deployed in Southwestern Ontario, Canada. Descriptive statistics were performed to understand the use patterns during the first 15 months of implementation (between August 2018 and October 2019). In addition, 42 qualitative semistructured interviews were conducted with 18 administrative stakeholders, 16 patients, 7 health care providers, and 1 informal caregiver to understand how the implementation approach influenced user experiences and to identify strategies for improvement. Qualitative data were analyzed using an inductive thematic analysis approach.

RESULTS: Between August 2018 and October 2019, 15,271 registration emails were sent, with 67.01% (10,233/15,271) registered for an account across 38 health care sites. The median number of patients registered per site was 19, with considerable variation (range 1-2114). Of the total number of sites, 55% (21/38) had ≤30 registered patients, whereas only 2 sites had over 1000 registered patients. Interview participants perceived that the patient experience of the portal would have been improved by enhancing the data comprehensiveness of the technology. They also attributed the lack of enrollment to the absence of a broad rollout and marketing strategy across sites. Participants emphasized that provider engagement, change management support, and senior leadership endorsement were central to fostering uptake. Finally, many stated that regional alignment and policy support should have been sought to streamline implementation efforts across participating sites.

CONCLUSIONS: Without proper management and planning, multi-institutional portals can suffer from minimal adoption. Data comprehensiveness is the foundational component of these portals and requires aligned policies and a key base of technology infrastructure across all participating sites. It is important to look beyond the category of the technology (ie, patient portal) and consider its functionality (eg, data aggregation, appointment scheduling, messaging) to ensure that it aligns with the underlying strategic priorities of the deployment. It is also critical to establish a clear vision and ensure buy-ins from organizational leadership and health care providers to support a cultural shift that will enable a meaningful and widespread engagement.

PMID:34709195 | DOI:10.2196/28924

Eur J Endocrinol. 2021 Oct 1:EJE-21-1080. doi: 10.1530/EJE-21-1080. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine factors associated with the reported incidence of pheochromocytoma and paraganglioma across studies.

METHODS: The annual incidence of pheochromocytoma and paraganglioma was examined according to geographic altitude and year of detection.

RESULTS: Although higher altitude and later year of detection were associated with a higher incidence of disease, these variables only accounted for a small degree of the between-study differences observed. There were large amounts of residual statistical heterogeneity after meta-regression. Other factors such as variable disease detection methods, data sources, and study quality were likely more important sources of statistical heterogeneity.

CONCLUSION: Variations in the incidence of pheochromocytoma and paraganglioma between studies were only partially explained by elevation and time of detection. Other factors, such as differences in study quality and the presence of clinical heterogeneity, likely impacted estimates of incidence.

PMID:34709199 | DOI:10.1530/EJE-21-1080

J Med Internet Res. 2021 Oct 28;23(10):e26886. doi: 10.2196/26886.

ABSTRACT

BACKGROUND: Most older people after a hip fracture injury never return to their prefracture status, and some are admitted to residential aged care facilities. Advancement of digital technology has helped in optimizing health care including self-management and telerehabilitation.

OBJECTIVE: This study aims to understand the perspectives of older patients with hip fracture and their family members and residential aged caregivers on the feasibility of developing a model of care using a personalized digital health hub.

METHODS: We conducted a mixed methods study in South Australia involving patients aged 50 years and older, their family members, and residential aged caregivers. Quantitative data analysis included basic demographic characteristics, and access to digital devices was analyzed using descriptive statistics. Spearman rank-order correlation was used to examine correlations between the perceived role of a personalized digital health hub in improving health and the likelihood of subsequent use. Findings from qualitative analysis were interpreted using constructs of capability, opportunity, and motivation to help understand the factors influencing the likelihood of potential personalized digital health hub use.

RESULTS: This study recruited 100 participants-55 patients, 13 family members, and 32 residential aged caregivers. The mean age of the patients was 76.4 (SD 8.4, range 54-88) years, and 60% (33/55) of the patients were female. Approximately 50% (34/68) of the patients and their family members had access to digital devices, despite less than one-third using computers as part of their occupation. Approximately 72% (72/100) of the respondents thought that personalized digital health hub could improve health outcomes in patients. However, a moderate negative correlation existed with increasing age and likelihood of personalized digital health hub use (Spearman ρ=-0.50; P<.001), and the perceived role of the personalized digital health hub in improving health had a strong positive correlation with the likelihood of personalized digital health hub use by self (Spearman ρ=0.71; P<.001) and by society, including friends and family members (Spearman ρ=0.75; P<.001). Most patients (54/55, 98%) believed they had a family member, friend, or caregiver who would be able to help them use a personalized digital health hub. Qualitative analysis explored capability by understanding aspects of existing knowledge, including willingness to advance digital navigation skills. Access could be improved through supporting opportunities, and factors influencing intrinsic motivation were considered crucial for designing a personalized digital health hub-enabled model of care.

CONCLUSIONS: This study emphasized the complex relationship between capabilities, motivation, and opportunities for patients, their family members, and formal caregivers as a patient networked unit. The next stage of research will continue to involve a cocreation approach followed by iterative processes and understand the factors influencing the development and successful integration of complex digital health care interventions in real-world scenarios.

PMID:34709183 | DOI:10.2196/26886

Inform Health Soc Care. 2021 Oct 28:1-12. doi: 10.1080/17538157.2021.1988955. Online ahead of print.

ABSTRACT

This study examined the association between caregivers’ burdens and their individual characteristics and identified characteristics that are useful for predicting the level of caregiver burden. We successfully surveyed 387 family caregivers, having them complete the caregiver burden inventory scale (CBI) and an individual characteristic questionnaire. When we compared the average CBI scores between groups with a particular individual characteristic (including caring for older adult(s), educational level, employment status, place of birth, marital status, financial status, need for family support, need for friend support, and need for nonprofit organizational support), we found a significant difference in the average scores. From a logistic regression model, with burden level as the outcome, we found that caring for older adult(s), educational level, employment status, place of birth, financial situation, and need for nonprofit organizational support were significant predictors of the burden level of caregivers. The research findings suggest that certain individual characteristics can be adopted for identifying and quantifying caregivers who may have a higher level of burden. The findings are useful to uncover caregivers who may need prompt support and social care.

PMID:34709118 | DOI:10.1080/17538157.2021.1988955

Rambam Maimonides Med J. 2021 Oct 25;12(4). doi: 10.5041/RMMJ.10451.

ABSTRACT

OBJECTIVES: To study the correlation between the putative cancer stem cell (CSC) markers aldehyde dehydrogenase 1 (ALDH1), cluster of differentiation 44 (CD44), sex-determining region Y-box 2 (SOX2), and octamer-binding protein 4 (OCT4) and human papilloma virus (HPV) infection using p16, the surrogate marker of HPV in oral epithelial dysplasia (OED) and normal mucosa.

METHODS: Five sections each from 40 histopathologically diagnosed cases of different grades of OED and 10 cases of normal oral mucosa without dysplasia were immunohistochemically stained with p16, ALDH1, CD44, SOX2, and OCT4, respectively.

RESULTS: Expression of ALDH1 and SOX2 was significantly increased in OED cases, whereas CD44 and OCT4 expression was increased in normal mucosa. P16-positive OED cases showed upregulation of ALDH1 and OCT4 expression as compared to p16-negative cases, while CD44 and SOX2 expression was downregulated in p16-positive OED cases; however, the results were not statistically significant.

CONCLUSION: The present study indicated a suggestive link between p16 and cancer stem cell marker expression in HPV-associated OED, and that p16 has a significant role in CSC progression in OED. This is the first study to evaluate the expression of putative CSC markers in HPV-associated OED. However, low study numbers are a potential limiting factor in this study.

PMID:34709167 | DOI:10.5041/RMMJ.10451

Nat Commun. 2021 Oct 27;12(1):6209. doi: 10.1038/s41467-021-26305-9.

ABSTRACT

Stimulated Brillouin scattering experiments in the ionospheric plasma using a single electromagnetic pump wave have previously been observed to generate an electromagnetic sideband wave, emitted by the plasma, together with an ion- acoustic wave. Here we report results of a controlled, pump and probe beat-wave driven Brillouin scattering experiment, in which an ion-acoustic wave generated by the beating of electromagnetic pump and probe waves, results in electromagnetic sideband waves that are recorded on the ground. The experiment used the EISCAT facility in northern Norway, which has several high power electromagnetic wave transmitters and receivers in the radio frequency range. An electromagnetic pump consisting of large amplitude radio waves with ordinary (O) or extraordinary (X) mode polarization was injected into the overhead ionosphere, along with a less powerful probe wave, and radio sideband emissions observed on the ground clearly show stimulated Brillouin emissions at frequencies agreeing with, and changing with, the pump and probe frequencies. The experiment was simulated using a numerical full-scale model which clearly supports the interpretation of the experimental results. Such controlled beat-wave experiments demonstrate a way of remotely investigating the ionospheric plasma parameters.

PMID:34707115 | DOI:10.1038/s41467-021-26305-9

Nat Commun. 2021 Oct 27;12(1):6210. doi: 10.1038/s41467-021-26369-7.

ABSTRACT

The average location of observed western North Pacific (WNP) tropical cyclones (TCs) has shifted north over the last several decades, but the cause remains not fully understood. Here we show that, for the annual average, the observed northward migration of WNP TCs is related to changes in TC seasonality, not to a northward migration in all seasons. Normally, peak-season (July-September) TCs form and travel further north than late-season (October-December) TCs. In recent decades, related to less frequent late-season TCs, seasonally higher-latitude TCs contribute relatively more to the annual-average location and seasonally lower-latitude TCs contribute less. We show that the change in TC seasonality is related to the different responses of late-season and peak-season TC occurrence to a stronger Pacific Walker Circulation. Our findings provide a perspective on long-term trends in TC activity, by decomposing the annual-average statistics into seasonal components, which could respond differently to anthropogenic forcing.

PMID:34707112 | DOI:10.1038/s41467-021-26369-7