Tag: nevin manimala

JCO Glob Oncol. 2021 Apr;7:486-494. doi: 10.1200/GO.20.00422.

ABSTRACT

PURPOSE: CNS relapse in patients with diffuse large B-cell lymphoma (DLBCL) is associated with poor prognosis with a median survival of about 2.5 months. Data demonstrating best prophylactic strategy remain controversial and need further definition.

PATIENTS AND METHODS: We present data of 110 patients with DLBCL treated with standard systemic therapy divided into four groups based on primary CNS prophylaxis strategy and CNS International Prognostic Index (IPI) risk categories. We compared their 3-year CNS relapse rate and overall survival in each group.

RESULTS: The CNS prophylaxis strategy consisted of intrathecal (IT) methotrexate (MTX) in group 1, high-dose (HD) MTX in group 2, combination IT and HD MTX in group 3, and IT and/or HD MTX with intensive chemotherapy in group 4. At 3 years, CNS relapse rate was 8.6% (4/46), 8.3% (1/12), 4.8% (2/42), and 18% (2/11) in groups 1-4 (P = .64), respectively. According to CNS IPI, the CNS relapse rate was 16.6%, 10.1%, and 0% in high-, intermediate-, and low-risk groups, respectively. The 3-year overall survival rate was 69%, 75%, 80%, and 45% in groups 1-4 (P = .71), respectively.

CONCLUSION: Our study while did not find statistical significance did indicate a lower incidence of CNS relapse with the addition of systemic HD MTX to IT MTX in the high-risk DLBCL population.

PMID:33835825 | DOI:10.1200/GO.20.00422

Br J Radiol. 2021 Apr 9:20200724. doi: 10.1259/bjr.20200724. Online ahead of print.

ABSTRACT

OBJECTIVES: To identify reproducible hematoma radiomics features (RFs) for use in predicting hematoma expansion (HE) in patients with acute intracerebral hemorrhage (ICH).

METHODS: For test-retest analysis, three syringes with different volumes of blood collected at the same time (to mimic homogeneous hematoma) and a phantom (FT/HK 2000; Huake, Szechwan, China) containing three cylindrical inserts were scanned seven times within 6 h on the same CT scanner. Three additional syringes with mixed blood collected at different time points (to mimic heterogeneous hematoma) were tied together with the first three syringes as well as the phantom were scanned using modified CT acquisition parameters for intra CT analysis. A coefficient of variation below 10% served as the cutoff value for reproducibility. Finally, reproducible and potentially useful RFs were used to predict HE in 144 acute ICH patients, with the area under the receiver operating characteristic curves (AUC) used to evaluate their diagnostic performance.

RESULTS: A total of 630 RFs including 18 first-order, 24 gray-level co-occurrence matrix (GLCM), 16 gray-level run length matrix (GLRLM), five neighborhood gray-tone difference matrix (NGTDM), 63 Laplacian of Gaussian (LoG), and 504 Wavelet features were evaluated. In the test-retest analysis, the percentages of reproducible RFs ranged from 42.54% (268/630) to 45.4% (286/630) for the three homogeneous hematoma samples and 79.05% (498/630) to 81.43% (513/630) for the phantom. In the intra-CT analysis, the percentages varied from 31.43% (198/630) to 42.38% (267/630) for the six hematoma samples and 48.89% (308/630) to 53.97% (340/630) for the phantom. In the in vitro experiment, 148 RFs were reproducible for all hematoma samples in both the test-retest and intra-CT analyses; however, only 80 were statistically different between homogeneous and heterogeneous hematoma samples. Finally, HE occurred in 25% (growth >6 ml, 36/144) to 31.94% (growth >3 ml or 33%, 46/144) of the patients. The AUCs in predicting HE ranged from 0.625 to 0.703.

CONCLUSIONS: Only a few CT-based RFs from the in vitro hematoma were reproducible and can distinguish between homogeneous and heterogeneous hematomas. The use of RFs alone to predict HE in acute ICH showed only a moderate performance.

ADVANCES IN KNOWLEDGE: Using an in vitro experiment and clinical validation, this study demonstrated for the first time that CT-based hematoma RFs can be used to predict HE in acute ICH; nonetheless, only a few RFs are reproducible and can be used for prediction.

PMID:33835831 | DOI:10.1259/bjr.20200724

Eur J Trauma Emerg Surg. 2021 Apr 9. doi: 10.1007/s00068-021-01655-7. Online ahead of print.

ABSTRACT

PURPOSE: Patients with surgically treated acetabular fractures using extensive dissection of hip muscles demonstrate an incomplete biomechanical recovery and limited joint mobility during movement. The purpose of this study was to evaluate the early biomechanical outcome in a series of patients with acetabular fractures treated using the less invasive anatomical pararectus approach.

METHODS: Eight patients (48 ± 14 years, BMI 25.8 ± 3 kg/m²) were investigated 3.8 ± 1.3 months after surgery and compared to matched controls (49 ± 13 years, BMI 26 ± 2.8 kg/m²). Trunk and lower extremity kinematics and kinetics during gait and stair climb were calculated. SF-12 and the Merle d’Aubigné score were used for functional evaluation. Statistical analysis was conducted using Mann-Whitney test and Student’s t test. Effect sizes were calculated using Cohen’s d.

RESULTS: No group differences for lower extremity kinematics during walking and stair climbing were found. During walking, patients showed significant reductions (p < 0.05) of the vertical ground reaction force (8%) and knee and hip extension moments (29 and 27%). Ipsilateral trunk lean was significantly increased by 3.1° during stair descend while reductions of vertical ground reaction force were found for stair ascend (7%) and descend (20%). Hip extension moment was significantly reduced during stair descend by 37%. Patients revealed acceptable SF-12 physical and mental component outcomes and a good rating for the Merle d’Aubigné score (15.9 ± 1.7).

CONCLUSION: Patients showed some biomechanical restrictions that can be related to residual deficits in weight bearing capacity and strength of the hip muscles. In contrast, an immediate recovery of mobility was achieved by preserving lower extremity and pelvic movement. Therefore, the pararectus approach can serve as a viable strategy in the surgical treatment of acetabular fractures.

CLINICAL TRIAL: Trial registration number DRKS00011308, 11/14/2016, prospectively registered.

PMID:33835187 | DOI:10.1007/s00068-021-01655-7

G3 (Bethesda). 2021 Feb 6:jkab040. doi: 10.1093/g3journal/jkab040. Online ahead of print.

ABSTRACT

Envirotyping is an essential technique used to unfold the nongenetic drivers associated with the phenotypic adaptation of living organisms. Here, we introduce the EnvRtype R package, a novel toolkit developed to interplay large-scale envirotyping data (enviromics) into quantitative genomics. To start a user-friendly envirotyping pipeline, this package offers: (1) remote sensing tools for collecting (get_weather and extract_GIS functions) and processing ecophysiological variables (processWTH function) from raw environmental data at single locations or worldwide; (2) environmental characterization by typing environments and profiling descriptors of environmental quality (env_typing function), in addition to gathering environmental covariables as quantitative descriptors for predictive purposes (W_matrix function); and (3) identification of environmental similarity that can be used as an enviromic-based kernel (env_typing function) in whole-genome prediction (GP), aimed at increasing ecophysiological knowledge in genomic best-unbiased predictions (GBLUP) and emulating reaction norm effects (get_kernel and kernel_model functions). We highlight literature mining concepts in fine-tuning envirotyping parameters for each plant species and target growing environments. We show that envirotyping for predictive breeding collects raw data and processes it in an eco-physiologically smart way. Examples of its use for creating global-scale envirotyping networks and integrating reaction-norm modeling in GP are also outlined. We conclude that EnvRtype provides a cost-effective envirotyping pipeline capable of providing high quality enviromic data for a diverse set of genomic-based studies, especially for increasing accuracy in GP across untested growing environments.

PMID:33835165 | DOI:10.1093/g3journal/jkab040

JAMA Netw Open. 2021 Apr 1;4(4):e215302. doi: 10.1001/jamanetworkopen.2021.5302.

ABSTRACT

IMPORTANCE: The World Health Organization End TB (Tuberculosis) Strategy aims to decrease the global incidence and mortality of TB by 90% and 95%, respectively, as of 2035.

OBJECTIVE: To characterize the recent epidemiological trend of pulmonary TB (PTB) in mainland China based on the national surveillance data.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study collected demographic and clinical data of all patients reported in the national Tuberculosis Information Management System of China from January 1, 2005, to November 21, 2016. Data were analyzed from December 1, 2019, to July 31, 2020.

EXPOSURES: Pulmonary TB was defined as bacteriologically confirmed or clinically diagnosed TB in the lung parenchyma or the tracheobronchial tree.

MAIN OUTCOMES AND MEASURES: Temporal and spatial variation of annual incidence and demographic features of PTB in mainland China.

RESULTS: In total, 10 582 903 patients with PTB were reported in mainland China from 2005 to 2016. The median age of patients with PTB was 46 (interquartile range [IQR], 30-61) years, and 28.53% were 60 years or older. Most patients with PTB were male (69.8%) and farmers or herders (70.0%). The mean (SD) incidence of PTB was 66.61 (8.09) per 100 000 population. The annual incidence decreased from 72.95 per 100 000 population in 2005 to 52.18 per 100 000 population in 2016, and the reduction was greater in the eastern and central regions (31.6%; from 69.43 to 47.48 per 100 000 population) than in the western region (21.0%; from 82.06 to 64.82 per 100 000 population). Xinjiang Uygur Autonomous Region (135.03 per 100 000 population), Guizhou Province (115.98 per 100 000 population), and the Tibet Autonomous Region (101.98 per 100 000 population) had the highest mean annual incidences. The median time from onset of illness to diagnosis decreased from 36 (IQR, 16-92) days from 2005 to 2007 to 31 (IQR, 15-63) days in 2008 and later (P < .001) and was longer in the western region than in the eastern and central regions (41 [IQR, 20-91] vs 30 [IQR, 13-61] days; P < .001).

CONCLUSIONS AND RELEVANCE: Although this study found that the incidence of PTB in mainland China showed a downward trend from 2005 to 2016, to achieve the World Health Organization 2035 goal, innovative and more efficient prevention and control strategies are needed, particularly among the most susceptible population, that is, farmers and herders in western China.

PMID:33835173 | DOI:10.1001/jamanetworkopen.2021.5302

JAMA Netw Open. 2021 Apr 1;4(4):e213059. doi: 10.1001/jamanetworkopen.2021.3059.

ABSTRACT

IMPORTANCE: Despite concern about harms related to long-term prescribed opioid use among individuals with chronic noncancer pain (CNCP), no study has examined whether the same patients engage in a risky pattern of use consistently for the long term.

OBJECTIVE: To examine the prevalence, incidence, persistence, and cessation of a range of opioid behaviors, indicators of extramedical use, and harm among individuals who are prescribed opioids.

DESIGN, SETTING, AND PARTICIPANTS: This 5-year prospective cohort study in communities across Australia included 1514 adults who were prescribed opioids for CNCP. Data collection took place from August 2012 to December 2018, and data analysis took place from February to November 2020.

EXPOSURE: Prescription opioid use.

MAIN OUTCOMES AND MEASURES: High-dose opioid use (≥200 oral morphine equivalent [OME] mg/d); requesting an increase in opioid dose; requesting an early prescription renewal; tampering with opioid medication; diversion of medication to others; and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision opioid dependence. Cessation of opioid use was also assessed.

RESULTS: Of the 1514 participants, 672 (44.39%) were men, the mean (SD) age was 58 (19) years, and 737 (48.68%) were unemployed. At each annual interview, approximately 1 in 8 people (10.98% [95% CI, 10.33%-11.63%] to 14.73% [95% CI, 13.98%-15.48%] at any given interview) were taking more than 200 OME mg/d; comparatively more had requested an increased dosage in the previous 3 months (8.46% [95% CI, 7.89%-9.03%] to 23.77% [95% CI, 22.82%-24.73%]); and fewer asked for an early prescription renewal (4.61% [95% CI, 4.19%-5.03%] to 13.97% [95% CI, 13.24%-14.70%]). In any given interview, between 3.06% (95% CI, 2.72%-3.40%) and 7.86% (95% CI, 7.31%-8.41%) of respondents reported tampering and between 0.47% (95% CI, 0.33%-0.60%) and 1.39% (95% CI, 1.16%-1.62%) reported diversion to others. Between 8.28% (95% CI, 7.71%-8.84%) and 13.06% (95% CI, 12.35%-13.77%) met criteria for opioid dependence at each interview. Opioid cessation increased across interviews, from year 1 (9.15% [95% CI, 8.55%-9.74%]) to year 5 (20.02% [19.14%-20.89%]). There was considerable incidence and cessation in all behaviors from 1 interview to the next: most who engaged in any of these behaviors only did so at only 1 interview. For pharmaceutical opioid dependence, between 55.26% (95% CI, 53.81%-56.71%) and 64.44% (95% CI, 62.87%-66.00%) of cases in 1 interview did not meet dependence criteria in the following interview.

CONCLUSIONS AND RELEVANCE: These findings suggest considerable fluidity in opioid use, extramedical behaviors, and opioid dependence among people with CNCP. This reinforces the need for reassessment of the effectiveness and safety of prescription opioid use over time.

PMID:33835176 | DOI:10.1001/jamanetworkopen.2021.3059

Clin Orthop Relat Res. 2021 Apr 7. doi: 10.1097/CORR.0000000000001749. Online ahead of print.

ABSTRACT

BACKGROUND: Lung cancer is one of the most commonly diagnosed cancers and is the leading cause of cancer-related deaths. Metastatic bone disease occurs in 20% to 40% of patients with lung cancer, and these patients often present with pain or skeletal-related events (SREs) that are associated with decreased survival. Bone-modifying agents such as denosumab or bisphosphonates are routinely used; however, to our knowledge, there has been no quantitative synthesis of randomized controlled trial data to determine the most effective pharmacologic treatment of metastatic bone disease because of lung cancer.

QUESTIONS/PURPOSES: We aimed to perform a network meta-analysis of randomized trials to identify the bone-modifying agent that is associated with the (1) highest overall survival, (2) longest time to SRE, (3) lowest SRE incidence, and (4) greatest likelihood of pain resolution.

METHODS: We conducted our study according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol and pre-registered the analysis on PROSPERO (ID: CRD42019124364). We performed a librarian-assisted search of MEDLINE, PubMed, EMBASE, Cochrane Library, and Chinese databases including China National Knowledge Infrastructure and Wanfang Data. We included randomized controlled trials reporting outcomes specifically for patients with lung cancer treated with a bisphosphonate or denosumab. SREs included pathologic fractures, spinal cord compression, hypercalcemia of malignancy, or pain resulting in surgical intervention or radiation therapy. We excluded trials exclusively reporting surrogate outcomes such as changes in bone turnover markers. Screening, data extraction, risk of bias evaluation, and Grading of Recommendations Assessment, Development, and Evaluation evaluations were performed in duplicate. We included 131 randomized controlled trials that evaluated 11,105 patients with skeletal metastases from lung cancer. The network meta-analysis was performed using a frequentist model and the R statistical software. Results are reported as relative risks or mean differences, and the I2 value is reported for heterogeneity. The P-score, a measure of ranking certainty that accounts for standard error, is reported for each outcome. Heterogeneity in the network was considered moderate for overall survival and time to SRE, mild for the incidence of SRE, and low for pain resolution.

RESULTS: For overall survival, denosumab was ranked above zoledronic acid and estimated to confer a mean of 3.3 months (95% CI 0.3-6.3) of increased overall survival compared with untreated patients (P-score = 89%). For the time to SRE, denosumab was ranked first with a mean of 9.1 additional SRE-free months (95% CI 6.7-11.5) compared with untreated patients (P-score = 99%), while zoledronic acid conferred an additional 4.8 SRE-free months (95% CI 3.6-6.1). Reduction in the incidence of SREs was not different between patients treated with denosumab (relative risk 0.54; 95% CI 0.33-0.87) and those treated with zoledronic acid (relative risk 0.56; 95% CI 0.46-0.67). Patients treated with the combination of ibandronate and systemic therapy were more likely to experience successful pain resolution than untreated patients (relative risk 2.4; 95% CI 1.8-3.2).

CONCLUSION: In this comprehensive synthesis of all available randomized controlled trial evidence guiding the pharmacologic treatment of bone metastases from lung cancer, denosumab was ranked above zoledronic acid for overall survival and time to SRE and was not different for reducing the incidence of SRE. Both were superior to no treatment for each of these outcomes. Given this, we encourage physicians to consider the use of denosumab or zoledronic acid in treating this patient population. The combination of ibandronate and systemic therapy was the most effective at reducing pain because of metastases. No cost-effectiveness analysis has yet been performed for denosumab and zoledronic acid on patients with metastatic lung cancer, and this represents an avenue for future research.

LEVEL OF EVIDENCE: Level I, therapeutic study.

PMID:33835092 | DOI:10.1097/CORR.0000000000001749

Plast Reconstr Surg. 2021 Apr 7. doi: 10.1097/PRS.0000000000007854. Online ahead of print.

ABSTRACT

BACKGROUND: A deviated nose can be attributable to multiple anatomical factors, including asymmetric maxilla. A subalar graft helps to correct maxillary hypoplasia and may be a useful tool for correcting a deviated nose. The authors’ objective is to show the effects of the subalar graft in improving nostril symmetry and to propose an algorithm for using this graft in open and endonasal rhinoplasty.

METHODS: A retrospective case series was performed on patients who had undergone rhinoplasty performed by the senior author (R.W.) from September of 2008 to July of 2015. Patients with at least 3 months of follow-up and adequate photographs were included. The mean follow-up period was 11.0 months (range, 3 to 72 months). A total of 68 patients were included. Preoperative and postoperative photographs were analyzed to measure changes in nasal axis deviation, alar facial angle on base view, alar facial angle on frontal view, and nostril show bilaterally.

RESULTS: Of the 68 patients, statistically significant improvement of nasal axis deviation of 4.32 degrees toward the midline was observed. Alar facial angle on base view was improved 1.01 degrees toward the horizontal. Nostril symmetry also improved based on the ratio between the shorter side and the longer side. The mean change in nostril show ratio was 0.19 toward a 1:1 ratio.

CONCLUSIONS: Previous studies have shown that the subalar grafting technique is an important adjunctive technique in rhinoplasty for patients with midfacial asymmetries. This case series demonstrates that this technique can provide sustained results in the correction of the nasal foundation.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

PMID:33835105 | DOI:10.1097/PRS.0000000000007854

Soc Cogn Affect Neurosci. 2021 Apr 9:nsab043. doi: 10.1093/scan/nsab043. Online ahead of print.

ABSTRACT

A well-established neuroimaging literature predicts a right-sided asymmetry in the activation of face-devoted areas such as the fusiform gyrus (FG) and its resulting M/N170 response during face processing. However, the face-related response sometimes appears to be bihemispheric. A few studies have argued that bilaterality depended on the sex composition of the sample. To shed light on this matter, two meta-analyses were conducted starting from a large initial database of 250 ERP/MEG peer-reviewed scientific articles. Paper coverage was 1985-2020. Thirty-four articles met the inclusion criteria of a sufficiently large and balanced sample size with strictly right-handed and healthy participants aged 18-35 and N170 measurements in response to neutral front view faces at left and right occipito/temporal sites. The data of 817 male (n = 414) and female (n = 403) healthy adults were subjected to repeated measures analyses of variance. The results of statistical analyses from the data of 17 independent studies (from Asia, Europe and America) seem to robustly indicate the presence of a sex difference in the way the two cerebral hemispheres process facial information in humans, with a marked right-sided asymmetry of the bioelectrical activity in males and a bilateral or left-sided activity in females.

PMID:33835164 | DOI:10.1093/scan/nsab043

Plast Reconstr Surg. 2021 Apr 7. doi: 10.1097/PRS.0000000000007878. Online ahead of print.

ABSTRACT

BACKGROUND: Knowledge of Medicare reimbursement is essential for plastic surgeons providing care to Medicare beneficiaries. The authors sought to evaluate changes in Medicare reimbursement for common plastic surgery procedures from 2010 to 2020.

METHODS: The authors assessed the Physician Fee Schedule of the Centers for Medicare and Medicaid Services website. Rates of work-, facility-, or malpractice-related relative value units and total monetary units for 26 common plastic surgery procedures between 2010 to 2020 were evaluated. Descriptive statistics were used to calculate relative differences and to compare observed changes over time with the rate of inflation.

RESULTS: For the selected procedures, the authors found an average relative difference in terms of monetary units of an increase by 2.02 percent. However, after adjusting for inflation, the average relative difference was a decrease by 14.31 percent. The authors’ analysis indicates that, on average, there was a 1.55 percent decrease in physician relative value units between 2010 and 2020.

CONCLUSIONS: Medicare reimbursement rates have changed significantly over the past decade. However, these changes did not keep pace with the rate of inflation. Plastic surgeons should be aware of these trends and advocate for more fair reimbursement rates.

PMID:33835082 | DOI:10.1097/PRS.0000000000007878