Tag: nevin manimala

Zhonghua Wai Ke Za Zhi. 2022 Jan 1;60(1):69-78. doi: 10.3760/cma.j.cn112139-20210331-00149. Online ahead of print.

ABSTRACT

Objective: To investigate the role of minimally invasive crenel lateral lumbar interbody fusion (CLIF) in the decision of fusion level in posterior correction for severe adult degenerative scoliosis. Methods: This is prospective study.Patients with level Ⅴ and Ⅵ of Lenke-Silva classification who were treated in department of spine surgery,orthopedics center,the Second Affiliated Hospital, School of Medicine, Zhejiang University from June 2016 to March 2019 were included.First,the enrolled patients completed the preoperative clinical and imaging examination,the Lenke-Silva classification was evaluated,the surgical segments in first-stage CLIF was determined and the fusion segments required for single-stage posterior correction was predicted.After the first-stage CLIF,patients received reassessment of Lenke-Silva classification and global coronal and sagittal balance.Patients were divided into two groups:the effective group (level of Lenke-Silva classification decreased) and the ineffective group (level of Lenke-Silva classification unchanged).Second-stage posterior surgery was performed based on the results of reassessments.The fusion segment,Cobb angle,parameters of global coronal and sagittal plane,visual analogue pain score (VAS) and Oswestry disability index (ODI) were compared between the two groups preoperatively,after first-stage CLIF,second-stage posterior fixation and at the final follow-up.The potential factors associated with the decrease of the level of Lenke-Silva classification were recorded and compared between the two groups.Independent sample t test,repeated measure analysis of variance,rank sum test,χ² test or Fisher exact method were used to compare the difference among groups. Results: Fifty-four patients were enrolled,including 8 males and 46 females,aged (68.8±5.8) years (range:56 to 77 years).Preoperatively,26 patients were classified as level Ⅴ by Lenke-Silva classification,28 cases were grade Ⅵ.CLIF was performed in 194 segments,with 114 (58.8%) segments receiving anterior column realignment (ACR) and 15 (7.7%) segments using hyperlordotic cages.After first-stage CLIF,22 patients with level Ⅴ and 10 patients with Ⅵ of Lenke-Silva classification decreased and were classified into effective group.The level of the remaining 4 patients with level Ⅴ and 18 patients with grade Ⅵ unchanged and were classified into ineffective group.Preoperatively,the apical vertebrae was below L₁ in all 32 patients of effective group and 18 (81.8%,18/22) patients of ineffective group.The difference was statistically significant (P=0.023).There were 7 (31.8%,7/22) patients had continuous osteophyte in front of the intervertebral space in ineffective group,while none patient had continuous osteophyte in front of the intervertebral space in effective group,and the difference was statistically significant (P=0.001).In first-stage CLIF,more intraoperative ACR(71.2% vs.39.5%,χ²=20.66,P<0.01)and hyperlordotic cage (12.7$ vs.0,P=0.001)were used in the effective group,while there was less severe cage subsidence after the operation (5.9% vs.15.8%,χ²=4.793,P=0.029) in effective group.After first-stage CLIF,there was no difference in the Cobb angle between the two groups.While,lumbar lordosis (LL) in effective group (34.0±8.3)° was greater than that of the ineffective group (25.5±9.7)° (t=3.478,P=0.001),and the difference between the pelvic incidence (PI) and LL in effective group (15.7±4.6)°was significantly smaller than ineffective group(20.0±10.8)° (t=-2.129,P=0.038).The posterior fusion levels was less,the rate of fusion to thoracic spine region and the actual fusion segment was less than that of single-stage posterior correction in effective group (all P<0.01).All patients were follow-up for 24 to 45 months.There was no significant difference in radiological and clinical results between the two groups after first-,second-stage surgery and at the final follow-up (all P>0.05). Conclusions: First-stage CLIF decreased the Lenke-Silva classification of some patients with severe degenerative scoliosis.Combined with the reassessment of Lenke-Silva classification and global coronal and sagittal plane,it helps to accurately determine the fusion segment.Decrease of Lenke-Silva classification was associated with the preoperative level of apical vertebrae,continuous osteophytes in front of the intervertebral space,intraoperative use of ACR and hyperlordotic cage and the degree of cage subsidence postoperatively.

PMID:34954950 | DOI:10.3760/cma.j.cn112139-20210331-00149

Zhonghua Fu Chan Ke Za Zhi. 2021 Dec 25;56(12):842-848. doi: 10.3760/cma.j.cn112141-20211009-00576.

ABSTRACT

Objective: To investigate the clinical features and long-term prognosis of patients co-existing with ovarian endometrioma (OMA) and deep infiltrating endometriosis (DIE). Methods: Totally 358 OMA patients were retrospectively analyzed, who had a minimum of 8 years follow-up after laparoscopic cystectomy, which was performed by one professional endometriosis surgery team at Peking Union Medical College Hospital from January 2009 to April 2013. All women were divided into DIE group and non-DIE group, and analysis was performed in preoperative characteristics, surgical findings and postoperative outcomes during follow-up. Results: A total of 358 OMA patients were included, of which 190 patients (53.1%, 190/358) were in the DIE group, while other 168 patients (46.9%, 168/358) in the non-DIE group. The average ages between the two groups were (33.7±5.4), (32.5±5.3) years (P=0.047), the average parity was (0.4±0.6) times vs (0.3±0.5) times (P=0.079). There were significant differences in the proportions of moderate to severe dysmenorrhea [67.4% (128/190) vs 56.5% (95/168)], chronic pelvic pain [24.2% (46/190) vs 7.7% (13/168)], and the increase in CA₁₂₅ [79.9% (139/190) vs 65.2% (101/168)] between the two groups (all P<0.05). The average operation time in the DIE and non-DIE groups was (75±21) vs (39±36) minutes (P<0.01). There was a significant difference in adenomyosis presence between the two groups [41.6% (79/190) vs 22.0% (37/168); P=0.001]. All patients were followed up for at least 8 years. At the end of the follow-up, though the DIE group was with higher total rate of disease relapse, yet no significant difference was found between the two groups in statistical comparison [21.6% (41/190) vs 16.1% (27/168); P=0.185]. A total of 41 cases in the DIE group recurred, the recurrence rate of pain was 15.8% (30/190), and the recurrence rate of cyst was 8.4% (16/190); 27 cases had recurrence after operation in the non-DIE group, the recurrence rate of pain was 8.9% (15/168), and the recurrence rate of cyst was 10.7% (18/168). There were no significant differences in the pain recurrence rate (P=0.067) and cyst recurrence rate (P=0.460) between the two groups. As for the successfully pregnant patients, live birth rates were 100.0% (65/65) vs 94.4% (68/72) between DIE group and non-DIE groups (P=0.120). Conclusions: Compared with the non-DIE group, OMA patients with concurrent DIE might have severe pain symptoms, higher probability of abnormal CA₁₂₅ levels and more severe pelvic adhesions. Although there are no significant differences in the total recurrence rate and the recurrence rate of various types between the two groups, the proportion of pain recurrence in the DIE group is higher than that in the non-DIE group. In terms of fertility outcomes, patients in the DIE group are with lower likelihood of pregnancy after surgery during the long-time follow-up. DIE has no significant influence on the fertility outcome.

PMID:34954962 | DOI:10.3760/cma.j.cn112141-20211009-00576

Zhonghua Shao Shang Za Zhi. 2021 Dec 24;37:1-8. doi: 10.3760/cma.j.cn501120-20211006-00346. Online ahead of print.

ABSTRACT

Objective: To explore the value of markers of cerebral hypoxia-ischemia injury in early diagnosis of sepsis associated encephalopathy (SAE) in burn sepsis patients. Methods: A retrospective case series study was used. From October 2018 to May 2021, 41 burn sepsis patients who were admitted to Zhengzhou First People’s Hospital met the inclusion criteria, including 23 males and 18 females, aged 18-65 (35±3) years. According to whether SAE occurred during hospitalization, the patients were divided into SAE group (21 cases) and non-SAE group (20 cases). The gender, age, deep partial-thickness burn area, full-thickness burn area, and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores of patients were compared between the two groups. The serum levels of central nervous system specific protein 100β and neuron specific enolase (NSE) at 12, 24, and 48 h after sepsis diagnosis (hereinafter referred to as after diagnosis), the serum levels of interleukin-6 (IL-6), IL-10, tumor necrosis factor α (TNF-α), Tau protein, adrenocorticotropic hormone (ACTH), and cortisol at 12, 24, 48, 72, 120, and 168 h after diagnosis, and the mean blood flow velocity of middle cerebral artery (VmMCA), pulsatility index, and cerebral blood flow index (CBFi) of patients in the two groups on 1, 3, and 7 d after diagnosis were counted. Data were statistically analyzed with chi-square test, analysis of variance for repeated measurement, independent sample t test, and Bonferroni correction. The independent variables to predict the occurrence of SAE was screened by multi-factor logistic regression analysis. The receiver operating characteristic (ROC) curve was drawn for predicting the occurrence of SAE in burn sepsis patients, and calculate the area under the curve (AUC), the best threshold, and the sensitivity and specificity under the best threshold were calculated. Results: The gender, age, deep partial-thickness burn area, full-thickness burn area, and APACHE Ⅱ score of patients in the two groups were similar (χ²=0.02, with t values of 0.71, 1.59, 0.91, and 1.07, respectively, P>0.05). At 12, 24, and 48 h after diagnosis, the serum levels of 100β and NSE of patients in SAE group were significantly higher than those in non-SAE group (with t values of 37.74, 77.84, 44.16, 22.51, 38.76, and 29.31, respectively, P<0.01). At 12, 24, 48, 72, and 120 h after diagnosis, the serum levels of IL-10, Tau protein, and ACTH of patients in SAE group were significantly higher than those in non-SAE group (with t values of 10.68, 13.50, 10.59, 8.09, 7.17, 4.71, 5.51, 3.20, 3.61, 3.58, 3.28, 4.21, 5.91, 5.66, 4.98, 4.69, 4.78, and 2.97, respectively, P<0.01). At 12, 24, 48, 72, and 120 h after diagnosis, the serum levels of IL-6 and TNF-α of patients in SAE group were significantly higher than those in non-SAE group (with t values of 8.56, 7.32, 2.08, 2.53, 3.37, 1.79, 4.44, 5.36, 5.35, 6.85, 5.15, and 1.85, respectively, P<0.05 or P<0.01). At 12, 24, and 48 h after diagnosis, the serum level of cortisol of patients in SAE group was significantly higher than that in non-SAE group (with t values of 5.44, 5.46, and 3.55, respectively, P<0.01). On 1 d after diagnosis, the VmMCA and CBFi of patients in SAE group were significantly lower than those in non-SAE group (with t values of 2.94 and 2.67, respectively, P<0.05). On 1, 3, and 7 d after diagnosis, the pulsatile index of patients in SAE group was significantly higher than that in non-SAE group (with t values of 2.56, 3.20, and 3.12, respectively, P<0.05 or P<0.01). Serum IL-6 at 12 h after diagnosis, serum Tau protein at 24 h after diagnosis, serum ACTH at 24 h after diagnosis, and serum cortisol at 24 h after diagnosis were included into multi-factor logistic regression analysis (with odds ratios of 2.424, 1.383, 4.292, and 2.191, 95% confidence interval of 1.762-3.818, 1.061-2.452, 1.374-6.680, and 3.323-8.791, respectively, P<0.01). For 41 burn sepsis patients, The AUC of ROC curve of serum IL-6 at 12 h after diagnosis for predicting SAE was 0.924 (95% confidence interval=0.843-1.000), the best threshold was 157 pg/mL, the sensitivity was 81%, and the specificity was 89%. The AUC of serum Tau protein at 24 h after diagnosis was 0.917 (95% confidence interval=0.822-1.000), the best threshold was 6.4 pg/mL, the sensitivity was 97%, and the specificity was 99%. The AUC of serum ACTH at 24 h after diagnosis was 0.962 (95% confidence interval=0.888-1.000), the best threshold was 14.7 pg/mL, the sensitivity was 90%, and the specificity was 94%. The AUC of serum cortisol at 24 h after diagnosis was 0.931 (95% confidence interval=0.855-1.000), the best threshold was 89 nmol/L, the sensitivity was 94%, and the specificity was 97%. Conclusions: Serum Tau protein, ACTH, and cortisol have higher clinical diagnostic value for burn sepsis patients complicated with SAE.

PMID:34954938 | DOI:10.3760/cma.j.cn501120-20211006-00346

Zhonghua Shao Shang Za Zhi. 2021 Dec 20;37:1-9. doi: 10.3760/cma.j.cn501120-20201201-00511. Online ahead of print.

ABSTRACT

Objective: To explore the application effects of bundle nursing of citric acid extracorporeal anticoagulation on continuous renal replacement therapy (CRRT) of severe burn patients. Methods: A non-randomized controlled study was conducted. Forty-six patients who met the inclusion criteria and received regular nursing of citric acid extracorporeal anticoagulation during CRRT in the First Affiliated Hospital of Army Medical University (the Third Military Medical University) from January to December 2017 were included in regular nursing group (30 males and 16 females, aged 42.0 (38.7,47.0) years, performed with 201 times of CRRT), and 48 patients who met the inclusion criteria and received bundle nursing of citric acid extracorporeal anticoagulation during CRRT in the same affiliation from January to December 2018 were included in bundle nursing group (32 males and 16 females, aged 41.0 (36.0,46.0) years, with 164 times of CRRT). The clinical data of all the patients in the two groups were recorded, including the length of intensive care unit (ICU) stay, total cost of treatment in ICU, cost of CRRT, unplanned ending of treatment, ending of treatment due to operation (calculating the rates of unplanned ending of treatment and ending of treatment due to operation), times of filter service time>24 h, times of CRRT, and filter service life. For the patients in the two groups who continuously received CRRT for 3 days or more from the first treatment, the prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), total calcium, ionic calcium (calculating the difference of total calcium and ionic calcium between before and after treatment), creatinine, urea, β₂ microglobulin, cystatin C, mean arterial pressure, pH value, oxygenation index, bicarbonate radical, and lactic acid before the first treatment (hereinafter referred to as before treatment) and 3 days after the first treatment (hereinafter referred to as after 3 days of treatment). The treatment-related complications of all patients in the two groups were recorded during hospitalization. Data were statistically analyzed with independent sample t test, Mann Whitney U test, and chi-square test. Results: Compared with those in regular nursing group, the length of ICU stay was significantly shortened (Z=-4.71, P<0.01), the total cost of treatment in ICU was significantly reduced (t=-1.39, P<0.01), the cost of CRRT had no significant change (P>0.05), the rates of unplanned ending of treatment and ending of treatment due to operation were both significantly decreased (with χ² values of 12.20 and 17.83, respectively, P<0.01), the times of filter service time>24 h was increased significantly (Z=-5.93, P<0.01), the times of CRRT were significantly reduced (Z=-4.75, P<0.01), and the filter service life was significantly prolonged (Z=-9.24, P<0.01) among patients in bundle nursing group. Thirty-one patients in bundle nursing group and 28 patients in regular nursing group continuously received CRRT for 3 days or more from the first treatment. Before treatment, PT, APTT, and INR of patients in bundle nursing group were 24.10 (16.08, 39.20) s, 38.81 (32.32, 45.50) s, and 1.17 (1.12, 1.19), respectively, similar to 31.75 (22.99, 40.96) s, 41.82 (35.05, 48.06) s, and 1.15 (1.11, 1.19) of patients in regular nursing group (P>0.05); the levels of total calcium and ionic calcium of patients in the two groups were similar (P>0.05). After 3 days of treatment, PT, APTT, and INR of patients in bundle nursing group and regular nursing group were 29.06 (20.11, 39.46) s, 35.25 (30.06, 40.28) s, 1.13 (1.09, 1.17) and 36.51 (26.64, 42.92) s, 39.89 (34.81, 46.62) s, 1.14 (1.10, 1.18), respectively, similar to those before treatment (P>0.05); the levels of total calcium and ionic calcium of patients in bundle nursing group were both significantly higher than those before treatment (with Z values of -3.55 and -3.69, respectively, P<0.01); compared with those in regular nursing group, APTT of patients was significantly shorter (Z=-2.29, P<0.05), while the total calcium level of patients was significantly higher in bundle nursing group (Z=-2.26, P<0.05). The difference of total calcium between before and after treatment of patients in bundle nursing group was significantly higher than that in regular nursing group (Z=-3.15, P<0.01). The differences of ionic calcium between before and after treatment of patients in the two groups were similar (P>0.05). Before treatment, the level of β₂ microglobulin of patients in bundle nursing group was significantly higher than that in regular nursing group (Z=-2.84, P<0.01), the platelet count of patients in bundle nursing group was significantly lower than that in regular nursing group (Z=-2.44, P<0.05), while the levels of creatinine, urea, cystatin C, mean arterial pressure, pH value, oxygenation index, bicarbonate radical, and lactic acid of patients in the two groups were similar (P>0.05). After 3 days of treatment, the levels of creatinine, urea, β₂ microglobulin, cystatin C, pH value, bicarbonate radical, and lactic acid of patients were all significantly lower than those before treatment (with Z values of -2.10, -2.90, -3.11, -2.02, -2.34, -2.63, and -2.84, respectively, P<0.05 or P<0.01), while the levels of platelet count, oxygenation index, and mean arterial pressure of patients were all significantly higher than those before treatment in bundle nursing group (with Z values of -6.65 and -2.40, respectively, t=-9.97, P<0.05 or P<0.01); the levels of creatinine, urea, β₂ microglobulin, cystatin C, platelet count, pH value, bicarbonate radical, and lactic acid of patients were all significantly lower than those before treatment (with Z values of -5.32, -2.31, -2.41, -2.21, -3.68, -2.93, -2.20, and -2.31, respectively, P<0.05 or P<0.01), while the oxygenation index and mean arterial pressure of patients were both significantly higher than those before treatment in regular nursing group (Z=-5.59, t=-7.74, P<0.01). After 3 days of treatment, compared with those in regular nursing group, the levels of creatinine, cystatin C, platelet count, oxygenation index, bicarbonate radical, and mean arterial pressure of patients were all significantly higher (with Z values of -2.93, -1.99, -6.39, -2.09, and -2.52, respectively, t=-3.28, P<0.05 or P<0.01), while the levels of urea, β₂ microglobulin, pH value, and lactic acid of patients were all significantly lower in bundle nursing group (with Z values of -3.87, -2.58, -4.24, and -2.75, respectively, P<0.05 or P<0.01). There were no treatment-related bleeding events or hypernatremia related to citric acid treatment of patients in the two groups. The ratio of total calcium to ionic calcium in one patient in bundle nursing group was >2.5, but there was no manifestation of citric acid accumulation poisoning; 1 patient had low ion calcium, and 1 patient had severe metabolic alkalosis, both of which were transient. Five patients had low ion calcium and 2 patients had transient severe metabolic alkalosis in regular nursing group. Conclusions: The implementation of bundle nursing of citric acid extracorporeal anticoagulation during CRRT for severe burn patients shortens the length of ICU stay, reduces the total cost of treatment in ICU and the occurrence of treatment complications, relieves the economic burden of patients, and improves the continuity and quality of treatment.

PMID:34954935 | DOI:10.3760/cma.j.cn501120-20201201-00511

Zhonghua Shao Shang Za Zhi. 2021 Dec 24;37:1-6. doi: 10.3760/cma.j.cn501120-20210427-00156. Online ahead of print.

ABSTRACT

Objective: To compare the differences of water barrier function of skin between keloid and surrounding normal skin in keloid patients and to explore the primary mechanism. Methods: A cross-sectional observational study was conducted. From October 2020 to March 2021, 30 keloid patients who met the inclusion criteria visited the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, including 18 females and 12 males, aged 20-48 years. The transepidermal water loss (TEWL) of their keloid tissues and the surrounding normal skin of the 30 patients were measured by multi probe adapter on the reception day. Hematoxylin-eosin staining was performed on keloid skin and normal skin of 5 patients after scar repair surgeries to measure the thickness of epidermis. Immunohistochemistry was used on samples from 3 patients to detect the expressions of cytokeratin-10, involucrin, and filaggrin in epidermis of keloid skin and normal skin. Data were statistically analyzed with paired sample t test and independent sample t test. Results: On the reception day, the TEWL of keloid skin of 30 patients is 9.0 (6.9, 13.4) g·m^-2·h^-1 and the TEWL of the normal skin was 8.1(6.4, 18.1) g·m^-2·h^-1, which showed no statistically significant differences (t=0.44, P>0.05). The thickness of epidermis in the keloid skin of 5 patients was (194±44) μm, which was significantly greater than (44±11) μm of the normal skin (t=6.88, P<0.01). Furthermore, increased keratinocytes, lack of normal epidermal ridge structures, and thickened stratum corneum were observed in the keloid area. The expression level of cytokeratin-10 in epidermis in the keloid skin was significantly lower than that in normal skin (t=8.50, P<0.01), but there were no statistically significant differences in the expression levels of involucrin and filaggrin between epidermis in the keloid skin and normal skin (with t values of 0.07 and 0.96, respectively, P>0.05). Conclusions: Keloid tissues present increased keratinocytes and thickened epidermis. But their water barrier function is similar to the surrounding normal skin, suggesting that transdermal water loss may not play a critical role in the prolonged development of keloids.

PMID:34954936 | DOI:10.3760/cma.j.cn501120-20210427-00156

J Perinat Med. 2021 Dec 22. doi: 10.1515/jpm-2020-0282. Online ahead of print.

ABSTRACT

OBJECTIVES: This study was performed to evaluate the effect of oral stimulation with breast milk for preterm infants.

METHODS: A total of 68 subjects form neonatal intensive care unit were randomly assigned into control group (n=20), premature infant oral motor intervention (PIOMI) group (n=25) and premature infant oral motor intervention with breast milk (BM-PIOMI) group (n=23).

RESULTS: BM-PIOMI group had significant shorter initiation of oral feeding (IOF) time compared to PIOMI group (2.95 days, 95% CI [0.42-5.48]) or control group (9.79 days, 95% CI [7.07-12.51]). BM-PIOMI group had significant sooner transition time from IOF to full oral feeding (FOF) compared to control group (6.68 days, 95% CI [2.2-11.16]), but not to PIOMI group (2.09 days, 95% CI [-2.07 to 6.25]). Length of hospital stay (LOS) did not show statistical different between three groups (control 38.85 ± 14.40 vs. PIOMI 38.48 ± 11.76 vs. BM-PIOMI 38.04 ± 12.2). Growth mixture model identified improvement in non-nutritive sucking (NNS) score in BM-PIOMI group compared to control and PIOMI group (0.8293, p<0.0001, and 0.8296, p<0.0001, respectively).

CONCLUSIONS: Oral stimulation with breast milk can better promotes the oral feeding process of premature infants than the simple oral stimulation, by shorten IOF time and improve early NNS score, but does not shorten transition time from IOF to FOF and LOS.

TRIAL REGISTRATION: The trial identification number is ChiCTR1800019134 (Chinese Clinical Trial Registry http://www.who.int/ictrp/network/chictr2/en/).

PMID:34954933 | DOI:10.1515/jpm-2020-0282

J Pediatr Endocrinol Metab. 2021 Dec 23. doi: 10.1515/jpem-2021-0587. Online ahead of print.

ABSTRACT

OBJECTIVES: Osteogenesis imperfecta (OI) is a heterogeneous group of inherited connective tissue disorders, characterised by skeletal fragility. Patients with OI may also exhibit extra-skeletal features like blue or grey scleral colour, fragile skin, easy bruising, joint laxity, short stature, deafness, cardiac valve abnormalities and abnormal pulmonary function. The objective of this study is to describe genetic mutations, prevalence of hearing issues, cardiac complications and impaired pulmonary function in children with OI.

METHODS: This is a cross-sectional study of 23 Saudi children aged 6 months to 18 years who were diagnosed with OI. The revised Sillence classification (2,105) was used to classify the OI type. Whole exome sequencing was performed for genetic mutations. The hearing was assessed by either pure-tone audiometry and/or otoacoustic emission testing. Cardiac defects were screened by echocardiograms. Spirometry was performed to assess pulmonary function. Data were analysed with descriptive statistics.

RESULTS: Based on the Sillence classification, 16 patients had OI type III, 6 had type IV and 1 had type I. Of the18 patients who had genetic sequencing, 66.6% had autosomal dominant and 33.3% had autosomal recessive mutations. Among children who had screening, hearing loss was diagnosed in 53% (9/17), congenital cardiac malformations in 26% (5/19) and restrictive lung disease in 70% (7/10).

CONCLUSIONS: We found significant extra-skeletal features and a high yield of genetic mutations associated with OI. We suggest further studies to develop a screening protocol for extra-skeletal features in children with OI.

PMID:34954934 | DOI:10.1515/jpem-2021-0587

Isr Med Assoc J. 2021 Dec;23(12):794-800.

ABSTRACT

BACKGROUND: New direct acting antiviral agent (DAA) therapies are associated with a high sustained virological response rate (SVR) in hepatitis C virus (HCV) patients. The understanding of the impact of SVR on fibrosis stage is limited.

OBJECTIVES: To determine the effect of treatment with the DAAs on long-term liver fibrosis stages, as determined by shear-wave elastography (SWE) or FibroTest.

METHODS: Fibrosis stage was determined at baseline and at 6-month intervals after end of treatment (EOT), using two-dimensional SWE or FibroTest©; APRI and FIB-4 scores.

RESULTS: The study comprised 133 SVR12 patients. After a median follow-up of 15 months (range 6-33), liver fibrosis stage decreased by at least 1 stage in 75/133 patients (56%). Cirrhosis reversal was observed in 24/82 (29%). Repeated median liver stiffness SWE values in cirrhotic patients were 15.1 kPa at baseline (range 10.5-100), 13.4 kPa (range 5.5-51) at 6 months, and 11.4 kPa (range 6.1-35.8) at 12 months after EOT, P = 0.01. During the second year after EOT, no statistically significant differences in liver fibrosis stage in 12, 18, and 24 months were found. Splenomegaly was the only significant negative predictor of liver fibrosis regression during all time points of repetitive noninvasive assessment.

CONCLUSIONS: Following successful DAA treatment, the majority of our HCV patients with advanced fibrosis demonstrated significant improvement, as assessed by non-invasive methods. Advanced fibrosis stage was a negative predictor of fibrosis regression. Longer follow-up periods are required to further establish the impact of DAAs treatment in HCV patients with advanced fibrosis.

PMID:34954919

Isr Med Assoc J. 2021 Dec;23(12):805-810.

ABSTRACT

BACKGROUND: For locally advanced rectal cancer patients a watch-and-wait strategy is an acceptable treatment option in cases of complete tumor response. Clinicians need robust methods of patient selection after neoadjuvant chemoradiation.

OBJECTIVES: To predict pathologic complete response (pCR) using computer vision. To analyze radiomic wavelet transform to predict pCR.

METHODS: Neoadjuvant chemoradiation for patients with locally advanced rectal adenocarcinoma who passed computed tomography (CT)-based simulation procedures were examined. Gross tumor volume was examind on the set of CT simulation images. The volume has been analyzed using radiomics software package with wavelets feature extraction module. Statistical analysis using descriptive statistics and logistic regression was performed was used. For prediction evaluation a multilayer perceptron algorithm and Random Forest model were used.

RESULTS: In the study 140 patients with II-III stage cancer were included. After a long course of chemoradiation and further surgery the pathology examination showed pCR in 38 (27.1%) of the patients. CT-simulation images of tumor volume were extracted with 850 parameters (119,000 total features). Logistic regression showed high value of wavelet contribution to model. A multilayer perceptron model showed high predictive importance of wavelet. We applied random forest analysis for classifying the texture and predominant features of wavelet parameters. Importance was assigned to wavelets.

CONCLUSIONS: We evaluated the feasibility of using non-diagnostic CT images as a data source for texture analysis combined with wavelets feature analysis for predicting pCR in locally advanced rectal cancer patients. The model performance showed the importance of including wavelets features in radiomics analysis.

PMID:34954921

Isr Med Assoc J. 2021 Dec;23(12):788-793.

ABSTRACT

BACKGROUND: Up to 60% of inflammatory bowel disease (IBD) patients treated with infliximab develop antibodies to infliximab (ATI), which are associated with low drug levels and loss of response (LOR). Hence, mapping out predictors of immunogenicity toward infliximab is essential for tailoring patient-specific therapy. Jewish Sephardi ethnicity, in addition to monotherapy, has been previously identified as a potential risk factor for ATI formation and infliximab failure.

OBJECTIVES: To explore the association between Jewish sub-group ethnicity among patients with IBD and the risk of infliximab immunogenicity and therapy failure. To confirm findings of a previous cohort that addressed the same question.

METHODS: This retrospective cohort study included all infliximab-treated patients of Jewish ethnicity with regular prospective measurements of infliximab trough levels and ATI. Drug and ATI levels were prospectively measured, clinical data was retrieved from medical charts.

RESULTS: The study comprised 109 Jewish patients (54 Ashkenazi, 55 Sephardi) treated with infliximab. There was no statistically significant difference in proportion of ATI between Sephardi and Ashkenazi patients with IBD (32% Ashkenazi and 33% Sephardi patients developed ATI, odds ratio [OR] 0.944, P = 0.9). Of all variables explored, monotherapy and older age were the only factors associated with ATI formation (OR 0.336, 95% confidence interval 0.145-0.778, P = 0.01, median 34 vs. 28, interquartile range 28-48, 23-35 years, P = 0.02, respectively).

CONCLUSIONS: Contrary to previous findings, Sephardi Jewish ethnicity was not identified as a risk factor for ATI formation compared with Ashkenazi Jewish ethnicity. Other risk factors remained unchanged.

PMID:34954918