Tag: nevin manimala

Am J Obstet Gynecol MFM. 2021 May 12:100394. doi: 10.1016/j.ajogmf.2021.100394. Online ahead of print.

ABSTRACT

BACKGROUND: Novel angiogenic biomarker profiles have demonstrated emerging evidence for predicting preeclampsia onset, severity, and adverse outcomes. Limited data exists in screening patients with fetal growth restriction for preeclampsia development using angiogenic biomarkers.

OBJECTIVE: The objective of this study was to risk stratify patients with fetal growth restriction using a soluble fms-like tyrosine kinase-1 (sFlt1) to placental growth factor (PlGF) ratio. Previously published cutoff of 38 was used to predict preeclampsia development and severity as well as adverse maternal or neonatal outcomes within a two-week time period.

STUDY DESIGN: This was a prospective observational cohort study carried out in a single tertiary hospital. Patients with a singleton fetal growth restriction pregnancy between 24 and 37 weeks gestation were evaluated using serial two-week encounters from the time of enrollment until delivery. Pregnancies with proven genetic or infectious etiology of fetal growth restriction or congenital anomalies were excluded. Ultrasound growth and Doppler measurements were obtained at the start of every encounter with routine preeclampsia labs and blood pressure checks when clinically indicated. Maternal serum was collected for all serial encounters and measured for sFlt1 and PlGF after delivery in a double blinded fashion. Maternal charts were reviewed for baseline demographic characteristics, pregnancy diagnoses and outcomes, and neonatal outcomes.

RESULTS: A total of 45 patients were enrolled for a total of 77 encounters, with the median (quartile 1, quartile 3) gestational age of the study enrolled at 31.43 (28.14, 33.57) weeks. Patients were divided into low risk (ratio < 38) and high risk (ratio ≥ 38) groups. Baseline characteristics of patients did not show any significant differences, including preeclampsia labs or ultrasound parameters, between the two groups. Systolic and diastolic blood pressures upon enrollment were statistically elevated when sFlt1/PlGF ≥ 38 (p = 0.02 and p = 0.01, respectively). Compared to patients with a low ratio, patients with a high ratio had a greater proportion of preeclampsia diagnosis, higher rates of preterm delivery under 34 and 37 weeks of gestation, smaller neonatal birthweight, and a smaller time to delivery from testing to delivery.

CONCLUSIONS: Among patients with fetal growth restriction, the sFlt1/PlGF ratio may serve as a potential biomarker for identifying at risk patients for developing preeclampsia and subsequently preterm delivery.

PMID:33991706 | DOI:10.1016/j.ajogmf.2021.100394

Radiol Oncol. 2021 May 16. doi: 10.2478/raon-2021-0023. Online ahead of print.

ABSTRACT

BACKGROUND: Breast intraoperative electron radiation therapy (B-IOERT) can be used in clinical practice both as elective irradiation (partial breast irradiation – APBI) in low risk breast cancer patients, and as an anticipated boost. The procedure generally includes the use of a shielding disk between the residual breast and the pectoralis fascia for the protection of the tissues underneath the target volume. The aim of the study was to evaluate the role of intraoperative ultrasound (IOUS) in improving the quality of B-IOERT.

PATIENTS AND METHODS: B-IOERT was introduced in Trieste in 2012 and its technique was improved in 2014 with IOUS. Both, needle and IOUS were used to measure target thickness and the latter was used even to check the correct position of the shielding disk. The primary endpoint of the study was the evaluation of the effectiveness of IOUS in reducing the risk of a disk misalignment related to B-IOERT and the secondary endpoint was the analysis of acute and late toxicity, by comparing two groups of patients treated with IOERT as a boost, either measured with IOUS and needle (Group 1) or with needle alone (Group 2). Acute and late toxicity were evaluated by validated scoring systems.

RESULTS: From the institutional patients who were treated between June 2012 and October 2019, 109 were eligible for this study (corresponding to 110 cases, as one patients underwent bilateral conservative surgery and bilateral B-IOERT). Of these, 38 were allocated to group 1 and 72 to group 2. The target thickness measured with the IOUS probe and with the needle were similar (mean difference of 0.1 mm, p = 0.38). The percentage of patients in which the shield was perfectly aligned after IOUS introduction increased from 23% to more than 70%. Moreover, patients treated after IOUS guidance had less acute toxicity (36.8% vs. 48.6%, p = 0.33) from radiation therapy, which reached no statistical significance. Late toxicity turned out to be similar regardless of the use of IOUS guidance: 39.5% vs. 37.5% (p = 0.99).

CONCLUSIONS: IOUS showed to be accurate in measuring the target depth and decrease the misalignment between collimator and disk. Furthermore there was an absolute decrease in acute toxicity, even though not statistically significant, in the group of women who underwent B-IOERT with IOUS guidance.

PMID:33991470 | DOI:10.2478/raon-2021-0023

JAMA Cardiol. 2021 May 15. doi: 10.1001/jamacardio.2021.1720. Online ahead of print.

ABSTRACT

IMPORTANCE: Shortened dual antiplatelet therapy followed by potent P2Y12 receptor inhibitor monotherapy reduces bleeding without increasing ischemic events after percutaneous coronary intervention (PCI).

OBJECTIVE: To explore sex differences and evaluate the association of sex with outcomes among patients treated with ticagrelor monotherapy vs ticagrelor plus aspirin.

DESIGN, SETTING, AND PARTICIPANTS: This was a prespecified secondary analysis of TWILIGHT, an investigator-initiated, placebo-controlled randomized clinical trial conducted at 187 sites across 11 countries. Study participants included patients who underwent successful PCI with drug-eluting stents, were planned for discharge with ticagrelor plus aspirin, and who had at least 1 clinical and at least 1 angiographic feature associated with high risk of ischemic or bleeding events. Data were analyzed from May to July 2020.

INTERVENTIONS: At 3 months after PCI, patients adherent to ticagrelor and aspirin without major adverse event were randomized to either aspirin or placebo for an additional 12 months along with ticagrelor.

MAIN OUTCOMES AND MEASURES: The primary end point was Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding at 12 months after randomization. The primary ischemic end point was a composite of death, myocardial infarction, or stroke.

RESULTS: Of 9006 enrolled patients, 7119 underwent randomization (mean [SD] age, 63.9 [10.2] years; 5421 [76.1%] men). Women were older (mean [SD] age, 65.5 [9.6] years in women vs 63.4 [10.3] years in men) with higher prevalence of chronic kidney disease (347 women [21.2%] vs 764 men [14.7%]). The primary bleeding end point occurred more often in women than men (hazard ratio [HR], 1.32; 95% CI, 1.06-1.64; P = .01). After multivariate adjustment, incremental bleeding risk associated with female sex was no longer significant (adjusted HR, 1.20; 95% CI, 0.95-1.52; P = .12). Ischemic end points were similar between sexes. Ticagrelor plus placebo vs ticagrelor plus aspirin was associated with lower risk of BARC type 2, 3, or 5 bleeding in women (adjusted HR, 0.62; 95% CI, 0.42-0.92; P = .02) and men (adjusted HR, 0.57; 95% CI, 0.44-0.73; P < .001; P for interaction = .69). Ischemic end points were similar between treatment groups in both sexes.

CONCLUSIONS AND RELEVANCE: These findings suggest that the higher bleeding risk in women compared with men was mostly attributable to baseline differences, whereas ischemic events were similar between sexes. In this high-risk PCI population, the benefits of early aspirin withdrawal with continuation of ticagrelor were generally comparable in women and men.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02270242.

PMID:33991416 | DOI:10.1001/jamacardio.2021.1720

J Anat. 2021 May 15. doi: 10.1111/joa.13454. Online ahead of print.

ABSTRACT

The surgical strategy in adolescent idiopathic scoliosis (AIS) aims to recreate the symmetry of the torso. This requires the minimisation of both the size of the scoliosis and the angulation between the sides of the torso, along with the recreation of a normal thoracic kyphosis. This study uses predictive modelling to identify the significance of the value of the pre-operative parameters, and the change in the magnitude of the parameters as a result of an operation on the shape of the torso using the ‘most prominent points’; two areas of maximum prominence on either side of the spine with x, y and z coordinates. The pre-operative values, and the change in magnitude between the pre and post-operative values, for scoliosis, kyphosis and skin angulation from a group of Lenke 1 convex to the right AIS were analysed with measures collected using Integrated Spine Imaging System 2 surface topography and compared with those without visible spinal deformity. The models best explained the z coordinate and least well explained the x coordinate, although there was a contribution to all of the models that remained unexplained. The parameters that affected the position of the coordinates in the model differed between the models. This confirms that surgically altering the shape of the spine and torso whilst correcting an AIS does not lead to a symmetrical torso. There are as yet, undefined factors which contribute to the shape of the torso and which if identified and corrected surgically would lead to greater symmetry post-operatively.

PMID:33991430 | DOI:10.1111/joa.13454

Pediatr Blood Cancer. 2021 May 15:e29079. doi: 10.1002/pbc.29079. Online ahead of print.

NO ABSTRACT

PMID:33991383 | DOI:10.1002/pbc.29079

Int J Dent Hyg. 2021 May 15. doi: 10.1111/idh.12517. Online ahead of print.

ABSTRACT

OBJECTIVE: To test the effectiveness of a dentifrice containing the turmeric and licorice extract compared to a control for preventing plaque and gingivitis over a four-month period.

MATERIAL AND METHODS: Ninety (non-dental) participants with moderate gingival inflammation(≥40%) were selected. The triple blind study consisted of two phases, namely at first a 3-week pre-experimental phase of using an oxygenating and chlorhexidine (CHX) mouthrinse. Secondly, a 4-months experimental period in which participants were randomly assigned to a test or control group. All were instructed to brush their teeth twice daily for 2 minutes with their assigned dentifrice. Gingival bleeding(BI), plaque(PI) and gingivitis(GI) were assessed.

RESULTS: Eighty participants completed the protocol. At the first assessment in the pre-experimental phase, the mean scores of all indices showed no differences for the two groups. At the second session, the values of all three parameters had decreased significantly (p<0.001). At the last session the BI values were 0.52(0.25) for the test group and 0.56(0.25) for the control, the mean GI was 0.27(0.17) for the test group and 0.31 0.16) for the control, and for PI the scores were 1.89(0.46) for the test group and 1.98(0.43) for the control group. Statistical comparison of the scores for the two groups at each stage of the study showed no significant difference for any of the parameters.

CONCLUSION: Within the limits of the current study design, dentifrice formulation and concentration of turmeric/licorice extracts the results show that the adjuvant effect of the natural ingredients in the test dentifrice was not evident on clinical parameters of gingivitis and plaque.

PMID:33991392 | DOI:10.1111/idh.12517

J Hepatobiliary Pancreat Sci. 2021 May 15. doi: 10.1002/jhbp.986. Online ahead of print.

ABSTRACT

BACKGROUND/PURPOSE: The current study aimed to develop a prediction model using a multi-marker panel as a diagnostic screening tool for pancreatic-ductal-adenocarcinoma.

METHODS: Multi-center cohort of 1,991 blood samples were collected from January 2011 to September 2019, of which 609 are normal, 145 are other-cancer (colorectal, thyroid, and breast cancer), 314 are pancreatic-benign-disease, and 923 are pancreatic-ductal-adenocarcinoma. The automated multi-biomarker Enzyme-Linked Immunosorbent Assay kit was developed using three potential biomarkers, LRG1, TTR, and CA 19-9. Using a logistic regression model trained on training data set, the predicted values for pancreatic-ductal-adenocarcinoma were obtained, and the result was classified into one of the three risk groups: low, intermediate, and high. The five covariates used to create the model were sex, age, and three biomarkers.

RESULTS: Participants were categorized into four groups as normal (n=609), other-cancer (n=145), pancreatic-benign-disease (n=314), and pancreatic-ductal-adenocarcinoma (n=923). The normal, other-cancer, and pancreatic-benign-disease groups were clubbed into the non-pancreatic-ductal-adenocarcinoma group (n=1068). The positive and negative predictive value, sensitivity, and specificity were 94.12, 90.40, 93.81, and 90.86, respectively.

CONCLUSIONS: This study demonstrates a significant diagnostic performance of the multi-marker panel in distinguishing pancreatic-ductal-adenocarcinoma from normal and benign pancreatic disease states, as well as patients with other cancers.

PMID:33991409 | DOI:10.1002/jhbp.986

J Magn Reson Imaging. 2021 May 15. doi: 10.1002/jmri.27684. Online ahead of print.

ABSTRACT

BACKGROUND: Endometrial carcinoma (EC) risk stratification is generally based on histological assessment. It would be beneficial to perform risk stratification noninvasively by MRI.

PURPOSE: To investigate the application of amide proton transfer-weighted imaging (APTWI), monoexponential, biexponential, and stretched exponential intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) for the evaluation of risk stratification in early-stage EC.

STUDY TYPE: Prospective.

POPULATION: Eighty patients with early-stage EC (47 classified as low risk, 20 as medium risk, and 13 as high risk by histological grade and International Federation of Gynecology and Obstetrics stage).

FIELD STRENGTH/SEQUENCE: T1-weighted imaging, T2-weighted imaging, IVIM, APTWI, and DKI MRI at 3 T.

ASSESSMENT: The magnetization transfer ratio asymmetry (MTRasym [3.5 ppm]), apparent diffusion coefficient (ADC), diffusion coefficient (D), pseudo diffusion coefficient (D*), perfusion fraction (f), distributed diffusion coefficient (DDC), water molecular diffusion heterogeneity index (α), mean kurtosis (MK), and mean diffusivity (MD) were calculated and compared between low-risk and non-low-risk groups.

STATISTICAL TESTS: Individual sample t test, analysis of variance, and logistic regression. A P-value <0.05 was considered statistically significant.

RESULTS: The α, ADC, D, DDC, and MD were significantly higher and the f, MK, and MTRasym (3.5 ppm) were significantly lower in the low-risk group than in the non-low-risk group. The difference in D* between the two groups was not significant (P = 0.289). MTRasym (3.5 ppm), D, and MK were independent predictors of risk stratification. The combination of these three parameters was better able to identify low- and non-low-risk groups than each individual parameter.

DATA CONCLUSION: The IVIM, DKI, and APTWI parameters have potential as imaging markers for risk stratification in early-stage EC.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 3.

PMID:33991377 | DOI:10.1002/jmri.27684

J Magn Reson Imaging. 2021 May 15. doi: 10.1002/jmri.27703. Online ahead of print.

ABSTRACT

BACKGROUND: Noninvasive diagnostic methods are urgently required in disease stratification and monitoring in nonalcoholic fatty liver disease (NAFLD). Multiparametric magnetic resonance imaging (MRI) is a promising technique to assess hepatic steatosis, inflammation, and fibrosis, potentially enabling noninvasive identification of individuals with active and advanced stages of NAFLD.

PURPOSE: To examine the diagnostic performance of multiparametric MRI for the assessment of disease severity along the NAFLD disease spectrum with comparison to histological scores.

STUDY TYPE: Prospective, cohort.

POPULATION: Thirty-seven patients with NAFLD.

FIELD STRENGTH/SEQUENCE: Multiparametric MRI at 3.0 T consisted of magnetic resonance (MR) spectroscopy (MRS) with multi-echo stimulated-echo acquisition mode, magnitude-based and three-point Dixon using a two-dimensional multi-echo gradient echo, MR elastography (MRE) using a generalized multishot gradient-recalled echo sequence and intravoxel incoherent motion (IVIM) using a multislice diffusion weighted single-shot echo-planar sequence.

ASSESSMENT: Histological steatosis grades were compared to proton density fat fraction measured by MRS (PDFF_MRS ), magnitude-based MRI (PDFF_MRI-M ), and three-point Dixon (PDFF_Dixon ), as well as FibroScan® controlled attenuation parameter (CAP). Fibrosis and disease activity were compared to IVIM and MRE. FibroScan® liver stiffness measurements were compared to fibrosis levels. Diagnostic performance of all imaging parameters was determined for distinction between simple steatosis and nonalcoholic steatohepatitis (NASH).

STATISTICAL TESTS: Spearman’s rank test, Kruskal-Wallis test, Dunn’s post-hoc test with Holm-Bonferroni P-value adjustment, receiver operating characteristic curve analysis. A P-value <0.05 was considered statistically significant.

RESULTS: Histological steatosis grade correlated significantly with PDFF_MRS (r_s = 0.66, P < 0.001), PDFF_MRI-M (r_s = 0.68, P < 0.001), and PDFF_Dixon (r_s = 0.67, P < 0.001), whereas no correlation was found with CAP. MRE and IVIM diffusion and perfusion significantly correlated with disease activity (r_s = 0.55, P < 0.001, r_s = -0.40, P = 0.016, r_s = -0.37, P = 0.027, respectively) and fibrosis (r_s = 0.55, P < 0.001, r_s = -0.46, P = 0.0051; r_s = -0.53, P < 0.001, respectively). MRE and IVIM diffusion had the highest area-under-the-curve for distinction between simple steatosis and NASH (0.79 and 0.73, respectively).

DATA CONCLUSION: Multiparametric MRI is a promising method for noninvasive, accurate, and sensitive distinction between simple hepatic steatosis and NASH, as well as for the assessment of steatosis and fibrosis severity.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: 2.

PMID:33991378 | DOI:10.1002/jmri.27703

Aging Clin Exp Res. 2021 May 15. doi: 10.1007/s40520-021-01870-7. Online ahead of print.

ABSTRACT

PURPOSE: A randomized controlled trial was conducted to investigate whether cognitive behavioral therapy (CBT) can improve postoperative pain, knee function, and negative emotion in patients aged 70 years and older who underwent total knee arthroplasty (TKA).

METHODS: This study used randomized, parallel group, controlled trial to divide the included 90 patients into CBT group and usual care group. The primary outcome measure of the study was the Visual Analogue Scale (VAS) at activity. The secondary outcome measures included the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Knee Range of Motion (ROM), Oxford Knee Score (OKS), Hospital for Special Surgery Knee Rating Scale (HSS), analgesics dose, and postoperative complications.

RESULTS: 83 patients who met the criteria were randomized into CBT group and usual care group. In the SAS, score of the CBT group decreased by 4.3 points at 7th day and 8.2 at 14th day after surgery with respect to preoperative SAS score, the usual care group increased by 1.5 at 7th day and decreased 1.1 at 14th day, and tended to be similar at 3rd month after surgery. There were no significant differences at 7th and 14th day in SDS, however, score of the CBT group was 5.8 and the usual care group was 1.9 at 3rd month after surgery. No statistically significant differences in VAS at activity, ROM, OKS, HSS, analgesics frequency, and postoperative complications between two groups.

CONCLUSIONS: CBT was superior to usual care group in relieving anxiety at 7th day and 14th day, and depression at 3rd month, however, CBT cannot relieve postoperative pain and improve joint function after TKA in patients aged 70 years and older.

PMID:33991330 | DOI:10.1007/s40520-021-01870-7