Tag: nevin manimala

Cancer. 2021 Apr 23. doi: 10.1002/cncr.33599. Online ahead of print.

ABSTRACT

BACKGROUND: Prior studies reveal a lack of illness understanding and prognostic awareness among patients with hematologic malignancies. Prognostic awareness and illness understanding among hospitalized patients with acute leukemia and multiple myeloma were evaluated, and patient-oncologist discordance was measured.

METHODS: Patients with acute leukemia and multiple myeloma hospitalized at Mount Sinai Hospital between February 2018 and February 2020 were enrolled. Patients were administered a survey assessing prognostic awareness, goals of care (GOC), and quality of life. Oncologists completed a similar survey for each patient. Discordance across the cohort of patients and oncologists using the likelihood-ratio χ² test and within patient-oncologist pairs using the κ statistic was assessed.

RESULTS: Sixty patients and 15 oncologists were enrolled. Among patients, 32 (53%) self-identified as White, 15 (25%) as self-identified as Black, and 9 (15%) self-identified as Hispanic. Across the entire cohort, patients were significantly more optimistic about treatment goals compared to oncologists (P < .001). Within patient-oncologist pairs, oncologists were significantly more optimistic than patients with respect to line of treatment (κ = 0.03). There was also a significant difference surrounding life expectancy (κ = 0.05), with 39 patients (65%) responding “don’t know” or deferring to a faith-based response compared to 18 oncologists (30%).

CONCLUSIONS: Significant discordance regarding prognosis and GOC among patients with hematologic malignancies and their oncologists was observed. These data support future interventions to improve prognostic understanding among this patient population to facilitate informed treatment choices.

LAY SUMMARY: Patients with blood cancer are known to have poor levels of illness understanding, and the role of patient-oncologist discordance is not well studied. We surveyed patients and oncologists about their understanding of disease prognosis, goals of care, and quality of life. We measured differences in patients’ and oncologists’ understanding of these key factors by comparing survey responses. There was significant disagreement between patients and oncologists surrounding prognosis and goals of care. Interventions are needed to improve patients’ understanding of prognosis, which will help them make more informed, value-aligned treatment choices.

PMID:33891716 | DOI:10.1002/cncr.33599

J Magn Reson Imaging. 2021 Apr 23. doi: 10.1002/jmri.27649. Online ahead of print.

ABSTRACT

BACKGROUND: Due to random motion of fetuses and maternal respirations, image quality of fetal brain MRIs varies considerably. To address this issue, visual inspection of the images is performed during acquisition phase and after 3D-reconstruction, and the images are re-acquired if they are deemed to be of insufficient quality. However, this process is time-consuming and subjective. Multi-instance (MI) deep learning methods (DLMs) may perform this task automatically.

PURPOSE: To propose an MI count-based DLM (MI-CB-DLM), an MI vote-based DLM (MI-VB-DLM), and an MI feature-embedding DLM (MI-FE-DLM) for automatic assessment of 3D fetal-brain MR image quality. To quantify influence of fetal gestational age (GA) on DLM performance.

STUDY TYPE: Retrospective.

SUBJECTS: Two hundred and seventy-one MR exams from 211 fetuses (mean GA ± SD = 30.9 ± 5.5 weeks).

FIELD STRENGTH/SEQUENCE: T₂ -weighted single-shot fast spin-echo acquired at 1.5 T.

ASSESSMENT: The T₂ -weighted images were reconstructed in 3D. Then, two fetal neuroradiologists, a clinical neuroscientist, and a fetal MRI technician independently labeled the reconstructed images as 1 or 0 based on image quality (1 = high; 0 = low). These labels were fused and served as ground truth. The proposed DLMs were trained and evaluated using three repeated 10-fold cross-validations (training and validation sets of 244 and 27 scans). To quantify GA influence, this variable was included as an input of the DLMs.

STATISTICAL TESTS: DLM performance was evaluated using precision, recall, F-score, accuracy, and AUC values.

RESULTS: Precision, recall, F-score, accuracy, and AUC averaged over the three cross validations were 0.85 ± 0.01, 0.85 ± 0.01, 0.85 ± 0.01, 0.85 ± 0.01, 0.93 ± 0.01, for MI-CB-DLM (without GA); 0.75 ± 0.03, 0.75 ± 0.03, 0.75 ± 0.03, 0.75 ± 0.03, 0.81 ± 0.03, for MI-VB-DLM (without GA); 0.81 ± 0.01, 0.81 ± 0.01, 0.81 ± 0.01, 0.81 ± 0.01, 0.89 ± 0.01, for MI-FE-DLM (without GA); and 0.86 ± 0.01, 0.86 ± 0.01, 0.86 ± 0.01, 0.86 ± 0.01, 0.93 ± 0.01, for MI-CB-DLM with GA.

DATA CONCLUSION: MI-CB-DLM performed better than other DLMs. Including GA as an input of MI-CB-DLM improved its performance. MI-CB-DLM may potentially be used to objectively and rapidly assess fetal MR image quality.

EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 3.

PMID:33891778 | DOI:10.1002/jmri.27649

J Magn Reson Imaging. 2021 Apr 23. doi: 10.1002/jmri.27650. Online ahead of print.

ABSTRACT

BACKGROUND: According to the Liver Imaging Reporting and Data System (LI-RADS), the LI-RADS category M (LR-M), which are probably or definitely malignant but are not specific for hepatocellular carcinomas (HCCs), does not exclude HCCs. A gap in knowledge remains, including their characteristics and recurrence of HCCs categorized as LR-M.

PURPOSE: To compare the characteristics of HCCs categorized as LR-M with HCCs categorized as LR-4 or LR-5 (LR-4/5) using the LI-RADS version 2018 and evaluate the relationship of these categories with the risk of early recurrence after curative resections of single HCCs.

STUDY TYPE: Retrospective.

SUBJECTS: Two hundred and eighty-one patients (mean age, 57 years; 191 men and 90 women) who underwent curative resections for single HCCs and preoperative contrast-enhanced MRI between 2015 and 2017.

FIELD STRENGTH/SEQUENCE: 3T Dual gradient-echo T₁ WI with in- and opposed-phase, turbo spin-echo T₂ WI, diffusion-weighted echo-planar images, and three-dimensional gradient-echo T₁ WI before and after administration of contrast agent.

ASSESSMENT: MRI features according to the LI-RADS version 2018 were evaluated and LI-RADS category were assigned for each observation. Clinical, imaging, and histopathological features were compared based on LI-RADS categorization. Early recurrence rates (<2 years) and associated factors were also evaluated.

STATISTICAL TESTS: Fisher’s exact test, two-sample t test after satisfying assumption of normality through Shapiro-Wilk test, Fleiss κ coefficient, Cox proportional hazards regression analysis, Kaplan-Meier method, and log-rank test.

RESULTS: Forty-one HCCs (14.6%) were categorized as LR-M and 240 HCCs (85.4%) were categorized as LR-4/5. LR-M HCCs showed poorer differentiation than LR-4/5 HCCs. In the multivariate analysis, the LR-M category was an independent predictor for early recurrence (hazard ratio, 1.904; 95% confidence interval, 1.024-3.542; P < 0.05). Early recurrence rates were significantly higher in patients with LR-M HCCs than in patients with LR-4/5 HCCs (32.0% vs. 18.4%, respectively, P < 0 05).

DATA CONCLUSION: Compared to LR-4/5 HCCs, LR-M HCCs were associated with poorer tumor differentiation and higher early recurrence rates after curative resections of single HCCs.

LEVEL OF EVIDENCE: 3 Technical Efficacy Stage: 2.

PMID:33891790 | DOI:10.1002/jmri.27650

PLoS One. 2021 Apr 23;16(4):e0250744. doi: 10.1371/journal.pone.0250744. eCollection 2021.

ABSTRACT

Exposures to heavy metals have been linked to prostate cancer risk. The relationship of these exposures with serum prostate-specific antigen (PSA), a marker used for prostate cancer screening, is unknown. We examined whether total urinary arsenic, urinary dimethylarsonic acid, blood cadmium, blood lead, and total blood mercury levels are associated with elevated PSA among presumably healthy U.S. men. Prostate cancer-free men, aged ≥40 years, were identified from the 2003-2010 National Health and Nutrition Examination Survey. Logistic regression analyses with survey sample weights were used to examine the association between heavy metal levels and elevated PSA for the total population and stratified by black and white race, after adjusting for confounders. There were 5,477 men included. Approximately 7% had elevated PSA. Men with an elevated PSA had statistically significantly higher levels of blood cadmium and blood lead compared to men with a normal PSA (p-values ≤ 0.02), with black men having higher levels. After adjusting for age, race/ethnicity, body mass index, smoking, and education, there was no association found between any of the heavy metal levels and elevated PSA for the total population. In addition, there was no association found when stratified by black and white race. Further investigation is warranted in a larger cohort of men who persistently are exposed to these heavy metals.

PMID:33891655 | DOI:10.1371/journal.pone.0250744

PLoS One. 2021 Apr 23;16(4):e0250716. doi: 10.1371/journal.pone.0250716. eCollection 2021.

ABSTRACT

INTRODUCTION: Colorectal cancer(CRC) is 3rd most common cancer and has a relatively high mortality rate. Currently, the relationships between CRC and serum cholesterol or statin treatment, especially in older adults under 75 years of age, remain questionable due to a lack of data. The present study evaluated the association between serum cholesterol levels and statin treatment continuity and CRC risk in older adults under 75 years of age.

METHODS: This study used senior cohort data obtained from the National Health Insurance Service of South Korea. The selected cohort contains 131,266 participants who were enrolled from 2009 to 2011 and followed for up to 5 years. Serum cholesterol levels were classified as categorical variables, and continuity of statin treatment was evaluated based on dyslipidemia diagnosis and average medication possession ratio. We used Cox regression analysis to evaluate the associations between CRC risk and serum cholesterol level or statin use.

RESULTS: A low level of high-density lipoprotein cholesterol(HDL-C) was significantly associated with high CRC risk compared to an HDL-C level in the normal range(hazard ratio [HR]: 1.197, 95% CI: 1.040-1.377). A high level of low-density lipoprotein cholesterol(LDL-C) was associated with increased CRC risk compared to a normal LDL-C level, but not statistically significant. Statin use was associated with decreased CRC risk, and high medication compliance was inversely associated with CRC risk in patients with and without dyslipidemia.

CONCLUSIONS: Statin use was associated with decreased CRC risk, and high medication compliance was inversely associated with CRC risk in patients with and without dyslipidemia compared to non-use of medication. Regular health examinations can help identify individuals who are vulnerable to CRC, and continued statin use may be associated with a reduced risk of CRC. This is particularly important in patients with diabetes and dyslipidemia.

PMID:33891657 | DOI:10.1371/journal.pone.0250716

Invest Ophthalmol Vis Sci. 2021 Apr 1;62(4):28. doi: 10.1167/iovs.62.4.28.

ABSTRACT

PURPOSE: Corneal alkali burns (CABs) are a common clinical ocular disease, presenting a poor prognosis. Although some long noncoding RNAs (lncRNAs) reportedly play a key role in epigenetic regulation associated with CABs, studies regarding the lncRNA signature in CABs remain rare and elusive.

METHODS: A CAB model was established in C57BL/6J mice and profiling of lncRNA expressions was performed by RNA-Seq. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were conducted to predicate the related pathological pathways and candidate genes. RT-qPCR was used to verify the expression pattern of lncRNAs and related mRNAs, both in vitro and in vivo. Data were statistically analyzed by GraphPad Prism version 6.0.

RESULTS: In all, 4436 aberrantly expressed lncRNAs were identified in CAB mice when compared with control mice. In the top 13 aberrantly expressed lncRNAs, Bc037156 and 4930511E03Rik were confirmed as the most significantly altered lncRNAs. Pathway analysis revealed that mitogen-activated protein kinase (MAPK) signaling pathway was most enriched. Following 4930511E03Rik siRNA treated, Srgn, IL-1β and Cxcr2 were significant upregulated in corneal epithelial cells, corneal keratocytes, and bone marrow dendritic cells, with NaOH treatment. Moreover, after Bc037156 siRNA treated, expression levels of IL-1β and Srgn were significantly downregulated in the three cell lines.

CONCLUSIONS: Our study suggests that Bc037156 and 4930511E03Rik may be involved in inflammation, immune response, and neovascularization by regulating Srgn, IL-1β, and Cxcr2 expression after CAB. These candidate lncRNAs and mRNAs may be the potential targets for the treatment strategy of the alkali injured cornea.

PMID:33891681 | DOI:10.1167/iovs.62.4.28

PLoS One. 2021 Apr 23;16(4):e0250494. doi: 10.1371/journal.pone.0250494. eCollection 2021.

ABSTRACT

Differences in technical efficiency across farms are one of the major factors explaining differences in farm survival and growth and changes in farm industry structure. This study employs Data Envelopment Analysis (DEA) to compute technical inefficiency scores for output, energy, materials, pesticides and fertiliser of a sample of Dutch indoor vegetable farms within the period 2006-2016. A bootstrap truncated regression model is used to determine statistical associations between producer-specific characteristics and technical inefficiency scores for the specified inputs. For the sample of indoor growers, the average technical inefficiency was about 14% for energy, 23% for materials, 24% for pesticides and 22% for fertilisers. The bootstrap truncated regression suggested that the degree of specialisation exerts adverse effects on the technical inefficiency of variable inputs. While age, short-term, long-term debt and subsidy were statistically significant, the coefficients were not economically significant. Building the capacity of farmers to reduce input inefficiency will enable farmers to be competitive and reduce the adverse effects of input overuse on the environment.

PMID:33891634 | DOI:10.1371/journal.pone.0250494

PLoS One. 2021 Apr 23;16(4):e0250348. doi: 10.1371/journal.pone.0250348. eCollection 2021.

ABSTRACT

The size of a city is not only essential for depicting the scale of the urban system, but also crucial to support the prosperity, order, and high-speed developments. However, its relation to the underlying urban structure has not been empirically investigated in detail. To examine the impact of city size on the city structure and quantify structural features, in this study, a statistical analysis was performed based on network science and an interdisciplinary theoretical system. To obtain the statistical law of internal node layout, the urban system was regarded as a complete graph weighted by the Euclidean distance. The relationship between the urban internal nodes layout (points of interest data, Weibo check-in data, and central point of road intersection data) and the city size was established. The results confirmed the existence of statistical laws in the layout of urban spatial elements, and explored the relationship between the changes in urban node network structure and inequality. This study provided a new perspective of urban structure to understand the complexity of the city, and suggested an approach to adjust this structure to narrow down the gap between the urban and rural areas.

PMID:33891635 | DOI:10.1371/journal.pone.0250348

PLoS One. 2021 Apr 23;16(4):e0250447. doi: 10.1371/journal.pone.0250447. eCollection 2021.

ABSTRACT

BACKGROUND: Many mothers still give birth outside a health facility in Sub-Saharan Africa particularly in East African countries. Though there are studies on the prevalence and associated factors of health facility delivery, as to our search of literature there is limited evidence on the pooled prevalence and associated factors of health facility delivery in East Africa. This study aims to examine the pooled prevalence and associated factors of health facility delivery in East Africa based on evidence from Demographic and Health Surveys.

METHODS: A secondary data analysis was conducted based on the most recent Demographic and Health Surveys (DHSs) conducted in the 12 East African countries. A total weighted sample of 141,483 reproductive-age women who gave birth within five years preceding the survey was included. All analyses presented in this paper were weighted for the sampling probabilities and non-response using sampling weight (V005), primary sampling unit (V023), and strata (V021). The analysis was done using STATA version 14 statistical software, and the pooled prevalence of health facility delivery with a 95% Confidence Interval (CI) was presented using a forest plot. For associated factors, the Generalized Linear Mixed Model (GLMM) was fitted to consider the hierarchical nature of the DHS data. The Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), and Likelihood Ratio (LR)-test were done to assess the presence of a significant clustering effect. Besides, deviance (-2LLR) was used for model comparison since the models were nested models. Variables with a p-value of less than 0.2 in the bivariable mixed-effect binary logistic regression analysis were considered for the multivariable analysis. In the multivariable mixed-effect analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to declare the strength and significance of the association between the independent variable and health facility delivery.

RESULTS: The proportion of health facility delivery in East Africa was 87.49% [95% CI: 87.34%, 87.64%], ranged from 29% in Ethiopia to 97% in Mozambique. In the Mixed-effect logistic regression model; country, urban residence [AOR = 2.08, 95% CI: 1.96, 2.17], primary women education [AOR = 1.61, 95% CI: 1.55, 1.67], secondary education and higher [AOR = 2.96, 95% CI: 2.79, 3.13], primary husband education [AOR = 1.19, 95% CI: 1.14, 1.24], secondary husband education [AOR = 1.38, 95% CI: 1.31, 1.45], being in union [AOR = 1.23, 95% CI: 1.18, 1.27], having occupation [AOR = 1.11, 95% CI: 1.07, 1.15], being rich [AOR = 1.36, 95% CI: 1.30, 1.41], and middle [AOR = 2.14, 95% CI: 2.04, 2.23], health care access problem [AOR = 0.76, 95% CI: 0.74, 0.79], having ANC visit [AOR = 1.54, 95% CI: 1.49, 1.59], parity [AOR = 0.56, 95% CI: 0.55, 0.61], multiple gestation [AOR = 1.83, 95% CI: 1.67, 2.01] and wanted pregnancy [AOR = 1.19, 95% CI: 1.13, 1.25] were significantly associated with health facility delivery.

CONCLUSION: This study showed that the proportion of health facility delivery in East African countries is low. Thus, improved access and utilization of antenatal care can be an effective strategy to increase health facility deliveries. Moreover, encouraging women through education is recommended to increase health facility delivery service utilization.

PMID:33891647 | DOI:10.1371/journal.pone.0250447

PLoS One. 2021 Apr 23;16(4):e0250490. doi: 10.1371/journal.pone.0250490. eCollection 2021.

ABSTRACT

The objective of this study is to identify essential aspects influencing radiation dose in computed tomography [CT] of the chest, abdomen and pelvis by intraindividual comparison of imaging parameters and patient related factors. All patients receiving at least two consecutive CT examinations for tumor staging or follow-up within a period of 22 months were included in this retrospective study. Different CT dose estimates (computed tomography dose index [CTDIvol], dose length product [DLP], size-specific dose estimate [SSDE]) were correlated with patient’s body mass index [BMI], scan length and technical parameters (tube current, tube voltage, pitch, noise level, level of iterative reconstruction). Repeated-measures-analysis was initiated with focus on response variables (CTDIvol, DLP, SSDE) and possible factors (age, BMI, noise, scan length, peak kilovoltage [kVp], tube current, pitch, adaptive statistical iterative reconstruction [ASIR]). A univariate-linear-mixed-model with repeated-measures-analysis followed by Bonferroni adjustments was used to find associations between CT imaging parameters, BMI and dose estimates followed by a subsequent multivariate-mixed-model with repeated-measures-analysis with Bonferroni adjustments for significant parameters. A p-value <0.05 was considered statistically significant. We found all dose estimates in all imaging regions were substantially affected by tube current. The iterative reconstruction significantly influenced all dose estimates in the thoracoabdominopelvic scans as well as DLP and SSDE in chest-CT. Pitch factor affected all dose parameters in the thoracoabdominopelvic CT group. These results provide further evidence that tube current has a pivotal role and potential in radiation dose management. The use of iterative reconstruction algorithms can substantially decrease radiation dose especially in thoracoabdominopelvic and chest-CT-scans. Pitch factor should be kept at a level of ≥1.0 in order to reduce radiation dose.

PMID:33891632 | DOI:10.1371/journal.pone.0250490