Tag: pubmed

J Appl Clin Med Phys. 2023 Nov 12:e14198. doi: 10.1002/acm2.14198. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate the impact of reducing Clinical Target Volume (CTV) to Planning Target Volume (PTV) margins on delivered radiation therapy (RT) dose and patient reported quality-of-life (QOL) for patients with localized prostate cancer.

METHODS: Twenty patients were included in a single institution IRB-approved prospective study. Nine were planned with reduced margins (4 mm at prostate/rectum interface, 5 mm elsewhere), and 11 with standard margins (6/10 mm). Cumulative delivered dose was calculated using deformable dose accumulation. Each daily CBCT dataset was deformed to the planning CT (pCT), dose was computed, and accumulated on the resampled pCT using a parameter-optimized, B-spline algorithm (Elastix, ITK/VTK). EPIC-26 patient reported QOL was prospectively collected pre-treatment, post-treatment, and at 2-, 6-, 12-, 18-, 24-, 36-, 48-, and 60-month follow-ups. Post -RT QOL scores were baseline corrected and standardized to a [0-100] scale using EPIC-26 methodology. Correlations between QOL scores and dosimetric parameters were investigated, and the overall QOL differences between the two groups (QOL_{Margin-reduced} -QOL_control ) were calculated.

RESULTS: The median QOL follow-up length for the 20 patients was 48 months. Difference between delivered dose and planned dose did not reach statistical significance (p > 0.1) for both targets and organs at risk between the two groups. At 4 years post-RT, standardized mean QOL_{Margin-reduced} -QOL_control were improved for Urinary Incontinence, Urinary Irritative/Obstructive, Bowel, and Sexual EPIC domains by 3.5, 14.8, 10.2, and 16.1, respectively (higher values better). The control group showed larger PTV/rectum and PTV/bladder intersection volumes (7.2 ± 5.8, 18.2 ± 8.1 cc) than the margin-reduced group (2.6 ± 1.8, 12.5 ± 8.3 cc), though the dose to these intersection volumes did not reach statistical significance (p > 0.1) between the groups. PTV/rectum intersection volume showed a moderate correlation (r = -0.56, p < 0.05) to Bowel EPIC domain.

CONCLUSIONS: Results of this prospective study showed that margin-reduced group exhibited clinically meaningful improvement of QOL without compromising the target dose coverage.

PMID:37952248 | DOI:10.1002/acm2.14198

Ir J Med Sci. 2023 Nov 12. doi: 10.1007/s11845-023-03570-9. Online ahead of print.

ABSTRACT

Artificial intelligence (AI) is a technique to make intelligent machines, mainly by using smart computer programs. It is based on a statistical analysis of data or machine learning. Using machine learning, software algorithms are designed according to the desired application. These techniques are found to have the potential for advancement in the medical field by generating new and significant perceptions from the data generated using various types of healthcare tests. Artificial intelligence (AI) in medicine is of two types: virtual and physical. The virtual part decides the treatment using electronic health record systems using various sensors whereas the physical part assists robots to perform surgeries, implants, replacement of various organs, elderly care, etc. Using AI, a machine can examine various kinds of health care test reports in one go which could save the time, money, and increase the chances of the patient to be treated without any hassles. At present, artificial intelligence (AI) is used while deciding the treatment, and medications using various tools which could analyze X-rays, CT scans, MRIs, and any other data. During the COVID pandemic, there was a huge/massive demand for AI-supported technologies and many of those were created during that time. This study is focused on various applications of AI in healthcare.

PMID:37952245 | DOI:10.1007/s11845-023-03570-9

Forensic Sci Med Pathol. 2023 Nov 12. doi: 10.1007/s12024-023-00749-5. Online ahead of print.

ABSTRACT

Gender determination of skeletal remains is an important forensic procedure in the identification process. Maxillary sinus remains intact even when the skull and other bones may be badly disfigured. Cone beam computed tomography (CBCT) can provide precise information about complex anatomical structures, as it is characterized by rapid volumetric image acquisition with high resolution. The present study aimed to assess the accuracy of maxillary sinus measurements using cone beam computed tomography in gender determination and to develop a formula using discriminate function analysis. Bilateral maxillary sinus images (left and right) were acquired for 200 patients (100 females and 100 males) and different parameters (width, length, height, area, perimeter, and volume) were measured and evaluated. Mean and standard deviation of both maxillary sinuses measurements were calculated and compared. The data was subjected to discriminative statistical analysis and analyzed using an unpaired t-test. The difference between all these variables was statistically significant between males and females. Based on discriminant analysis, the most pronounced variable in the differentiation of gender groups was maxillary sinus height. Gender assessment was established correctly with an accuracy of 75% for females and 64% for males with an overall accuracy of 69.5%. Adding other independent variables to the model did not result in an improvement in overall accuracy. Cone beam computed tomography measurement of maxillary sinus can be used as an aid in forensic anthropology for gender determination.

PMID:37952242 | DOI:10.1007/s12024-023-00749-5

J Endocrinol Invest. 2023 Nov 12. doi: 10.1007/s40618-023-02233-x. Online ahead of print.

ABSTRACT

PURPOSE: In recent years, epidemiological studies have revealed the relationship between gestational diabetes mellitus (GDM) and cardiovascular disease (CVD). In this study, we utilized Mendelian randomization (MR) to investigate the potential causal impact of GDM on cardiovascular disease for the first time.

METHODS: We retrieved summary statistics from published genome-wide association studies. MR was first performed using significant SNPs extracted from the eighth data release of the FinnGen study. Next, a replication analysis for coronary artery disease (CAD) was conducted in another European ancestry population to validate our findings. Finally, mediation analysis was carried out to assess potential mediation effects.

RESULTS: Our data analysis revealed that genetically predicted GDM was significantly associated with increased CAD risk (OR 1.10, 95% CI 1.02-1.18, p 0.006). Replication analysis confirmed a significant genetic association between GDM and CAD (OR 1.07, 95% CI 1.02-1.12, p 0.003) in another European ancestry population. Mediation analysis indicated no significant mediation effect by type 2 diabetes mellitus (T2DM) on the GDM-CAD relationship (mediation effect β [95% CI]: 0.005 [-0.003, -0.017]).

CONCLUSION: Women with a prior history of GDM face an elevated risk of future CAD. This increased risk of CAD cannot be solely attributed to the subsequent onset of diabetes. Regular CAD risk assessment and primary prevention strategies are of paramount importance for women with a history of GDM.

PMID:37952233 | DOI:10.1007/s40618-023-02233-x

Eur J Appl Physiol. 2023 Nov 12. doi: 10.1007/s00421-023-05347-5. Online ahead of print.

ABSTRACT

PURPOSE: Cancer-related fatigue (CRF) is the most reported side effect of cancer and its treatments. Mechanisms of CRF are multidimensional, including neuromuscular alterations leading to decreased muscle strength and endurance (i.e., fatigability). Recently, exercise fatigability and CRF have been related, while fatigability mechanisms remain unclear. Traditionally, fatigability is assessed from maximal voluntary contractions (MVC) decrease, but some authors hypothesized that the rate of force development (RFD) determined during a rapid contraction could also be an interesting indicator of functional alterations. However, to our knowledge, no study investigated RFD in cancer patients. The purpose of this study was to determine whether RFD, fatigability amplitude, and etiology are different between fatigued and non-fatigued cancer patients.

METHODS: Eighteen participants with cancer, divided in fatigued or non-fatigued groups according their CRF level, completed a 5-min all-out exercise in ankle plantar flexor muscles composed of 62 isometric MVC of 4 s with 1 s rest, to assess fatigability amplitude as the force-time relationship asymptote (F_A). Before and after exercise, fatigability etiologies (i.e., voluntary activation (VA) and evoked forces by electrical stimulation (Db₁₀₀)) were assessed as well as RFD in 50 and 100 ms (RFD₅₀ and RFD₁₀₀, respectively) during rapid contractions.

RESULTS: F_A is significantly lower in fatigued group. Significant differences were found between pre- and post-exercise VA, Db₁₀₀, RFD₅₀, and RFD₁₀₀ for both groups, with no statistical difference between groups.

CONCLUSION: During treatments, fatigability is higher in fatigued patients; however, the mechanisms of fatigability and RFD alterations are similar in both groups.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT04391543, May 2020.

PMID:37952231 | DOI:10.1007/s00421-023-05347-5

Childs Nerv Syst. 2023 Nov 12. doi: 10.1007/s00381-023-06214-6. Online ahead of print.

ABSTRACT

PURPOSE: Neuro-endoscopic lavage (NEL) is an increasingly popular intervention for intraventricular haemorrhage (IVH) and post-haemorrhagic hydrocephalus (PHH), with considerable variation in technique dependent on clinician and clinical circumstances. Whilst efforts to standardise the technique are ongoing, this work describes a tertiary centre experience utilising NEL, highlighting potential caveats to standardisation.

METHODS: A retrospective review of electronic case notes for patients undergoing temporising surgical intervention for IVH between 2012 and 2021 at our centre was performed. Data collected included (i) gestational age, (ii) aetiology of hydrocephalus, (iii) age at time of intervention, (iv) intervention performed, (v) need for permanent CSF diversion, (vi) ‘surgical burden’, i.e. number of procedures following primary intervention, and (vii) wound failure and infection rate. Data was handled in Microsoft Excel and statistical analysis SPSS v27.0 RESULTS: 49 neonates (n = 25 males) were included. Overall mean gestational age was 27 weeks and at intervention 35 + 3 weeks. IVH was the predominant cause of hydrocephalus (93.8%) and primary surgical interventions included insertion of a ventriculosubgaleal shunt (VSGS) in n = 41 (83.6%) patients, NEL in n = 6 (12.2%) patients and insertion of an EVD in n = 2 (4.1%). N = 9 (18.4%) patients underwent NEL at some point during the time interval reviewed; n = 4 (8.2%) received NEL monotherapy and n = 5 (10.2%) also received a VSGS. Rate of conversion to definitive CSF diversion between NEL (n = 8, 88.9%) and VSGS cohorts (n = 37, 92.5%) was not significantly different (p = 0.57), nor between NEL alone (n = 3, 75%) and NEL + VSGS (n = 5, 100%) (p = 0.44). None of the patients that underwent NEL monotherapy had any wound issues or CNS infection as a result of the initial intervention, compared to n = 3 (60%) of those that underwent NEL and implantation of VSGS (p = 0.1).

CONCLUSION: Both NEL and VSGS are effective in temporising hydrocephalus in neonates, occasionally offering a definitive solution in and of themselves. The benefit of dual therapy however remains to be seen, with the addition of VSGS potentially increasing the risk of wound failure in an already vulnerable cohort.

PMID:37952209 | DOI:10.1007/s00381-023-06214-6

Nicotine Tob Res. 2023 Nov 11:ntad223. doi: 10.1093/ntr/ntad223. Online ahead of print.

ABSTRACT

INTRODUCTION: Pictorial health warning labels on waterpipe tobacco packages represent a better strategy for communicating the health risks associated with waterpipe use and promoting quit intention than text-only. However, the mechanism by which these warnings lead to higher intentions to quit remains unknown. This study explores how pictorial warnings vs. text-only induce higher quit intention among a sample of young adult waterpipe smokers in Lebanon.

METHODS: An online randomized cross-over experimental study was conducted in August 2021 among 276 young adult waterpipe smokers who were exposed to two conditions: pictorial health warning label and text-only warning on waterpipe tobacco packages in random order. After each image, participants completed post-exposure assessments of health communication outcomes (e.g., attention and negative affect). Using serial and parallel mediation analysis, we examined the role of attention, negative affect, cognitive elaboration, and perceived harm in mediating the relationship between exposure to HWLs and intention to quit.

RESULTS: Using serial mediation, exposure to pictorial warnings vs. text-only was found to affect intention to quit through the following pathways: attention and negative affect, which accounted for 17.28% of the total effect, and through negative affect and cognitive elaboration, which accounted for 21.53% of the total effect. Results of parallel mediation showed that the indirect effect pathways via negative affect [β= 0.063; (95% bootstrap CI=0.004, 0.149)] and cognitive elaboration [0.047; (0.001, 0.114)] were statistically significant.

CONCLUSIONS: The findings call on designing and implementing attention-grabbing, emotionally evocative, and cognitively persuasive pictorial warnings in Lebanon and other countries to curb waterpipe tobacco smoking.

IMPLICATIONS: This is among the first experimental studies looking at multiple mediators underlying the effect of exposure to pictorial health warning labels on intention to quit in a sample of current waterpipe smokers in Lebanon. The findings showed that using attention-grabbing, emotionally evocative, and persuasive pictures with a clear textual warning is crucial to maximizing the impact of implementing waterpipe health warning labels regulations in Lebanon and other countries to curb waterpipe tobacco smoking.

PMID:37952202 | DOI:10.1093/ntr/ntad223

Eur J Cardiothorac Surg. 2023 Nov 11:ezad385. doi: 10.1093/ejcts/ezad385. Online ahead of print.

ABSTRACT

Prognostic models are widely used across medicine and within cardiothoracic surgery, where predictive tools such as EuroSCORE are commonplace. Such models are a useful component of clinical assessment but may be misapplied. In this article, we demonstrate some of the major issues with risk scores by using the popular BBC television programme Strictly Come Dancing (SCD; known as Dancing with the Stars in many other countries) as an example. We generated a multivariable prognostic model using data from the then completed 19 series of SCD to predict prospectively the results of the 20th series. The initial model based solely on demographic data was limited in its predictive value (0.25, 0.22; R2 and Spearman’s Rank Correlation respectively) but was substantially improved following introduction of early judges’ scores deemed representative of whether contestants could actually dance (0.40, 0.30). Finally, we utilise our model to discuss the difficulties and pitfalls in using and interpreting prognostic models in cardiothoracic surgery and beyond, particularly where these do not adequately capture potentially important prognostic information.

PMID:37952190 | DOI:10.1093/ejcts/ezad385

Circulation. 2023 Nov 12. doi: 10.1161/CIRCULATIONAHA.123.067512. Online ahead of print.

ABSTRACT

Background: Device-detected atrial fibrillation (AF) (also known as subclinical AF or atrial high-rate episodes) is a common finding in patients with an implanted cardiac rhythm device and is associated with an increased risk of ischemic stroke. Whether oral anticoagulation is effective and safe in this patient population is unclear. Methods: We performed a systematic review of MEDLINE and Embase for randomized trials comparing oral anticoagulation to antiplatelet or no antithrombotic therapy in adults with device-detected AF recorded by a pacemaker, implantable cardioverter-defibrillator, cardiac resynchronization therapy device or implanted cardiac monitor. We used random-effects models for meta-analysis and rated the quality of evidence using the GRADE framework. The review was pre-registered (PROSPERO CRD42023463212). Results: From 785 unique citations, we identified two randomized trials with relevant clinical outcome data; NOAH-AFNET 6 (2,536 participants) evaluated edoxaban and ARTESiA (4,012 participants) evaluated apixaban. Meta-analysis demonstrated that oral anticoagulation with these agents reduced ischemic stroke (relative risk [RR] 0.68, 95% confidence interval [CI] 0.50-0.92; high-quality evidence). The results from the two trials were consistent (I² statistic for heterogeneity=0%). Oral anticoagulation also reduced a composite of cardiovascular death, all-cause stroke, peripheral arterial embolism, myocardial infarction or pulmonary embolism (RR 0.85, 95% CI 0.73-1.00, I²=0%; moderate-quality evidence). There was no reduction in cardiovascular death (RR 0.95, 95% CI 0.76-1.17, I²=0%; moderate-quality evidence) or all-cause mortality (RR 1.08, 95% CI 0.96-1.21 I²=0%; moderate-quality evidence). Oral anticoagulation increased major bleeding (RR 1.62, 95% CI 1.05-2.5 I^²=61%; high-quality evidence). Conclusions: The results of the NOAH-AFNET 6 and ARTESiA trials are consistent with each other. Meta-analysis of these two large randomized trials provides high-quality evidence that oral anticoagulation with edoxaban or apixaban reduces the risk of stroke in patients with device-detected AF and increases the risk of major bleeding.

PMID:37952187 | DOI:10.1161/CIRCULATIONAHA.123.067512

Gerontol Geriatr Educ. 2023 Nov 12:1-12. doi: 10.1080/02701960.2023.2280061. Online ahead of print.

ABSTRACT

Researchers conducted a four-week pilot sexual health education intervention to investigate changes among older adults’ attitudes about and comfort with sexuality. Six adults between the ages of 74-83 participated in a pilot intervention on sexual health and were administered a pretest and posttest on comfort with and attitudes about sexuality. The intervention included information on personal history of sexuality, sex education, masturbation, sexuality and bodily change in older adulthood, safe sex, healthy relationships, and talking to health care providers. Descriptive statistics for average responses in the pretest and posttest before and after the intervention were used to highlight differences among the participants. Implications for gerontologists, geriatric providers, and education and research regarding older adults are shared.

PMID:37952185 | DOI:10.1080/02701960.2023.2280061