Tag: pubmed

Int J Radiat Oncol Biol Phys. 2023 Jul 21:S0360-3016(23)07647-2. doi: 10.1016/j.ijrobp.2023.07.015. Online ahead of print.

ABSTRACT

BACKGROUND: Radiation necrosis (RN) secondary to stereotactic radiosurgery is a significant cause of morbidity. The optimal management of corticosteroid-refractory brain RN remains unclear.

OBJECTIVE: To summarise the literature specific to efficacy and toxicity of treatment paradigms for patients with symptomatic corticosteroid refractory RN. To provide consensus guidelines for grading and management of RN on behalf of the International Stereotactic Radiosurgery Society (ISRS).

METHODS: A systematic review of articles pertaining to treatment of RN with bevacizumab, laser interstitial thermal therapy (LITT), surgical resection, or hyperbaric oxygen therapy (HBOT) was performed. The primary composite outcome was clinical and/or radiological stability/ improvement (i.e., proportion of patients achieving improvement or stability with the given intervention). Proportions of patients achieving the primary outcome were pooled using random weighted-effects analysis, but not directly compared between interventions.

RESULTS: Twenty-one articles were included, of which only two were prospective studies. Thirteen reports were relevant for bevacizumab, 5 for LITT, 5 for surgical resection and 1 for HBOT. Weighted effects analysis revealed that bevacizumab had a pooled symptom improvement/stability rate of 86% (95% CI: 77-92%), pooled T2 imaging improvement/stability rate of 93% (95% CI: 87 -98%), and pooled T1-post contrast improvement/stability rate of 94% (95% CI: 87 – 98%). Subgroup analysis showed a statistically significant improvement favouring treatment with low-dose (below median, ≤7.5 mg/kg every 3 weeks) vs. high-dose bevacizumab with regards to symptom improvement/stability rate (P=0.02), but not for radiological T1 or T2 changes. The pooled T1-post contrast improvement/stability rate for LITT was 88% (95% CI 82 – 93%), and pooled symptom improvement/stability rate for surgery was 89% (95% CI 81 – 96%). Toxicity was inconsistently reported but was generally low for all treatment paradigms.

CONCLUSION: Corticosteroid-refractory RN that does not need urgent surgical intervention, with sufficient non-invasive diagnostic testing that favours RN, can be treated medically with bevacizumab in carefully selected patients as a strong recommendation. The role of LITT is evolving as a less invasive image-guided surgical modality, however, the overall evidence for each modality is of low quality. Prospective head-to-head comparisons are needed to evaluate the relative efficacy and toxicity profile amongst treatment approaches.

PMID:37482137 | DOI:10.1016/j.ijrobp.2023.07.015

Int J Radiat Oncol Biol Phys. 2023 Jul 21:S0360-3016(23)07649-6. doi: 10.1016/j.ijrobp.2023.07.017. Online ahead of print.

ABSTRACT

INTRODUCTION: The aim of this study is to report pulmonary function tests (PFTs), clinician-reported and patient-reported QoL outcomes on a cohort of NSCLC patients treated with SABR.

METHODS: 119 patients with NSCLC were treated with SABR in the prospective cohort SSBROC study of patients with T1-T2N0M0 NSCLC. PFTs and quality of life measures were obtained at baseline pre-treatment and 6 monthly. Here we report on the 6- to 18-month time points. ANCOVA methods adjusting for baseline analysed potential predictors on outcomes of PFT and patient-reported dyspnoea at 18 months.

RESULTS: The only statistically significant decline in PFTs was seen in FEV1 at 18 months post-SABR with a decline of -0.11L (p = 0.0087, 95% CI -0.18 to -0.02). Of potential predictors of decline, only a 1 unit increase in smoking pack years resulted in a -0.12 change in DLCO (p = 0.026, 95% CI -0.02 to -0.23) and a 0.003 decrease in FEV1 (p = 0.026, 95% CI -0.006 to -0.0004). For patient reported outcomes, statistically significant worsening in both QLQC30 and QLQLC13 dyspnoea scores occurred at the 18-month time point, but not earlier. No potential predictors of worsening dyspnoea were statistically significant. There was no statistically significant decline in clinician-reported outcomes or global QoL scores.

CONCLUSIONS: We found a statistically significant decline in FEV1 at 18 months post-treatment. Smoking pack years was a predictor for decline in DLCO and FEV1 at 18 months. Worsening of patient-reported dyspnoea scores was observed, consistent with the expected progression of lung co-morbid disease.

PMID:37482136 | DOI:10.1016/j.ijrobp.2023.07.017

Complement Ther Med. 2023 Jul 21:102966. doi: 10.1016/j.ctim.2023.102966. Online ahead of print.

ABSTRACT

BACKGROUND: Ayurveda interventions have been used for prophylaxis and care during the COVID-19 pandemic in India and have shown promising results in promoting early clinical recovery from COVID-19.

OBJECTIVE: To assess the efficacy and safety of Ashwagandha [Withania somnifera (L.) Dunal] tablet and Shunthi (Zingiber officinale Roscoe) capsule in mild and moderate COVID-19 compared to conventional standard care.

METHODS: A randomized controlled exploratory trial was conducted at a designated COVID-19 care center in India with 60 participants having mild or moderate COVID-19. Ashwagandha, two tablets (250mg each), and Shunthi, two capsules (500mg each) twice daily for 15 days, were given orally to the participants in the Ayurveda group (AG) and the control group (CG) received conventional standard care. The outcome measures included clinical recovery rate, the proportion of participants with negative RT-PCR assay for COVID-19 on day 7 and day 15, mean time to attain clinical recovery, change in pro-inflammatory markers, serum IgG for COVID-19, HRCT chest findings, disease progression and incidence of adverse events (AE).

RESULTS: A total of 60 participants were enrolled, and the data of 48 participants (AG = 25 and CG = 23) were considered for the statistical analysis. The mean time for clinical recovery was reduced by almost 50% in the AG (6.9 days) compared to CG (13.0 days) (p<0.001). The proportion of participants who attained viral clearance in AG was 76.0% compared to 60.8% in the CG (RR= 1.24, 95% CI: 0.841, 1.851, p-value = 0.270). Changes in the pro-inflammatory markers, serum IgG for COVID-19, and HRCT chest findings were comparable in both groups, and no AE or disease progression was reported.

CONCLUSIONS: The Ayurveda interventions, Ashwagandha and Shunthi, can effectively reduce the duration of clinical recovery and improve time for viral clearance in mild and moderate COVID-19 is safe and well-tolerated during the duration of the trial.

TRIAL REGISTRATION: Clinical Trial Registry of India – CTRI/2020/08/027224.

PMID:37482107 | DOI:10.1016/j.ctim.2023.102966

Cerebrovasc Dis. 2023 Jul 21. doi: 10.1159/000531861. Online ahead of print.

ABSTRACT

INTRODUCTION: Several observational studies have indicated that polyunsaturated fatty acids serum levels (PUFAs) are associated with vascular dementia (VaD), but their causal relationships remain elusive. Therefore, we attempted to evaluate the causal effect of PUFAs on VaD in a two-sample Mendelian randomization (MR) analysis by using summary statistics from aggregated genome-wide association studies.

METHODS: The inverse-variance weighted (IVW) method was performed as the primary analysis. Sensitivity analyses (MR-Egger regression, weighted median, penalized weighted median and MR pleiotropy residual sum and outlier methods) were also implemented to estimate the effects of potential violations of MR hypotheses.

RESULTS: No causality was found for PUFAs (OR, 1.14; 95% CI, .91-1.42; p = .25) on VaD in the IVW model. The results were consistent in sensitivity analyses. There was no notable horizontal pleiotropy or heterogeneity.

CONCLUSION: In this two-sample MR analysis, our findings did not support the assumption that PUFAs play causal role in the occurrence or development of VaD.

PMID:37482052 | DOI:10.1159/000531861

Water Res. 2023 Jul 13;243:120344. doi: 10.1016/j.watres.2023.120344. Online ahead of print.

ABSTRACT

Understanding response of bacterioplankton community responsible for maintaining ecological functions of aquatic ecosystems to environmental disturbance is an important subject. However, it remains largely unclear how bacterioplankton generalists and specialists respond to dredging disturbance. Illumina MiSeq sequencing and statistical analyses were used to evaluate landscape patterns, evolutionary potentials, environmental adaptability, and community assembly processes of generalists and specialists in response to dredging in eutrophic Lake Nanhu. The Proteobacteria and Actinobacteria dominated bacterioplankton communities of generalists and specialists, and abundances of Proteobacteria decreased and Actinobacteria increased after dredging. The generalists displayed higher phylogenetic distance, richness difference, speciation rate, extinction rate, and diversification rate as well as stronger environmental adaptation than that of specialists. In contrast, the specialists rather than generalists showed higher community diversity, taxonomic distance, and species replacement as well as closer phylogenetic clustering. Stochastic processes dominated community assemblies of generalists and specialists, and stochasticity exhibited a larger effect on community assembly of generalists rather than specialists. Our results emphasized that lake dredging could change landscape patterns of bacterioplankton generalists and specialists, whereas the short-term dredging conducted within one year was unable to reverse community difference between generalists and specialists. Our findings extend our understanding of how bacterioplankton generalists and specialists responding to dredging disturbance, and these findings might in turn call on long-term dredging for better ecological restoration of eutrophic lakes.

PMID:37482008 | DOI:10.1016/j.watres.2023.120344

Water Res. 2023 Jul 13;243:120352. doi: 10.1016/j.watres.2023.120352. Online ahead of print.

ABSTRACT

Thirty-two short term (∼7.5 h) abiotic experiments were conducted with new ductile iron and copper coupons exposed to various water qualities, including pH (7 or 9), dissolved inorganic carbon (DIC, 10 or 50 mg C L^-1) and phosphate (0 or 3 mg P L^-1) concentrations and 4 mg Cl₂ L^-1 free chlorine or monochloramine. To quantify oxidant reactivity with the new metal coupons, microelectrodes were used to obtain oxidant (free chlorine or monochloramine and dissolved oxygen (DO)) concentration and pH microprofiles from the bulk water to near the metal coupon surface. From the microprofiles, apparent surface reaction rate constants (k) were determined for each oxidant. An ANOVA analysis evaluated if the five variables (Material, Oxidant, Phosphate, DIC, and pH) significantly affected estimates of k, finding that the Material and Oxidant variables and their interaction were statistically significant (p<0.05), but the effect of variables of Phosphate, DIC, and pH on k values were not significant in this study. In general, both ductile iron and copper coupons showed significant surface reactivity towards free chlorine and monochloramine. For ductile iron, DO consumption was greater than for copper, which showed minimal DO reactivity, and DO was less reactive towards the copper surface than either free chlorine or monochloramine. Furthermore, pH microprofiles provided insight into the complexity that might exist near corroding metal surfaces where the bulk water pH may be substantially different from that measured near metal surfaces which is significant as pH is a controlling variable in terms of scale formation and metal solubility. This study represents an important first step towards using microelectrodes to (1) understand and provide direct measurement of oxidant microprofiles from the bulk water to the metal surface; (2) determine pipe wall reactivity using the directly measured concentrations profiles versus estimated pipe wall reactivity from bulk water measurements, and (3) understand how variables measured by bulk water samples (e.g., pH) may be drastically different from what is occurring at and near the metal surface. Together, these insights will assist in understanding disinfectant residual maintenance, corrosion, and metal release.

PMID:37482000 | DOI:10.1016/j.watres.2023.120352

Psychoneuroendocrinology. 2023 Jul 14;156:106334. doi: 10.1016/j.psyneuen.2023.106334. Online ahead of print.

ABSTRACT

BACKGROUND: A high prevalence of mental disorders following COVID-19 has been described. It is therefore essential to elucidate underlying biological mechanisms linking SARS-CoV-2 infection and mental health. The kynurenine and catecholamine metabolic pathways are modulated by inflammation and can affect systemic levels of serotonin and dopamine. Their activity may hence link physical disorders with mental health. We investigated factors that affect kynurenine and catecholamine pathway activity in SARS-CoV-2 infection and recovery.

METHODS: The cross-sectional SIMMUN (n = 165) and longitudinal INCOV cohort (n = 167, Su et al. 2022) were analyzed. Demographic and clinical characteristic, inflammatory markers, SARS-CoV-2 infection, symptoms of depression and anxiety (HADS), and mental stress (PSS-4) served as explanatory variables. Blood serotonin and markers of kynurenine (kynurenine/tryptophan ratio), and catecholamine pathway activity (dopamine 3-O-sulfate, phenylalanine/tyrosine ratio) were modeled by multi-parameter linear regression.

RESULTS: In the SIMMUN cohort, the inflammatory marker neopterin (β = 0.47 [95% CI: 0.34-0.61]), SARS-CoV-2-positivity (0.42 [0.16-0.68]), mental stress (0.18 [0.055-0.31]), and age (0.26 [0.12-0.39]) were positively associated with the kynurenine/tryptophan ratio. The phenylalanine/tyrosine ratio was lower in SARS-CoV-2-positive than uninfected participants (-0.38 [-0.68 to -0.08]). In the INCOV cohort, markers of inflammation were associated with lower serotonin (IL6: -0.22 [-0.38 to -0.053]) and dopamine 3-O-sulfate levels (interferon-gamma: -0.15 [-0.26 to -0.036]). Serotonin (0.76 [0.34-1.2]) and dopamine 3-O-sulfate levels (0.63 [0.28-0.99]) were higher during recovery than in acute SARS-CoV-2 infection.

CONCLUSION: SARS-CoV-2 infection, inflammation, age and mental stress are key independent predictors of kynurenine pathway activity, which may influence serotonin availability. The catecholamine pathway was also affected in SARS-CoV-2 infection. Altered activity of these pathways may contribute to impaired mental health following COVID-19.

PMID:37481962 | DOI:10.1016/j.psyneuen.2023.106334

Epilepsy Behav. 2023 Jul 21;146:109353. doi: 10.1016/j.yebeh.2023.109353. Online ahead of print.

ABSTRACT

PURPOSE: Perampanel (PER) and lacosamide (LCM) are the new third-generation anti-seizure medications (ASMs) that were approved for the monotherapy of focal epilepsy in children over four years of age in China, in 2021. Very few studies have analyzed the application of PER monotherapy among pediatric patients aged ≥four years, and no study compared the efficacy and tolerability of PER monotherapy with LCM monotherapy in pediatric patients with focal epilepsy. The present study aimed to investigate the efficacy, tolerability, and effect on behavior and emotion of PER and LCM as monotherapy in pediatric patients with newly diagnosed focal epilepsy, which is beneficial for clinicians to have more choices to treat pediatric patients with focal epilepsy.

METHODS: This was a prospective, single-center, observational study that involved pediatric patients (disease onset age ≥four years) with newly diagnosed focal epilepsy treated with PER or LCM as primary monotherapy. Outcomes included retention, being responders, and seizure-free rates after 3, 6, and 12 months. Adverse events (AEs) were noticed throughout the follow-up period. Behavioral outcomes were evaluated with Achenbach Child Behavior Checklist (CBCL/4-16) at baseline and after three and six months.

RESULTS: Using randomization, 60 patients receiving PER (31 females, 29 males, median age: 7.79 [5.34, 10.16] years, median dose: 3.0 [2.0, 4.0] mg/day) and 60 patients receiving LCM (25 females, 35 males, median age: 7.72 [5.91, 10.72] years, median dose: 150.0 [100.0, 200.0] mg/day) were enrolled in the study. At the 12-month follow-up, the retention rates in the PER and LCM groups, both were 90.4%, and the responder rates were 65.4% and 71.2%, while seizure-free rates were 57.7% and 67.3%, respectively. There were no significant differences in the retention, responder and seizure-free rates between the two groups (P > 0.05). There were no significant differences in the responder rates between patients with BECTS, abnormal brain magnetic resonance imaging (MRI), or types of seizure in the two groups (P > 0.05). In the PER group, 28.8% (15/52) of patients experienced AEs, of which the most frequently reported were irritability (n = 7; 13.5%), dizziness (n = 5; 9.6%), somnolence (n = 3; 5.8%), ataxia (n = 1; 1.9%), headache (n = 1; 1.9%), and rash (n = 1; 1.9%). In the LCM group, 15.4% (8/52) of the patients had AEs, including headache (n = 4; 7.5%), dizziness (n = 4; 7.5%), nausea (n = 2; 3.8%), somnolence (n = 2; 3.8%), irritability (n = 1; 1.9%), stomach ache (n = 1; 1.9%), and vomiting (n = 1; 1.9%). The incidence of irritability was significantly higher in the PER group than in the LCM group (13.5% vs. 1.9%, P = 0.031), which occurred mainly within eight weeks after drug administration. Patients with irritability were not dangerous to surrounding people by the assessment of parental observation in the life. And the symptoms were relieved spontaneously within a few months. The outcomes of total scores, internalizing scores, and externalizing scores of the CBCL did not show statistically significant differences in the PER and LCM groups between baseline and three and six months. Characteristics of behavior and emotion did not have substantial changes in patients treated with PER and LCM monotherapy.

CONCLUSIONS: The present study documented similar good effectiveness and good tolerance of PER and LCM as monotherapy in pediatric patients with newly diagnosed focal epilepsy and showed no behavioral or emotional impact, as assessed by the CBCL. Though the incidence of irritability with PER monotherapy may be higher than that with LCM monotherapy soon after medication initiation, this side effect appears to resolve spontaneously within a few months. At present, this study was the first research about PER and LCM monotherapy in pediatric patients with newly diagnosed focal epilepsy evaluating efficacy, tolerability, and behavior in China.

PMID:37481960 | DOI:10.1016/j.yebeh.2023.109353

Orv Hetil. 2023 Jul 23;164(29):1127-1133. doi: 10.1556/650.2023.32811. Print 2023 Jul 23.

ABSTRACT

The health status of health professionals, including medical doctors is an important topic, although it is an under-researched area in Hungary and in the East-Central European countries as well. Our quasi-cohort research was focused on the health status, morbidities, anthropometric parameters, lifestyle and professional career of Hungarian medical doctors who graduated in 1979, following them 25y, 30y and 40y after graduation, seeking differences between professional groups and genders. In 2019, the mean age of participants was 64.9y, the average number of children was 2.08, higher among surgical professionals (2.43). Men reported higher number of own children. The number of night shifts decreased during the past decades. Most of them is already retired, 70% is working besides receiving a pension. 27% changed their medical specialty, 36% intended to work in another field of medicine, when graduated. About 10% of them achieved scientific (PhD) degree, most of them were satisfied with own professional carrier. The body weight and BMI significantly increased during decades, without statistical difference between genders and professional groups. Diabetes was self reported in 7%, hypertension in 44%. Men neglected more frequently their regular health check-up. Compared to their patients at the same age, 71% rated their own health status better. Among those, who reported regular physical activities, the ratio of men was higher; the average time spent on sport was the same as in the past decades, although the ratio of persons who had regular physical activity decreased, fewer participated in team sport activities. Their sleeping habit is quiet, the time is 6.3 h between workdays and 7.7 h on weekends. Burn-out was not reported. The ratio of smokers decreased; the self-reported daily intake of alcoholic beverages was 1.3, the weekly 3.7 units. Differences described earlier between professional groups disappeared. The problems of the recent Hungarian health care system were similarly rated, although the income of Hungarian physicians has increased to a great extent in the past years. Orv Hetil. 2023; 164(29): 1127-1133.

PMID:37481769 | DOI:10.1556/650.2023.32811

J Chin Med Assoc. 2023 Jul 24. doi: 10.1097/JCMA.0000000000000968. Online ahead of print.

ABSTRACT

BACKGROUND: Cochlear implantation (CI) has long been the standard of care for patients with severe-to-profound hearing impairment. Yet the benefits of CI extend far beyond speech understanding, with mounting recent literature supporting its role in tinnitus abatement. However, those studies have uniformly analyzed the effects of tinnitus after the traditional 3-4 week waiting period between CI surgery and device activation. As many clinics are shifting these waiting intervals to become shorter (in some cases within 24 hours, little is known about tinnitus abatement very early in the post-operative period. The aim of this study is to compare pre- and post-operative tinnitus handicap in this unique but growing population of very early activated patients.

METHODS: Twenty-seven adults with severe-to-profound hearing impairment with chronic tinnitus (> 6 months) were included. Patients with concomitant psychiatric disorders were excluded. All patients were implanted with the same array and were switched on within 24 hours after the surgery. Tinnitus Handicap Inventory (THI) was recorded pre-operatively, immediately after activation at 24 hours post-operatively, at 1 week, 2 weeks, and I month after activation. Wilcoxon signed-rank test was used to compare values between pre-operative assessment and respective fitting sessions.

RESULTS: Mean THI 24 hours after implantation increased in comparison to that assessed pre-operatively (77.6 vs. 72.5, p = .001). By one week after surgery, the THI had decreased to 54.9 (p<0.001). This trend continued and was statistically significant at 2 weeks (36.0, p < .001) and 1 month (28.5, p < .001).

CONCLUSION: On average, most patients with tinnitus will note a significant improvement in their tinnitus handicap when activated within 24 hours of cochlear implantation. However, tinnitus does increase between surgery and 24 hours, most likely reflecting not only intracochlear changes, but modulation of the entire auditory pathway. Following this early rise, the tinnitus continues to abate over the following month. Patients with tinnitus may benefit from early activation, though should be counseled that they may experience an exacerbation during the very early post-operative period.

PMID:37481759 | DOI:10.1097/JCMA.0000000000000968