Tag: pubmed

Oncologist. 2022 Feb 19:oyab069. doi: 10.1093/oncolo/oyab069. Online ahead of print.

ABSTRACT

BACKGROUND: In the past decade, several successful clinical trials provided new therapeutic agents approved for advanced gastric cancer (AGC). This study evaluated whether these practice-changing results actually altered the clinical practice.

PATIENTS AND METHODS: We retrospectively reviewed medical records of treatment-naive AGC patients who received combination chemotherapy of fluoropyrimidine and platinum between 2007 and 2018 and divided them into three groups: Groups A (2007-10), B (2011-14), and C (2015-2018), respectively. We compared the clinicopathological features, treatment details, and clinical outcomes among the three groups.

RESULTS: In total, 1004 consecutive patients were enrolled (A; n = 254, B; n = 300, and C; n = 450). The number of patients with poor performance status, older age, esophagogastric junction adenocarcinoma, and primary tumor increased during the study period. All groups had similar median overall survival (OS); ~16 months) without any statistical difference but steady prolongation of survival was observed in the adjusted with imbalance prognostic factors among groups (B/A; hazard ratio, HR 0.82, 95% C.I 0.68-0.98, C/A; HR 0.72, 95% CI 0.60-0.86); OS of HER2-positive AGC patients was clearly improved (HER2-positive vs HER2-negative in Group B, HR 0.80, 95% CI 0.60-1.06; Group C, HR 0.68, 95% CI 0.51-0.90) but that of diffuse-type AGC patients remained dismal.

CONCLUSIONS: The increasing availability of chemotherapy options potentially contributed to improved survival of AGC patients, but expanded chemotherapeutic indications made the survival benefit inconspicuous in the whole population. Future therapeutic development for the AGC subset not adequately receiving benefit from previous clinical trials is warranted.

PMID:35596939 | DOI:10.1093/oncolo/oyab069

Rheumatol Ther. 2022 May 21. doi: 10.1007/s40744-022-00454-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Belimumab is a recombinant human monoclonal antibody that binds to soluble B-lymphocyte stimulator and inhibits its biological activity. Since receiving approvals for the treatment of systemic lupus erythematosus (SLE), several observational studies have investigated the effectiveness of belimumab in the real-world setting. This study reports a systematic review and meta-analysis of the literature to evaluate the real-world effectiveness of belimumab for the treatment of SLE.

METHODS: A literature search following PRISMA Guidelines and limited to studies in English was performed (2014-2020) to identify relevant studies reporting effectiveness outcomes of belimumab in patients with SLE. A modified version of the Newcastle-Ottawa Scale was used to assess study quality. Outcomes, including SLE Disease Activity Index (SLEDAI) score, prednisone-equivalent use, and SLE flare were pooled and analyzed using statistical aggregation methods.

RESULTS: The literature search identified 514 articles for initial review. Of these, 17 articles were suitable for data extraction and summary. Baseline characteristics of patients in real-world studies were generally similar to those of relevant clinical trials, including age, sex, disease duration, SLEDAI score, and prednisone-equivalent use. Real-world use of belimumab was associated with reductions in SLEDAI score (mean baseline score to month 6: 10.1-4.4; 57% reduction), prednisone-equivalent dosing (mean baseline dose to month 6: 12.1 mg/day to 6.9 mg/day; 43% reduction), and flare frequency (12 months prior to belimumab to 12 months after belimumab: 1.15-0.39 mean flares per patient per year; 66% reduction). Long-term data (up to 2 years post-treatment initiation) for SLEDAI score and prednisone-equivalent dose indicated that improvements in both outcomes continue over time among patients remaining on therapy.

CONCLUSIONS: In the real-world setting, observed outcomes with belimumab for the treatment of SLE are consistent with those reported from randomized clinical trials. Improvements persist long-term for SLEDAI activity and prednisone-equivalent use with belimumab.

PMID:35596922 | DOI:10.1007/s40744-022-00454-9

BJOG. 2022 May 21. doi: 10.1111/1471-0528.17225. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the peri-operative characteristics associated with an increased risk of post-operative urinary retention (POUR) following vaginal pelvic floor surgery.

DESIGN: A retrospective cohort study using multivariable prediction modelling.

SETTING: A tertiary referral urogynaecology unit.

POPULATION: Patients undergoing vaginal pelvic floor surgery from January 2015 to February 2020.

METHODS: Eighteen variables (24 parameters) were compared between those with and without POUR and then included as potential predictors in statistical models to predict POUR. The final model was chosen as the one with the largest c-index from internal cross-validation. This was then externally validated using a separate data set (n=94) from another surgical centre.

MAIN OUTCOME MEASURES: Diagnosis of POUR following surgery while the patient was in hospital.

RESULTS: Among the 700 women undergoing surgery, 301 (43%) experienced POUR. Pre-operative variables with statistically significant univariate relationships with POUR included age, menopausal status, prolapse stage, and uroflow parameters. Significant peri-operative factors included estimated blood loss, amount of intravenous fluid administered, operative time, length of stay, and specific procedures including vaginal hysterectomy with intraperitoneal vault suspension, anterior colporrhaphy, posterior colporrhaphy, and colpocleisis. The lasso logistic regression model had the best combination of internally cross-validated c-index (0.73; 95% CI:071-0.74) and a calibration curve that showed good alignment of observed and predicted risks. Using this data, a POUR risk calculator was developed (https://pourrisk.shinyapps.io/POUR/).

CONCLUSIONS: This POUR risk calculator will allow physicians to counsel patients pre-operatively on their risk of developing POUR after vaginal pelvic surgery and help focus discussion around potential management options.

PMID:35596931 | DOI:10.1111/1471-0528.17225

Transl Stroke Res. 2022 May 21. doi: 10.1007/s12975-022-01036-1. Online ahead of print.

ABSTRACT

This study aimed to develop a supervised deep learning (DL) model for grading collateral status from dynamic susceptibility contrast magnetic resonance perfusion (DSC-MRP) images from patients with large vessel occlusion (LVO) acute ischemic stroke (AIS) and compare its performance against experts’ manual grading. Among consecutive LVO-AIS at three medical center sites, DSC-MRP data were processed to generate collateral flow maps consisting of arterial, capillary, and venous phases. With the use of expert readings as a reference, a DL model was developed to analyze collateral status with output classified into good and poor grades. The resulting model was externally validated in a later-collected population from one medical center site. The model was trained on 255 patients and externally validated on 72 patients. In the all-site internal validation population, DL grading of good collateral probability yielded a c statistic of 0.91; in the external validation population, the c statistic was 0.85. In the external validation population, there was moderate agreement between the experts’ grades and DL grades (kappa = 0.53, 95% CI = 0.32-0.73, p < 0.0001). Day 7 infarct growth volume was higher in DL-graded poor collateral group than good collateral group patients (median volume [26 mL vs. 6 mL], p = 0.01) in patients with successful reperfusion (modified treatment in cerebral infarction (mTICI) = 2b-3). In all patients with a 90-day modified Rankin Scale (mRS) score, there was a shift to more favorable outcomes in the good collateral group, with a common odds ratio of 2.99 (95% CI = 1.89-4.76, p < 0.0001). The DL-based collateral grading was in good agreement with expert manual grading in both development and validation populations. After exclusion of patients with large infarct volume, early reperfusion is more likely to benefit patients with the poor collateral flow, and the DL method has the potential to aid the assessment of collateral status.

PMID:35596910 | DOI:10.1007/s12975-022-01036-1

J Med Syst. 2022 May 21;46(7):45. doi: 10.1007/s10916-022-01825-z.

ABSTRACT

An early identification of prehospital phenotypes may allow health care workers to speed up and improve patients’ treatment. To determine emergency phenotypes by exclusively using prehospital clinical data, a multicenter, prospective, and observational ambulance-based study was conducted with a cohort of 3,853 adult patients treated consecutively and transferred with high priority from the scene to the hospital emergency department. Cluster analysis determined three clusters with highly different outcome scores and pathological characteristics. The first cluster presented a 30-day mortality after the index event of 45.9%. The second cluster presented a mortality of 26.3%, while mortality of the third cluster was 5.1%. This study supports the detection of three phenotypes with different risk stages and with different clinical, therapeutic, and prognostic considerations. This evidence could allow adapting treatment to each phenotype thereby helping in the decision-making process.

PMID:35596887 | DOI:10.1007/s10916-022-01825-z

Endocr Pathol. 2022 May 21. doi: 10.1007/s12022-022-09721-5. Online ahead of print.

ABSTRACT

Conventional cytology-based diagnosis for thyroid cancer is limited with more than 30-45% of nodules categorized as indeterminate, necessitating surgery for confirming or refuting the diagnosis. This systematic review and meta-analysis were aimed at identifying immunocytochemical markers effective in delineating benign from malignant thyroid lesions in fine needle aspiration cytology (FNAC) samples, thereby improving the accuracy of cytology diagnosis. A systematic review of relevant articles (2000-2021) from online databases was carried out and the search protocol registered in PROSPERO database (CRD42021229121). The quality of studies was assessed using QUADAS-2. Review Manager 5.4.1 from Cochrane collaboration and MetaDisc Version 1.4 was used to conduct the meta-analysis. Bias in the studies were visually analyzed using funnel plots, and statistical significance was evaluated by Egger’s test. Systematic review identified 64 original articles, while meta-analysis in eligible articles (n = 41) identified a panel of 5 markers, Galectin-3, HBME-1, CK-19, CD-56, and TPO. Assessment of the diagnostic performance revealed that Gal-3 (sensitivity: 0.81; CI: 0.79-0.83; specificity: 0.84; CI: 0.82-0.85) and HBME-1 (sensitivity: 0.83; Cl: 0.81-0.86; specificity: 0.85; CI: 0.83-0.86) showed high accuracy in delineating benign from malignant thyroid nodules. Efficacy analysis in indeterminate nodules showed Gal-3 and HBME-1 have high specificity of 0.86 (CI 0.84-0.89) and 0.82 (CI 0.78-0.86), respectively, and low sensitivity of 0.76 (CI 0.72-0.80) and 0.75 (CI 0.70-0.80), respectively. Diagnostic odds ratio (DOR) of Galectin-3 and HBME-1 were 39.18 (CI 23.38-65.65) and 24.44 (CI 11.16-53.54), respectively. Significant publication bias was observed for the markers Galectin-3 and CK-19 (p < 0.05). The panel of 5 markers identified from this meta-analysis are high-confidence candidates that need to be validated in thyroid cytology to establish their efficacy and enable clinical applicability.

PMID:35596875 | DOI:10.1007/s12022-022-09721-5

Environ Sci Pollut Res Int. 2022 May 21. doi: 10.1007/s11356-022-20865-z. Online ahead of print.

ABSTRACT

In settlements, special attention is given to the study of anthropogenic aerosol pollution, and insufficient attention is given to natural sources of pollution, especially from active zones of the Earth. The aim of this work was to study atmospheric pollution (the Srednyaya Akhtuba village (Volgograd region, Russia)) using indicators (pH; EC, μS/cm) of aerosol suspensions (washing off aerosols from the leaves of Prunus armeniaca L.) during 2018-2020 and the forecast of pollution sources. Research hypothesis: low mineralization and close to neutral acidity of aerosol suspensions indicate the purity of the atmospheric air, and there is no load of anthropogenic and natural sources. Acid mineralized aerosols were found in the residential area of Srednyaya Akhtuba, which indicates air pollution during 2018-2020. The correlation relationship between pH and EC in μS/cm was investigated using standard least squares regression. The results obtained indicate statistically significant differences between the experimental territory and the (relatively) clean location from 2018 to 2020 in terms of the studied indicators, as well as the revealed correlation between them in Srednyaya Akhtuba village, which indicates the revealed patterns and the influence of the system factor. Anthropogenic and natural sources were the system factors. The authors predict an active underground ancient volcanic zone in the area of Srednyaya Akhtuba with a possible natural load on the residential areas of the village, the assumption of which is based on analysis of heat anomaly maps using the Landsat-8 program and other programs.

PMID:35596864 | DOI:10.1007/s11356-022-20865-z

Environ Sci Pollut Res Int. 2022 May 21. doi: 10.1007/s11356-022-20889-5. Online ahead of print.

ABSTRACT

Concern regarding global climate change and its detrimental effects on society demands the building sector, one of the major contributors to global warming. Reducing cement usage is a significant challenge for the concrete industry; achieving this objective can help reduce global carbon dioxide emissions. Replacing the cement in concrete with by-product ashes is a promising approach for reducing the embodied carbon in concrete and improving some of its properties. Among different by-product ashes, ground granulated blast furnace slag (GGBFS) is a viable option to produce sustainable self-compacting concrete (SCC). Compressive strength (CS), on the other hand, is an essential characteristic among other evaluated properties. As a result, establishing trustworthy models to forecast the CS of SCC is critical to saving cost, time, and energy. Furthermore, it provides helpful instruction for planning building projects and determining the best time to remove the formwork. In this study, four alternative models were suggested to predict the CS of SCC mixes produced by GGBFS: the artificial neural network (ANN), nonlinear model (NLR), linear relationship model (LR), and multi-logistic model (MLR). To do so, an extensive set of data consisting of about 200 mixtures were extracted and analyzed to develop the models, and various mixture proportions and curing times were considered input variables. To test the effectiveness of the suggested models, several statistical evaluations including determination coefficient (R²), mean absolute error (MAE), scatter index (SI), root mean squared error (RMSE), and objective (OBJ) value were utilized. In comparison to other models, the ANN model performed better to forecast the CS of SCC mixes incorporating GGBFS. The RMSE, MAE, OBJ, and R² values for this model were 4.73 MPa, 2.3 MPa, 3.4 MPa, and 0.955, respectively.

PMID:35596861 | DOI:10.1007/s11356-022-20889-5

Environ Sci Pollut Res Int. 2022 May 21. doi: 10.1007/s11356-022-20766-1. Online ahead of print.

ABSTRACT

The large population residing in the northern region of India surrounding Delhi mostly depends on water of River Yamuna, a tributary of mighty Ganga for agriculture, drinking and various religious activities. However, continuous anthropogenic activities mostly due to pollution mediated by rapid urbanization and industrialization have profoundly affected river microflora and their function thus its health. In this study, potential of whole-genome metagenomics was exploited to unravel the novel consortia of microbiome and their functional potential in the polluted sediments of the river at Delhi. Analysis of high-quality metagenome data from Illumina NextSeq500 revealed substantial differences in composition of microbiota at different sites dominated by Proteobacteria, Bacteroidetes, Firmicutes, Actinobacteria and Chloroflexi phyla. The presence of highly dominant anaerobic bacteria like Dechloromonas aromatica (benzene reducing and denitrifying), Rhodopseudomonas palustris (organic matter reducing), Syntrophus aciditrophicus (fatty acid reducing) and Syntrophobacter fumaroxidans (sulphate reducing) in the polluted river Yamuna signifies the impact of unchecked pollution in declining health of the river ecosystem. A decline in abundance of phages was also noticed along the downstream river Yamuna. Mining of mycobiome reads uncovered plethora of fungal communities (i.e. Nakaseomyces, Aspergillus, Schizosaccharomyces and Lodderomyces) in the polluted stretches due to the availability of higher organic carbon and total nitrogen (%) could be decoded as promising bioindicators of river trophic status. Pathway analysis through KEGG revealed higher abundance of genes involved in energy metabolism (nitrogen and sulphur), methane metabolism, degradation of xenobiotics (Nitrotoluene, Benzoate and Atrazine), two-component system (atoB, cusA and silA) and membrane transport (ABC transporters). Catalase-peroxidase and 4-hydroxybenzoate 3-monooxygenase were the most enriched pollution degrading enzymes in the polluted study sites of river Yamuna. Overall, our results provide crucial insights into microbial dynamics and their function in response to high pollution and could be insightful to the ongoing remediation strategies to clean river Yamuna.

PMID:35596862 | DOI:10.1007/s11356-022-20766-1

Bull Math Biol. 2022 May 21;84(7):67. doi: 10.1007/s11538-022-01016-4.

ABSTRACT

We derive a discrete predator-prey model from first principles, assuming that the prey population grows to carrying capacity in the absence of predators and that the predator population requires prey in order to grow. The proposed derivation method exploits a technique known from economics that describes the relationship between continuous and discrete compounding of bonds. We extend standard phase plane analysis by introducing the next iterate root-curve associated with the nontrivial prey nullcline. Using this curve in combination with the nullclines and direction field, we show that the prey-only equilibrium is globally asymptotic stability if the prey consumption-energy rate of the predator is below a certain threshold that implies that the maximal rate of change of the predator is negative. We also use a Lyapunov function to provide an alternative proof. If the prey consumption-energy rate is above this threshold, and hence the maximal rate of change of the predator is positive, the discrete phase plane method introduced is used to show that the coexistence equilibrium exists and solutions oscillate around it. We provide the parameter values for which the coexistence equilibrium exists and determine when it is locally asymptotically stable and when it destabilizes by means of a supercritical Neimark-Sacker bifurcation. We bound the amplitude of the closed invariant curves born from the Neimark-Sacker bifurcation as a function of the model parameters.

PMID:35596850 | DOI:10.1007/s11538-022-01016-4