bluuebunny/crossref_metadata_2025 huggingface dataset:
Age- and sex-related differences in community-acquired pneumonia at presentation to the emergency department: a retrospective cohort study
Authors: Ravioli Svenja , Germann Célina , Gygli Rebecca , Exadaktylos Aristomenis K. , Lindner Gregor
Published: April 2022

Background and importance

Because of its associated high morbidity and mortality, early identification and treatment of community-acquired pneumonia (CAP) are essential.

Objectives

To investigate age- and sex-related differences in clinical symptoms, radiologic findings and outcomes in patients presenting to the emergency department (ED) with CAP.

Design

Retrospective cohort study.

Setting and participants

Patients admitted to one Swiss ED with radiologically confirmed CAP between 1 January 2017 and 31 December 2018.

Outcome measures and analysis

Primary aim was to evaluate differences in clinical and radiologic presentation of men vs. women and patients >65 years vs. <65 years with CAP. Secondary outcomes were age- and sex-related differences in terms of Pneumonia Severity Index (PSI) risk class, need for ICU referral, mechanical ventilation, in-hospital mortality, 30-day readmission and 180-day pneumonia recurrence.

Main results

In total 467 patients with CAP were included. 211 were women (45%). 317 were ≥65 years (68%), of which 145 were women (46%). Older patients less commonly reported chest pain (13 vs. 27%; effect size 14%; 95% CI, 0.07–0.23), fever (39 vs. 53%, effect size 14%; 95% CI, 0.05–0.24), chills (6 vs. 20%; effect size 14%; 95% CI, 0.08–0.0.214), cough (44 vs. 57%; effect size 13%; 95% CI, 0.03–0.22), headache (5 vs. 15%, effect size 10%, 95% CI, 0.04–0.17) and myalgias (5 vs. 19%; effect size 14%; 95% CI, 0.07–0.21). However, 85% of patients with no symptoms were ≥65 years. PSI was lower in women [95 (SD 31) vs. 104 (SD 31); 95% CI, −14.44 to 2.35] and sputum was more common in men (32 vs. 22%; effect size 10%; 95% CI, −0.18 to −0.02). Raw mortality was higher in elderly patients [14 vs. 3%; odds ratio (OR), 4.67; 95% CI, 1.81–12.05], whereas it was similar in men and women (11 vs. 10%; OR, 1.22; 95% CI, 0.67–2.23).

Conclusion

Patients, less than 65 years with CAP presenting to the ED had significantly more typical symptoms such as chest pain, fever, chills, cough, headache and myalgias than those being above 65 years. No relevant differences between men and women were found in clinical presentation, except for PSI on admission, and radiologic findings and neither age nor sex was a predictor for mortality in CAP.
Clinicopathological Significance of BRCAness in Resectable Pancreatic Ductal Adenocarcinoma and Its Association With Anticancer Drug Sensitivity in Pancreatic Cancer Cells
Authors: Tadehara Masayoshi , Kato Takuya , Adachi Kai , Tamaki Akihiro , Kesen Yurika , Sakurai Yasutaka , Ichinoe Masaaki , Koizumi Wasaburo , Murakumo Yoshiki
Published: April 2022

Objective

The concept of BRCAness has been proposed as a homologous recombination repair dysfunction triggered by a genetic defect in the BRCA pathway including the BRCA1/2 mutations. A certain number of pancreatic ductal adenocarcinoma (PDAC) patients have BRCAness. However, a large-scale analysis of BRCAness in PDAC has not been performed. In addition, no basic studies have examined the significance of BRCAness in PDAC cell lines.

Methods

Ninety-two patients who underwent surgery for PDAC were enrolled. Formalin-fixed and paraffin-embedded specimens of resected PDACs were used to analyze BRCAness by multiplex ligation-dependent probe amplification. We also analyzed BRCAness in pancreatic cancer cell lines and the sensitivity to cisplatin and olaparib using a colony formation assay.

Results

Of the 92 patients with PDAC, 6 were detected to have BRCAness-positive PDAC (6.5%). No significant differences in overall survival and progression-free survival were observed between the BRCAness-positive and BRCAness-negative groups. One PDAC cell line, KP-2, was positive for BRCAness and was more sensitive to cisplatin and olaparib than the BRCAness-negative cell lines.

Conclusions

Our results revealed that a considerable number of PDACs are positive for BRCAness, suggesting that BRCAness status could be a useful biomarker for selecting anticancer treatments for advanced or relapsed PDAC.
The Role of Estrogen Signaling in Cellular Iron Metabolism in Pancreatic β Cells
Authors: Taneera Jalal , Ali Amjad , Hamad Mawieh
Published: April 2022

Several lines of evidence suggest that estrogen (17-β estradiol; E2) protects against diabetes mellitus and plays important roles in pancreatic β-cell survival and function. Mounting clinical and experimental evidence also suggest that E2 modulates cellular iron metabolism by regulating the expression of several iron regulatory genes, including hepcidin (HAMP), hypoxia-inducible factor 1-α, ferroportin (SLC40A1), and lipocalin (LCN2). However, whether E2 regulates cellular iron metabolism in pancreatic β cells and whether the antidiabetic effects of E2 can be, at least partially, attributed to its role in iron metabolism is not known. In this context, pancreatic β cells express considerable levels of conventional E2 receptors (ERs; mainly ER-α) and nonconventional G protein-coupled estrogen receptors and hence responsive to E2 signals. Moreover, pancreatic islet cells require significant amounts of iron for proper functioning, replication and survival and, hence, well equipped to manage cellular iron metabolism (acquisition, utilization, storage, and release). In this review, we examine the link between E2 and cellular iron metabolism in pancreatic β cells and discuss the bearing of such a link on β-cell survival and function.
Auditing Management of Acute Pancreatitis Using Comprehensive Quality Indicators
Authors: Wee Diana , Izard Stephanie , Raphael Kara , Yang Jeff , Hussein Karim , Wu Grace , Trindade Arvind J.
Published: April 2022

Objectives

Recently, 40 comprehensive quality indicators in various management domains were created. The aim was to determine if these indicators could be used to audit the management of acute pancreatitis.

Methods

A retrospective study of consecutive patients admitted with acute pancreatitis in 2018 was conducted. Adherence rates with the individual quality indicators were calculated and compared between services.

Results

A total of 320 patients were included in this study. Twenty-eight of the 40 quality indicators (70%) could be used to audit management retrospectively. The medical service was found to have lower adherence rates for quality indicators 12 (initial assessment and risk stratification domain; 11% vs 22%, P = 0.009), 14 (initial management domain; 72% vs 88%, P = 0.003), and 33 (surgery domain; 83% vs 100%, P = 0.006). The surgical service was noted to have statistically significant lower adherence rates for quality indicators 4, 5, and 6 of the etiology domain (54% vs 72%, P = 0.002; 86% vs 96%, P = 0.004; and 45% vs 71%, P < 0.0001, respectively), and 21 of the nutrition domain (76% vs 93%, P < 0.0001).

Conclusions

We show that these quality indicators can be used to audit the management of acute pancreatitis in specific management domains.
Clinicopathological Characteristics of Gastroenteropancreatic Neuroendocrine Tumors
Authors: Şentürk Mustafa , Acar Berkan , Yildirim Mehmet Aykut , Çakir Murat , Küçükkartallar Tevfik , Vatansev Celalettin
Published: April 2022

Objectives

Gastorenteropancreatic neuroendocrine (GEP-NET) tumors are the second most common tumors of the gastrointestinal tract. We aimed to investigate the clinicopathological features and factors affecting the prognosis of patients with GEP-NET.

Methods

Clinicopathological features of 158 patients were evaluated, including tumor location, TNM stage and grade, pathological features, presence of lymph nodes and distant metastases at the time of diagnosis, maximum tumor diameter and treatment details. Also, follow-up information was analyzed to discover possible prognostic factors.

Results

The most common primary site is pancreas (45.6%, n = 72). Most of the GEP-NETs were nonfunctional (93.6%, n = 148). Of the 158 patients, 94 (59.5%) were grade 1, 46 (29.1%) grade 2, and 18 (11.4%) grade 3. The 1-year, 3-year, and 5-year survival rates were 82.3% (130/158), 61.4% (70/114), and 47.2% (35/74), respectively. In multivariate analysis, histological grade (P = 0.04) and TNM stage (P < 0.001) were independent prognostic factors for survival in patients with GEP-NET.

Conclusions

They are increasing in frequency and are the most common tumors in the pancreas. Nonfunctional tumors made up the majority of cases. The main treatment was surgical resection. Histological grade and TNM stage are independent prognostic factors.
Sarcopenia
Authors: Asama Hiroyuki , Ueno Makoto , Kobayashi Satoshi , Fukushima Taito , Kawano Kuniyuki , Sano Yusuke , Tanaka Satoshi , Nagashima Shuhei , Morimoto Manabu , Ohira Hiromasa , Maeda Shin
Published: April 2022

Objective

The aim of the study was to clarify the association of skeletal muscle mass and the prognosis of unresectable pancreatic ductal adenocarcinoma (PDAC) treated with gemcitabine plus nab-paclitaxel (GnP).

Methods

We included 124 unresectable PDAC patients who received GnP chemotherapy. Skeletal muscle mass of the third lumbar vertebrae (L3) level was measured by computed tomography immediately before GnP initiation, and the skeletal muscle index (L3-SMI) was calculated. Sarcopenia was defined as L3-SMI less than 42 cm2/m2 in male patients and less than 38 cm2/m2 in female patients.

Results

Sarcopenia was found in 63 patients (50.8%). There was no significant difference in overall survival (OS) between sarcopenia and nonsarcopenia patients; however, in elderly patients (>70 years), the OS of sarcopenia patients was significantly poorer than that of nonsarcopenia patients (390 vs 631 days, respectively; hazard ratio, 2.64; 95% confidence interval, 1.33–5.23). Multivariate analyses in elderly patients revealed that sarcopenia and tumor stage were independent poor prognostic factors. Despite the short OS of elderly sarcopenia patients, there were no significant differences in progression-free survival or response rate.

Conclusions

Sarcopenia diagnosed by L3-SMI is a prognostic factor in elderly patients who receive GnP for unresectable PDAC. However, GnP exhibits a certain efficacy in sarcopenia and nonsarcopenia patients.
Extrapancreatic Complications in Hospitalized Patients With Mild Acute Pancreatitis Are Associated With Poorer Outcomes
Authors: Shah Ishani , Yakah William , Ahmed Awais , Kandasamy Cinthana , Tintara Supisara , Sorrento Cristina , Freedman Steven D. , Kothari Darshan J. , Sheth Sunil G.
Published: April 2022

Objective

Patients with acute pancreatitis (AP) are at risk for extrapancreatic complications (EPCs) when admitted to the intensive care unit (ICU). We assessed the prevalence of EPCs in non-ICU AP patients and their outcomes.

Methods

We retrospectively studied EPCs in non-ICU AP patients between 2008 and 2018. Outcomes such as length of stay (LOS), inpatient mortality, and 30-day readmission rates were compared between those with and without EPC.

Results

Of the 830 AP patients, 151 (18.1%) had at least 1 EPC. These included urinary tract infection (15.9%), Clostridium difficile infection (17.2%), pneumonia (7.3%), bacteremia (17.2%), acute kidney injury requiring dialysis (3.3%), gastrointestinal bleeding (12.5%), alcohol withdrawal (24.5%), delirium (14.5%), and falls (1.32%). Patients with EPC had increased mean LOS (6.98 vs 4.42 days; P < 0.001) and 30-day readmissions (32.5% vs 19%; P < 0.001). On multivariate regression, EPCs were independently associated with higher LOS (odds ratio, 1.45 [95% confidence interval, 1.36–1.56]; P < 0.001) and 30-day readmissions (odds ratio, 1.94 [95% confidence interval 1.28–2.95]; P < 0.001).

Conclusions

The EPCs are common among noncritical AP patients and contribute to poor outcomes like increased LOS and 30-day readmissions.
Celiac Plexus Neurolysis Is Associated With Decreased Survival in Patients With Pancreatic Cancer
Authors: Zylberberg Haley M. , Nagula Satish , Rustgi Sheila D. , Aronson Anne , Kessel Elizabeth , Kumta Nikhil A. , DiMaio Christopher J. , Lucas Aimee L.
Published: April 2022

Objective

The aim of this study was to investigate survival in patients who received celiac plexus neurolysis (CPN) compared with patients who received opioids.

Methods

The Surveillance, Epidemiology and End Results–Medicare database was used to identify patients older than 65 years diagnosed with pancreatic cancer between 2007 and 2015. We used claims data to identify patients with a history of CPN and opioid use within 1 year of diagnosis, and other demographic, clinical, and treatment variables. Kaplan-Meier analyses and inverse propensity-weighted adjusted Cox proportional hazard ratios were used to evaluate survival.

Results

We identified 648 patients who underwent CPN (19.0%) compared with 2769 patients who received opioids (81.0%). The median survival and interquartile range for patients who received CPN was 4.0 months (2.0–8.0 months) compared with 7.0 months (3.0–12.0 months) for opioid users (P < 0.0001). After adjusting for confounders and propensity score, the patients who received CPN showed worsened survival (hazard ratio, 1.69; 95% confidence interval, 1.59–1.79).

Conclusions

Pancreatic cancer patients who underwent CPN had decreased survival compared with opioid users. This suggests that opioid sparing methods to reduce pancreatic cancer pain may actually be harmful. Future prospective studies should investigate whether other opioid sparing therapies impact pancreatic cancer survival.
HDAC4 Mediates Smoking-Induced Pancreatic Cancer Metastasis
Authors: Yang Jiyong , Chheda Chintan , Lim Adrian , Hauptschein Dina , Zayou Latifa , Tang Josiah , Pandol Stephen J. , Edderkaoui Mouad
Published: April 2022

Objective

Cigarette smoking is an established risk factor for pancreatic ductal adenocarcinoma (PDAC). In this project, we investigated the effect of smoking and the role of histone deacetylase 4 (HDAC4) in PDAC invasion and metastasis.

Methods

Cells were treated with 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone and cigarette smoke extract and the mRNA levels of HDACs were measured by real-time polymerase chain reaction. Invasion was measured using the Matrigel Invasion Assay. Syngeneic PDAC mice were treated with 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone and metastasis measured. Human PDAC primary and metastatic tissues were analyzed by immunohistochemistry.

Results

Levels of HDAC4 mRNA were increased by smoking. Smoking compounds significantly promoted invasion of cancer cells and promoted metastasis of PDAC cells to different organs, including the liver and the lung, whereas inhibition of HDAC4 prevented this effect. The effect of HDAC4 inhibition on preventing smoking-induced metastasis was greater in the liver compared with the lung. We found that HDAC4 is highly expressed in primary and metastatic PDAC tumors.

Conclusions

We found that HDAC4 is the only HDAC induced by smoking among all HDACs analyzed. We found that smoking promotes invasion and metastasis of PDAC cells through a mechanism that involves HDAC4 and that HDAC4 is a promising target for preventing PDAC metastasis.
Validation of the Enriching New-Onset Diabetes for Pancreatic Cancer Model
Authors: Boursi Ben , Patalon Tal , Webb Muriel , Margalit Ofer , Beller Tamar , Yang Yu-Xiao , Chodick Gabriel
Published: April 2022

Objectives

The Enriching New-onset Diabetes for Pancreatic Cancer (END-PAC) model identified patients at high-risk for pancreatic ductal adenocarcinoma (PDAC) more than 6 months before diagnosis. The current study aimed to validate the END-PAC model using a large, state-mandated health care provider database.

Methods

A retrospective cohort study of patients older than 50 years that had a diagnosis of new-onset diabetes (NOD) between 2006 and 2015. A risk score was assigned according to the END-PAC model. Patients who developed PDAC over the 3-year period after NOD diagnosis were identified using the Israeli National Cancer Registry.

Results

Twenty-three percent (1245/5408) of NOD patients were classified as high-risk, of them 32 (2.6%) developed PDAC. Median follow-up time from NOD detection to PDAC diagnosis was 609 days (interquartile range, 367–997). The hazard ratio for PDAC diagnosis among individuals at the high-risk group compared with the low-risk group was 5.70 (95% confidence interval, 2.93–11.06). Using the high-risk group as the screening threshold, the sensitivity, specificity, positive predictive value and negative predictive value of the model were 54.2%, 76.98%, 2.57%, and 99.4%, respectively. Area under the curve of the model was 0.69.

Conclusions

Our findings support the robustness, generalizability and clinical applicability of the END-PAC model.
Multiarea Brain Activation and Gait Deterioration During a Cognitive and Motor Dual Task in Individuals With Parkinson Disease
Authors: Liu Yan-Ci , Yang Yea-Ru , Yeh Nai-Chen , Ku Pei-Hsin , Lu Chia-Feng , Wang Ray-Yau
Published: April 2022

Background and Purpose:

In people with Parkinson disease (PD), gait performance deteriorating during dual-task walking has been noted in previous studies. However, the effects of different types of dual tasks on gait performance and brain activation are still unknown. The purpose of this study was to investigate cognitive and motor dual-task walking performance on multiarea brain activity in individuals with PD.

Methods:

Twenty-eight participants with PD were recruited and performed single walking (SW), walking while performing a cognitive task (WCT), and walking while performing a motor task (WMT) at their self-selected speed. Gait performance including walking speed, stride length, stride time, swing cycle, temporal and spatial variability, and dual-task cost (DTC) was recorded. Brain activation of the prefrontal cortex (PFC), premotor cortex (PMC), and supplementary motor areas (SMA) were measured using functional near-infrared spectroscopy during walking.

Results:

Walking performance deteriorated upon performing a secondary task, especially the cognitive task. Also, a higher and more sustained activation in the PMC and SMA during WCT, as compared with the WMT and SW, in the late phase of walking was found. During WMT, however, the SMA and PMC did not show increased activation compared with during SW. Moreover, gait performance was negatively correlated with PMC and SMA activity during different walking tasks.

Discussion and Conclusions:

Individuals with mild to moderate PD demonstrated gait deterioration during dual-task walking, especially during WCT. The SMA and PMC were further activated in individuals with PD when performing cognitive dual-task walking.

Supplemental Digital Content is Available in the Text.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A383).
Clinical and Epidemiological Characterization of Lymphogranuloma Venereum in a Sexually Transmitted Diseases Clinic in Lisbon, 2001 to 2020
Authors: Bonito Frederico , Alves João , Lodhia Zohra , Cordeiro Dora , Borges Vítor , Azevedo Jacinta , Borrego Maria José
Published: April 2022

Between 2001 and 2020, 54 LGV cases were diagnosed in a sexually transmitted disease clinic in Lisbon, most in men who have sex with men (87%), HIV negative (63%), from the anorectal mucosa (72.2%). Cases among heterosexuals were also identified (13%). Surveillance programs irrespective of sexual orientation and HIV status are needed to avoid the morbidity associated with LGV.
Two-Corner Fusion or Four-Corner Fusion of the Wrist for Midcarpal Osteoarthritis? A Multicenter Prospective Comparative Cohort Study
Authors: Duraku Liron S. , Hundepool Caroline A. , Hoogendam Lisa , Selles Ruud W. , van der Heijden Brigitte E. P. A. , Colaris Joost W. , Hovius Steven E. R. ,   Hand-Wrist Study Group, Zuidam J. Michiel
Published: April 2022

Background:

Midcarpal osteoarthritis is a debilitating wrist pain, and a mainstay treatment is midcarpal fusion. The accepted standard for midcarpal fusion is four-corner fusion, but lately, two-corner fusion (i.e., capitolunate fusion) has gained popularity. This is the first prospective, multicenter, cohort study comparing capitolunate fusion with four-corner fusion for midcarpal osteoarthritis.

Methods:

Patients with scaphoid nonunion advanced collapse or scapholunate advanced collapse wrist of grade 2 to 3 undergoing capitolunate fusion or four-corner fusion between 2013 and 2019 were included. Sixty-three patients (34 with capitolunate fusion, 29 with four-corner fusion) were included. Patient demographics were similar between groups. Patient-Rated Wrist Hand Evaluation questionnaire score, visual analog scale pain score, grip strength, range of motion, and complications were measured at baseline and 3 months and 12 months postoperatively. Complications (i.e., nonunion, hardware migration, conversion to wrist arthrodesis, or arthroplasty) were determined.

Results:

A significant difference in Patient-Rated Wrist Hand Evaluation or visual analog scale pain score at 3 and 12 months postoperatively between the capitolunate fusion and four-corner fusion groups was not found. There were no differences in grip strength between patient groups preoperatively or 12 months postoperatively. At 12 months postoperatively, capitolunate fusion patients had better flexion compared with that in the four-corner fusion group (p = 0.002); there were no differences in complications and reoperation rates between groups.

Conclusions:

Capitolunate fusion and four-corner fusion were comparable in terms of functional scores (i.e., Patient-Rated Wrist Hand Evaluation and visual analog scale pain scores) and complication scores. Capitolunate fusion showed favorable wrist mobility compared with four-corner fusion in treatment of midcarpal osteoarthritis. Capitolunate fusion advantages include use of less material, less need for bone-graft harvesting, and easier reduction of the lunate during fixation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
An Analytic Method for Calculating Scanner-, Kilovoltage Peak–, and Patient Size–Specific Hounsfield Unit Scale Thresholds for Agatston Score
Authors: Peng Boyu , Jambawalikar Sachin , Einstein Andrew J.
Published: April 2022

Objective

This study aimed to calculate scanner-, kilovoltage peak (kVp)–, and patient size–specific computed tomography (CT) number thresholds for determining Agatston score (AgSc).

Methods

The proposed method was validated using calcium measurements in an anthropomorphic phantom for 4 CT scanners made by 4 vendors. The derived mass concentration (γ) thresholds were used to calculate kVp- and patient size–specific CT number thresholds. Two models were applied to reduce intrascanner and interscanner AgSc variation, respectively.

Results

The mean error of the modeled CT numbers is 1.8% (0.1%–4.4%). Model 1 has comparable results to the published phantom calibration method for an average-size patient (error, 1.5%; 0.1%–5.1%). The size- and the kVp-dependent fitting of modeled results have R
2 greater than 0.965.

Conclusions

Our results show a potential to enable accurate determination of AgSc under diverse conditions (eg, reduced tube potential) and are more easily applicable to different patient sizes than the phantom calibration method.
Association of Serum Ferritin With Marrow Iron Concentration Using a Three-Dimension Fat Analysis & Calculation Technique Sequence in Postmenopausal Women
Authors: Li Guanwu , Xu Zheng , Wang Yi , Jiang Lei , Chang Shixin , Yuan Wei , Dai Yongming
Published: April 2022

Objective

The aim of the study was to determine whether serum iron and ferritin levels are determinants of iron accumulation in bone marrow using a three-dimension Fat Analysis & Calculation Technique (FACT) sequence.

Methods

We measured spinal marrow R2* using a 3T FACT sequence in 112 postmenopausal women (mean age, 62.6 years; range, 50–82.6 years). Serum iron and ferritin levels were determined in blood specimens. Lumbar spine bone mineral density was measured by dual-energy x-ray absorptiometry. The levels of serum iron and ferritin were evaluated in relation to the spinal marrow R2* values before and after adjustments for potential confounders.

Results

In the unadjusted model, magnetic resonance imaging–based spinal marrow R2* was positively correlated to the levels of serum ferritin (Spearman ρ = 0.436, P < 0.001) and iron (Spearman ρ = 0.245, P = 0.009). Multiple stepwise linear regression analyses (adjusting for age, years since menopause, body mass index, alcohol intake, tobacco use, physical activity, serum lipids profile, biomarkers of bone turnover, and lumbar spine bone density) were performed in 3 separate models with marrow R2* values as potential explanatory variables. The level of serum ferritin, but not iron, was an independent predictor of marrow R2* (standardized β coefficient, 0.302, 95% confidence interval, 0.141–0.509, P = 0.001). Similarly, spinal marrow R2* increased with a linear trend from the lowest (<139 ng/mL) to highest (≥180 ng/mL) serum ferritin quartiles (P for trend = 0.007).

Conclusions

Quantitative assessment of R2* derived from FACT is a fast, simple, noninvasive, and nonionizing method to evaluate marrow iron accumulation.
Spinal MRI-Based Radiomics Analysis to Predict Treatment Response in Multiple Myeloma
Authors: Wu Zengjie , Bian Tiantian , Dong Cheng , Duan Shaofeng , Fei Hairong , Hao Dapeng , Xu Wenjian
Published: April 2022

Objective

The aim of this study was to explore the clinical utility of spinal magnetic resonance imaging–based radiomics to predict treatment response (TR) in patients with multiple myeloma (MM).

Methods

A total of 123 MM patients (85 in the training cohort and 38 in the test cohort) with complete response (CR) (n = 40) or non-CR (n = 83) were retrospectively enrolled in the study. Key feature selection and data dimension reduction were performed using the least absolute shrinkage and selection operator regression. A nomogram was built by combining radiomic signatures and independent clinical risk factors. The prediction performance of the nomogram was assessed using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis. Treatment response was assessed by determining the serum and urinary levels of M-proteins, serum-free light chain ratio, and the percentage of bone marrow plasma cells.

Results

Thirteen features were selected to build a radiomic signature. The International Staging System (ISS) stage was selected as an independent clinical factor. The radiomic signature and nomogram showed better calibration and higher discriminatory capacity (AUC of 0.929 and 0.917 for the radiomics and nomogram in the training cohort, respectively, and 0.862 and 0.874 for the radiomics and nomogram in the test cohort, respectively) than the clinical model (AUC of 0.661 and 0.674 in the training and test cohort, respectively). Decision curve analysis confirmed the clinical utility of the radiomics model.

Conclusions

Nomograms incorporating a magnetic resonance imaging–based radiomic signature and ISS stage help predict the response to chemotherapy for MM and can be useful in clinical decision-making.
A Comparative and Summative Study of Radiomics-based Overall Survival Prediction in Glioblastoma Patients
Authors: Ruan Zhuoying , Mei Nan , Lu Yiping , Xiong Ji , Li Xuanxuan , Zheng Weiwei , Liu Li , Yin Bo
Published: April 2022

Purpose

This study aimed to assess different machine learning models based on radiomic features, Visually Accessible Rembrandt Images features and clinical characteristics in overall survival prediction of glioblastoma and to identify the reproducible features.

Materials and Methods

Patients with preoperative magnetic resonance scans were allocated into 3 data sets. The Least Absolute Shrinkage and Selection Operator was used for feature selection. The prediction models were built by random survival forest (RSF) and Cox regression. C-index and integrated Brier scores were calculated to compare model performances.

Results

Patients with cortical involvement had shorter survival times in the training set (P = 0.006). Random survival forest showed higher C-index than Cox, and the RSF model based on the radiomic features was the best one (testing set: C-index = 0.935 ± 0.023). Ten reproducible radiomic features were summarized.

Conclusions

The RSF model based on radiomic features had promising potential in predicting overall survival of glioblastoma. Ten reproducible features were identified.
Cystic Lesions of the Pancreas: Is Apparent Diffusion Coefficient Value Useful at 3 T Magnetic Resonance Imaging?
Authors: Boraschi Piero , Scalise Paola , Casotti Maria Teresa , Kauffmann Emanuele Federico , Boggi Ugo , Donati Francescamaria
Published: April 2022

Objective

The objective of this study is to determine the role of apparent diffusion coefficient (ADC) value at 3T magnetic resonance imaging (MRI) in the characterization of pancreatic cystic lesions.

Methods

We retrospectively selected a total number of 223 patients with a conclusive diagnosis of pancreatic cystic lesion, previously undergoing MR examination on a 3 T system. The MRI protocol first included axial T1/T2-weighted sequences and magnetic resonance cholangiopancreatography. Diffusion-weighted MRI was performed using a spin-echo echo-planar sequence with multiple b values (0, 150, 500, 1000, and 1500 s/mm2) in all diffusion directions, obtaining an ADC map. Contrast-enhanced T1-weighted sequences were performed during the initial work-up of a pancreatic cystic lesion and when signs of malignancy were suspected during the MRI follow-up. The ADC value of each pancreatic lesion was measured using a monoexponential curve fitting with all the multiple b.

Results

The final diagnosis of our study group included the following: serous cystadenomas (n = 42), mucinous cystadenomas (n = 14), intraductal papillary mucinous neoplasms (IPMNs) (n = 121), IPMNs with signs of malignancy at histopathologic examination (n = 24), pseudocysts (n = 9), other cystic lesions (n = 13). A statistically significant difference was observed between the ADC values of malignant IPMNs and those of each other group of pancreatic lesions (P < 0.001). The ADC value of benign IPMN was significantly higher than that of serous cystadenomas (P = 0.024). A statistically significant difference was observed between the ADCs of all mucinous cystic tumors (benign IPMNs together to mucinous cystadenomas) and the ADCs of serous cystadenomas (P = 0.014).

Conclusions

Fitted ADC value obtained at 3T MRI may be helpful in the characterization of pancreatic cystic lesions with particular regards of differential diagnosis between mucinous and serous cystic tumors and between malignant and benign IPMNs.
Deep Learning–Based Automatic CT Quantification of Coronavirus Disease 2019 Pneumonia: An International Collaborative Study
Authors: Yoo Seung-Jin , Qi Xiaolong , Inui Shohei , Kim Hyungjin , Jeong Yeon Joo , Lee Kyung Hee , Lee Young Kyung , Lee Bae Young , Kim Jin Yong , Jin Kwang Nam , Lim Jae-Kwang , Kim Yun-Hyeon , Kim Ki Beom , Jiang Zicheng , Shao Chuxiao , Lei Junqiang , Zou Shengqiang , Pan Hongqiu , Gu Ye , Zhang Guo , Goo Jin Mo , Yoon Soon Ho
Published: April 2022

Objective

We aimed to develop and validate the automatic quantification of coronavirus disease 2019 (COVID-19) pneumonia on computed tomography (CT) images.

Methods

This retrospective study included 176 chest CT scans of 131 COVID-19 patients from 14 Korean and Chinese institutions from January 23 to March 15, 2020. Two experienced radiologists semiautomatically drew pneumonia masks on CT images to develop the 2D U-Net for segmenting pneumonia. External validation was performed using Japanese (n = 101), Italian (n = 99), Radiopaedia (n = 9), and Chinese data sets (n = 10). The primary measures for the system's performance were correlation coefficients for extent (%) and weight (g) of pneumonia in comparison with visual CT scores or human-derived segmentation. Multivariable logistic regression analyses were performed to evaluate the association of the extent and weight with symptoms in the Japanese data set and composite outcome (respiratory failure and death) in the Spanish data set (n = 115).

Results

In the internal test data set, the intraclass correlation coefficients between U-Net outputs and references for the extent and weight were 0.990 and 0.993. In the Japanese data set, the Pearson correlation coefficients between U-Net outputs and visual CT scores were 0.908 and 0.899. In the other external data sets, intraclass correlation coefficients were between 0.949–0.965 (extent) and between 0.978–0.993 (weight). Extent and weight in the top quartile were independently associated with symptoms (odds ratio, 5.523 and 10.561; P = 0.041 and 0.016) and the composite outcome (odds ratio, 9.365 and 7.085; P = 0.021 and P = 0.035).

Conclusions

Automatically quantified CT extent and weight of COVID-19 pneumonia were well correlated with human-derived references and independently associated with symptoms and prognosis in multinational external data sets.
Initial Investigation of Clinical Value of Noise-Optimized Virtual Monoenergetic Images Derived From Dual-Energy Computed Tomography Angiography in Preoperative Perforator Planning of Anterolateral Thigh Flap Transplantation
Authors: Li Xiaoqin , Zhang Jing , Shen Hesong , Wang Xiaoxia , Liu Daihong , Yu Hong , Lan Xiaosong , Shi Jinfang , Zeng Xiangfei , Liu Meiling , Lin Meng , Tan Yong , Zhang Bin , Zhang Jiuquan
Published: April 2022

Objective

To objectively and subjectively assess the image characteristics of noise-optimized virtual monoenergetic images [MEI (+)] and polyenergetic images (PEIs) from dual-energy computed tomography angiography and then to explore the clinical value of the optimal MEI (+) in preoperative perforator planning of anterolateral thigh (ALT) flap transplantation.

Methods

Sixteen patients (32 thighs) who underwent lower extremity run-off dual-energy computed tomography angiography for planning ALT flap transplantation were enrolled. One standard PEI and 5 MEI (+) in 10-keV intervals (range, 40–80 keV) were reconstructed. First, we compared the image quality subjectively (branch order, image quality, and vascular network continuity) and objectively (vascular attenuation, image noise, signal-to-noise ratio, and the contrast-to-noise ratio). Then, we compared the clinical value (number, type, source artery, pedicle length, caliber, and location of all sizable perforators) between the optimal MEI (+) and PEI groups.

Results

The 40-keV MEI (+) was rated superior subjective and objective image quality metrics to PEI (all P < 0.001). Compared with PEI, 40 keV MEI (+) increased the number of visible perforators, the percentage of perforators with identifiable types, and the measurable length of perforator pedicle (all P < 0.001).

Conclusions

We recommend 40 keV MEI (+) for the visualization of perforators and their contribution to the selection and location of suitable perforators in preoperative planning for ALT flaps.
Influence of Robotic Rectal Resection Versus Laparoscopic Rectal Resection on Postoperative Ileus: A Single-center Experience
Authors: Hu Qingjiang , Oki Eiji , Fujimoto Yoshiaki , Jogo Tomoko , Hokonohara Kentaro , Nakanishi Ryota , Hisamatsu Yuichi , Ando Koji , Kimura Yasue , Mori Masaki
Published: April 2022

Aim:

This study was performed to clarify the relationship between robotic rectal resection and postoperative ileus (POI) by comparing robotic surgery with laparoscopic surgery.

Materials and Methods:

We retrospectively reviewed 238 patients who underwent robotic (n=41) or laparoscopic (n=197) rectal resection for rectal cancer in our institution from January 2013 to June 2020. First, we compared the background factors and short-term surgical outcomes between robotic and laparoscopic surgery. Next, we investigated the postoperative complications of robotic and laparoscopic rectal resection. Finally, we identified the risk factors for POI following rectal cancer resection.

Results:

The percentages of patients with an Rb tumor location, treatment by abdominoperitoneal resection/intersphincteric resection/low anterior resection, a temporary diverting ileostomy, and a long operation time were significantly higher in robotic than laparoscopic surgery (P<0.0001, P=0.0002, P=0.0078, and P=0.0001, respectively). There was no significant difference in any individual postoperative complication between robotic and laparoscopic surgery. Risk factors for POI were male sex (P=0.0078), neoadjuvant chemoradiotherapy (P=0.0007), an Rb tumor location (P=0.0005), treatment by abdominoperitoneal resection/intersphincteric resection/low anterior resection (P=0.0044), a temporary diverting ileostomy (P<0.0001), and operation time of ≥240 minutes (P=0.0024). Notably, robotic surgery was not a risk factor for POI following rectal resection relative to laparoscopic surgery.

Conclusion:

Although patients who underwent robotic surgery had more risk factors for POI, the risk of POI was similar between robotic and laparoscopic rectal resection.
Kinetic exchange income distribution models with saving propensities: inequality indices and self-organized poverty level
Authors: Paul Sanjukta , Mukherjee Sudip , Joseph Bijin , Ghosh Asim , Chakrabarti Bikas K.
Published: April 2022

We report the numerical results for the steady-state income or wealth distribution

P
(
m
)

and the resulting inequality measures (Gini

g

and Kolkata

k

indices) in the kinetic exchange models of market dynamics. We study the variations of

P
(
m
)

and of the indices

g

and

k

with the saving propensity

λ

of the agents, with two different kinds of trade (kinetic exchange) dynamics. In the first case, the exchange occurs between randomly chosen pairs of agents and in the next, one of the agents in the chosen pair is the poorest of all and the other agent is randomly picked up from the rest of the population (where, in the steady state, a self-organized poverty level or SOPL appears). These studies have also been made for two different kinds of saving behaviours. One, where each agent has the same value of

λ

(constant over time) and the other where

λ

for each agent can take two values (0 and 1), changing randomly over a fraction of time

ρ
(
<
1
)

of choosing

λ
=
1

. We find that the inequality decreases with increasing savings (

λ

); inequality indices (

g

and

k

) decrease and SOPL increases with increasing

λ

, indicating possible applications in economic policy making.

This article is part of the theme issue ‘Kinetic exchange models of societies and economies’.
Double transition in kinetic exchange opinion models with activation dynamics
Authors: Pires Marcelo A. , Crokidakis Nuno
Published: April 2022

In this work, we study a model of opinion dynamics considering activation/deactivation of agents. In other words, individuals are not static and can become inactive and drop out from the discussion. A probability

w

governs the deactivation dynamics, whereas social interactions are ruled by kinetic exchanges, considering competitive positive/negative interactions. Inactive agents can become active due to interactions with active agents. Our analytical and numerical results show the existence of two distinct non-equilibrium phase transitions, with the occurrence of three phases, namely ordered (ferromagnetic-like), disordered (paramagnetic-like) and absorbing phases. The absorbing phase represents a collective state where all agents are inactive, i.e. they do not participate in the dynamics, inducing a frozen state. We determine the critical value

w
c

above which the system is in the absorbing phase independently of the other parameters. We also verify a distinct critical behaviour for the transitions among different phases.

This article is part of the theme issue ‘Kinetic exchange models of societies and economies’.
Virtual walks inspired by a mean-field kinetic exchange model of opinion dynamics
Authors: Saha Surajit , Sen Parongama
Published: April 2022

We propose two different schemes of realizing a virtual walk corresponding to a kinetic exchange model of opinion dynamics. The walks are either Markovian or non-Markovian in nature. The opinion dynamics model is characterized by a parameter

p

which drives an order disorder transition at a critical value

p
c

. The distribution

S
(
X
,
t
)

of the displacements

X

from the origin of the walkers is computed at different times. Below

p
c

, two time scales associated with a crossover behaviour in time are detected, which diverge in a power law manner at criticality with different exponent values.

S
(
X
,
t
)

also carries the signature of the phase transition as it changes its form at

p
c

. The walks show the features of a biased random walk below

p
c

, and above

p
c

, the walks are like unbiased random walks. The bias vanishes in a power law manner at

p
c

and the width of the resulting Gaussian function shows a discontinuity. Some of the features of the walks are argued to be comparable to the critical quantities associated with the mean-field Ising model, to which class the opinion dynamics model belongs. The results for the Markovian and non-Markovian walks are almost identical which is justified by considering the different fluxes. We compare the present results with some earlier similar studies.

This article is part of the theme issue ‘Kinetic exchange models of societies and economies’.
A tale of two habitats: Bacteroides fragilis, a lethal pathogen and resident in the human gastrointestinal microbiome
Authors: Patrick Sheila
Published: April 2022

Bacteroides fragilis

is an obligately anaerobic Gram-negative bacterium and a major colonizer of the human large colon where

Bacteroides

is a predominant genus. During the growth of an individual clonal population, an astonishing number of reversible DNA inversion events occur, driving within-strain diversity. Additionally, the

B. fragilis

pan-genome contains a large pool of diverse polysaccharide biosynthesis loci, DNA restriction/modification systems and polysaccharide utilization loci, which generates remarkable between-strain diversity. Diversity clearly contributes to the success of

B. fragilis

within its normal habitat of the gastrointestinal (GI) tract and during infection in the extra-intestinal host environment. Within the GI tract,

B. fragilis

is usually symbiotic, for example providing localized nutrients for the gut epithelium, but

B. fragilis

within the GI tract may not always be benign. Metalloprotease toxin production is strongly associated with colorectal cancer.

B. fragilis

is unique amongst bacteria; some strains export a protein >99 % structurally similar to human ubiquitin and antigenically cross-reactive, which suggests a link to autoimmune diseases.

B. fragilis

is not a primary invasive enteric pathogen; however, if colonic contents contaminate the extra-intestinal host environment, it successfully adapts to this new habitat and causes infection; classically peritoneal infection arising from rupture of an inflamed appendix or GI surgery, which if untreated, can progress to bacteraemia and death. In this review selected aspects of

B. fragilis

adaptation to the different habitats of the GI tract and the extra-intestinal host environment are considered, along with the considerable challenges faced when studying this highly variable bacterium.
Potential gains in health-adjusted life expectancy by reducing burden of non-communicable diseases: a population-based study
Authors: Xi Jun-Yan , Zhang Wang-Jian , Chen Zhuo , Zhang Yan-Ting , Chen Li-Chang , Zhang Yu-Qin , Lin Xiao , Hao Yuan-Tao
Published: April 2022

Background

The United Nations Sustainable Development Goals (SDGs) target 3.4 aims to reduce premature mortality attributable to non-communicable diseases (NCDs) by one-third of their 2015 levels by 2030. Although meeting this target leads to longevity, survivors may suffer from long-term disability caused by NCDs. This paper quantifies the potential gains in health-adjusted life expectancy for people aged 30-70 years (HALE[30–70)) by examining the reductions in disability in addition to premature mortality. Additionally, we also assessed the feasibility of meeting the SDGs target 3.4.

Methods

We extracted data from the Global Burden of Disease Study 2019 for all NCDs and four major NCDs (cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes mellitus) in 188 countries from 1990 to 2019. Bayesian age-period-cohort models were used to predict possible premature mortality in 2030. The life table was used to estimate the unconditional probability of death and HALE[30–70). Estimates of the potential gains in HALE[30–70) were based on three alternative future scenarios: a) eliminating all premature deaths and disability from a specific cause, b) meeting SDGs target 3.4, and survivors’ disability is eliminated, and c) meeting SDGs target 3.4, but survivors remain disabled for the rest of their lives.

Results

In 2030, the unconditional probability of premature mortality for four major NCDs in most countries remained at more than two-thirds of the 2015 baseline. In all scenarios, the high-income group has the greatest potential gains in HALE[30–70), above the global average of HALE[30–70). In scenario A, the potential gains in HALE[30–70) of reducing premature mortality for four major NCDs are significantly lower than those for all NCDs (range of difference for all income groups: 2.88 - 3.27 years). In scenarios B and C, the potential gains of HALE[30–70) in reducing premature mortality for all NCDs and the four major NCDs are similar (scenario B: 0.14 - 0.22, scenario C: 0.05 - 0.19). In scenarios A and B, countries from the high-income group have the greatest potential gains in HALE[30–70) from cancer intervention, whilst countries from the other income groups result in a greater possible HALE[30–70) gains from cardiovascular diseases control. In scenario C, countries from each income group have the largest potential gains in HALE[30–70) from diabetes reduction and chronic respiratory diseases prevention.

Conclusions

Achieving SDGs target 3.4 remains challenging for most countries. The elimination of disability among the population who benefit from the target could lead to a sizable improvement in HALE[30–70). Reducing premature death and disability at once and attaching equal importance to each to in line with the WHO goal of “leaving no one behind”.