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Journal of Clinical and Translational... Oct 2020Radiomics has revolutionized the world of medical imaging. The aim of this review is to guide oncologists in radiomics and its applications in diagnosis, prediction of...
UNLABELLED
Radiomics has revolutionized the world of medical imaging. The aim of this review is to guide oncologists in radiomics and its applications in diagnosis, prediction of response and damage, prediction of survival, and prognosis in lung cancer. In this review, we analyzed published literature on PubMed and MEDLINE with papers published in the last 10 years. We included papers in English language with information about radiomics features and diagnostic, predictive, and prognosis of radiomics in lung cancer. All citations were evaluated for relevant content and validation.
RELEVANCE FOR PATIENTS
The evolution of technology allows the development of computer algorithms that facilitate the diagnosis and evaluation of response after different oncological treatments and their non-invasive follow-up.
PubMed: 33521373
DOI: No ID Found -
Journal of Fungi (Basel, Switzerland) Jan 2021is a frequent cause of fungal bloodstream infections, especially in critically ill neonates or immunocompromised patients. Due to the formation of biofilms, the use of...
is a frequent cause of fungal bloodstream infections, especially in critically ill neonates or immunocompromised patients. Due to the formation of biofilms, the use of indwelling catheters and other medical devices increases the risk of infection and complicates treatment, as cells embedded in biofilms display reduced drug susceptibility. Therefore, biofilm formation may be a significant clinical parameter, guiding downstream therapeutic choices. Here, we phenotypically characterized 120 selected isolates out of a prospective collection of 215 clinical isolates, determining biofilm formation, major emerging colony morphotype, and antifungal drug susceptibility of the isolates and their biofilms. In our isolate set, increased biofilm formation capacity was independent of body site of isolation and not predictable using standard or modified European Committee on Antimicrobial Susceptibility Testing (EUCAST) drug susceptibility testing protocols. In contrast, biofilm formation was strongly correlated with the appearance of non-smooth colony morphotypes and invasiveness into agar plates. Our data suggest that the observation of non-smooth colony morphotypes in cultures of may help as an indicator to consider the initiation of anti-biofilm-active therapy, such as the switch from azole- to echinocandin- or polyene-based strategies, especially in case of infections by potent biofilm-forming strains.
PubMed: 33430377
DOI: 10.3390/jof7010033 -
JAMA Jan 2021Antibiotics are an effective and safe alternative to appendectomy for managing uncomplicated acute appendicitis, but the optimal antibiotic regimen is not known. (Comparative Study)
Comparative Study Randomized Controlled Trial
IMPORTANCE
Antibiotics are an effective and safe alternative to appendectomy for managing uncomplicated acute appendicitis, but the optimal antibiotic regimen is not known.
OBJECTIVE
To compare oral antibiotics with combined intravenous followed by oral antibiotics in the management of computed tomography-confirmed uncomplicated acute appendicitis.
DESIGN, SETTING, AND PARTICIPANTS
The Appendicitis Acuta (APPAC) II multicenter, open-label, noninferiority randomized clinical trial was conducted from April 2017 until November 2018 in 9 Finnish hospitals. A total of 599 patients aged 18 to 60 years with computed tomography-confirmed uncomplicated acute appendicitis were enrolled in the trial. The last date of follow-up was November 29, 2019.
INTERVENTIONS
Patients randomized to receive oral monotherapy (n = 295) received oral moxifloxacin (400 mg/d) for 7 days. Patients randomized to receive intravenous antibiotics followed by oral antibiotics (n = 288) received intravenous ertapenem (1 g/d) for 2 days followed by oral levofloxacin (500 mg/d) and metronidazole (500 mg 3 times/d) for 5 days.
MAIN OUTCOMES AND MEASURES
The primary end point was treatment success (≥65%) for both groups, defined as discharge from hospital without surgery and no recurrent appendicitis during 1-year follow-up, and to determine whether oral antibiotics alone were noninferior to intravenous and oral antibiotics, with a margin of 6% for difference.
RESULTS
Among 599 patients who were randomized (mean [SD] age, 36 [12] years; 263 [44%] women), 581 (99.7%) were available for the 1-year follow-up. The treatment success rate at 1 year was 70.2% (1-sided 95% CI, 65.8% to ∞) for patients treated with oral antibiotics and 73.8% (1-sided 95% CI, 69.5% to ∞) for patients treated with intravenous followed by oral antibiotics. The difference was -3.6% ([1-sided 95% CI, -9.7% to ∞]; P = .26 for noninferiority), with the confidence limit exceeding the noninferiority margin.
CONCLUSION AND RELEVANCE
Among adults with uncomplicated acute appendicitis, treatment with 7 days of oral moxifloxacin compared with 2 days of intravenous ertapenem followed by 5 days of levofloxacin and metronidazole resulted in treatment success rates greater than 65% in both groups, but failed to demonstrate noninferiority for treatment success of oral antibiotics compared with intravenous followed by oral antibiotics.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03236961; EudraCT Identifier: 2015-003633-10.
Topics: Acute Disease; Administration, Intravenous; Administration, Oral; Adult; Anti-Bacterial Agents; Appendectomy; Appendicitis; Drug Therapy, Combination; Ertapenem; Female; Follow-Up Studies; Humans; Levofloxacin; Male; Metronidazole; Middle Aged; Moxifloxacin; Tomography, X-Ray Computed; Young Adult
PubMed: 33427870
DOI: 10.1001/jama.2020.23525 -
Medical Oncology (Northwood, London,... Nov 2020Stereotactic Body Radiotherapy (SBRT) is a technique for delivering high doses of radiation to tumors while preserving the normal tissues located around this area. Bone... (Review)
Review
Stereotactic Body Radiotherapy (SBRT) is a technique for delivering high doses of radiation to tumors while preserving the normal tissues located around this area. Bone metastases are frequent in cancer patients. They can be distressingly painful or may cause pathological fractures. Radiation therapy is a fundamental aspect of treatment for bone metastases. The objective of this study is to analyze the literature on non-spine bone metastasis treated with SBRT, including immobilization, volume delineation, dose and fractionation, local control, side effects, and assessment of response after treatment. Full-text articles written in English language and published in the last 10 years were included in this review and were accessible on PubMed and MEDLINE. We examined 78 articles. A total of 40 studies were included in this review. Most were retrospective studies. The articles included were evaluated for content and validation. The immobilization systems and imaging tests used for tumor delimitation were variable between studies. The use of CTV (Clinical Target Volume) has not been defined. Doses and fractions were variable from 15 to 24 Gy/1 fraction to 24-50 Gy in 3-5 fractions, with local control being around 90% with a low rate of side effects. We review state of the art in SBRT non-spine metastases. SBRT can result in better local control and pain management in non-spine bone metastases patients. We need more research in volume delineation determining whether or not to use CTV and the role of MRI in volume contouring, optimal doses, and fractionation according to histology and a reliable response assessment tool. Studies that compare SBRT to conventional radiotherapy in local control and pain control are needed.
Topics: Bone Neoplasms; Humans; Magnetic Resonance Imaging; Radiosurgery; Tomography, X-Ray Computed
PubMed: 33221952
DOI: 10.1007/s12032-020-01442-1 -
The Journal of Infectious Diseases Feb 2021
PubMed: 33215671
DOI: 10.1093/infdis/jiaa560 -
JAMA Surgery Feb 2021Diverticulitis has a tendency to recur and affect quality of life. (Comparative Study)
Comparative Study Randomized Controlled Trial
Comparing Laparoscopic Elective Sigmoid Resection With Conservative Treatment in Improving Quality of Life of Patients With Diverticulitis: The Laparoscopic Elective Sigmoid Resection Following Diverticulitis (LASER) Randomized Clinical Trial.
IMPORTANCE
Diverticulitis has a tendency to recur and affect quality of life.
OBJECTIVE
To assess whether sigmoid resection is superior to conservative treatment in improving quality of life of patients with recurrent, complicated, or persistent painful diverticulitis.
DESIGN, SETTING, AND PARTICIPANTS
This open-label randomized clinical trial assessed for eligibility 128 patients with recurrent, complicated, or persistent painful diverticulitis in 6 Finnish hospitals from September 29, 2014, to October 10, 2018. Exclusion criteria included age younger than 18 years or older than 75 years; lack of (virtual) colonoscopy or sigmoidoscopy data within 2 years, or presence of cancer, contraindication to laparoscopy, or fistula. Outcomes were assessed using intention-to-treat analysis. A prespecified interim analysis was undertaken when 66 patients had been randomized and their 6-month follow-up was assessable. Data were analyzed from June 2018 to May 2020.
INTERVENTIONS
Laparoscopic sigmoid resection or conservative treatment.
MAIN OUTCOMES AND MEASURES
The primary outcome was difference in Gastrointestinal Quality of Life Index (GIQLI) score between randomization and 6 months.
RESULTS
Of 128 patients assessed for eligibility, 90 were randomized (28 male [31%]; mean [SD] age, 54.11 [11.9] years; 62 female [69%]; mean [SD] age, 57.13 [7.6] years). A total of 72 patients were included in analyses for the primary outcome (37 in the surgery group and 35 in the conservative treatment group), and 85 were included in analyses for clinical outcomes (41 in the surgery group and 44 in the conservative treatment group). The difference between GIQLI score at randomization and 6 months was a mean of 11.96 points higher in the surgery group than in the conservative treatment group (mean [SD] of 11.76 [15.89] points vs -0.2 [19.07] points; difference, 11.96; 95% CI, 3.72-20.19; P = .005). Four patients (10%) in the surgery group and no patients in the conservative treatment group experienced major complications (Clavien-Dindo grade III or higher). There were 2 patients (5%) in the surgery group and 12 patients (31%) in the conservative treatment group who had new episodes of diverticulitis within 6 months.
CONCLUSIONS AND RELEVANCE
In this randomized clinical trial, elective laparoscopic sigmoid resection improved quality of life in patients with recurrent, complicated, or persistent painful diverticulitis but carried a 10% risk of major complications.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02174926.
Topics: Aged; Colon, Sigmoid; Conservative Treatment; Diverticulitis, Colonic; Elective Surgical Procedures; Female; Finland; Humans; Laparoscopy; Male; Middle Aged; Quality of Life
PubMed: 33206182
DOI: 10.1001/jamasurg.2020.5151 -
International Journal of Dermatology Jan 2021
Topics: Brazil; Humans; Pinta
PubMed: 33151546
DOI: 10.1111/ijd.15264 -
International Journal of Radiation... Mar 2021We report long-term outcomes of phase 2 trial on patients with invasive breast cancer treated with accelerated partial-breast irradiation (APBI) using tomotherapy after...
PURPOSE
We report long-term outcomes of phase 2 trial on patients with invasive breast cancer treated with accelerated partial-breast irradiation (APBI) using tomotherapy after breast conservative surgery.
METHODS AND MATERIALS
From December 2010 to December 2018, we treated 338 women with APBI-tomotherapy: 38.5 Gy in 10 once-daily fractions. Patients selected were age ≥50 years old, with ≤3 cm in size unifocal tumor and at least 2 mm of clear margins. Disease outcomes were analyzed by clinicopathologic characteristics, molecular phenotypes, and American Society for Radiation Oncology (ASTRO) 2017 updated consensus groupings.
RESULTS
The median age was 65 years (range, 50-86). The invasive ductal (87.5%) and the luminal A-like molecular phenotype (70%) were the most common tumors. Overall 242 patients (71.6%) were considered "suitable" for enrollment in APBI according to the eligibility criteria of the ASTRO-2017 consensus statement. With a median follow-up of 76 months (range, 17-113), 2 patients (0.6%) had an invasive ipsilateral breast tumor recurrence (IBTR), and 2 patients (0.6%) had an axillary ipsilateral failure. The rate of local control in terms of free of IBTR was 99.4% and locoregional control (no recurrence in ipsilateral breast as well as in regional nodes) was 98.8%. Progression-free survival was 98.4% and 92% at 5 and 10 years, respectively. Acute and late skin toxicity, graded according to the Common Terminology Criteria for Adverse Events, were 7.7% (G1) and 0.6% (G2) and 4.4% (G1) and 1.1% (G2), respectively. There were no grade 3/4 toxicities, however. Very few patients (2%) or physicians (2%) assessed cosmetic outcome as fair or poor at the 2-year follow-up.
CONCLUSIONS
This phase 2 trial on APBI-tomotherapy shows excellent long-term results. Once-daily fractionation schedule was well tolerated with a low rate of adverse events and worse cosmetic outcome. In this series, even among those deemed cautionary or unsuitable for APBI by ASTRO criteria, we demonstrated a low rate of IBTR.
Topics: Aged; Aged, 80 and over; Breast Neoplasms; Carcinoma, Ductal, Breast; Carcinoma, Lobular; Consensus; Dose Fractionation, Radiation; Esthetics; Female; Humans; Kaplan-Meier Estimate; Margins of Excision; Mastectomy, Segmental; Middle Aged; Neoplasm Recurrence, Local; Progression-Free Survival; Radiotherapy; Radiotherapy, Intensity-Modulated; Time Factors; Treatment Outcome
PubMed: 33098960
DOI: 10.1016/j.ijrobp.2020.10.009 -
Journal of Medical Internet Research Oct 2020Many factors involved in the onset and clinical course of the ongoing COVID-19 pandemic are still unknown. Although big data analytics and artificial intelligence are...
Clinical Characteristics and Prognostic Factors for Intensive Care Unit Admission of Patients With COVID-19: Retrospective Study Using Machine Learning and Natural Language Processing.
BACKGROUND
Many factors involved in the onset and clinical course of the ongoing COVID-19 pandemic are still unknown. Although big data analytics and artificial intelligence are widely used in the realms of health and medicine, researchers are only beginning to use these tools to explore the clinical characteristics and predictive factors of patients with COVID-19.
OBJECTIVE
Our primary objectives are to describe the clinical characteristics and determine the factors that predict intensive care unit (ICU) admission of patients with COVID-19. Determining these factors using a well-defined population can increase our understanding of the real-world epidemiology of the disease.
METHODS
We used a combination of classic epidemiological methods, natural language processing (NLP), and machine learning (for predictive modeling) to analyze the electronic health records (EHRs) of patients with COVID-19. We explored the unstructured free text in the EHRs within the Servicio de Salud de Castilla-La Mancha (SESCAM) Health Care Network (Castilla-La Mancha, Spain) from the entire population with available EHRs (1,364,924 patients) from January 1 to March 29, 2020. We extracted related clinical information regarding diagnosis, progression, and outcome for all COVID-19 cases.
RESULTS
A total of 10,504 patients with a clinical or polymerase chain reaction-confirmed diagnosis of COVID-19 were identified; 5519 (52.5%) were male, with a mean age of 58.2 years (SD 19.7). Upon admission, the most common symptoms were cough, fever, and dyspnea; however, all three symptoms occurred in fewer than half of the cases. Overall, 6.1% (83/1353) of hospitalized patients required ICU admission. Using a machine-learning, data-driven algorithm, we identified that a combination of age, fever, and tachypnea was the most parsimonious predictor of ICU admission; patients younger than 56 years, without tachypnea, and temperature <39 degrees Celsius (or >39 ºC without respiratory crackles) were not admitted to the ICU. In contrast, patients with COVID-19 aged 40 to 79 years were likely to be admitted to the ICU if they had tachypnea and delayed their visit to the emergency department after being seen in primary care.
CONCLUSIONS
Our results show that a combination of easily obtainable clinical variables (age, fever, and tachypnea with or without respiratory crackles) predicts whether patients with COVID-19 will require ICU admission.
Topics: Adult; Aged; Betacoronavirus; COVID-19; Coronavirus Infections; Electronic Health Records; Emergency Service, Hospital; Female; Hospitalization; Humans; Intensive Care Units; Machine Learning; Male; Middle Aged; Natural Language Processing; Pandemics; Pneumonia, Viral; Prognosis; Retrospective Studies; SARS-CoV-2; Spain; Treatment Outcome
PubMed: 33090964
DOI: 10.2196/21801 -
Breast (Edinburgh, Scotland) Dec 2020Capsular contracture (CC) is the most common complication following Immediate Breast Reconstruction (IBR) with breast implants. Different implant surfaces were developed... (Comparative Study)
Comparative Study
BACKGROUND
Capsular contracture (CC) is the most common complication following Immediate Breast Reconstruction (IBR) with breast implants. Different implant surfaces were developed aiming to reduce the incidence of CC. We evaluated the incidence and degree of CC after Direct-to-Implant (DTI) IBR with insertion of textured (TE) or polyurethane (PU) covered implants.
METHODS
A retrospective review of consecutive patients treated at our Institution with mastectomy and one-stage IBR and implant reconstruction between 2013 and 2018, with or without post mastectomy radiation therapy (PMRT), was conducted. Immediate breast reconstruction was performed by implanting 186 PU covered implants and 172 TE implants.
RESULTS
Three-hundred-twelve women underwent 358 DTI IBR with PU or TE implants, were analyzed with a median follow-up time of 2.3 years (range 1.0-3.0). The overall rate of CC Baker grade III and IV was 11.8% (95%CI: 8.4-16.3), while, after PU and TE implant placement it was 8.1% (95% CI: 4.1-15.7) and 15.8% (95% CI: 4.1-15.7) [p = 0.009]), respectively. Irradiated breasts developed CC more frequently rather than non-irradiated breasts (HR = 12.5, p < 0.001), and the relative risk was higher in the TE group compared with the PU group (HR = 0.3, p = 0.003).
CONCLUSIONS
After mastectomy and one-stage IBR, the use of PU covered implants is associated with a lower incidence of CC compared to TE implants. This advantage is amplified several folds for patients who necessitate PMRT. Footnote: Capsular contracture (CC); Immediate Breast Reconstruction (IBR); Directto- Implant (DTI); Textured (TE); Polyurethane (PU); Post mastectomy radiation therapy (PMRT); Nipple Sparing mastectomy (NSM).
Topics: Adult; Breast Implantation; Breast Implants; Breast Neoplasms; Female; Humans; Implant Capsular Contracture; Incidence; Mastectomy; Middle Aged; Polyurethanes; Prosthesis Design; Retrospective Studies; Time Factors; Treatment Outcome
PubMed: 33010626
DOI: 10.1016/j.breast.2020.09.009