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Cureus May 2024Stereotactic body radiation therapy (SBRT) has been established as a safe and effective treatment for prostate cancer. SBRT requires high accuracy to reduce treatment...
PURPOSE
Stereotactic body radiation therapy (SBRT) has been established as a safe and effective treatment for prostate cancer. SBRT requires high accuracy to reduce treatment margins. Metal hip prostheses create artifacts that distort pelvic imaging and potentially decrease the accuracy of target/organ at risk (OAR) identification and radiation dose calculations. Data on the safety and efficacy of SBRT after hip replacement is limited. This single-institution study sought to evaluate the safety and local control following SBRT for prostate cancer in men with hip replacements.
METHODS
23 patients treated with localized prostate cancer and a history of pre-treatment hip replacement, treated with SBRT from 2007 to 2017 at MedStar Georgetown University Hospital were included in this retrospective analysis. Treatment was administered with the CyberKnife (Accuray Incorporated, Sunnyvale, CA) at doses of 35 Gy or 36.25 Gy in 5 fractions. The targets and OARs were identified and contoured by a single experienced Radiation Oncologist (SPC). The adequacy of the CT and T2W MRI images for treatment planning was assessed with a three-point scale (good, adequate, or suboptimal). During treatment planning, care was taken to avoid treatment beams that directly traversed the hip prosthesis. Toxicities were recorded and scored using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v.4.0). Local recurrence was confirmed by magnetic resonance imaging and/or prostate biopsy.
RESULTS
The median follow-up was seven years. The patients were elderly (median age = 71 years) with a high rate of comorbidities (Charlson Comorbidity Index > 2 in 25%). Four patients had bilateral hip replacements. The majority of patients were low to intermediate risk per the D'Amico classification. Around 13% received upfront ADT. In total, 13 patients were treated with 35 Gy, and 10 were treated with 36.25 Gy. The rates of late > Grade 3 GU toxicity and > Grade 2 GI toxicity were 8.6% and 4.3%, respectively. There were no Grade 4 or 5 toxicities. Six patients (26%) developed a local recurrence at a median time of 7.5 years. Of these six patients, four had unilateral hip replacements and two had bilateral. Three underwent salvage cryotherapy and three received salvage ADT.
CONCLUSIONS
In the general population, high-grade toxicities and local recurrences are uncommon following prostate SBRT. However, in this cohort of patients with prior hip replacements, prostate SBRT had higher than expected rates of late toxicity and local recurrence. In the opinion of the authors, such patients should be counseled regarding an elevated risk of late toxicity and local recurrence with prostate SBRT. With its ultrasound guidance, brachytherapy would have the advantage of circumventing the need for MRI/CT-based imaging and thus may represent a preferable radiation alternative in this patient population. If these patients are treated with SBRT, they should be monitored closely for local recurrence so early salvage can be performed. We hope that recent advances in metal artifact reduction techniques and dose-calculation algorithms will improve future outcomes.
PubMed: 38947568
DOI: 10.7759/cureus.61432 -
IScience Jun 2024Taste organs contain distinct gustatory receptors that help organisms differentiate between nourishing and potentially harmful foods. The detection of high pH levels...
Taste organs contain distinct gustatory receptors that help organisms differentiate between nourishing and potentially harmful foods. The detection of high pH levels plays a crucial role in food selection, but the specific gustatory receptors responsible for perceiving elevated pH in foods have remained unknown. By using as a model organism, we have uncovered the involvement of ionotropic receptors (IRs) in avoiding high-pH foods. Our study involved a combination of behavioral tests and electrophysiological analyses, which led to the identification of six from bitter-sensing gustatory receptor neurons essential for rejecting food items with elevated pH levels. Using the same methodology, our study reevaluated the significance of Alka and OtopLa. The findings highlight that Alka, in conjunction with IRs, is crucial for detecting alkaline substances, whereas OtopLa does not contribute to this process. Overall, our study offers valuable insights into the intricate mechanisms governing taste perception in organisms.
PubMed: 38947501
DOI: 10.1016/j.isci.2024.110087 -
Heliyon Jun 2024In recent decades, biosynthesis of metal and (or) metal oxide nanoparticles using microbes is accepted as one of the most sustainable, cost-effective, robust, and green... (Review)
Review
In recent decades, biosynthesis of metal and (or) metal oxide nanoparticles using microbes is accepted as one of the most sustainable, cost-effective, robust, and green processes as it does not encompass the usage of largely hazardous chemicals. Accordingly, numerous simple, inexpensive, and environmentally friendly approaches for the biosynthesis of silver nanoparticles (AgNPs) were reported using microbes avoiding conventional (chemical) methods. This comprehensive review detailed an advance made in recent years in the microbes-mediated biosynthesis of AgNPs and evaluation of their antimicrobial activities covering the literature from 2015-till date. It also aimed at elaborating the possible effect of the different phytochemicals, their concentrations, extraction temperature, extraction solvent, pH, reaction time, reaction temperature, and concentration of precursor on the shape, size, and stability of the synthesized AgNPs. In addition, while trying to understand the antimicrobial activities against targeted pathogenic microbes the probable mechanism of the interaction of produced AgNPs with the cell wall of targeted microbes that led to the cell's reputed and death have also been detailed. Lastly, this review detailed the shape and size-dependent antimicrobial activities of the microbes-mediated AgNPs and their enhanced antimicrobial activities by synergetic interaction with known commercially available antibiotic drugs.
PubMed: 38947433
DOI: 10.1016/j.heliyon.2024.e32333 -
Journal of Cancer 2024It's a major public health problem of global concern that malignant gliomas tend to grow rapidly and infiltrate surrounding tissues. Accurate grading of the tumor can...
It's a major public health problem of global concern that malignant gliomas tend to grow rapidly and infiltrate surrounding tissues. Accurate grading of the tumor can determine the degree of malignancy to formulate the best treatment plan, which can eliminate the tumor or limit widespread metastasis of the tumor, saving the patient's life and improving their prognosis. To more accurately predict the grading of gliomas, we proposed a novel method of combining the advantages of 2D and 3D Convolutional Neural Networks for tumor grading by multimodality on Magnetic Resonance Imaging. The core of the innovation lies in our combination of tumor 3D information extracted from multimodal data with those obtained from a 2D ResNet50 architecture. It solves both the lack of temporal-spatial information provided by 3D imaging in 2D convolutional neural networks and avoids more noise from too much information in 3D convolutional neural networks, which causes serious overfitting problems. Incorporating explicit tumor 3D information, such as tumor volume and surface area, enhances the grading model's performance and addresses the limitations of both approaches. By fusing information from multiple modalities, the model achieves a more precise and accurate characterization of tumors. The model I s trained and evaluated using two publicly available brain glioma datasets, achieving an AUC of 0.9684 on the validation set. The model's interpretability is enhanced through heatmaps, which highlight the tumor region. The proposed method holds promise for clinical application in tumor grading and contributes to the field of medical diagnostics for prediction.
PubMed: 38947386
DOI: 10.7150/jca.95987 -
World Journal of Gastroenterology Jun 2024In this editorial we comment on the article by Agatsuma published in the . They suggest policies for more effective colorectal screening. Screening is the main policy...
In this editorial we comment on the article by Agatsuma published in the . They suggest policies for more effective colorectal screening. Screening is the main policy that has led to lower mortality rates in later years among the population that was eligible for screening. Colonoscopy is the gold standard tool for screening and has preventive effects by removing precancerous or early malignant polyps. However, colonoscopy is an invasive process, and fecal tests such as the current hemoglobin immunodetection were developed, followed by endoscopy, as the general tool for population screening, avoiding logistical and economic problems. Even so, participation and adherence rates are low. Different screening options are being developed with the idea that if people could choose between the ones that best suit them, participation in population-based screening programs would increase. Blood tests, such as a recent one that detects cell-free DNA shed by tumors called circulating tumor DNA, showed a similar accuracy rate to stool tests for cancer, but were less sensitive for advanced precancerous lesions. At the time when the crosstalk between the immune system and cancer was being established as a new hallmark of cancer, novel immune system-related biomarkers and information on patients' immune parameters, such as cell counts of different immune populations, were studied for the early detection of colorectal cancer, since they could be effective in asymptomatic people, appearing earlier in the adenoma-carcinoma development compared to the presence of fecal blood. sCD26, for example, detected 80.37% of advanced adenomas. To reach as many eligible people as possible, starting at an earlier age than current programs, the direction could be to apply tests based on blood, urine or salivary fluid to samples taken during routine visits to the primary health system.
PubMed: 38947291
DOI: 10.3748/wjg.v30.i22.2849 -
Psychologica Belgica 2024Profile similarity measures are used to quantify the similarity of two sets of ratings on multiple variables. Yet, it remains unclear how different measures are distinct...
Profile similarity measures are used to quantify the similarity of two sets of ratings on multiple variables. Yet, it remains unclear how different measures are distinct or overlap and what type of information they precisely convey, making it unclear what measures are best applied under varying circumstances. With this study, we aim to provide clarity with respect to how existing measures interrelate and provide recommendations for their use by comparing a wide range of profile similarity measures. We have taken four steps. First, we reviewed 88 similarity measures by applying them to multiple cross-sectional and intensive longitudinal data sets on emotional experience and retained 43 useful profile similarity measures after eliminating duplicates, complements, or measures that were unsuitable for the intended purpose. Second, we have clustered these 43 measures into similarly behaving groups, and found three general clusters: one cluster with difference measures, one cluster with product measures that could be split into four more nuanced groups and one miscellaneous cluster that could be split into two more nuanced groups. Third, we have interpreted what unifies these groups and their subgroups and what information they convey based on theory and formulas. Last, based on our findings, we discuss recommendations with respect to the choice of measure, propose to avoid using the Pearson correlation, and suggest to center profile items when stereotypical patterns threaten to confound the computation of similarity.
PubMed: 38947283
DOI: 10.5334/pb.1297 -
The Yale Journal of Biology and Medicine Jun 2024Environmental mismatches are defined as changes in the environment that induce public health crises. Well known mismatches leading to chronic disease include the... (Review)
Review
Environmental mismatches are defined as changes in the environment that induce public health crises. Well known mismatches leading to chronic disease include the availability of technologies that facilitate unhealthy diets and sedentary lifestyles, both factors that adversely affect cardiovascular health. This commentary puts these mismatches in context with biota alteration, an environmental mismatch involving hygiene-related technologies necessary for avoidance of infectious disease. Implementation of hygiene-related technologies causes a loss of symbiotic helminths and protists, profoundly affecting immune function and facilitating a variety of chronic conditions, including allergic disorders, autoimmune diseases, and several inflammation-associated neuropsychiatric conditions. Unfortunately, despite an established understanding of the biology underpinning this and other environmental mismatches, public health agencies have failed to stem the resulting tide of increased chronic disease burden. Both biomedical research and clinical practice continue to focus on an ineffective and reactive pharmaceutical-based paradigm. It is argued that the healthcare of the future could take into account the biology of today, effectively and proactively dealing with environmental mismatch and the resulting chronic disease burden.
Topics: Humans; Chronic Disease; Immune System Diseases; Animals; Environment
PubMed: 38947109
DOI: 10.59249/VUNF1315 -
MedRxiv : the Preprint Server For... Jun 2024Elevated anxiety and uncertainty avoidance are known to exacerbate maladaptive choice in individuals with affective disorders. However, the differential roles of state...
Elevated anxiety and uncertainty avoidance are known to exacerbate maladaptive choice in individuals with affective disorders. However, the differential roles of state vs. trait anxiety remain unclear, and underlying computational mechanisms have not been thoroughly characterized. In the present study, we investigated how a somatic (interoceptive) state anxiety induction influences learning and decision-making under uncertainty in individuals with clinically significant levels of trait anxiety. A sample of 58 healthy comparisons (HCs) and 61 individuals with affective disorders (iADs; i.e., depression and/or anxiety) completed a previously validated explore-exploit decision task, with and without an added breathing resistance manipulation designed to induce state anxiety. Computational modeling revealed a pattern in which iADs showed greater information-seeking (i.e., directed exploration; Cohen's =.39, =.039) in resting conditions, but that this was reduced by the anxiety induction. The affective disorders group also showed slower learning rates across conditions (Cohen's =.52, =.003), suggesting more persistent uncertainty. These findings highlight a complex interplay between trait anxiety and state anxiety. Specifically, while elevated trait anxiety is associated with persistent uncertainty, acute somatic anxiety can paradoxically curtail exploratory behaviors, potentially reinforcing maladaptive decision-making patterns in affective disorders.
PubMed: 38947082
DOI: 10.1101/2024.06.19.24309110 -
MedRxiv : the Preprint Server For... Jun 2024The NKF-ASN Task Force recommends accurate kidney function estimation avoiding biases through racial adjustments. We explored the use of multiple kidney function...
RATIONALE AND OBJECTIVE
The NKF-ASN Task Force recommends accurate kidney function estimation avoiding biases through racial adjustments. We explored the use of multiple kidney function biomarkers and hence estimated glomerular filtration rate (eGFR) equations to improve kidney function calculations in an ethnically diverse patient population.
STUDY DESIGN
Prospective community cohort study.
SETTING AND PARTICIPANTS
Rural New Mexico clinic with patients > 18 yo.
METHODS
Markers of kidney function, IDMS-Creatinine (SCr), chemiluminescence Beta-2 Microglobulin (B2M), Nephelometry-calibrated ELISA Cystatin C (CysC), inflammation, glucose tolerance, demographics, BUN/UACR from the baseline visit of the COMPASS cohort, were analyzed by Kernel-based Virtual Machine learning methods.
RESULTS
Among 205 participants, the mean age was 50.1, 62% were female, 54.1% Hispanic American and 30.2% Native American. Average kidney function biomarkers were: SCr 0.9 mg/dl, B2M 1.8 mg/L, and CysC 0.7 mg/dl. The highest agreement was observed between SCr and B2M-based eGFR equations [mean difference in eGFRs: (4.48 ml/min/1.73m ], and the lowest agreement between B2M and CysC-based eGFR equations (-24.75 ml/min/1.73m ). There was no pattern of association between the differences in eGFR measures and gender. In the continuous analyses, the absolute eGFR value (p<2 × 10 ) and serum albumin (p =6.4 × 10 ) predicted the difference between B2M- and SCr-based e-GFR. The absolute eGFR value (p<2 × 10 ) and age (p =7.6 x 10 ) predicted the difference between CysC- and SCr-based e-GFR.
LIMITATIONS
Relatively small sample size, elevated inflammatory state in majority of study participants and no inulin excretion rate measurements.
CONCLUSION
B2M should be strongly considered as a kidney function biomarker fulfilling the criteria for the NKF-ASN. B2M's eGFR equation does not need adjustment for gender or race and showed the highest agreement with SCr-based eGFR equations.
PubMed: 38946981
DOI: 10.1101/2024.06.10.24308724 -
MedRxiv : the Preprint Server For... Jun 2024The use of big data and large language models in healthcare can play a key role in improving patient treatment and healthcare management, especially when applied to...
BACKGROUND
The use of big data and large language models in healthcare can play a key role in improving patient treatment and healthcare management, especially when applied to large-scale administrative data. A major challenge to achieving this is ensuring that patient confidentiality and personal information is protected. One way to overcome this is by augmenting clinical data with administrative laboratory dataset linkages in order to avoid the use of demographic information.
METHODS
We explored an alternative method to examine patient files from a large administrative dataset in South Africa (the National Health Laboratory Services, or NHLS), by linking external data to the NHLS database using specimen barcodes associated with laboratory tests. This offers us with a deterministic way of performing data linkages without accessing demographic information. In this paper, we quantify the performance metrics of this approach.
RESULTS
The linkage of the large NHLS data to external hospital data using specimen barcodes achieved a 95% success. Out of the 1200 records in the validation sample, 87% were exact matches and 9% were matches with typographic correction. The remaining 5% were either complete mismatches or were due to duplicates in the administrative data.
CONCLUSIONS
The high success rate indicates the reliability of using barcodes for linking data without demographic identifiers. Specimen barcodes are an effective tool for deterministic linking in health data, and may provide a method of creating large, linked data sets without compromising patient confidentiality.
PubMed: 38946964
DOI: 10.1101/2024.06.19.24309149