CT-derived radiomics predict the growth rate of renal tumours in von Hippel-Lindau syndrome

AIM

To predict renal tumour growth patterns in von Hippel-Lindau syndrome by utilising radiomic features to assist in developing personalised surveillance plans leading to better patient outcomes.

MATERIALS AND METHODS

The study evaluated 78 renal tumours in 55 patients with histopathologically-confirmed clear cell renal cell carcinomas (ccRCCs), which were segmented and radiomics were extracted. Volumetric doubling time (VDT) classified the tumours into fast-growing (VDT <365 days) or slow-growing (VDT ≥365 days). Volumetric and diametric growth analyses were compared between the groups. Multiple logistic regression and random forest classifiers were used to select the best features and models based on their correlation and predictability of VDT.

RESULTS

Fifty-five patients (mean age 42.2 ± 12.2 years, 27 men) with a mean time difference of 3.8 ± 2 years between the baseline and preoperative scans were studied. Twenty-five tumours were fast-growing (low VDT, i.e., <365 days), and 53 tumours were slow-growing (high VDT, i.e., ≥365 days). The median volumetric and diametric growth rates were 1.71 cm3/year and 0.31 cm/year. The best feature using univariate analysis was wavelet-HLL_glcm_ldmn (area under the receiver operating characteristic [ROC] curve [AUC] of 0.80, p<0.0001), and with the random forest classifier, it was log-sigma-0-5-mm-3D_glszm_ZonePercentage (AUC: 79). The AUC of the ROC curves using multiple logistic regression was 0.74, and with the random forest classifier was 0.73.

CONCLUSION

Radiomic features correlated with VDT and were able to predict the growth pattern of renal tumours in patients with VHL syndrome.

Predictive profiling of gram-negative antibiotics in CagA oncoprotein inactivation: a molecular dynamics simulation approach

Gastric cancer (GC) is the fifth most prevalent form of cancer worldwide. CagA - positive Helicobacter pylori infects more than 60% of the human population. Moreover, chronic infection of CagA-positive H. pylori can directly affect GC incidence. In the current study, we have repurposed FDA-approved antibiotics that are viable alternatives to current regimens and can potentially be used as combination therapy against the CagA of H. pylori. The 100 FDA-approved gram negative antibiotics were screened against CagA protein using the AutoDock 4.2 tool. Further, top nine compounds were selected based on higher binding affinity with CagA. The trajectory analysis of MD simulations reflected that binding of these drugs with CagA stabilizes the system. Nonetheless, atomic density map and principal component analysis also support the notion of stable binding of antibiotics to the protein. The residues ASP96, GLN100, PRO184, and THR185 of compound cefpiramide, doxycycline, delafloxacin, metacycline, oxytetracycline, and ertapenem were involved in the binding with CagA protein. These residues are crucial for the CagA that aids in entry or pathogenesis of the bacterium. The screened FDA-approved antibiotics have a potential druggability to inhibit CagA and reduce the progression of H. pylori borne diseases.

PGPR: the treasure of multifarious beneficial microorganisms for nutrient mobilization, pest biocontrol and plant growth promotion in field crops

Plant growth-promoting rhizobacteria (PGPR) have multifarious beneficial activities for plant growth promotion; act as source of metabolites, enzymes, nutrient mobilization, biological control of pests, induction of disease resistance vis-a-vis bioremediation potentials by phytoextraction and detoxification of heavy metals, pollutants and pesticides. Agrochemicals and synthetic pesticides are currently being utilized widely in all major field crops, thereby adversely affecting human and animal health, and posing serious threats to the environments. Beneficial microorganisms like PGPR could potentially substitute and supplement the toxic chemicals and pesticides with promising application in organic farming leading to sustainable agriculture practices and bioremediation of heavy metal contaminated sites. Among field crops limited bio-formulations have been prepared till now by utilization of PGPR strains having plant growth promotion, metabolites, enzymes, nutrient mobilization and biocontrol activities. The present review contributes comprehensive description of PGPR applications in field crops including commercial, oilseeds, leguminous and cereal crops to further extend the utilization of these potent groups of beneficial microorganisms so that even higher level of crop productivity and quality produce of field crops could be achieved. PGPR and bacteria based commercialized bio-formulations available worldwide for its application in the field crops have been compiled in this review which can be a substitute for the harmful synthetic chemicals. The current knowledge gap and potential target areas for future research have also been projected.

Global prevalence of edentulism and dental caries in middle-aged and elderly persons: A systematic review and meta-analysis

OBJECTIVE

The aim of the study was to analyze data collected from studies worldwide on the prevalence of edentulism and dental caries, in community-dwellers aged ≥ 45 years.

DATA

Inclusion criteria; participants aged ≥ 45 years, community-dwellers. Exclusion criteria; participants aged < 45 years, in nursing homes, data obtained from dental clinics or pre-2005. The quality assessment tool by The National Heart, Lung and Blood Institute for Observational Cohort and Cross-sectional studies was used. Meta-analysis using the random-effects model (95% confidence interval) was done with data on participants who were edentulous and/or had active dental caries and stratified by regions of the world, age and Gross National Income per capita. Limitations in the data arose from several factors such as design of the studies included differences in socioeconomic status and access to health care among different countries.

SOURCES

Embase, MEDLINE via Pubmed and Scopus, manual searches, from January 2016, restricted to English. Experts from different countries were contacted to identify National oral health surveys (NOHS) conducted from 2010 onwards.

STUDY SELECTION

Eighty-six papers and seventeen NOHS were selected for data extraction. Majority of the studies (n = 69) were cross-sectional and of fair quality. 1.1%-70%, 4.9% - 98% prevalence of edentulism and dental caries, respectively. 22%, 45% estimated random-effects pooled prevalence of edentulism and dental caries, respectively.

CONCLUSIONS

Within the limitations of this study, the findings indicate that untreated dental caries and tooth loss are prevalent on a global level with wide variations among different countries, age groups and socioeconomic status.

CLINICAL SIGNIFICANCE

The findings demonstrate the reality of the new cohort of older adults, with higher tooth retention implying more dental caries incidence and the need for different care strategies to ensure better oral health. Large variations and difficulty in making comparisons among different countries highlight the need for more standardized, regular research.

Artificial Intelligence for Caries Detection: Value of Data and Information

If increasing practitioners’ diagnostic accuracy, medical artificial intelligence (AI) may lead to better treatment decisions at lower costs, while uncertainty remains around the resulting cost-effectiveness. In the present study, we assessed how enlarging the data set used for training an AI for caries detection on bitewings affects cost-effectiveness and also determined the value of information by reducing the uncertainty around other input parameters (namely, the costs of AI and the population’s caries risk profile). We employed a convolutional neural network and trained it on 10%, 25%, 50%, or 100% of a labeled data set containing 29,011 teeth without and 19,760 teeth with caries lesions stemming from bitewing radiographs. We employed an established health economic modeling and analytical framework to quantify cost-effectiveness and value of information. We adopted a mixed public–private payer perspective in German health care; the health outcome was tooth retention years. A Markov model, allowing to follow posterior teeth over the lifetime of an initially 12-y-old individual, and Monte Carlo microsimulations were employed. With an increasing amount of data used to train the AI sensitivity and specificity increased nonlinearly, increasing the data set from 10% to 25% had the largest impact on accuracy and, consequently, cost-effectiveness. In the base-case scenario, AI was more effective (tooth retention for a mean [2.5%–97.5%] 62.8 [59.2–65.5] y) and less costly (378 [284–499] euros) than dentists without AI (60.4 [55.8–64.4] y; 419 [270–593] euros), with considerable uncertainty. The economic value of reducing the uncertainty around AI’s accuracy or costs was limited, while information on the population’s risk profile was more relevant. When developing dental AI, informed choices about the data set size may be recommended, and research toward individualized application of AI for caries detection seems warranted to optimize cost-effectiveness.

Cost-effectiveness of Artificial Intelligence for Proximal Caries Detection

Artificial intelligence (AI) can assist dentists in image assessment, for example, caries detection. The wider health and cost impact of employing AI for dental diagnostics has not yet been evaluated. We compared the cost-effectiveness of proximal caries detection on bitewing radiographs with versus without AI. U-Net, a fully convolutional neural network, had been trained, validated, and tested on 3,293, 252, and 141 bitewing radiographs, respectively, on which 4 experienced dentists had marked carious lesions (reference test). Lesions were stratified for initial lesions (E1/E2/D1, presumed noncavitated, receiving caries infiltration if detected) and advanced lesions (D2/D3, presumed cavitated, receiving restorative care if detected). A Markov model was used to simulate the consequences of true- and false-positive and true- and false-negative detections, as well as the subsequent decisions over the lifetime of patients. A German mixed-payers perspective was adopted. Our health outcome was tooth retention years. Costs were measured in 2020 euro. Monte-Carlo microsimulations and univariate and probabilistic sensitivity analyses were conducted. The incremental cost-effectiveness ratio (ICER) and the cost-effectiveness acceptability at different willingness-to-pay thresholds were quantified. AI showed an accuracy of 0.80; dentists’ mean accuracy was significantly lower at 0.71 (minimum–maximum: 0.61–0.78, P < 0.05). AI was significantly more sensitive than dentists (0.75 vs. 0.36 [0.19–0.65]; P = 0.006), while its specificity was not significantly lower (0.83 vs. 0.91 [0.69–0.98]; P > 0.05). In the base-case scenario, AI was more effective (tooth retention for a mean 64 [2.5%–97.5%: 61–65] y) and less costly (298 [244–367] euro) than assessment without AI (62 [59–64] y; 322 [257–394] euro). The ICER was −13.9 euro/y (i.e., AI saved money at higher effectiveness). In the majority (>77%) of all cases, AI was less costly and more effective. Applying AI for caries detection is likely to be cost-effective, mainly as fewer lesions remain undetected. Notably, this cost-effectiveness requires dentists to manage detected early lesions nonrestoratively.

Nonsmoked Tobacco Addiction Playing a Major Role in Oral Mucosal Changes in Northern Indian Population Over Smoked and Alcohol Use

Background: Oral cavity is prone for myriad of changes with advancing age as well result of environmental and life style related factors like consumption of tobacco (smoke or smokeless) and alcohol. Aim: The aim of this study was to quantify and compare the association of oral mucosal changes (OMC) with nonsmoked tobacco over smoked tobacco and alcohol. Methods: Data of 11,145 subjects from 106 health screening camps, organized in Uttar Pradesh and Rajasthan between April 2015 to June 2017 was analyzed to unveil and determine the mode of addiction and prevalence of OMC. Bivariate and multivariable models were tested for comparison and identification of factors associated with an increasing risk of developing OMC. Results: The primary symptoms were mouth ulcer in 5.6% and trismus (1.0%). The overall proportions of tobacco chewing, smoking and alcohol addiction were 12.5%, 10.7% and 2.5% respectively. The highest prevalence of smoking noted in the age-group 55-64 years (14.4%), for tobacco chewing and alcohol consumption in the age-group 25-34 years was 15.6% and 4.2% respectively ( P < 0.001). The prevalence of mouth ulcers were 20.7% among smokers and 27.8% among tobacco chewers ( P < 0.001) while the percentage of trismus 26.1% among smokers and 53.0% among tobacco chewers ( P < 0.001). Conclusion: Results of this study can be used for creating awareness among the population regarding the hazards of tobacco use. More number of studies needs to be conducted all over India to understand the prevalence and the biologic behavior of these oral premalignant lesions and its progression to invasive diseases.

Tuberculosis of the Cervix – Mimicking Cervical Cancer

We present  a case of tuberculosis of the cervix due to the rarity of this condition and its clinical resemblance to a dreadful disease, “carcinoma of cervix.” 

A model for the nutritional transport in capillary-tissue exchange system

By introducing the lubrication theory to the squeezing flow of the plasma between the cell and the vessel wall, an analysis of the flow and the nutritional transport within the tissue has been presented in this paper. Cells are assumed to flow in a single file, with axi-symmetric shapes. The concentration profiles of the dissolved nutrients within the tissue have been drawn under the assumption of the uniform distribution in the capillary due to continuous mixing in bolus flows between the 2 adjacent cells in the capillary. The analysis concludes that, in diseased state, the penetration depth for the substance in the tissue decreases and the cells in the deeper region do not get sufficient nutrition for their survival and they die out.

A parametric investigation of mortality transition in India: 1970-89

"This paper attempts to analyze mortality transition in India during [the] 1970s and 1980s through the modelling of the age pattern of mortality by applying the Heligman-Pollard model mortality schedule. The analysis reveals that mortality transition in India has not been uniform in all the age [or sex] groups....Middle-life mortality has been found to be more or less unchanged during the period under reference. Implications of the age pattern of mortality transition [on] health policy [are also] discussed."

Regional variations in age pattern of mortality in India

"Using the cluster analysis technique and Heligman-Pollard mortality model, the present paper analyses the regional variations in age pattern of mortality in India around 1986-88. The paper identifies three broad patterns of age-specific mortality rates in the country--the Central-India Pattern; the South-India Pattern; and the North-West India Pattern. In addition, Kerala has its own typical pattern of age-specific mortality. Similarly, Assam (Males) and Jammu and Kashmir (Males) have their own typical pattern of age-specific mortality rates while the same is also true for Rajasthan (Females). The implications of age patterns of mortality identified in this analysis have also been discussed."

A porous implant model for a knee joint

A study of the lubrication mechanism occurring in knee joint replacement is presented. The idealized model has been shown to produce results consistent with those in normal situations. In the present problem viscoelastic fluid has been considered to represent the synovial fluid in the fluid-film region and purely viscous Newtonian fluid in the porous layer due to filtration. Because of exact solution not being possible for the governing non-linear partial differential equations, the perturbation method has been used to obtain approximate solutions. The effect of an increase in the viscoelastic parameter of the lubricant is similar to that of an increase in concentration of hyaluronic acid molecules in synovial fluid. Important deductions are made for load carrying capacity and coefficient of friction and it has been shown that the slip velocity plays an important role in maintaining the self-adjusting nature of human joints.

Spectrophotometric determination of ascorbic acid in pharmaceuticals by background correction and flow injection

Background correction has been shown to be an effective and indispensable modification in the spectrophotometric determination of ascorbic acid. The decomposition of ascorbic acid in pharmaceutical samples was carried out by incubation with sodium hydroxide to give products that were insensitive to ultraviolet light. The rapid oxidation in air of ascorbic acid, especially in dilute solutions, was avoided by the use of the flow injection principle for spectrophotometric determination and by employing a carrier stream of an anti-oxidizing nature consisting of 6 micrograms ml(-1) of 2-mercaptoethanol in 0.25% sulphuric acid. The optimized method with a single channel manifold made use of a carrier stream flow rate of 1.1 ml min(-1), an injection volume of 50 microl, a delay coil of 50 cm (0.5 mm i.d.) and detection at 245 nm. The throughput was at least 180 injections h(-1). The proposed flow injection method yielded results for the analysis of 0-20 micrograms ml(-1) of ascorbic acid that were 99-102% (relative standard deviation 0.6% or better) in agreement with those produced by comparable methods involving titration with iodine, chloranil or 2,6-dichlorophenolindophenol [4-(2,6-dichloro-4-hydroxyphenylimino)cyclohexa-2,5-dieno ne], and high-performance liquid chromatography. When the agreement was not good (as low as 14% with respect to the method being compared), this was traced to the presence of substances which are known to interfere in one or other of the methods of comparison.