Risk model-based management for second primary lung cancer among lung cancer survivors through a validated risk prediction model

BACKGROUND

Recent therapeutic advances and screening technologies have improved survival among patients with lung cancer, who are now at high risk of developing second primary lung cancer (SPLC). Recently, an SPLC risk-prediction model (called SPLC-RAT) was developed and validated using data from population-based epidemiological cohorts and clinical trials, but real-world validation has been lacking. The predictive performance of SPLC-RAT was evaluated in a hospital-based cohort of lung cancer survivors.

METHODS

The authors analyzed data from 8448 ever-smoking patients diagnosed with initial primary lung cancer (IPLC) in 1997-2006 at Mayo Clinic, with each patient followed for SPLC through 2018. The predictive performance of SPLC-RAT and further explored the potential of improving SPLC detection through risk model-based surveillance using SPLC-RAT versus existing clinical surveillance guidelines.

RESULTS

Of 8448 IPLC patients, 483 (5.7%) developed SPLC over 26,470 person-years. The application of SPLC-RAT showed high discrimination area under the receiver operating characteristics curve: 0.81). When the cohort was stratified by a 10-year risk threshold of ≥5.6% (i.e., 80th percentile from the SPLC-RAT development cohort), the observed SPLC incidence was significantly elevated in the high-risk versus low-risk subgroup (13.1% vs. 1.1%, p < 1 × 10-6 ). The risk-based surveillance through SPLC-RAT (≥5.6% threshold) outperformed the National Comprehensive Cancer Network guidelines with higher sensitivity (86.4% vs. 79.4%) and specificity (38.9% vs. 30.4%) and required 20% fewer computed tomography follow-ups needed to detect one SPLC (162 vs. 202).

CONCLUSION

In a large, hospital-based cohort, the authors validated the predictive performance of SPLC-RAT in identifying high-risk survivors of SPLC and showed its potential to improve SPLC detection through risk-based surveillance.

PLAIN LANGUAGE SUMMARY

Lung cancer survivors have a high risk of developing second primary lung cancer (SPLC). However, no evidence-based guidelines for SPLC surveillance are available for lung cancer survivors. Recently, an SPLC risk-prediction model was developed and validated using data from population-based epidemiological cohorts and clinical trials, but real-world validation has been lacking. Using a large, real-world cohort of lung cancer survivors, we showed the high predictive accuracy and risk-stratification ability of the SPLC risk-prediction model. Furthermore, we demonstrated the potential to enhance efficiency in detecting SPLC using risk model-based surveillance strategies compared to the existing consensus-based clinical guidelines, including the National Comprehensive Cancer Network.

Uranium bioavailability in soil pore water: A long-term investigation in a contaminated soil mesocosm

Uranium in soil can exist in both (IV) and (VI) oxidation states, distributed among different soil fractions (exchangeable, carbonate, oxidizable, reducible, and residual). Following its release from these fractions, uranium enters the soil pore water, becoming bioavailable and potentially posing risks due to its radio and chemical toxicity. Given the significant health and environmental risks associated with uranium, it is crucial to understand its behaviour in contaminated soil pore water and how it changes over time, especially in response to seasonal variations. To address this issue, study was designed to investigate the temporal changes in uranium availability in soil pore water, with a special focus on effect of seasonal variations and biogeochemical reactions that govern the bioavailability of uranium in a contaminated soil mesocosm. This field investigation was carried out for two consecutive years, and revealed that, seasonal variation has a significant effect on the bioavailability of the uranium in the upper soil layers (<30 cm). The biogenic NO3- induced oxidative dissolution of uranium was found to be the predominant reaction causing the dissolution of uranium into soil pore water, followed by ion-exchange in upper layer, whereas at higher depths (30 cm < d < 70 cm) bioavailability is predominantly controlled by ion-exchange reaction. Furthermore, the study shows that at upper layers bioavailability is high during the summer, which is attributed to higher rate of biogenic denitrification and ion exchange reactions. Fast vertical migration of uranium in the soil column is attributed to formation of stable mobile species such as hydroxo‑carbonato ((UO2)xCO3(OH)y-), hydroxo (UO2)x(OH)y and carbonato (UO2CO3) complexes, identified by speciation modelling. For the first time, this study reports the process controlling uranium behaviour in soil pore water and the effect of seasonal variation on it in a contaminated soil. The findings are essential for assessing its potential radiological impact and remediation planning.

Advancing peristalsis deciphering in mouse small intestine by multi-parameter tracking

Assessing gastrointestinal motility lacks simultaneous evaluation of intraluminal pressure (ILP), circular muscle (CM) and longitudinal muscle (LM) contraction, and lumen emptying. In this study, a sophisticated machine was developed that synchronized real-time recordings to quantify the intricate interplay between CM and LM contractions, and their timings for volume changes using high-resolution cameras with machine learning capability, the ILP using pressure transducers and droplet discharge (DD) using droplet counters. Results revealed four distinct phases, BPhase, NPhase, DPhase, and APhase, distinguished by pressure wave amplitudes. Fluid filling impacted LM strength and contraction frequency initially, followed by CM contraction affecting ILP, volume, and the extent of anterograde, retrograde, and segmental contractions during these phases that result in short or long duration DD. This comprehensive analysis sheds light on peristalsis mechanisms, understand their sequence and how one parameter influenced the other, offering insights for managing peristalsis by regulating smooth muscle contractions.

Genome-Wide Association Study of Gallstone Disease Identifies Novel Candidate Genomic Variants in a Latino Community of Southwest USA

Gallstone disease (GSD) is a prevalent health condition that impacts many adults and is associated with presence of stones in gallbladder cavity that results in inflammation, pain, fever, nausea and vomiting. Several genome-wide association studies (GWAS) in the past have identified genes associated with GSD but only a few were focused on Latino population. To identify genetic risk factors for GSD in Latino population living in the Southwest USA we used self-reported clinical history, physical and lab measurements data in Sangre Por Salud (SPS) cohort and identified participants with and without diagnosis of GSD. We performed a GWAS on this phenotype using GSD cases matched to normal controls based on a tight criterion. We identified several novel loci associated with GSD as well as loci that were previously identified in past GWAS studies. The top 3 loci (MATN2, GPRIN3, GPC6) were strongly associated with GSD phenotype in our combined analysis and a sex stratified analysis results in females were closest to the overall results reflecting a general higher disease prevalence in females. The top identified variants in MATN2, GPRIN3, and GPC6 remain unchanged after local ancestry adjustment in SPS Latino population. Follow-up pathway enrichment analysis suggests enrichment of GO terms that are associated with immunological pathways; enzymatic processes in gallbladder, liver, and gastrointestinal tract; and GSD pathology. Our findings suggest an initial starting point towards better and deeper understanding of differences in gallstone disease pathology, biological mechanisms, and disease progression among Southwest US Latino population.

Microplastics as vectors of radioiodine in the marine environment: A study on sorption and interaction mechanism

Radioiodine is one of the long-lived fission products and also an important radionuclide released during nuclear accidents, which generates interest in its environmental fate. Its sorption has been studied in a wide range of materials, but no equivalent study exists for microplastics, an emerging environmental vector. Weathering and biofilm formation on microplastics can enhance radioiodine sorption. For the first time, we're reporting how radioiodine interacts with different types of polyethylene derived microplastics (pristine, irradiated, and biofilm developed microplastics). This study revealed that exposure to radiation and the marine environment significantly alters the physico-chemical properties of microplastics. In particular, in marine-exposed samples, a signature of biofilm development was detected. Speciation study indicates that iodine exists in the iodide form in the studied marine environment. The study revealed that, iodide ions attach to biofilm-developed microplastics via electrostatic, ion-dipole, pore filling, and van der Waals interactions. Pore filling, ion-dipole, and van der Waals interactions may cause iodide binding to irradiated microplastics, whereas pore-filling and van der Waals interactions cause iodide binding to pristine microplastics. The distribution coefficient (K_d) of iodine on microplastics is positively correlated with biofilm biomass, which signifies the role of biofilm in radioiodine uptake. The K_d indicates microplastics are potential iodide accumulators and could be a possible vector in the marine system.

Simulated experimental investigation of microplastic weathering in marine environment

Microplastics act as a potential vector for a wide range of contaminants, which have emerged as a major environmental hazard in the modern world. Considering the seriousness of the problem, a simulated laboratory and field experiment were conducted to study the weathering of pristine microplastics following long-term exposure to natural background radiation and the marine environment after being disposed of in the open environment. For the study, polyethylene-originating (HDPE and LDPE) microplastics were chosen. The study revealed that radiation exposure causes surface roughness and cracks, leading to an increased surface area, which can invite a wide spectrum of pollutants to sorb on their surface. Furthermore, we report that the radiation-induced morphological changes favor microbial colonization on the microplastic surface when exposed to the marine environment. The growth of biofilms on the surface of microplastics reduces their hydrophobicity, which may attract a wide variety of polar contaminants. The study led to an interesting finding: that the HDPE microplastic surface is more conducive for biofilm growth in comparison to the LDPE surface.

Give me a SINE: how Selective Inhibitors of Nuclear Export modulate autophagy and aging

Autophagy is a cellular recycling process leading to lysosomal degradation of damaged macromolecules, which can protect cells against aging. The transcription factor EB (TFEB), a major transcriptional regulator of genes involved in autophagy and lysosomal function, is emerging as an attractive target for pharmacological modulation. Recently, we demonstrated that inhibiting the function of nuclear export protein exportin 1 (XPO1 or CRM1) with RNAi or with selective inhibitors of nuclear export (SINE) results in the nuclear enrichment of TFEB and enhancement of autophagy in model organisms and human cells. In addition to current efforts to validate the use of SINE in cancer therapies, our work highlights the potential benefits of these drugs toward improving outcomes in neurodegenerative diseases and aging.

De novo HNF1 homeobox B mutation as a cause for chronic, treatment-resistant hypomagnesaemia

29-year-old female presenting with an 8-year history of unexplained hypomagnesaemia, which was severe enough to warrant intermittent inpatient admission for intravenous magnesium. Urinary magnesium was inappropriately normal in the context of hypomagnesaemia indicating magnesium wasting. Ultrasound imaging demonstrated unilateral renal cysts and computed tomography of kidneys, ureters and bladder showed a bicornuate uterus. Referral to genetic services and subsequent testing revealed a de novo HNF1B deletion.

Natural radioactivity in roadside soil along Jamshedpur-Musabani road: a mineralised and mining region, Jharkhand and associated risk

The specific activity and the gamma radiation dose rates due to naturally occurring radioactive materials ((238)U, (232)Th and (40)K) were determined in 26 roadside surface soils along Jamshedpur-Musabani road-a mineralised and mining region, using high-resolution gamma-ray spectrometry. The concentrations of (238)U, (232)Th and (40)K in the soil samples were found to be in the range of 16.6 +/- 0.6-390.5 +/- 1.6, 24.1 +/- 0.7-148.2 +/- 2.1 and 85.9 +/- 3.8-881.6 +/- 22.4 Bq kg(-1), respectively. The annual effective dose equivalent was found to be in the range of 0.04-0.32 mSv y(-1) with an average value of 0.13 mSv y(-1). The excess cancer risk is in the range of 0.16 x 10(-3)-1.22 x 10(-3) with an average value of 0.49 x 10(-3).

Hyperinfection Strongyloidiasis: An Anticipated Outbreak in Kidney Transplant Recipients in Kuwait

BACKGROUND

Hyperinfection strongyloidiasis is a potentially fatal syndrome associated with conditions of depressed host cellular immunity. A high degree of suspicion is required to detect cases early and thereby avoid a fatal outcome.

PATIENTS AND METHODS

Three consecutive cadaveric kidney transplant recipients died within 2 months from hyperinfections with strongyloides. All members of the transplant team were involved in a campaign to localize the source of infection, identify and treat affected patients, and provide adequate prophylaxis to other transplant recipients. We reviewed cadaveric donor files and screened 61 hospital personnel, 27 hospital inpatients, and the 87 hospital outpatients transplanted in a year's time before that event for a possible source. The screening test included analysis of fresh stool samples on 3 consecutive days for strongyloides larvae. The anti-helminthic drug albendazol was administered to all patients during screening. They were followed for possible development of the disease during the infectivity period.

RESULTS

The first 2 recipients received their kidneys from 1 cadaveric donor, while the third received it from a different donor. Both donors came from areas endemic for strongyloidiasis. The 3 recipients were on tacrolimus-based immunosuppression. The twin recipient of the second kidney was on cyclosporine and did not manifest a disease. All stool samples taken for screening were negative for the infective larvae. None of the other recipients developed the disease.

CONCLUSIONS

Cadaveric donors were the possible source for this outbreak. Cyclosporine probably has a protective effect against strongyloides. In our setting, screening of cadaveric donors for strongyloides is mandatory before accepting them for donation, and oral prophylaxis is required for all recipients.

Finite element analysis of covered microstents

Currently available neuroendovascular devices are inadequate for effective treatment of many wide-necked or fusiform intracranial aneurysms and intracranial carotid-cavernous fistulae (CCF). Placing a covered microstent across the intracranial aneurysm neck and CCF rent could restore normal vessel morphology by preventing blood flow into the aneurysm lumen or CCF rent. To fabricate covered microstents, our research group has developed highly flexible ultra thin (approximately 150 microm) silicone coverings and elastomerically captured them onto commercially available metal stents without stitching. Preliminary in vivo studies were conducted by placing these covered microstents in the common carotid artery of rabbits. The feasibility of using covered stents was demonstrated. However, the cover affected the deployment pressure and the stents failed occasionally during deployment due to tearing of the cover. Appropriate modeling of covered stents will assist in designing suitable coverings, and help to reduce the failure rate of covered microstents. The purpose of this study is to use the finite element method to determine the mechanical properties of the covered microstent and investigate the effects of the covering on the mechanical behavior of the covered microstent. Variations in the mechanical properties of the covered microstent such as deployment pressure, elastic recoil and longitudinal shortening due to change in thickness and material properties of the cover have been investigated. This work is also important for custom design of covered microstents such as adding cutout holes to save adjacent perforating arteries.

Thoracic reconstruction with the omentum: indications, complications, and results

This study provides a retrospective analysis of 60 patients who underwent thoracic reconstruction with the omentum. Patients were identified by searching several databases to determine demographics, indications for surgery, operative technique, and postoperative course, including donor and recipient site morbidity. From January 1975 to May 2000, the authors harvested and transferred the omentum successfully (57 pedicled, 3 free) in 60 patients (mean age, 60 years; age range, 21-86 years) for sternal wound infections (N = 34), chest wall resections (N = 17), pectus deformities (N = 2), intrathoracic defects (N = 4), and breast reconstruction (N = 3). The omentum was used as a primary flap in 39 patients and as a salvage flap in 21 patients. Average operative time was 3.9 hours and average hospital stay was 34.3 days. Partial flap loss occurred in 7 patients, with no total flap failures. Morbidity included six abdominal wound infections and seven epigastric hernias. Mortality was 11.7%. The omentum can be harvested safely and used reliably to reconstruct varying thoracic wounds and defects. Specific indications from this series include osteoradionecrosis, chest wall tumors, massive sternal wounds, and refractory mediastinitis. Hultman CS, Culbertson JH, Jones GE, et al. Thoracic reconstruction with the omentum: indications, complications, and results.

Atmospheric and children's blood lead as indicators of vehicular traffic and other emission sources in Mumbai, India

Average concentration of Pb in atmospheric air particulates in different suburbs of Mumbai was studied for almost a decade and its spatial and temporal profiles are discussed in relation to emission sources. In general the concentration of Pb in all the residential suburban atmosphere is well below the Central Pollution Control Board (CPCB, 1994) prescribed limit of 1.5 microg m(-3) barring a few exceptions for some residential/industrial sites, such as those of Thane and Kurla scrap yards. The correlation between blood lead of children and air lead reveals that the blood Pb level in children could increase by 3.6 microg dl(-1) for an incremental rise of 1.0 microg Pb m(-3) of air. The temporal profile of air Pb values indicates a decreasing trend in residential suburbs (Khar: 1984, 0.39 microg m(-3); 1996, 0.17 microg m(-3)) as well as in suburban residential areas with low traffic (Goregaon: 1984, 0.53 microg m(-3); 1996, 0.30 microg m(-3)).

Daily intake of trace metals through coffee consumption in India

The trace element contents of five varieties of instant coffee powder available in the Indian market have been analysed. Ca, Cr, Fe, K, Mg, Mn, Ni, Sr, Zn and Pb, Cd, Cu have been determined using atomic absorption spectrophotometry and differential pulse anodic stripping voltammetry, respectively. The metal levels in the coffee powders observed in this study are comparable with those reported for green coffe beans (Arabica and Robusta variety) reported worldwide with the exception of Sr and Zn, which were on the lower side of the reported values. Concentrations of these metals have been converted into intake figures based on coffee consumption. The daily intakes of the above metals through ingestion of coffee are 1.4 mg, 1.58 microg, 124 microg, 41.5 mg, 4.9 mg, 17.9 microg, 2.9 microg, 3.8 microg, 12.5 microg, 0.2 microg, 0.03 microg and 15.5 microg, respectively. The values, which were compared with the total dietary, intake of metals through ingestion by the Mumbai population, indicate that the contribution from coffee is less than or around 1% for most of the elements except for Cr and Ni which are around 3%.

Body piercing in the accident and emergency department

Recently an increasing number of patients with complications related to pierced body jewellery have been seen. Often removal of the jewellery is indicated. Removal of these items may also be required for radiological purposes. If the doctor is familiar with the opening mechanism of the item, removal is not usually difficult. Uninformed attempts at removal may cause unnecessary trauma and distress. In a survey of 28 accident and emergency doctors, only six were able accurately to describe the opening mechanisms of all three commonly used types of jewellery. Descriptions of the types of jewellery currently used are not available in the medical literature. The aim of this article is to familiarize doctors with the types of jewellery used, describe their opening mechanisms, and suggest techniques for their removal. The complications of body piercing and the indications for the removal of body jewellery are also outlined.

Assessment of Pb, Cd, Cu, and Zn exposures of 6- to 10-year-old children in Mumbai

Population exposures to toxic trace metals are of great concern due to their nonbiodegradable nature and long biological half-lives for elimination from the body. Response to a toxic metal varies with age group; children are more sensitive and hence more at risk than others. The present study was therefore undertaken on 6- to 10-year-old children residing in various localities of Greater Mumbai and Thane. Blood samples from 566 children residing in 13 locations in Mumbai along with 410 air particulate samples and 64 "duplicate diet" samples were collected for this study. Levels of Pb, Cd, Cu, and Zn in these samples were estimated by differential pulse anodic stripping voltammetric technique. Intake of Pb, Cd, Cu, and Zn for 6- to 10-year-old children through ingestion and inhalation pathways have also been assessed. A correlation coefficient of 0.88 is observed between air lead and blood lead. It is also seen that every microgram increase in the Pb concentration in air (m-3) results in 3.56 microg increase in the blood Pb concentration (dl-1) in children. Similar correlation, however, was not observed in cases of Cd, Cu, and Zn.

Safety of thrombolytic therapy following acute myocardial infarction in patients above 65 years

The safety of thrombolytic therapy for acute myocardial infarction in the elderly population has not been clearly established. In a retrospective study we evaluated the efficacy and complications of thrombolytic therapy in the elderly as compared to younger patients. Consecutive 588 patients who received thrombolytic therapy were studied. Clinical data in 136 patients aged above 65 years were compared with 85 patients below 40 years. Cigarette smoking was a common risk factor in the young (46 vs 13; p < 0.0001). Coexistent systemic diseases and conduction system disturbances (28 vs 9; p < 0.05) were common in the older patients, but the incidence of bleeding complications to thrombolytic therapy (6 vs 1; p = NS) was not found to be higher. Ninety percent of the elderly who had cardiogenic shock died. There was no significant difference between the two groups in reinfarction rate (12 vs 15; p = NS) and post-infarct angina (20 vs 20; p = NS). Coronary angiography revealed a higher incidence of multivessel disease in the elderly. To conclude, thrombolytic therapy is safe and effective even in older individuals.

Bioabsorbable plates and screws in pediatric craniofacial surgery: a review of 22 cases

The purpose of this study was to evaluate the application of bioabsorbable fixation devices in reconstructive craniofacial procedures in the pediatric population. We reviewed 22 cases in which bioabsorbable plates and screws were used in craniofacial surgery for reconstruction. The procedures were performed in a 7-month period. The patients ranged in age from 5 to 228 months at the time of surgery (mean, 76.7 months). The postoperative clinical follow-up ranged from 2 to 16 weeks. The fixation devices were evaluated with regards to satisfactory fixation at the time of procedure. The postoperative follow-up evaluated clinical wound healing, signs of infection or local inflammation, and visibility or palpability of plates through the skin. All patients except one showed satisfactory wound healing with no sign of infection or local inflammation. The plates provided satisfactory fixation and were not visible through the skin. Two patients had plates that were palpable at the 4-month follow-up period. One patient with repair of a blow-out fracture of the orbit with resorbable mesh had redness and swelling over the wound site 2 weeks postoperatively with resolution 4 weeks postoperatively. Our early experience suggests reabsorbable fixation is an attractive option in pediatric plastic and craniofacial surgery. With further experience, this technology may represent the standard of care in reconstruction of the infant calvarium.