Relationship between platelet indices in acute cholecystitis: A case-control study

INTRODUCTION AND AIMS

We aimed to investigate changes in initial platelet indices in patients arriving at the emergency department with acute cholecystitis.

MATERIAL AND METHODS

A retrospective case-control study was conducted at a tertiary care teaching hospital. Demographics, comorbidities, laboratory data, length of hospital stay, and mortality data for the acute cholecystitis group were retrospectively obtained from the hospital digital database. Platelet count, mean platelet volume, plateletcrit, platelet distribution width, and platelet mass index were collected.

RESULTS

A total of 553 patients with acute cholecystitis were the study cases, and 541 hospital employees were the study controls. According to the results of the multivariate analysis of the platelet indices studied, only mean platelet volume and platelet distribution width showed significant differences between the two groups (adjusted odds ratio: 2, 95% confidence interval: 1.4-2.7, p < 0.001 and adjusted odds ratio: 5.88, 95% confidence interval: 2.44-14.4, p < 0.001, respectively). The multivariate regression model created had an area under the curve of 0.969 in the prediction of acute cholecystitis (accuracy: 0.917, sensitivity: 89%, and specificity: 94.5%).

CONCLUSION

The study results indicate that the initial mean platelet volume and platelet distribution width were independent predictors of acute cholecystitis.

Diagnostic Performance of Machine Learning Models Based on 18F-FDG PET/CT Radiomic Features in the Classification of Solitary Pulmonary Nodules

Objectives

This study aimed to evaluate the ability of ¹⁸fluorine-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) radiomic features combined with machine learning methods to distinguish between benign and malignant solitary pulmonary nodules (SPN).

Methods

Data of 48 patients with SPN detected on ¹⁸F-FDG PET/CT scan were evaluated retrospectively. The texture feature extraction from PET/CT images was performed using an open-source application (LIFEx). Deep learning and classical machine learning algorithms were used to build the models. Final diagnosis was confirmed by pathology and follow-up was accepted as the reference. The performances of the models were assessed by the following metrics: Sensitivity, specificity, accuracy, and area under the receiver operator characteristic curve (AUC).

Results

The predictive models provided reasonable performance for the differential diagnosis of SPNs (AUCs ~0.81). The accuracy and AUC of the radiomic models were similar to the visual interpretation. However, when compared to the conventional evaluation, the sensitivity of the deep learning model (88% vs. 83%) and specificity of the classic learning model were higher (86% vs. 79%).

Conclusion

Machine learning based on ¹⁸F-FDG PET/CT texture features can contribute to the conventional evaluation to distinguish between benign and malignant lung nodules.

Prognostic Prediction of BRCA Mutations by 18F-FDG PET/CT SUVmax in Breast Cancer

Objectives:

This study aimed to investigate the prognostic prediction of germline BRCA1 and BRCA2 mutations by comparing the maximum standardized uptake value (SUV_max) obtained from ¹⁸fluoride-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT), which is considered a prognostic factor in breast cancer (BC).

Methods:

Retrospective interdisciplinary laboratory results of 92 patients with BC who had germline BRCA1 or BRCA2 mutation profiles and underwent ¹⁸F-FDG PET/CT were compared. Genotyping was made by next-generation sequencing, and PET/CT scans were re-evaluated. The histopathological data, genetic results, and clinical demographics of all patients were recorded. Patients were divided into two groups in accordance with the presence of germline BRCA1 and/or BRCA2 mutations. Between-group statistical comparison was performed.

Results:

In PET/CT performed for primary staging, patients with BRCA-positive BC had significantly higher SUV_max (p=0.039), larger tumor size (p=0.025), and presence of axillary nodal metastases (p=0.023) than patients with BRCA-negative BC. Although the Ki-67 index was higher in the BRCA-positive group than BRCA-negative group, this difference was not significant (p=0.157). Moreover, in the BRCA-positive and negative groups, SUV_max, Ki-67 index, and tumor size, grade, and stage were significantly correlated with each other.

Conclusion:

The results of this study showed a strong association between BRCA mutations and SUV_max, which indicates the poor prognosis of BC.

Effects of otosclerosis and stapedotomy on vestibular-evoked myogenic potentials

OBJECTIVE

Limited data are available on the effects of otosclerosis and otosclerosis surgery on the utricle and saccule. This study aimed to determine the effect of otosclerosis and stapedotomy on vestibular-evoked myogenic potentials.

METHODS

This retrospective study included 16 otosclerosis patients and 18 controls. Thirty-two ears of 16 patients with otosclerosis were divided into 2 groups based on whether the ear had been operated on or not. All patients and subjects underwent 500 Hz air- and bone-conducted ocular and cervical vestibular-evoked myogenic potentials testing.

RESULTS

Overall comparison of response rates showed a significant difference among the groups. Further statistical tests showed that this difference arose from differences between both operated and unoperated groups and the control group, for air-conducted cervical and ocular vestibular-evoked myogenic potentials.

CONCLUSION

Otosclerosis and stapedotomy may affect the elicitability of vestibular-evoked myogenic potentials. Otosclerosis is associated with lower response rates for air-conducted ocular and cervical vestibular-evoked myogenic potentials, regardless of whether operated on. Having been operated on does not significantly increase the response rate of air-conducted vestibular-evoked myogenic potentials.

Demand for Cancer Screening Services: Results From Randomized Controlled Discrete Choice Experiments

OBJECTIVES

Low uptake of cancer screening services is a global concern. Our aim was to understand factors that influence the screening decision, including screening and treatment subsidies and a gain-frame message designed to present screening as a win-win.

METHODS

We analyzed preferences for mammography and Pap smear among women in Singapore by means of discrete choice experiments while randomly exposing half of respondents to a gain-framed public health message promoting the benefits of screening.

RESULTS

Results showed that the message did not influence stated uptake, and given the levels shown, respondents were influenced more by treatment attributes, including effectiveness and out-of-pocket cost should they test positive, than by screening attributes, including the offer of a monetary incentive for screening. Respondents also underestimated the survival chances of screen-detected breast and cervical cancers.

CONCLUSIONS

Combined, these findings suggest that correcting misconceptions about screen-detected cancer prognosis or providing greater financial protection for those who test positive could be more effective and more cost-effective than subsidizing screening directly in increasing screening uptakes.

Comparison of SUVmax Values Obtained from F-18 FDG PET/CT and Cell-free DNA Levels Measured from Plasma in Oncology Patients

Objectives

The aim of this study was to compare the quantitative value of standardized uptake value (SUV) SUV_max obtained from F-18 FDG positron emission tomography/computed tomography (PET/CT) imaging of oncology patients with the cell-free DNA (cfDNA) amounts measured in plasma of patients and thus investigate if cfDNA is a significant marker to identify the presence of malignancy in the early period.

Methods

A total of 184 patients were included in the study. The clinical, histopathologic, laboratory and treatment parameters were extracted from patient files. SUV_max and cfDNA quantities were assessed

Results

There was no statistically significant difference in plasma cfDNA values between patient and control groups. The comparison of SUV_max and cfDNA values in the study showed that there was a weak correlation between SUV_maxand cfDNA. There was a significant difference between tumor size and SUV_max values. However, there was no statistically significant difference between tumor size and cfDNA.

Conclusion

cfDNA measurements in the blood as a screening test have provided hope for early diagnosis and monitoring of cancer patients. Comparison of cfDNA levels obtained from plasma and quantitative parameters from PET/CT images of oncology patients in detailed advanced studies with larger patient series are required.

Assessment of the effects of frequent ventricular extrasystoles on the left ventricle using speckle tracking echocardiography in apparently normal hearts

Objective:

Impairment in left ventricular (LV) function due to excessive ventricular extrasystoles (VESs) occurs during long-time follow-up. Speckle tracking echocardiography (STE) has been shown to be superior to conventional methods for evaluating cardiac functions. We aimed to use STE for early detection of LV dysfunction in patients with apparently normal hearts who have frequent VESs.

Methods:

Fifty-five patients with frequent VESs were identified according to the Lown classification (Grade 2; unifocal more than 30 times in 1 h). Subjects aged 22-60 years with frequent VESs that had been detected for at least 1 year were included in the study according to the inclusion criteria. Forty-five subjects with similar demographic characteristics, but without VESs, were included as the control group. All participants were evaluated by STE.

Results:

Fifty-five patients with frequent VESs (mean age 47 years, range 22-60 years; 42.2% male) and 45 control subjects (mean age 46 years, range 22–60 years; 37.8% male) were enrolled in the study. Global LV longitudinal strain (GLS) was decreased in patients with frequent VESs (-18.41±3.37 and -21.82±2.43; p<0.001). In addition, global LV circumferential strain was decreased in patients with frequent VESs (-16.83±6.06, -20.51±6.02; p<0.001). The frequency and exposure time of VESs were negatively correlated with GLS (r=-0.398, p<0.001; r=-0.191, p=0.001, respectively).

Conclusion:

STE revealed that LV functions were decreased in patients with VESs. This deterioration increased with the frequency and exposure time of VESs. Impairment of LV function due to excessive VESs occurs during long-time follow-up. STE may be used for early detection of LV dysfunction.

Assessment of Heart Rate Recovery with GATED-Myocardial Perfusion Scintigraphy Outcome in Patients with Coronary Artery Disease: A Retrospective Study and Institutional Experience

Objective:

This study aimed to investigate the effects of assessment with myocardial perfusion scintigraphy (MPS) and heart rate recovery (HRrec) measurements in combination to evaluate the current status of patients with a diagnosis or suspicion of coronary artery disease (CAD).

Methods:

A total of 350 patients were included in the study. CAD group consisted of 200 patients with stable angina pectoris and a known history of CAD, while the control group consisted of 150 patients with suspicious stress test who had no history of known CAD. In order to calculate the HRrec index, the treadmill exercise test was performed in all patients according to the Bruce protocol. The MPS results were evaluated for the presence or absence of myocardial ischemia and infarction by visual and quantitative (summed stress score and summed difference score) assessments.

Results:

When the MPS results and HRrec were evaluated together, there was no statistically significant difference in the non-CAD group. But, when GATED-MPS was evaluated alone in the triple-vessel patient group, 27 (36%) patients were found to be normal while evaluated with HRrec, four (5.3%) patients were found to be normal.

Conclusion:

HRrec measurements obtained during stress MPS is important in patient evaluation. Therefore, evaluation of MPS results and HRrec measurements together may provide a more accurate estimation of possible presence of CAD in patients.

Effect of extended aeration on the fate of particulate components in sludge stabilization

The study investigated the effect of extended aeration on the fate of particulate components of biological sludge in aerobic stabilization. Biological sludge was generated in a fill and draw reactor fed with domestic sewage and sustained at steady state, at a sludge age of 20 days. Particulate fractions of sludge were determined by model evaluation of the corresponding oxygen uptake rate profile. Extended aeration could not produce a mineralized biomass. External aerobic stabilization of the thickened sludge achieved a volatile suspended solids reduction of 68% after 60 days. High reduction could be attributed to the relatively higher rate for the hydrolysis of accumulated particulate metabolic products, compared to conventional activated sludge. Model evaluation based on death-regeneration mechanism indicated a gradually decreasing decay rate for solids; the first phase could be associated with the inactivation/death of the viable biomass and the second controlled by the slower breakdown of particulate metabolic products.

Evaluation of liver perfusion in diabetic patients using 99mTc-sestamibi

OBJECTIVE

The liver is an important organ for various aspects of glucose metabolism, including glucose uptake, storage, and synthesis. It is a major organ in the metabolic process with perfusion provided by both the portal vein and hepatic artery. In diabetic patients organ perfusion is reduced and this is linked to atherosclerosis, and as a result complications occur. In this study, we aimed to evaluate liver perfusion by scintigraphic methods in diabetic patients.

DESIGN AND PATIENTS

We retrospectively investigated 1,100 myocardial perfusion scintigraphies taken between January 2011 and December 2012 at Canakkale Onsekiz Mart University Medical Faculty Nuclear Medicine Department. A total of 66 patients who were diagnosed with diabetes mellitus and had myocardial perfusion scintigraphies were included in the study. The control subjects included 127 patients without diabetes mellitus who were chosen at random. Patients with chronic liver disease were not included in the study. The values from liver regions of interest (liver-ROI) rates and heart regions of interest (heart-ROI) rates were compared between the patients and controls.

RESULTS

Patients were grouped according to the presence of diabetes. In the diabetes mellitus group, the liver-ROI average was lower (p = 0.66) than in the controls. In the control group, the average liver-ROI/heart-ROI ratios were higher than the ratio in the diabetes mellitus group (p = 0.019). Multivariate variance analysis showed that the diabetes mellitus liver-ROI/heart-ROI ratio was independent of other risk factors (p = 0.003; F: 9.6). Powered by Editorial Manager(®) and ProduXion Manager(®) from Aries Systems Corporation.

CONCLUSIONS

This study shows that liver perfusion in diabetic patients is reduced compared with those without diabetes. Prospective studies with larger patient groups are required.

A combination of methylprednisolone and quercetin is effective for the treatment of cardiac contusion following blunt chest trauma in rats

Cardiac contusion is a potentially fatal complication of blunt chest trauma. The effects of a combination of quercetin and methylprednisolone against trauma-induced cardiac contusion were studied. Thirty-five female Sprague-Dawley rats were divided into five groups (n=7) as follows: sham, cardiac contusion with no therapy, treated with methylprednisolone (30 mg/kg on the first day, and 3 mg/kg on the following days), treated with quercetin (50 mg·kg⁻¹·day⁻¹), and treated with a combination of methylprednisolone and quercetin. Serum troponin I (Tn-I) and tumor necrosis factor-alpha (TNF-α) levels and cardiac histopathological findings were evaluated. Tn-I and TNF-α levels were elevated after contusion (P=0.001 and P=0.001). Seven days later, Tn-I and TNF-α levels decreased in the rats treated with methylprednisolone, quercetin, and the combination of methylprednisolone and quercetin compared to the rats without therapy, but a statistical significance was found only with the combination therapy (P=0.001 and P=0.011, respectively). Histopathological degeneration and necrosis scores were statistically lower in the methylprednisolone and quercetin combination group compared to the group treated only with methylprednisolone (P=0.017 and P=0.007, respectively). However, only degeneration scores were lower in the combination therapy group compared to the group treated only with quercetin (P=0.017). Inducible nitric oxide synthase positivity scores were decreased in all treatment groups compared to the untreated groups (P=0.097, P=0.026, and P=0.004, respectively). We conclude that a combination of quercetin and methylprednisolone can be used for the specific treatment of cardiac contusion.

Modeling the fate of particulate components in aerobic sludge stabilization--performance limitations

The study investigated the effect of sludge composition on the limitations of aerobic stabilization. It was designed with the foresight that the stabilization mechanism could only be elucidated if the observed volatile suspended solids reduction were correlated with the fate of particulate components in sludge. Biomass sustained at sludge ages of 2 and 10 days were used in the stabilization reactors. Particulate components were determined by model evaluation of corresponding oxygen uptake rate profiles. Interpretation of the experimental data by modeling, based on death-regeneration mechanism without external substrate, could simulate the fate and evolution of major components in sludge during stabilization. It showed that both microbial decay and hydrolysis of non viable cellular material proceeded at much slower rates as compared with biological systems sustained with substrate feeding. Modeling also indicated that particulate metabolic products generated by sludge acclimated to high sludge age undergo slow biodegradation under prolonged stabilization.

Are gastroenterologists less tolerant of treatment risks than patients? Benefit-risk preferences in Crohn's disease management

BACKGROUND

Crohn's disease is a serious and debilitating gastrointestinal disorder with a high, unmet need for new treatments. Biologic agents have the potential to alter the natural course of Crohn's disease but present known risks of potential serious adverse events (SAEs). Previous studies have shown that patients are willing to accept elevated SAE risks in exchange for clinical efficacy. Gastroenterologists and patients may have similar goals of maximizing treatment benefit while minimizing risk; however, gastroenterologists may assess the relative importance of risk differently than patients.

OBJECTIVE

To (a) understand how gastroenterologists caring for patients with Crohn's disease balance benefits and risks in their treatment decisions and (b) compare their treatment preferences with those of adult patients with Crohn's disease.

METHODS

Both patient and gastroenterologist treatment preferences were elicited using a web-based, choice-format conjoint survey instrument. The conjoint questions required subjects to choose between 2 hypothetical treatment options with differing levels of treatment attributes. Patients evaluated the treatment options for themselves, and gastroenterologists evaluated the treatment options for each of 3 hypothetical patient types: (a) female aged 25 years with no history of Crohn's disease surgery (young), (b) male aged 45 years with 1 Crohn's disease surgery (middleaged), and (c) female older than 70 years with 4 Crohn's disease surgeries (older). Treatment attributes represented the expected outcomes of treatment: severity of daily symptoms, frequency of flare-ups, serious disease complications, oral steroid use, and the risks of 3 potentially fatal SAEs - lymphoma, serious or opportunistic infections, and progressive multifocal leukoencephalopathy (PML) - during 10 years of treatment. Maximum acceptable risk (MAR), defined as the highest level of SAE risk that subjects would accept in return for a given improvement in efficacy (i.e., the increase in treatment risk that exactly offsets the hypothetical increase in treatment benefit), was calculated using preference weights (parameter marginal log odds ratios) that were estimated with conjoint analysis (random parameters logit models). Gastroenterologists' and patients' mean MARs for 3 SAE risks were calculated for 6 improvements in Crohn's disease symptoms, and gastroenterologists' preference weights for each of the 3 patient profiles were compared. Gastroenterologists' MARs for a hypothetical middle-aged patient were then compared with predicted MARs derived using data from the patient study for male patients aged 40 to 50 years with 1 surgery.

RESULTS

After exclusion of nonrespondents (n = 4,021 of 4,422 gastroenterologists; n = 681 of 1,285 patients) and nonevaluable respondents (n = 86 gastroenterologists; n = 24 patients), 315 gastroenterologists and 580 patients were included in the final analytic samples. There were no statistically significant differences in gastroenterologists' preference weights for the middle-aged versus young patient profiles. However, preference weights indicated that gastroenterologists are more concerned about 5% side-effect risks for the older patient profile than for the middle-aged patient profile. For symptomatic improvements from severe symptoms to remission, gastroenterologists' highest MARs were for lymphoma: 6.21%, 8.99%, and 25.00% for the young, middle-aged, and older patient types, respectively. In analyses of improvements from severe to moderate symptoms and from moderate symptoms to remission for hypothetical middle-aged patients, gastroenterologists' 10-year risk tolerance ranged between 1.96% lymphoma risk in return for an improvement from moderate symptoms to remission and 4.93% lymphoma risk for an improvement from severe to moderate symptoms; patients' 10-year risk tolerance for middle-aged patients ranged between 1.52% PML risk in return for an improvement from severe to moderate symptoms and 5.86% infection risk for an improvement from moderate symptoms to remission. On average, gastroenterologists and patients disagreed about how much risk is tolerable for improvements in efficacy. In exchange for improvements from severe to moderate symptoms for the middle-aged patient profile, gastroenterologists were significantly more tolerant than patients of treatment risks of PML (P < 0.001) and serious infection (P = 0.001) but not lymphoma (P = 0.230). In contrast, in exchange for improvements from moderate symptoms to remission for the same patient profile, patients were significantly more tolerant than gastroenterologists of treatment risks for serious infection (P < 0.001) and lymphoma (P < 0.001) but not PML (P = 0.158).

CONCLUSIONS

Gastroenterologists and patients have well-defined preferences among treatment attributes and are willing to accept tradeoffs between efficacy and treatment risks. However, risk tolerance varies depending on the type of patient for whom gastroenterologists are being asked to consider treatment. In rating treatment preferences for patients with a middle-aged profile, gastroenterologists are less tolerant of SAE risks than patients in exchange for improvement from moderate symptoms to remission.

Patients' Benefit-Risk Preferences for Chronic Idiopathic Thrombocytopenic Purpura Therapies

Background:

Idiopathic thrombocytopenic purpura (ITP) primarily is a disorder of adults characterized by autoantibody-induced platelet destruction and reduced platelet production, leading to a low peripheral blood platelet count. The long-term management of many patients with chronic ITP is unsatisfactory, largely due to the variable efficacy and risks of severe adverse effects associated with current treatment options.

Objective:

To estimate patients' benefit-risk preferences for treatments for ITP.

Methods:

Patients' adverse event risk tolerance and the levels of benefit required to offset possible risks were evaluated using choice-format conjoint analysis. Subjects chose between pairs of hypothetical treatment alternatives defined by probability of achieving safe platelet levels, need for corticosteroids, mode of administration, risk of rebound, risk of elevated liver enzyme levels, and risk of thromboembolism.

Results:

In this study, we demonstrate that patients have clear and measurable benefit-risk preferences that physicians should consider when discussing treatment options with their patients. Patients were willing to accept significant risks of adverse events in return for an increase in the probability of achieving safe platelet levels, to avoid corticosteroids, and for more convenient administration. Patients were willing to accept significant risks of rebound and elevated liver enzymes for improvements in outcomes.

Conclusions:

These results demonstrate that patients with ITP are willing to accept treatment-related risks in exchange for improvements in treatment efficacy and administration attributes and suggest the importance of considering a patient's benefit-risk preferences during discussions of therapeutic options.