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Abstract: There is an urgent need for validated tools to measure sclerotic cutaneous chronic graft-versus-host disease (scGVHD). We examined the interobserver reproducibility within a session and intraobserver repeatability between sessions of the Myoton device for quantifying skin sclerosis in 36 adults with scGVHD. The Myoton was used to measure oscillation frequency and relaxation time of soft tissues at 7 bilateral sites (14 anatomic sites) by 2 study personnel at 2 study sessions. Agreement was measured using mean pairwise absolute difference (MPD), and reliability was measured using intraclass correlation coefficient (ICC). For each of the 2 Myoton parameters, the overall interobserver MPD was <5% of the average overall values and the interobserver ICC was >0.90 between the 2 observers, indicating excellent agreement and reliability within a measurement session. The median time between sessions 1 and 2 was 47.5 days. The overall normalized intraobserver MPD was <7% of the average overall values for each of the 2 Myoton parameters, reflecting good agreement between sessions. The intraobserver ICC for frequency and relaxation time parameters were 0.85 and 0.84, respectively, indicating good reliability between sessions. The reproducibility and repeatability of a bonus site selected at each study visit were similar to the standard 14 anatomic sites. However, no individual site was nearly as reproducible or repeatable as the overall Myoton measurements averaged across the patient. Our findings emphasize the utility of the Myoton for assessing skin properties in scGVHD with patient-level measurements.
Importance There are limited means to predict which crewmembers are at risk for developing optic disc edema (ODE) during spaceflight. Identifying crewmembers who have a low probability of developing ODE will allow for reduced monitoring and countermeasure resources, thereby enabling alternate mission activities. Objective To determine if magnitude of ODE early in flight is associated with magnitude of ODE later in flight. Design, Setting, and Participants This cohort study involved crewmembers on board the International Space Station. Participants were astronauts who had optical coherence tomography (OCT) imaging before, during, after their spaceflight mission. Preflight and in-flight total retinal thickness (TRT) was quantified within the annular region from Bruch membrane opening to 250 μm using OCT. The change (Δ) in TRT is an objective approach to quantifying ODE. Exposure Spaceflight missions lasting approximately 6 months long. Main Outcomes and Measures Preflight to in-flight ΔTRT. Data were analyzed using linear and log-binomial mixed effects models to determine (1) if ΔTRT on flight day (FD) 30 was associated with ΔTRT on FD150 and (2) the probability a crewmember with ΔTRT less than 20 μm on FD30 would exhibit ΔTRT less than 55 μm on FD150 or a crewmember with ΔTRT of 20 of 55 μm on FD30 would develop ΔTRT greater than 55 μm on FD150. Results Data from 43 ISS crewmembers (mean [SD] age, 47 [7] years; 35 males [81%] and 8 females [19%]) with a mean (SD) flight duration of 198 (55) days were included. There was an association between FD30 ΔTRT and FD150 ΔTRT (repeated-measure correlation coefficient = 0.89; 95% CI, 0.80-0.94; P < .001). Eyes with ΔTRT less than 20 on FD30 had 2% probability (95% CI, 1%-15%) of ΔTRT of 55 μm or greater on FD150. Receiver operating curve analysis determined an optimal threshold ΔTRT of greater than 29 μm on FD30 to distinguish eyes at risk of ΔTRT of 55 μm or greater on FD150. Eyes with ΔTRT of 20 to 55 μm or 29 to 55 μm on FD30 had a 34% (95% CI, 19%-60%) or 58% (95% CI, 37%-90%) probability, respectively, of ΔTRT of 55 μm or greater on FD150. Conclusions and Relevance Findings suggest crewmembers who did not develop ODE on FD30 were unlikely to develop clinically concerning ODE on FD150. The data suggest that OCT imaging during spaceflight missions provides an opportunity to predict the magnitude of ODE that may develop during a longer-lasting mission.
Systemic corticosteroids, recommended for adult patients with coronavirus disease 2019 (COVID-19) who require supplemental oxygen, may carry an increased risk of reactivating latent infections such as hepatitis B virus (HBV) infection. This retrospective observational cohort study of prospectively collected clinical data evaluated HBV screening frequency and examined the prevalence and reactivation of HBV among hospitalised adults treated with systemic corticosteroids for COVID-19 at a tertiary care hospital in Slovenia. Anti-HBc screening was conducted in 1,793/2,134 (84
Introduction: The 2019 American Heart Association (AHA) guidelines highlight perfusion assessment and imaging in peripheral artery disease (PAD) as critical, yet unmet needs in clinical practice. We hypothesized that over the course of 1-year the microcirculation of the skeletal calf muscles will not change in matched controls but marked variations will be observed due to structural and functional impairment in PAD patients. Methods: The perfusion in tissue can be mapped and quantified in various metrics, we have proposed three novel variables viz. hypoperfusion (Hy) %, heterogeneity (He) %, and mean signal enhancement (MSE) , as a perfusion metric to represent frame-wise perfusion impairment in contrast enhanced magnetic resonance imaging (CE-MRIs ) among PAD patients. With these three variables referred to as impairment , we calculated the association of baseline, and 1-year perfusion change in matched controls and PAD patients. Cross-sectional CE-MRIs of 31 participants (controls=12, PAD=19) were acquired from the mid-calf level at a supine position during the baseline visit and at the 1-year follow-up. A self-enhancement based perfusion mapping (SEPM) algorithm was developed to identify the three proposed perfusion metrics from the CE-MRIs. All CE-MRIs were post-processed to remove faulty and noisy frames, and later semi-automatically segmented into five muscle compartments to represent the anterior muscle (AM), lateral muscle (LM), deep posterior muscle (DM), soleus muscle (SM), and gastrocnemius muscles (GM) groups. Results: Our experiment shows He % in GM and SM were significantly higher in PAD patients than in matched controls (p<0.05).There was a lower association of all 3 perfusion metrics changes from baseline to 1-year in PAD patients compared to the matched controls. In a sub-group analysis of PAD subgroups, showed an ‘ increase in Hy % ’ in PAD groups with other complications like diabetes and reduced ability to walk . The recurrent neural networks (RNNs) were separately trained and tested (6:4) using these perfusion variables as features from baseline visits, so a prediction can be done for the 1-year. The overall prediction calculated via root mean squared error (RMSE) ( MSE: 4.05, He: 13.74%, Hy: 18.87%), and R 2 is moderately good. Conclusion: Our finding indicate that calf muscle CE-MRI-based proposed perfusion metrics are associated with PAD progression and could be used to train RNNs for predicting patients’ 1-year perfusion characteristics.
Background and Objectives Surgery is the mainstay of treatment for localized colorectal cancer (CRC); however, little is known about survival outcomes following CRC surgery in low- and middle-income countries (LMICs). Here, we examine the available data on long-term outcomes following CRC resections in LMICs.Methods A systematic review and meta-analysis were conducted on primary research studies reporting survival data after CRC resection with curative intent in LMICs. Disease-free survival (DFS) and overall survival (OS) data were extracted, and random effects modelling was used to estimate the pooled survival rates.Results One hundred and fifty-four studies representing 20,589 CRC patients were analyzed. Notably, only 27 (20%) of the 137 LMICs were represented in the literature. The pooled 5-year OS estimate was 88% (95% CI: 77-95), 76% (69-81), and 57% (49-64) for Stages I, II, and III, respectively. 5-year DFS estimates were 82% (71-90), 76% (67-84), and 59% (51-65) for stages I, II, and III, respectively. Combined OS and DFS estimates for all three stages were 76% and 69%, respectively. Survival rates varied considerably across the included studies and between income groups.Conclusions With the rising incidence of CRC globally, our work highlights the dearth of data on long-term outcomes following CRC operations in most LMICs and emphasizes the urgent need for research capacity building.
