A systematic review of machine learning-based tumor-infiltrating lymphocytes analysis in colorectal cancer: Overview of techniques, performance metrics, and clinical outcomes.

The incidence of colorectal cancer (CRC), one of the deadliest cancers around the world, is increasing. Tissue microenvironment (TME) features such as tumor-infiltrating lymphocytes (TILs) can have a crucial impact on diagnosis or decision-making for treating patients with CRC. While clinical studies showed that TILs improve the host immune response, leading to a better prognosis, inter-observer agreement for quantifying TILs is not perfect. Incorporating machine learning (ML) based applications in clinical routine may promote diagnosis reliability. Recently, ML has shown potential for making progress in routine clinical procedures. We aim to systematically review the TILs analysis based on ML in CRC histological images. Deep learning (DL) and non-DL techniques can aid pathologists in identifying TILs, and automated TILs are associated with patient outcomes. However, a large multi-institutional CRC dataset with a diverse and multi-ethnic population is necessary to generalize ML methods.

Assessment of the Tumor-Stroma Ratio and Tumor-Infiltrating Lymphocytes in Colorectal Cancer: Inter-Observer Agreement Evaluation.

BACKGROUND: To implement the new marker in clinical practice, reliability assessment, validation, and standardization of utilization must be applied. This study evaluated the reliability of tumor-infiltrating lymphocytes (TILs) and tumor-stroma ratio (TSR) assessment through conventional microscopy by comparing observers' estimations. METHODS: Intratumoral and tumor-front stromal TILs, and TSR, were assessed by three pathologists using 86 CRC HE slides. TSR and TILs were categorized using one and four different proposed cutoff systems, respectively, and agreement was assessed using the intraclass coefficient (ICC) and Cohen's kappa statistics. Pairwise evaluation of agreement was performed using the Fleiss kappa statistic and the concordance rate and it was visualized by Bland-Altman plots. To investigate the association between biomarkers and patient data, Pearson's correlation analysis was applied. RESULTS: For the evaluation of intratumoral stromal TILs, ICC of 0.505 (95% CI: 0.35-0.64) was obtained, kappa values were in the range of 0.21 to 0.38, and concordance rates in the range of 0.61 to 0.72. For the evaluation of tumor-front TILs, ICC was 0.52 (95% CI: 0.32-0.67), the overall kappa value ranged from 0.24 to 0.30, and the concordance rate ranged from 0.66 to 0.72. For estimating the TSR, the ICC was 0.48 (95% CI: 0.35-0.60), the kappa value was 0.49 and the concordance rate was 0.76. We observed a significant correlation between tumor grade and the median of TSR (0.29 (95% CI: 0.032-0.51), p-value = 0.03). CONCLUSIONS: The agreement between pathologists in estimating these markers corresponds to poor-to-moderate agreement; implementing immune scores in daily practice requires more concentration in inter-observer agreements.

Detection of key mRNAs in liver tissue of hepatocellular carcinoma patients based on machine learning and bioinformatics analysis.

One methodology extensively used to develop biomarkers is the precise detection of highly responsive genes that can distinguish cancer samples from healthy samples. The purpose of this study was to screen for potential hepatocellular carcinoma (HCC) biomarkers based on non-fusion integrative multi-platform meta-analysis method. The gene expression profiles of liver tissue samples from two microarray platforms were initially analyzed using a meta-analysis based on an empirical Bayesian method to robust discover differentially expressed genes in HCC and non-tumor tissues. Then, using the bioinformatics technique of weighted correlation network analysis, the highly associated prioritized Differentially Expressed Genes (DEGs) were clustered. Co-expression network and topological analysis were utilized to identify sub-clusters and confirm candidate genes. Next, a diagnostic model was developed and validated using a machine learning algorithm. To construct a prognostic model, the Cox proportional hazard regression analysis was applied and validated. We identified three genes as specific biomarkers for the diagnosis of HCC based on accuracy and feasibility. The diagnostic model's area under the curve was 0.931 with confidence interval of 0.923-0.952.•Non-fusion integrative multi-platform meta-analysis method.•Classification methods and biomarkers recognition via machine learning method.•Biomarker validation models.

Minimally invasive and invasive liver surgery based on augmented reality training: a review of the literature.

A liver surgeon's knowledge of anatomy is critical. Due to the patient's small field of vision, patient specific, complex nerve system, and other factors, even a minor loss can result in irreversible damage. Surgeons could benefit from the use of augmented reality (AR) technology, which would bring three-dimensional image data into the operating room. AR visualization can improve surgical procedures, facilitate intraoperative planning, and enhance surgical guidance for the anatomy of interest, all of which contribute to the application's minimal invasiveness. This literature review on image guidance in liver surgery provides the reader with information about AR techniques. To ascertain the current state of Augmented reality technology's application in liver surgery, a PubMed and Embase search were conducted using the following keywords: < (Augmented reality) AND (liver surgery) > and < 'Augmented reality' AND 'liver surgery' > (publication date from January 1991 until Jun 2022). The query yielded a total of 205 publications-excluded papers in other languages, virtual reality (VR), and reviews leaving 135 studies for review. After removing duplication, the titles and abstracts of those studies were manually reviewed. Finally, 31 pertinent studies were determined to be pertinent to the subject. Generally, augmented reality technology includes preoperative planning and three-dimensional reconstruction, intraoperative three-dimensional navigation, and registration. Visualization may be aided by virtual three-dimensional reconstruction models of the liver from Computed Tomography/Magnetic Resonance Imaging scans. The results demonstrate that by utilizing augmented reality technology, blood vessels and tumor structures in the liver can be visualized during surgery, allowing for precise navigation during complicated surgical procedures. Augmented reality has been demonstrated to be safe and effective in both minimally invasive and invasive liver surgery. With recent advancements and significant effort by liver surgeons, augmented reality technologies have the potential to increase hepatobiliary surgical procedures dramatically. However, further clinical trials will be necessary to evaluate augmented reality as a tool for reducing post-operative morbidity and mortality. The impact of these cutting-edge computerized image guidance techniques on clinically relevant outcome parameters should be assessed in the future.

Effect of a Text Message-Based Support Program on Outcomes of Patients After Flexor Tendon Injury Repair.

PURPOSE: Although the effectiveness of using text messages in home-based rehabilitation programs has been investigated, its ability to engage patients in home rehabilitation exercises and, as a result, improve hand outcomes, specifically in patients with flexor tendon injuries, has not been evaluated. The aim of this study was to determine whether the addition of a text message-based intervention to usual care is effective in improving hand outcomes in patients with flexor tendon injuries after repair. METHODS: In this 2-arm parallel randomized controlled trial, 40 patients were randomly assigned to either the intervention group (usual care plus the support program) or the control group (usual care only). Intervention included an automated package of instructional text messages containing links to a secure website for instructional rehabilitation videos delivered over 12 weeks. The Quick Disabilities of the Arm, Shoulder, and Hand and visual analog scale for pain scores were assessed at 6 and 12 weeks. Physician-reported grip strength and total active motion were assessed after 12 weeks. RESULTS: The study was completed by 90% (36 of 40) of the patients who were enrolled. There were statistically significant differences between the 2 groups with respect to Quick Disabilities of the Arm, Shoulder, and Hand and visual analog scale scores at the 6-week and 12-week assessments. In addition, there were statistically significant differences between the 2 groups with respect to total active motion and grip strength at 12 weeks. Finally, a high level of satisfaction with the intervention was reported. CONCLUSIONS: The text message-based program was associated with improved outcomes over the first 12 weeks after flexor tendon repair. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

Thyroid Ultrasound-Image Dataset.

Thyroid Computer-Aided Diagnosis (CAD) systems have been developed to assist radiologists in improving efficiency, reliability, and diagnosis performance. Often the performance of these CAD systems is evaluated with different datasets that make it incomparable. A valuable thyroid ultrasound (US) dataset is presented in this work. This dataset consists of 2450 thyroid US images from 2018 to 2020 in Prospective Epidemiological Research Studies in Mashhad, Iran (PERSIAN), a large national cohort study. These US images have the ROI of thyroid nodules and the associated American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TIRADS) features by expert physicians provided in XML format. Dataset's images are categorized into five groups based on the ACR-TIRADS (Tirads1-Tirads5). The presented dataset is expected to be a valuable resource to develop and assess thyroid CAD systems to help radiologists better diagnose.

Efficacy of low-fat milk and yogurt fortified with vitamin D3 on systemic inflammation in adults with abdominal obesity.

BACKGROUND: The prevalence of vitamin D deficiency is increasing globally and is associated with an increased risk of metabolic syndrome, autoimmune disease, and cardiovascular disease. Vit D deficiency is also associated with increased systemic inflammation. The current study aimed to determine the efficacy of low-fat milk and yogurt fortified with 1500 IU nano-encapsulated vitamin D, on systemic inflammation in abdominal obese participants. METHOD: This multi-center study was conducted using a 2.5-month parallel total-blind randomized clinical trial design. Two hundred and eighty nine subjects were allocated to four groups: low-fat milk fortified by 1500 IU nano-encapsulated vitamin D3 (200 mL/day). Simple milk (200 mL/day), low-fat yogurt fortified by 1500 IU nano-encapsulated vitamin D3 (150 g/day), and simple yogurt (150 g/day). RESULTS: The results showed that serum levels of neutrophils, lymphocytes, platelets and red blood cell distribution width (RDW) were significantly lower before and after the intervention in fortified dairy groups. The results showed that serum levels of neutrophils, lymphocytes, platelets, and RDW before and after intervention in the fortified dairy groups were significantly lower (p < 0.05). The values of = neutrophil to lymphocyte ratio (NLR), platelets to lymphocyte ratio, and RDW to platelets ratio (RPR) reduced significantly in the fortification group (p < 0.05). CONCLUSION: Fortification with nano-encapsulated vitamin D3 of dairy products may decrease inflammation in individuals with abdominal obesity.

Colorectal Cancer in North-Eastern Iran: a retrospective, comparative study of early-onset and late-onset cases based on data from the Iranian hereditary colorectal cancer registry.

BACKGROUND: The incidence rate of colorectal cancer (CRC) is increasing among patients below 50 years of age. The reason for this is unclear, but could have to do with the fact that indicative variables, such as tumour location, gender preference and genetic preponderance have not been followed up in a consistent mann er. The current study was primarily conducted to improve the hereditary CRC screening programme by assessing the demographic and clinicopathological characteristics of early-onset CRC compared to late-onset CRC in northeast Iran. METHODS: This retrospective study, carried out over a three-year follow-up period (2014-2017), included 562 consecutive CRCs diagnosed in three Mashhad city hospital laboratories in north-eastern Iran. We applied comparative analysis of pathological and hereditary features together with information on the presence of mismatch repair (MMR) gene deficiency with respect to recovery versus mortality. Patients with mutations resulting in absence of the MMR gene MLH1 protein product and normal BRAF status were considered to be at high risk of Lynch syndrome (LS). Analyses using R studio software were performed on early-onset CRC (n = 222) and late-onset CRC (n = 340), corresponding to patients ≤50 years of age and patients > 50 years. RESULTS: From an age-of-onset point of view, the distribution between the genders differed with females showing a higher proportion of early-onset CRC than men (56% vs. 44%), while the late-onset CRC disparity was less pronounced (48% vs. 52%). The mean age of all participants was 55.6 ± 14.8 years, with 40.3 ± 7.3 years for early-onset CRC and 65.1 ± 9.3 years for late-onset CRC. With respect to anatomical tumour location (distal, rectal and proximal), the frequencies were 61, 28 and 11%, respectively, but the variation did not reach statistical significance. However, there was a dramatic difference with regard to the history of CRC in second-degree relatives between two age categories, with much higher numbers of family-related CRCs in the early-onset group. Expression of the MLH1 and PMS2 genes were significantly different between recovered and deceased, while this finding was not observed with regard to the MSH6 and the MSH2 genes. Mortality was significantly higher in those at high risk of LS. CONCLUSION: The variation of demographic, pathological and genetic characteristics between early-onset and late-onset CRC emphasizes the need for a well-defined algorithm to identify high-risk patients.

A randomized, double-blind, placebo-controlled, clinical trial to evaluate the benefits of Nigella sativa seeds oil in reducing cardiovascular risks in hypertensive patients.

The efficacy, safety, and utility of Nigella sativa seeds oil as a complementary treatment for hypertension, glucose control, and lipid metabolism were evaluated. Hypertensive patients in the intervention (n = 26) and placebo (n = 29) groups received 2.5 ml of N. sativa seeds oil and sunflower oil twice daily for 8 weeks, respectively. The levels of systolic and diastolic blood pressure (SBP, DBP), blood lipid profile, and fasting blood sugar (FBS), at different stages of the treatment period (0, 3, 6, 8 weeks), and malondialdehyde (MDA) and glutathione reductase (GR), at the baseline and end of the study, were assessed. SBP level in the intervention group was significantly reduced, compared with the baseline values (p < .001) and the placebo group (p < .05). A significant decline was observed in the levels of DBP, total cholesterols, and low density lipoprotein (LDL) (p < .000), MDA, and FBS (p < .001); also, a significant increase was observed in the levels of high density lipoprotein (HDL) and GR (p < .001). The use of N. sativa seeds oil as an adjunct to common medications exhibited additional antihypertensive effects as well as beneficial effects on glucose control and lipid metabolism in hypertensive patients with no renal, hepatic, and patient-reported adverse events.

A cohort study of membranous nephropathy, primary or secondary.

BACKGROUND: Although IgG4 deposit against phospholipase A2 receptor (anti-PLA2R) is predominantly presented in the renal biopsy of patients with primary membranous nephropathy (MN), its diagnostic value of this immune complex has not been fully established. METHODS: In this cohort study, 108 biopsy-proven MN patients with proteinuria were evaluated during two years follow up and were divided into primary and secondary groups. Renal biopsy specimens were pathologically assessed for IgG4 and PLA2R depositions by immunohistochemistry (IHC). Therefore, the relationships between staining severity, MN type and total proteinuria in all patients were determined. RESULTS: Of 108 patients, 73.1% had primary MN and 26.9% were diagnosed as secondary form. IHC staining in patients with primary MN was positive for PLA2R in 76 (96.2%) and IgG4 in 68 (86.1%). Cases with positive PLA2R expression had a significantly higher rate among patients with mild to moderate stages (P = 0.03). No significant relationship was found between intensity of PLA2R and IgG4 deposits with proteinuria and serum creatinine. Based on our data, double positivity/negativity of PLA2R and IgG4 expression adds prominent information to the clinical data and were found to be useful and robust biomarkers for detection of primary MN patients with high sensitivity and specificity (97.1 and 96.3% respectively, PPV = 98.5% and NPV = 92.9%). CONCLUSIONS: Simultaneously expression of PLA2R and IgG4 in renal biopsy specimens of patients with MN could possibly be used as a potential diagnostic method to distinguish primary from secondary MN and also pathological severity of the disease.

Comprehensive assessment of nutritional status and nutritional-related complications in newly diagnosed esophageal cancer patients: A cross-sectional study.

BACKGROUND & AIMS: Malnutrition is prevalent in upper gastrointestinal cancer patients. The purpose of this study was a comprehensive assessment of nutritional status in newly diagnosed patients with esophageal cancer. METHODS: Newly diagnosed esophageal cancer patients were referred to a chemo-radiation referral center in Mashhad, Iran, between February 2017 to February 2019. Anthropometric indices, a Patient-Generated Subjective Global Assessment (PG-SGA) tool, body composition, dietary intake, nutritional-related complications, and laboratory tests were assessed. RESULTS: One hundred and eighty-nine patients with a mean age of 67.1 ± 12 and a male to female ratio of 98 to 91 were included. Ninety-seven (51.3%) of patients had experienced significant weight loss and 56 (29.6%) were underweight at diagnosis. According to PG-SGA, 179 (94.7%) needed nutritional interventions. Reduced muscle mass and low handgrip strength were observed in 70 (39.4%) and 26 (14.4%) of patients, respectively. Inadequate intakes of energy (less than 24 kcal/kg/day) and protein (less than 1.2 g/kg/day) were found in 146 (77.8%) and 171 (91%) patients, respectively. The mean total daily energy and protein intakes of subjects were 943.8 ± 540 kcal/day, and 30.6 ± 21 g/day, respectively. The most common nutritional-related complications were as follows: dysphagia (84.8%), anorexia (31.6%), constipation (62.1%), esophageal pain (48.4%), and dyspepsia (41.1%). CONCLUSION: Our study demonstrated a high prevalence of malnutrition in newly diagnosed esophageal cancer patients. This fact demonstrates the importance of early screening of nutritional status via PG-SGA tool, clinical evaluation, dietary intake evaluations, and laboratory tests, based on which effective nutritional interventions and Symptoms management may be introduced in these patients.

Evaluation of the Effects of Radio-Frequency Identification Technology on Patient Tracking in Hospitals: A Systematic Review.

OBJECTIVE: The aim of this study was to systematically review all studies that evaluated the effects of using radio-frequency identification (RFID) for tracking patients in hospitals. METHODS: The PubMed and Embase databases were searched (to August 2015) for relevant English language studies, and those that evaluated the effects of a real-time locating systems with RFID for patient tracking in hospitals were identified and extracted. RESULTS: Of the 652 studies found, the 17 relevant studies were extracted for inclusion. Five of the extracted studies used RFID systems in operating theaters, two in emergency departments, one in a magnetic resonance imaging department, one in a radiology room, and the remaining eight studies were in other wards. In these studies, features such as the feasibility, accuracy, precision, reliability, security, level of satisfaction, cost of care, and time efficiency of the RFID systems were reported. Of all the extracted studies, seven evaluated the accuracy of the systems in crowded and unattended areas, and five of these were satisfied with their accuracy. Six evaluated the reliability of the systems, and all of these found the systems to be reliable. Six evaluated time-savings, and all of them reported the systems to be time effective. Two focused on the cost of care, and both of these reported the systems to be cost effective. CONCLUSIONS: Although most studies reported a positive impact on the accuracy and precision of patient identification, there is insufficient good evidence to show that RFID systems can accurately localize patients in crowded settings.

Prevalence of Mismatch Repair-Deficient Colorectal Adenoma/Polyp in Early-Onset, Advanced Cases: a Cross-Sectional Study Based on Iranian Hereditary Colorectal Cancer Registry.

BACKGROUND: Lynch syndrome (LS) increases the risk of many types of cancer, mainly colorectal cancer (CRC). The purpose of this study was to assess the prevalence of mismatch repair (MMR) deficiency in patients under the age of 50 with advanced adenomatous polyps, aiming at an early diagnosis of LS. METHODS: This retrospective, cross-sectional study included eligible patients with advanced adenomas diagnosed ≤ 50 years of age registered between April 2014 and February 2017 at three pathology centers in Mashhad. Pathological records were reviewed, and colon tissue specimens were analyzed by immunohistochemistry (IHC) staining to identify proteins which serve as markers for LS as they are related to loss of MMR gene (MLH1, MSH2, MSH6, and PMS2) expression. RESULTS: Of 862 consecutive patients, a total of 50 adenomas (54% males, 46% females of mean age 41.24 ± 6.5) met the eligibility criteria. Of the adenomas examined, 20 (40%) had a tubulovillous component, 34 (68%) had high-grade dysplasia, and 30 (60%) had were larger than 10 mm protrusions. None of the patients had loss of MMR protein expression. CONCLUSION: No individual with MMR genetic disorder was identified by IHC screening of early-onset advanced colorectal adenomas. This strategy is therefore not an effective strategy for detecting MMR mutation carriers.

Spatio-temporal mapping of breast and prostate cancers in South Iran from 2014 to 2017.

BACKGROUND: The most common gender-specific malignancies are cancers of the breast and the prostate. In developing countries, cancer screening of all at risk is impractical because of healthcare resource limitations. Thus, determining high-risk areas might be an important first screening step. This study explores incidence patterns of potential high-risk clusters of breast and prostate cancers in southern Iran. METHODS: This cross-sectional study was conducted in the province of Kerman, South Iran. Patient data were aggregated at the county and district levels calculating the incidence rate per 100,000 people both for cancers of the breast and the prostate. We used the natural-break classification with five classes to produce descriptive maps. A spatial clustering analysis (Anselin Local Moran's I) was used to identify potential clusters and outliers in the pattern of these cancers from 2014 to 2017. RESULTS: There were 1350 breast cancer patients (including, 42 male cases) and 478 prostate cancer patients in the province of Kerman, Iran during the study period. After 45 years of age, the number of men with diagnosed prostate cancer increased similarly to that of breast cancer for women after 25 years of age. The age-standardised incidence rate of breast cancer for women showed an increase from 29.93 to 32.27 cases per 100,000 people and that of prostate cancer from 13.93 to 15.47 cases per 100,000 during 2014-2017. Cluster analysis at the county level identified high-high clusters of breast cancer in the north-western part of the province for all years studied, but the analysis at the district level showed high-high clusters for only two of the years. With regard to prostate cancer, cluster analysis at the county and district levels identified high-high clusters in this area of the province for two of the study years. CONCLUSIONS: North-western Kerman had a significantly higher incidence rate of both breast and prostate cancer than the average, which should help in designing tailored screening and surveillance systems. Furthermore, this study generates new hypotheses regarding the potential relationship between increased incidence of cancers in certain geographical areas and environmental risk factors.

The burden and predisposing factors of non-communicable diseases in Mashhad University of Medical Sciences personnel: a prospective 15-year organizational cohort study protocol and baseline assessment.

BACKGROUND: The rising burden of premature mortality for Non-Communicable Diseases (NCDs) in developing countries necessitates the institutionalization of a comprehensive surveillance framework to track trends and provide evidence to design, implement, and evaluate preventive strategies. This study aims to conduct an organization-based prospective cohort study on the NCDs and NCD-related secondary outcomes in adult personnel of the Mashhad University of Medical Sciences (MUMS) as main target population. METHODS: This study was designed to recruit 12,000 adults aged between 30 and 70 years for 15 years. Baseline assessment includes a wide range of established NCD risk factors obtaining by face-to-face interview or examination. The questionnaires consist of demographic and socioeconomic characteristics, lifestyle pattern, fuel consumption and pesticide exposures, occupational history and hazards, personal and familial medical history, medication profile, oral hygiene, reproduction history, dietary intake, and psychological conditions. Examinations include body size and composition test, abdominopelvic and thyroid ultrasonography, orthopedic evaluation, pulse wave velocity test, electrocardiography, blood pressure measurement, smell-taste evaluation, spirometry, mammography, and preferred tea temperature assessment. Routine biochemical, cell count, and fecal occult blood tests are also performed, and the biological samples (i.e., blood, urine, hair, and nail) are stored in preserving temperature. Annual telephone interviews and repeated examinations at 5-year intervals are planned to update information on health status and its determinants. RESULTS: A total of 5287 individuals (mean age of 43.9 ± 7.6 and 45.9% male) were included in the study thus far. About 18.5% were nurses and midwives and 44.2% had at least bachelor's degree. Fatty liver (15.4%), thyroid disorders (11.2%), hypertension (8.8%), and diabetes (4.9%) were the most prevalent NCDs. A large proportion of the population had some degree of anxiety (64.2%). Low physical activity (13 ± 22.4 min per day), high calorie intake (3079 ± 1252), and poor pulse-wave velocity (7.2 ± 1.6 m/s) highlight the need for strategies to improve lifestyle behaviors. CONCLUSION: The PERSIAN Organizational Cohort study in Mashhad University of Medical Sciences is the first organizational cohort study in a metropolitan city of Iran aiming to provide a large data repository on the prevalence and risk factors of the NCDs in a developing country for future national and international research cooperation.

A spatial database of colorectal cancer patients and potential nutritional risk factors in an urban area in the Middle East.

OBJECTIVES: Colorectal cancer (CRC) is the third most common cancer across the world that multiple risk factors together contribute to CRC development. There is a limited research report on impact of nutritional risk factors and spatial variation of CRC risk. Geographical information system (GIS) can help researchers and policy makers to link the CRC incidence data with environmental risk factor and further spatial analysis generates new knowledge on spatial variation of CRC risk and explore the potential clusters in the pattern of incidence. This spatial analysis enables policymakers to develop tailored interventions. This study aims to release the datasets, which we have used to conduct a spatial analysis of CRC patients in the city of Mashhad, Iran between 2016 and 2017. DATA DESCRIPTION: These data include five data files. The file CRCcases_Mashhad contains the geographical locations of 695 CRC cancer patients diagnosed between March 2016 and March 2017 in the city of Mashhad. The Mashhad_Neighborhoods file is the digital map of neighborhoods division of the city and their population by age groups. Furthermore, these files include contributor risk factors including average of daily red meat consumption, average of daily fiber intake, and average of body mass index for every of 142 neighborhoods of the city.

Nutritional Status in Patients with Esophageal Cancer Receiving Chemoradiation and Assessing the Efficacy of Usual Care for Nutritional Managements.

BACKGROUND: Malnutrition is prevalent in esophageal cancer patients which affects cancer prognosis. The purpose of this study was a comprehensive assessment of nutritional status during Chemoradiation (CRT). METHODS: Newly diagnosed adults with esophageal cancer were recruited for this study. Patient-Generated- Subjective Global Assessment (PG-SGA), anthropometric indices, body composition, dietary intake, laboratory tests, and nutritional-related complications were assessed before, after, and 4 to 6 weeks after CRT. RESULTS: Seventy-one cases were enrolled. The mean age was 66.8±12 years. Patients' mean weight loss was 2.42±2.4 kilograms during treatment. A significant reduction observed in mean MUAC (26.68±4.9 vs. 25.42±5.1 cm), fat mass percentage (24.11±11.8 vs. 22.8±12.5), fat free mass index (16.87±2.4 vs. 16.47±2.6 kg/m2) and hand grip strength (43.2±19 vs. 36.1±20 kg) during CRT (all p-values <0.0001). We had also a non-significant change in mean energy intake (19.5±11 vs. 18.3±11 kcal/kgw. day) and protein intake (0.56±0.4 vs. 0.66±0.5 g/kgw.day) during CRT.  In our assessment before, immediately after and 4-6 weeks following CRT, we recorded energy intake insufficiency in 55.7%, 58.7% and 27.3% and protein intake inadequacy in 89.8%, 89.1% and 72.7% of cases, respectively. The most common complications were dysphagia (56.7%), anorexia (25%), and constipation (47.9%) at admission. Dysphagia improved in some cases (42%), but anorexia (35%), early satiety (25%), Esophagitis (25%), dysosmia (21%) and dysgeusia (17%) were increased as CRT complication. yet, 25% of patients had dysphagia and 34.4% had constipation 4-6 weeks after CRT. The twelve-months mortality was significantly associated with lower BMI after CRT, primary PG-SGA score, weight loss, BMI<18.5, MUAC, physical performance, living in rural or urban areas, addiction. CONCLUSION: Our study demonstrated a high prevalence of malnutrition among esophageal cancer patients which worsened during Chemoradiotherapy. Our findings warrant early screening and monitoring of nutritional status and effective nutritional interventions with symptoms management during treatment in these patients.
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External Validation of European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) for Risk Prioritization in an Iranian Population.

INTRODUCTION: The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is a prediction model which maps 18 predictors to a 30-day post-operative risk of death concentrating on accurate stratification of candidate patients for cardiac surgery. OBJECTIVE: The objective of this study was to determine the performance of the EuroSCORE II risk-analysis predictions among patients who underwent heart surgeries in one area of Iran. METHODS: A retrospective cohort study was conducted to collect the required variables for all consecutive patients who underwent heart surgeries at Emam Reza hospital, Northeast Iran between 2014 and 2015. Univariate and multivariate analysis were performed to identify covariates which significantly contribute to higher EuroSCORE II in our population. External validation was performed by comparing the real and expected mortality using area under the receiver operating characteristic curve (AUC) for discrimination assessment. Also, Brier Score and Hosmer-Lemeshow goodness-of-fit test were used to show the overall performance and calibration level, respectively. RESULTS: Two thousand five hundred eight one (59.6% males) were included. The observed mortality rate was 3.3%, but EuroSCORE II had a prediction of 4.7%. Although the overall performance was acceptable (Brier score=0.047), the model showed poor discriminatory power by AUC=0.667 (sensitivity=61.90, and specificity=66.24) and calibration (Hosmer-Lemeshow test, P<0.01). CONCLUSION: Our study showed that the EuroSCORE II discrimination power is less than optimal for outcome prediction and less accurate for resource allocation programs. It highlights the need for recalibration of this risk stratification tool aiming to improve post cardiac surgery outcome predictions in Iran.

Models to predict length of stay in the Intensive Care Unit after coronary artery bypass grafting: a systematic review.

INTRODUCTION: Intensive Care Units (ICU) length of stay (LoS) prediction models are used to compare different institutions and surgeons on their performance, and is useful as an efficiency indicator for quality control. There is little consensus about which prediction methods are most suitable to predict (ICU) length of stay. The aim of this study is to systematically review models for predicting ICU LoS after coronary artery bypass grafting and to assess the reporting and methodological quality of these models to apply them for benchmarking. EVIDENCE ACQUISITION: A general search was conducted in Medline and Embase up to 31-12-2016. Three authors classified the papers for inclusion by reading their title, abstract and full text. All original papers describing development and/or validation of a prediction model for LoS in the ICU after CABG surgery were included. We used a checklist developed for critical appraisal and data extraction for systematic reviews of prediction modeling and extended it on handling specific patients subgroups. We also defined other items and scores to assess the methodological and reporting quality of the models. EVIDENCE SYNTHESIS: Of 5181 uniquely identified articles, fifteen studies were included of which twelve on development of new models and three on validation of existing models. All studies used linear or logistic regression as method for model development, and reported various performance measures based on the difference between predicted and observed ICU LoS. Most used a prospective (46.6%) or retrospective study design (40%). We found heterogeneity in patient inclusion/exclusion criteria; sample size; reported accuracy rates; and methods of candidate predictor selection. Most (60%) studies have not mentioned the handling of missing values and none compared the model outcome measure of survivors with non-survivors. For model development and validation studies respectively, the maximum reporting (methodological) scores were 66/78 and 62/62 (14/22 and 12/22). CONCLUSIONS: There are relatively few models for predicting ICU length of stay after CABG. Several aspects of methodological and reporting quality of studies in this field should be improved. There is a need for standardizing outcome and risk factor definitions in order to develop/validate a multi-institutional and international risk scoring system.