Immune checkpoint inhibitor-induced diarrhea and colitis: an overview.

Immune checkpoint inhibitors (ICIs) have emerged as an integral component of the management of various cancers and have contributed to significant improvements in overall survival. Most available ICIs target anti-cytotoxic T-lymphocyte-associated protein 4 (anti-CTLA4), and anti-programmed cell death 1/programmed cell death ligand 1 (anti-PD1/PDL1). Gastrointestinal immune-related adverse events remain a common complication of ICIs. The predominant manifestations include diarrhea and colitis, which often manifest concurrently as immune-mediated diarrhea and colitis (IMDC). Risk factors for developing these side effects include baseline gut microbiota, preexisting autoimmune disorders, such as inflammatory bowel disease, and type of neoplasm. The hallmark symptom of colitis is diarrhea which may be accompanied by mucus or blood in stools. Patients may also experience abdominal pain, fever, vomiting, and nausea. If not treated rapidly, ICI-induced colitis can lead to serious life-threatening complications. Current management is based on corticosteroids as first-line, and immunosuppressants like infliximab or vedolizumab for refractory cases. Microbiota transplantation and specific cytokines and lymphocyte replication inhibitors are being investigated. Optimal patient care requires maintaining a balance between treatment toxicity and efficacy, hence the aim of this review is to enhance readers' comprehension of the gastrointestinal adverse events associated with ICIs, particularly IMDC. In addition to identifying the risk factors, we discuss the incidence, clinical presentation, workup, and management options of IMDC.

Functional assessment using 3D movement analysis can better predict health-related quality of life outcomes in patients with adult spinal deformity: a machine learning approach.

Introduction: Adult spinal deformity (ASD) is classically evaluated by health-related quality of life (HRQoL) questionnaires and static radiographic spino-pelvic and global alignment parameters. Recently, 3D movement analysis (3DMA) was used for functional assessment of ASD to objectively quantify patient's independence during daily life activities. The aim of this study was to determine the role of both static and functional assessments in the prediction of HRQoL outcomes using machine learning methods. Methods: ASD patients and controls underwent full-body biplanar low-dose x-rays with 3D reconstruction of skeletal segment as well as 3DMA of gait and filled HRQoL questionnaires: SF-36 physical and mental components (PCS&MCS), Oswestry Disability Index (ODI), Beck's Depression Inventory (BDI), and visual analog scale (VAS) for pain. A random forest machine learning (ML) model was used to predict HRQoL outcomes based on three simulations: (1) radiographic, (2) kinematic, (3) both radiographic and kinematic parameters. Accuracy of prediction and RMSE of the model were evaluated using 10-fold cross validation in each simulation and compared between simulations. The model was also used to investigate the possibility of predicting HRQoL outcomes in ASD after treatment. Results: In total, 173 primary ASD and 57 controls were enrolled; 30 ASD were followed-up after surgical or medical treatment. The first ML simulation had a median accuracy of 83.4%. The second simulation had a median accuracy of 84.7%. The third simulation had a median accuracy of 87%. Simulations 2 and 3 had comparable accuracies of prediction for all HRQoL outcomes and higher predictions compared to Simulation 1 (i.e., accuracy for PCS = 85 ± 5 vs. 88.4 ± 4 and 89.7% ± 4%, for MCS = 83.7 ± 8.3 vs. 86.3 ± 5.6 and 87.7% ± 6.8% for simulations 1, 2 and 3 resp., p < 0.05). Similar results were reported when the 3 simulations were tested on ASD after treatment. Discussion: This study showed that kinematic parameters can better predict HRQoL outcomes than stand-alone classical radiographic parameters, not only for physical but also for mental scores. Moreover, 3DMA was shown to be a good predictive of HRQoL outcomes for ASD follow-up after medical or surgical treatment. Thus, the assessment of ASD patients should no longer rely on radiographs alone but on movement analysis as well.

Evaluation of Third Molar Impaction Distribution and Patterns in a Sample of Lebanese Population.

Background: Classifications of impaction based on panoramic radiographs such as the ones of Pell and Gregory and Winter are essential to allow a better understanding of third molar position regarding depth and bone coverage of the impacted tooth and to evaluate the difficulties of the surgical procedures. The aim of the study was to classify upper and lower third molars teeth in a sample of a Lebanese population and compare the data to results from other studies. Materials and Methods: Digital panoramic radiographs of 71 patients with a total of 181 wisdom teeth from patients that had been subjected for third molars extraction, from November 2016 to November 2018, were collected and analyzed. The mean age was 26.25 years. All third molars were categorized according to Pell and Gregory by using A, B, C scores for depth in upper and lower third molars, and angulations were classified according to Winter's classification. Nonparametric normality tests evaluating age group and gender distribution were conducted by utilizing the Chi-square test for age distribution and the binomial and Kruskal-Wallis tests for gender. Results: In the Pell and Gregory classification, the lower third molars showed type B impaction as the most frequent with 66.1% for the right side and 60.3% for the left side; the maxillary third molars both showed the type C impaction as the most frequent with 63.3% for the right side and 59.2% for the left side. According to the Winter classification, lower third molars showed mesio-angulation as the most frequent angle of impaction with 41.1% for right mandibular side and 46.5% for mandibular left side; As for the maxillary third molars, the disto-angulation was the most frequent angulation seen in both maxillary right and left side teeth 53.3% and 43.2%. Conclusions: Comparison of our results with other populations has shown similarities in certain criteria like angulation and relation to ramus, but most results varied. Thus, the current study can be taken as a baseline for further studies.