Comparative Evaluation of 99mTc-Octreotide for Diagnostic Accuracy Assessment and Localization of 177Lu-DOTA-TATE in Neuroendocrine Tumors.

INTRODUCTION: Neuroendocrine tumors, due to uncommon and multi-centric origin, pose a clinical challenge for their diagnosis and treatment. Developing countries where Ga-68 DOTA-TOC/NOC PET imaging is very limited and costly, 99mTc based SSR imaging can be used as the key tool for its diagnosis and assessment of therapy response. Hence we used two different 99mTc-radiopharmaceuticals for NET imaging designated as RP-1 and RP-2 for clinical assessment and peptide receptor therapy response of 177Lu-DOTA-TATE by manually synthesized acetate buffer. 99mTc- labeled RP-1 and RP-2 sensitivity, specificity; positive and negative predictive values were calculated and compared by SPECT/CT images for utilization in peptide receptor radionuclide therapy (PRRT). METHOD: Sodium-pertechnetate was used for labeling both radiopharmaceuticals, while 177Lu nca (0.04 N HCl) DOTA-TATE was synthesized by 0.1M ammonium acetate/ascorbic acid. 75 patients of known primary NET imaging with RP-1 and RP-2 were evaluated for SRR avidity and 3 were selected for PRRT. All images were correlated with 68Ga-DOTA-TOC scan, histopathology, CT and/or MRI reports. RESULTS: Out of 75 patients, the somatostatin receptor imaging of 39 patients of neuro-endocrine was performed with RP-1, found 23 as true positive, 7 as true negative with sensitivity, specificity, PPV and NPV of 71.87%, 100%, 100% and 43.75%, whereas 36 images with RP-2 calculated 22 T/P, 6 as T/N, 8 as F/N, with 75.8%, 100%, 100% and 50% respectively. Their 177Lu-DOTA-TATE SPECT/CT revealed specific localization of therapeutic radionuclide. CONCLUSION: 99mTc-imaging of RP-2, as compared to RP-1, had better efficiency and sensitivity and could effectively be used as an alternative to Ga-68 DOTA/TOC PET imaging and Lu-177 DOTA-TATE PRRT therapy response evaluation.

Outcome Assessment after Reconstruction of Tumor-Related Mandibular Defects Using Free Vascularized Fibular Flap-A Clinical Study.

The objective of this study was to analyze the outcomes of the free vascularized fibular flap in the reconstruction of mandibular defects, and to assess the oral health impact profile of these patients before surgery and after oral rehabilitation. Patients requiring reconstruction of defects greater than 6 cm were selected for this study. The defect size and type, the size of the required skin paddle, the need for second flaps, the intraoperative complications, and the type of closure were documented. Patients were evaluated postoperatively for function, aesthetics, and donor- or reconstruction-site complications. The validated oral health impact profile (OHIP-14) questionnaires were filled before and after surgery and after dental rehabilitation. This study included 11 cases of squamous-cell carcinomas, 2 cases of malignant nerve sheath tumors, and 1 case each of malignant melanoma, ameloblastoma, giant-cell tumor, osteosarcoma, and chondrosarcoma. The analysis revealed a significant association (p = 0.030) of gender with free vascular flap complications, while no significant association (p > 0.05) was found when donor- and recipient- site complications, as well as the type of resection (Brown's classification), were compared with free vascular flaps. Moreover, the total OHIP-14 scores for patients before surgery, after surgery, and after dental rehabilitation were 12.03 ± 1.34, 10.66 ± 1.41, and 08.33 ± 0.62, respectively. The oral health-related quality of life was markedly improved after the reconstruction of the mandibular defects with free vascularized fibular flap and dental rehabilitation. The overall success rate of fibular flap in our study was 72.2%, which is lower than that reported in the literature. This may be attributed to the fact that almost all of our cases included large segmental defects that extended across the midline of the mandible.

Assessment of Panoramic Radiographic Variables as Predictors of Inferior Alveolar Nerve Injury During Third Molar Extraction

ABSTRACT Objective: To assess the role of radiological predictive markers on orthopantomogram for inferior alveolar nerve (IAN) injury related to the removal of mandibular third molar surgery and the occurrence of post-operative IAN paresthesia. Material and Methods: This prospective observational study was conducted on 60 patients (aged 17-35 years) indicated for extraction and showed one or more of the seven previously known panoramic radiographic risk signs of IAN injury. Variables such as age, sex, tooth angulation, and relationship with the inferior alveolar canal (IAC) were assessed to see their outcome on IAN injury. Data analysis is presented through tables and descriptive methods. Results: Among patients, 26 were male and 34 were female, with a mean age of 26.17 years. Out of seven radiological predictive markers, only six were found in this study, whereas one marker, viz. interruption of white line of the canal was not found. After surgical removal of the lower third molar, only two patients with radiographic signs showing the deflection of roots and darkening of roots continued with sensory deficit 5 weeks post-operatively. Conclusion: The risk of inferior alveolar nerve injury during lower third molar surgery is very low, even in patients with radiological predictive markers.

Assessment of the Current Endodontic Practices among General Dental Practitioners in the Kingdom of Saudi Arabia.

A contemporary knowledge of root canal treatment (RCT) is a prerequisite for a successful outcome. Studies observed that General Dental Practitioners (GDPs) were not abreast of current endodontic knowledge due to a lack of continuing dental education, not following the treatment protocols that they had learned in their undergraduate program, and overlooking the evidence-based current endodontic practices. Therefore, this study was intended to assess the awareness, attitude, and clinical endodontic practices among General Dental Practitioners in Saudi Arabia. This cross-sectional questionnaire-based study was conducted among all 312 GDPs working in Saudi Arabia. The questionnaire consisted of socio-demographic details and 23 questions regarding current endodontic practices. The collected data was analyzed using the SPSS Version 21 (Chicago, IL, USA). The chi-square test was applied to explore the influence of gender, workplace, and the years of professional activity on the materials and techniques employed in the RCT procedure. The study results showed that of all respondents, 159 (51.0%) were males, 153 (49.0%) were females, and 286 (91.7%) were Saudi nationals. Most of the GDPs, i.e., 204 (65.4%) practiced in private hospitals or clinics whereas 108 (34.6%) practiced in Government hospitals. Root canal treatment on all teeth had been performed by 196 (62%) of the practitioners. Association of gender with demographic details and endodontic practices revealed a statistically significant difference between both genders with respect to region, nationality, type of RCT treated on the tooth, and the technique used to measure the working length (p < 0.05). Furthermore, years of professional experience and workplace significantly affect endodontic practices (p < 0.05). This study concluded that most of the general dental practitioners complied with quality standard guidelines showing a positive attitude toward endodontic practices. Furthermore, irrespective of gender, most of the steps in endodontic procedures revealed a significant association with years of professional experience and the workplace.

Assessment of Potential Benefits of Functional Food Characteristics of Beetroot Energy Drink and Flavored Milk.

Objective: This study was designed to determine the antioxidant activity of the extracts of beetroot by using beetroot energy drink and flavored milk (products). Material & Methods. This experimental trial was conducted at Jinnah University for Women, Pakistan, under the approval of local institutional review board number JUW/DFST/RCB010/2020. All the materials such as beetroot, carrot, cucumber, and lemon were obtained commercially from which two products were formulated: beetroot energy drink (sample1) and flavored milk (sample 2). These formulated products were evaluated for quality analysis (pH and brix), phytochemical screening using the Keller-Kiliani test, Salkowski's test, Alkaline reagent test, lead acetate test, ferric chloride test, protein test, quantitative test of phenol, antioxidant activity, sensory analysis, and shelf life study. The paired t-test was applied to detect significant differences between two samples. Results: The phytochemical analysis revealed that cardiac glycosides, phytosterol, flavonoids, and terpenoids were found in both energy booster drink (EBD) and flavored milk (FM) except phenolic compounds that were found only in EBD. The antioxidant capacity of beetroot juice was far greater than FM. The statistical sensorial analysis of FM and EBD reported a significant mean difference between most of the groups with p < 0.0001. Conclusion: This study concludes that energy drinks having beetroot indicated higher antioxidant capacity than flavored milk. The nutraceutical products (energy booster drink and flavored milk) containing beetroot are enriched with optimum quantities of proteins and fats and low carbohydrates at a stable pH with an adequate total energy content.

Combined role of industrialization and urbanization in determining carbon neutrality: empirical story of Pakistan.

A rapid process of industrialization, on the one hand, transformed the economies from agrarian to industrial societies to improve the living standards and welfare of people. On the other hand, the urbanized and industrialized economies have posed challenging threats to environmental sustainability. The query at hand is whether the growing environmental emissions are driven by industrialization and urbanization or not. This research aims to empirically examine the combined role of industrialization and urbanization in achieving carbon neutrality in Pakistan by considering foreign direct investment and economic growth as control variables in the model. The core empirical results are the following: firstly, industrialization and economic growth exhibit negative but statistically insignificant impacts on CO2 emissions, imparting a neutral role in determining the environmental degradation in Pakistan. Secondly, urbanization and foreign direct investment disclose positive and statistically significant (at 1% level of significance) impacts on CO2 emissions, manifesting an environmental degradation driving impact in the country. Thirdly, given the slope coefficients of urbanization and foreign direct investment (0.058 and 0.035), urbanization proved to be a stronger driver than foreign direct investment. Finally, foreign direct investment is revealed to make the Pakistani economy a "Pollution Haven" for the foreign enterprises in the country. Based on empirical results, none of the variables predicted the support for carbon neutrality in Pakistan.

An assessment of unstimulated salivary flow rate, IgA and clinical oral dryness among active and passive smokers.

OBJECTIVES: The aim of this study was to assess the impact of smoking on the whole salivary flow rate (SFR), IgA levels and clinical oral dryness (COD) among active and passive smokers. MATERIAL AND METHODS: The participants were categorized as active smokers (N = 54) or passive smokers (N = 163). Saliva was collected in tubes and placed in ice storage at -70°C. Salivary IgA levels were assessed in duplication using the enzyme linked immunosorbent assay (ELISA) method. Following the saliva sample collection, the subjects were assessed for COD using the COD score, SFR and caries. Chi-square test, the t-test and ANOVA were employed to compare the clinical impact of the smoking status associated with specific variables (smoking status, number of cigarettes, active caries, gender, age, COD score, IgA level and SFR). A p-value of <0.05 was considered significant. RESULTS: Two hundred and seventeen subjects with the mean age of 32.86±6.30 years, with 145 males (66.8%) and 72 females (33.2%), were included in the study. Among the active smokers, 88.8% were males compared to 11.2% females. The active smokers had the mean age of 32.52 years, a COD score of 1.43, an IgA level of 1.39 g/l, and a SFR of 0.37 ml/min. Among the passive smokers, 59.5% were males and 40.5% were females, with the mean age of 32.97 years, a COD score of 0.87 g/l, an IgA level of 1.47, and a SFR of 0.42 ml/min. Active caries showed a positive correlation with the number of cigarettes, with significance in the >35 years age group (p < 0.05). CONCLUSIONS: The study demonstrated significant differences in SFR, IgA and COD scores among the active and passive smokers. The number of cigarettes had a negative impact on saliva production, IgA levels, the oral health status, and the progression of caries with respect to age and gender. Smoking potentially leads to xerostomia associated with active caries. Int J Occup Med Environ Health. 2022;35(1):39-51.

Operational Implications and Risk Assessment of COVID-19 in Dental Practices.

The unprecedented situation of the coronavirus pandemic has impacted the entire world, with dental practice being significantly affected. In this study, we aim to evaluate the operational implications and risk assessment of the coronavirus in dental practice. This observational study comprised the electronic distribution of two surveys, one to patients and the second to dental professionals. The first questionnaire consisted of demographics along with 15 closed-ended questions. The second questionnaire consisted of demographics along with 43 questions from eight domains: financial impact, psychological impact, patient satisfaction, hygiene, patient management, COVID-19 lockdown, perspective, and practicing dentistry after the COVID-19 pandemic. The statistical analysis was performed using SPSS-25. A linear regression test was applied to assess the effect of the dependent variable (patient's satisfaction with the dental practice) on independent variables (age, gender, education). The ANOVA test was applied to assess the effect of the independent variables (financial impact, psychological impact, patient satisfaction, hygiene, patient management, lockdown, perspective, and post-COVID-19) on the dependent variables (age, gender, education, experience of dentists, qualification of dentists). A total of 711 patients and dental professionals participated in this study, with a response rate of 88.87%. Approximately 67.9% of the patients felt comfortable in the dental clinic, with 74.5% being satisfied with the dental clinic's services. The majority (77.4%) of the dentists were psychologically affected. Many of the participants chose to use masks, gowns, respiratory equipment, and face shields for protection. Teledentistry was preferred by the majority of dentists in non-emergency cases. Many of the dentists chose alternative procedures to minimize the generation of aerosols. The majority of the dentists suggested changes in the dynamics of dentistry in the post-COVID era, such as the suggestion that the management of the finances of a dental practice along with infection control protocols should be practiced more optimally. Patients and dental professionals were well aware of the necessary precautionary measures required to combat the coronavirus, as well as the implications of different operational measures along with performing risk assessment, keeping in mind the changing dynamics of dentistry.

Assessment of Unstimulated Whole Salivary Tumor Necrosis Factor Alpha (TNF-α) and Cellular Micronuclei Levels in Snuff (Naswar) Users and Non-Users for Early Diagnosis of Oral Squamous Cell Carcinoma.

The aim of the study was to investigate the unstimulated whole saliva (UWS) tumor necrosis factor alpha (TNF-α) and cellular micronuclei in snuff dippers (Naswar) compared to healthy control subjects. The case control study was conducted over 9 months at a tertiary care center. Sixty patients were divided into two groups: Snuff dippers (SD) (Naswar) and non-snuff dippers (NSD) (control subjects). The included self-reported SD used Snuff twice daily for more than 12 months. UWS was collected and salivary TNF-α assessment was performed using enzyme-linked immunosorbent assay (ELISA). For cellular micronuclei, buccal mucosa was brushed to obtain cells in Naswar users, fixed with a dibutylphthalate polystyrene xylene (DPX) mounting to view micronuclei. Means and standard deviations were compared using the t-test and outcomes were related using Pearson correlation, considering p ≤ 0.05 as significant. The mean age of participants was 38.85 ± 11.56 years. The mean duration of snuff use was 20.43 ± 12.79 years and the common site for Naswar placement was the lower vestibule (n = 19, 63.3%). TNF-α levels among SD were 9.6 ± 3.3 pg/mL, which were significantly higher than levels in NSD, 5.2 ± 3 pg/mL (p < 0.05). The number of cellular micronuclei in SD was 30.7 ± 7.8, which was comparatively higher than in NSD, which was 9.2 ± 3.3 (p < 0.05). The duration of snuff use was positively correlated to TNF-α levels (p = 0.048) rather than the micronuclei number (p = 0.97). SD showed higher levels of TNF-α and cellular micronuclei compared with NSD (control subjects); a positive correlation was shown with the duration of snuff use. We conclude that TNF-α and micronuclei are potential salivary biomarkers for an oral biological effect in snuff (Naswar) users.

Empirics on heterogeneous links among urbanization, the intensity of electric power consumption, water-based emissions, and economic progress in regional China.

This study investigates the heterogeneous causal linkages between urbanization, the intensity of electric power consumption, water-based pollutant emissions, and GRP in regional China by developing an urbanization-augmented "Stochastic Impacts by Regression on Population, Affluence, and Technology" (STIRPAT) model. A whole country panel of 29 provinces as well as region sub-panels of China, for the period 1999 to 2018, are estimated employing common correlated effects mean group approach (CCEMGA), which offers robustness against heterogeneous characteristics and cross-sectionally dependent series. From the theoretic modeling aspect, the intensity of electric power consumption and urbanization have been introduced as the determinants of water-based pollutant emissions in the STIRPAT modeling framework. Based on empirical results, first, GRP growth has shown appealing behavior in the form of its heterogeneous impacts on water-based pollutant emissions growth in the case of different regions. For instance, its impact is noted to be positive and statistically significant for the western region, which turned positive but statistically insignificant for the intermediate region. And it further turned significantly negative in the case of the eastern region. We call this phenomenon as "development level-based emission mitigation effect." Second, in terms of the impact of GRP growth on urbanization, the "development-based urbanization ladder effect" has been found. Based on heterogeneous causal links, firstly, the existence of a positive bilateral causal link between the intensity of electric power consumption and GRP growth and urbanization and GRP growth has been validated. Secondly, a positive unidirectional causal link emerged from urbanization to the intensity of electric power consumption and water-based pollutant emissions growth. Thirdly, the causal connection between GRP growth and water-based pollutant emissions growth remained very interesting and of mixed nature. Based on empirical findings, useful policies are extended. Graphical abstract.

Impact of malnutrition on survival and healthcare utilization in Medicare beneficiaries with diabetes: a retrospective cohort analysis.

OBJECTIVE: The aim of this study was to examine the impact of pre-existing malnutrition on survival and economic implications in elderly patients with diabetes. RESEARCH DESIGN AND METHODS: A retrospective observational study was conducted to examine the impact of malnutrition with or without other significant health conditions on survival time and healthcare costs using the Centers for Medicare and Medicaid Services (CMS) data from 1999 to 2014 for beneficiaries with a confirmed first date of initial diagnosis of diabetes (n=15 121 131). The primary outcome was survival time, which was analyzed using all available data and after propensity score matching. Healthcare utilization cost was a secondary outcome. RESULTS: A total of 801 272 beneficiaries were diagnosed with malnutrition. The analysis on propensity score-matched data for the effect of common conditions on survival showed that the risk for death in beneficiaries with diabetes increased by 69% in malnourished versus normo-nourished (HR, 1.69; 99.9% CI 1.64 to 1.75; P<0.0001) beneficiaries. Malnutrition increased the risk for death within each of the common comorbid conditions including ischemic heart disease (1.63; 1.58 to 1.68), chronic obstructive pulmonary disorder (1.60; 1.55 to 1.65), stroke or transient ischemic attack (1.57; 1.53 to 1.62), heart failure (1.54; 1.50 to 1.59), chronic kidney disease (1.50; 1.46 to 1.55), and acute myocardial infarction (1.47; 1.43 to 1.52). In addition, the annual total spending for the malnourished beneficiaries was significantly greater than that for the normo-nourished beneficiaries ($36 079 vs 20 787; P<0.0001). CONCLUSIONS: Malnutrition is a significant comorbidity affecting survival and healthcare costs in CMS beneficiaries with diabetes. Evidence-based clinical decision pathways need to be developed and implemented for appropriate screening, assessment, diagnosis and treatment of malnourished patients, and to prevent malnutrition in normo-nourished patients with diabetes.

Does Motion Assessment With 4-Dimensional Computed Tomographic Imaging for Non-Small Cell Lung Cancer Radiotherapy Improve Target Volume Coverage?

INTRODUCTION: Modern radiotherapy with 4-dimensional computed tomographic (4D-CT) image acquisition for non-small cell lung cancer (NSCLC) captures respiratory-mediated tumor motion to provide more accurate target delineation. This study compares conventional 3-dimensional (3D) conformal radiotherapy (3DCRT) plans generated with standard helical free-breathing CT (FBCT) with plans generated on 4D-CT contoured volumes to determine whether target volume coverage is affected. MATERIALS AND METHODS: Fifteen patients with stage I to IV NSCLC were enrolled in the study. Free-breathing CT and 4D-CT data sets were acquired at the same simulation session and with the same immobilization. Gross tumor volume (GTV) for primary and/or nodal disease was contoured on FBCT (GTV_3D). The 3DCRT plans were obtained, and the patients were treated according to our institution's standard protocol using FBCT imaging. Gross tumor volume was contoured on 4D-CT for primary and/or nodal disease on all 10 respiratory phases and merged to create internal gross tumor volume (IGTV)_4D. Clinical target volume margin was 5 mm in both plans, whereas planning tumor volume (PTV) expansion was 1 cm axially and 1.5 cm superior/inferior for FBCT-based plans to incorporate setup errors and an estimate of respiratory-mediated tumor motion vs 8 mm isotropic margin for setup error only in all 4D-CT plans. The 3DCRT plans generated from the FBCT scan were copied on the 4D-CT data set with the same beam parameters. GTV_3D, IGTV_4D, PTV, and dose volume histogram from both data sets were analyzed and compared. Dice coefficient evaluated PTV similarity between FBCT and 4D-CT data sets. RESULTS: In total, 14 of the 15 patients were analyzed. One patient was excluded as there was no measurable GTV. Mean GTV_3D was 115.3 cm3 and mean IGTV_4D was 152.5 cm3 (P = .001). Mean PTV_3D was 530.0 cm3 and PTV_4D was 499.8 cm3 (P = .40). Both gross primary and nodal disease analyzed separately were larger on 4D compared with FBCT. D95 (95% isodose line) covered 98% of PTV_3D and 88% of PTV_4D (P = .003). Mean dice coefficient of PTV_3D and PTV_4D was 84%. Mean lung V20 was 24.0% for the 3D-based plans and 22.7% for the 4D-based plans (P = .057). Mean heart V40 was 12.1% for the 3D-based plans and 12.7% for the 4D-based plans (P = .53). Mean spinal cord Dmax was 2517 and 2435 cGy for 3D-based and 4D-based plans, respectively (P = .019). Mean esophageal dose was 1580 and 1435 cGy for 3D and 4D plans, respectively (P = .13). CONCLUSIONS: IGTV_4D was significantly larger than GTV_3D for both primary and nodal disease combined or separately. Mean PTV_3D was larger than PTV_4D, but the difference was not statistically significant. The PTV_4D coverage with 95% isodose line was inferior, indicating the importance of incorporating the true size and shape of the target volume. Relatively less dose was delivered to spinal cord and esophagus with plans based on 4D data set. Dice coefficient analysis for degree of similarity revealed that 16% of PTVs from both data sets did not overlap, indicating different anatomical positions of the PTV due to tumor/nodal motion during a respiratory cycle. All patients with lung cancer planned for radical radiotherapy should have 4D-CT simulation to ensure accurate coverage of the target volumes.

Monte Carlo simulations of in vivo K-shell X-ray fluorescence bone lead measurement and implications for radiation dosimetry.

In order to improve measurement precision and decrease minimum detectable limit, recent applications of K-shell X-ray fluorescence (KXRF) bone lead measurement have used shorter source-to-sample (S-S) distances (approximately 0.5 cm) than the traditionally standard values ranging between 2.0 and 3.0 cm. This alteration will have an effect on subject radiation dose. This paper reports a comprehensive Monte Carlo study performed to investigate the radiation energy deposition values delivered to the leg of model human subjects of various ages. The simulations were run for models approximating 1-year, 5-year, and adult subjects, assuming lead concentrations of 10 microg/g in bone and tracing 500 million photons in each simulation. Trials were performed over a range of S-S distances, from 0.5 to 6.0 cm. The energy deposition due to photoelectric and Compton processes occurring in bone and soft tissue are presented. For each subject age, the Monte Carlo analysis demonstrates that the amount of energy deposited in the bone is increased as the sample is moved closer to the source (from 3.0 to 0.5 cm). The amount of energy deposited in the bone was found to increase by approximately 91% (1-year old), 66% (5-year old), and 41% (adult). The amount of energy deposited to the leg sample as a whole increased by approximately 43% (1-year old), 32% (5-year old), and 21% (adult). Results are used to estimate the changes in the amount of dose received by subjects of different ages.

Monte Carlo investigations of distance-dependent effects on energy deposition in K-shell x-ray fluorescence bone lead measurement.

Radiation energy deposition results are presented from a Monte Carlo code simulating the lower part of a leg during an in vivo 109Cd K-shell x-ray fluorescence (KXRF) bone lead measurement. The simulations were run for a leg phantom model representing an adult subject, assuming concentrations of 10 microg Pb per gram bone mineral and tracing 500 million photons in each simulation. Trials were performed over a range (0.5-6.0 cm) of source-to-sample (S-S) distances. Energies deposited due to Compton and photoelectric processes occurring in the bone and the soft tissue were obtained. The data show an increase in the amount of energy deposited in the bone as the sample is moved closer to the source (from 2.0 cm to 0.5 cm). However, there is a decrease in the amount of energy deposited in the soft tissue as the sample is moved closer to the source over the same distance interval. In decreasing the S-S distance from 2.0 cm to 0.5 cm, the amount of energy deposited in the sample as a whole was found to increase by 11%. By calculating the energy deposition in the bone and in the soft tissue as a fraction of the total energy deposited in the sample, the corresponding changes are quantified as a function of S-S distance. Similarly, the proportions of energy deposited via the photoelectric effect and Compton scattering are presented as a function of S-S distance.