A retrospective cohort study to evaluate disease burden, health care resource utilization, and costs in patients with breast cancer in Dubai, UAE.

BACKGROUND: The current study evaluated the disease burden, health care resource utilization and analyzed the cost burden due to events of special interest among patients with breast cancer (BC) diagnosed and treated in Dubai, United Arab Emirates (UAE), in general and in the subset of patients treated with cyclin-dependent kinase (CDK) 4/6 inhibitors. METHODS: This retrospective cohort study, using insurance e-claims data from Dubai Real-World Database, was conducted from 01 January 2014 to 30 September 2021. Female patients aged ≥ 18 years with at least 1 diagnosis claim for BC and with continuous enrollment during the index period were included. RESULTS: Overall, 8,031 patients were diagnosed with BC (median age: 49.0 years), with the majority (68.1%) being in 41-60-year age group. During the post-index period, BC-specific costs contributed to 84% of the overall disease burden among patients with BC. Inpatient costs (USD 16,956.2) and medication costs (USD 10,251.3) contributed significantly to BC-specific costs. In the subgroup of patients in whom CDK4/6 inhibitors were part of the treatment regimen (n = 174), CDK4/6 inhibitors were commonly prescribed in combination with aromatase inhibitors (41.4%) and estrogen receptor antagonists (17.9%). In patients with BC, health care costs due to events of special interest (n = 1,843) contributed to 17% of the overall disease cost burden. CONCLUSION: The study highlights the significant cost burden among patients with BC, with BC-specific costs contributing to 84% of the overall disease cost burden. Despite few limitations such as study population predominantly comprising of privately insured expatriate patients and only direct healthcare costs being assessed in the current study, most indicative costs have been captured in the study, by careful patient selection and cost comparisons, as applicable. The findings can guide key health care stakeholders (payers and providers) on future policy measures aiming to reduce the cost burden among patients with BC.

Systematic green synthesis of silver oxide nanoparticles for antimicrobial activity.

In this present research, we succeeded in synthesizing nanostructured silver particles (NS-AgPs) using bio active agent present in the leaf extracts of Cleome gynandra (CG) under green synthesis. While adding silver nitrate (AgNO3) solution in green extracts of CG leaf containing bio compound, the mixture turns from yellow to reddish brown, as a consequence of existence of nanostructured silver particles (NS-AgPs) and later UV instrument is used to obtain the Ultraviolet visible spectroscopy (UV-vis) spectra to confirm existing nanostructured silver particles (NS-AgPs) in aqueous solutions (synthesized sample). To confirm existing functional groups in NS-AgPs, the fourier transform infrared spectroscopy (FTIR) study is carried throughout this research. The scanning and tunneling of wave like nature of electrons passing through powdered NS-AgPs sample gives Scanning electron microscopy (SEM) and Transmission electron microscopy (TEM) images respectively, which are carried out to find out the 2-dimensional size and shape distribution of NS-AgPs. Further dynamic light scattering (DLS) and zeta potential studies are used to confirm the size and good stability of NS-AgPs respectively. It is evident that NS-AgPs exhibits a strong toxic activity against microorganism and to confirm this mechanism the antibacterial (against Escherichia coli and Staphylococcus aureus) study is carried out.

Studies on the spectrometric analysis of metallic silver nanoparticles (Ag NPs) using Basella alba leaf for the antibacterial activities.

In this present investigation, an aqueous Basella alba leaves extract was used to synthesize AgNPs. The green synthesis approach is carried out in our work due to non-toxic, less cost, and ecofriendly methods. FTIR spectra are used to confirm the biomolecules present in B.alba leaves extract along with AgNPs and these compounds are responsible for Ag particle from micro to nanostructure. The FCC structure and crystalline nature of the AgNPs are analyzed with the help of XRD and TEM techniques respectively. DLS and Zeta potential techniques are carried out to find the size and stability of AgNPs respectively and UV is used to verify the presence of AgNPs in synthesized samples employing SPR peaks around 435 nm. The antioxidant studies expose eminent scavenging activity which ranges from 13.71% to maximum 67.88%. Green synthesized AgNPs possess well organized biological activities concerning antioxidant and antibacterial, which can be used in some biologically applications.

A novel biogenic Allium cepa leaf mediated silver nanoparticles for antimicrobial, antioxidant, and anticancer effects on MCF-7 cell line.

In the present study, Allium cepa leaf extract was utilized to reduce the silver nitrate into the nanoscale range of silver ions (Ag NPs). The biosynthesized Ag NPs were extensively characterized by X-ray diffraction analysis (XRD), Dynamic light scattering analysis (DLS), UV-Visible spectroscopy (UV-vis), Transmission electron microscopy (TEM), Energy dispersive X-ray analysis (EDX) and Fourier transform infrared spectroscopy (FTIR). The antioxidant activity of synthesized Ag NPs was verified by DPPH assay. From the results obtained from XRD and DLS studies, the size of Ag NPs was determined to be around 54.3 nm. The measured zeta potential value of -19.1 mV confirms the excellent stability of biosynthesized Ag NPs. TEM analyses reveal that the biosynthesized Ag NPs have a spherical structure of 13 nm in size. The presence of various functional groups was confirmed through FTIR studies and EDAX verifies the weight percentage of silver content in biosynthesized nanoparticles to be 30.33%. In the present study, anti-cancer activity was carried out by using breast cancer cell line MCF-7. Further, silver nanoparticles exhibited antimicrobial effectiveness against gram-positive Bacillus cereus and gram-negative Escherichia coli. The MTT assay also showed better cytotoxic activity against the MCF- 7 cell line.

Spectroscopic and structural investigations on modafinil by FT-IR, FT-Raman, NMR, UV-Vis and DFT methods.

Chiral sulfoxide based smart drug modafinil were studied experimentally and theoretically. Vibrational spectra were recorded in the mid IR region and electronic spectra were recorded in UV-Visible region. The molecular geometry, vibrational spectra, magnetic spectra and electronic spectra were simulated using Density Functional Theory (DFT) employed with B3LYP/6-311++G(d,p) basis set. The molecular geometry optimization, vibrational frequencies, chemical shifts and solvent effect on electronic properties were reported. The intermolecular interactions have been studied by Hirshfeld surface analysis. There is good agreement was found between calculated and observed values, thereby to confirm the molecular structure of modafinil.

A preliminary study on the anti-inflammatory activity of methanol extract of Ulva lactuca in rat.

Anti-inflammatory drugs presently available for the treatment of various inflammatory disorders have diverse and undesirable side effects. In recent years; active principles of varied chemical structures have been isolated from plants possessing anti-inflammatory activity. Sulfated polysaccharides present in algae were shown to posses anti-inflammatory properties. Ulva lactuca the green alga available in Tuticorin coast was found to show anti-inflammatory effect as evidenced by the reduction in the inhibition of oedema at the 4th day of the experiment compared with the positive control drug and control. Microscopic examination of the elite organs did not show any alteration compared with the control and reference group. Moreover the hematological parameters were found normal compared with the control. The present study suggests the need for further studies for the development of anti-inflammatory drug of marine origin with proper clinical trials.

Vibrational spectroscopy investigation using ab initio and density functional theory on p-anisaldehyde.

The FTIR and FT Raman spectra of p-anisaldehyde has been recorded in the regions 4,000-400 and 3,500-100 cm(-1), respectively. The optimized geometry, frequency and intensity of the vibrational bands of p-anisaldehyde were obtained by ab initio and DFT levels of theory with complete relaxation in the potential energy surface using 6-31G(d,p) basis set. A complete vibrational assignment aided by the theoretical harmonic frequency analysis has been proposed. The harmonic vibrational frequencies calculated have been compared with experimental FTIR and FT Raman spectra. The observed and the calculated frequencies are found to be in good agreement. The experimental spectra also coincide satisfactorily with those of theoretically constructed bar type spectrograms.

Synthesis, characterization, and biological evaluation of Schiff base-platinum(II) complexes.

The platinum complexes of Schiff base ligands derived from 4-aminoantipyrine and a few substituted aldehydes were synthesized and characterized by elemental analysis, mass, (1)H NMR, IR, electronic spectra, molar conductance, and powder XRD. The structure of one of the ligands L5 was confirmed by a single crystal XRD analysis. The Schiff base ligand crystallized in the triclinic, space group P-1 with a=7.032(2)Ǻ, b=9.479(3)Ǻ, c=12.425(4)Ǻ, α=101.636(3)°, ß=99.633(3)°, γ=94.040(3)°, V=795.0(4)Ǻ(3), Z=2, F(000)=352, Dc=1.405 mg/m(3), µ=0.099 mm(-1), R=0.0378, and wR=0.0967. The spectral results show that the Schiff base ligand acts as a bidentate donor coordinating through the azomethine nitrogen and the carbonyl oxygen atoms. The geometrical structures of these complexes are found to be square planar. Antimicrobial studies indicate that these complexes exhibit better activity than the ligand. The anticancer activities of the complexes have also been studied towards human cervical cancer cell line (HeLa), Colon Cancer Cells (HCT116) and Epidermoid Carcinoma Cells (A431) and it was found that the [Pt(L3)Cl2] complex is more active.

Crystal structure of l-tryptophan-fumaric acid-water (1/1/1).

In the title compound, C11H12N2O2·C4H4O4·H2O, the l-tryp-to-phan mol-ecule crystallized as a zwitterion, together with a neutral fumaric acid mol-ecule and a water solvent mol-ecule. In the crystal, the three components are linked by a series of N-H⋯O, O-H⋯O and C-H⋯O hydrogen bonds, forming slabs lying parallel to (001). The slabs are connected by O-H⋯O hydrogen bonds, involving inversion-related fumaric acid groups, leading to the formation of a three-dimensional structure.

Contribution of disc degeneration to osteophyte formation in the cervical spine: a biomechanical investigation.

Cervical spine disorders such as spondylotic radiculopathy and myelopathy are often related to osteophyte formation. Bone remodeling experimental-analytical studies have correlated biomechanical responses such as stress and strain energy density to the formation of bony outgrowth. Using these responses of the spinal components, the present study was conducted to investigate the basis for the occurrence of disc-related pathological conditions. An anatomically accurate and validated intact finite element model of the C4-C5-C6 cervical spine was used to simulate progressive disc degeneration at the C5-C6 level. Slight degeneration included an alteration of material properties of the nucleus pulposus representing the dehydration process. Moderate degeneration included an alteration of fiber content and material properties of the anulus fibrosus representing the disintegrated nature of the anulus in addition to dehydrated nucleus. Severe degeneration included decrease in the intervertebral disc height with dehydrated nucleus and disintegrated anulus. The intact and three degenerated models were exercised under compression, and the overall force-displacement response, local segmental stiffness, anulus fiber strain, disc bulge, anulus stress, load shared by the disc and facet joints, pressure in the disc, facet and uncovertebral joints, and strain energy density and stress in the vertebral cortex were determined. The overall stiffness (C4-C6) increased with the severity of degeneration. The segmental stiffness at the degenerated level (C5-C6) increased with the severity of degeneration. Intervertebral disc bulge and anulus stress and strain decreased at the degenerated level. The strain energy density and stress in vertebral cortex increased adjacent to the degenerated disc. Specifically, the anterior region of the cortex responded with a higher increase in these responses. The increased strain energy density and stress in the vertebral cortex over time may induce the remodeling process according to Wolff's law, leading to the formation of osteophytes.

Finite element modeling approaches of human cervical spine facet joint capsule.

The human cervical spine facet joint capsule was modeled using four nonlinear finite element approaches: slideline, contact surface, hyperelastic, and fluid models. Slideline elements and contact surface definitions were used in the first two models to simulate the synovial fluid between the articulating cartilages. Incompressible solid elements approximated the synovial fluid in the hyperelastic model. Hydrostatic fluid elements idealized the synovial fluid in the fluid model. The finite element analysis incorporated geometric, material and contact nonlinearities. All models were subjected to compression, flexion, extension, and lateral bending. The fluid model idealization better approximates the actual facet joint anatomy and its behavior than the gap assumption in the slideline and contact surface models, and the solid element simulation in the hyperelastic model.

Finite element applications in human cervical spine modeling.

The authors present a comprehensive state-of-the-art and critical review of the finite element models of the human cervical spine. They also focused on the developments in model construction (geometry generation), constitutive law (material property) identification, loading and boundary condition details, and validation, the most important phase. A data base of available experimental sources is also provided, which can be used by the modeler for validating the finite element model. The potential developments in finite element modeling of the human cervical spine are discussed.

Finite element analysis of cervical facetectomy.

STUDY DESIGN: Moment-rotation responses and disc anulus stresses of intact and facetectomized C4-C6 cervical spinal units were analyzed using detailed, three-dimensional, finite element models. OBJECTIVES: To evaluate biomechanical effects of progressive unilateral and bilateral facet resections on cervical spine segmental mobility (external response) and disc anulus stress (internal response). SUMMARY OF BACKGROUND DATA: Experimental studies have demonstrated that facetectomy significantly increases segmental mobility of the cervical spine. The biomechanical effects of facetectomy on the internal response, however, have not been investigated. METHODS: Moment-rotation responses of C4 with respect to C6 and von Mises stress in the disc anulus were examined using finite element models of a 0% (intact), 25%, 50%, 75%, and 100% unilaterally and bilaterally facetectomized cervical spinal unit. The model simulations were conducted under the pure-moment loading of 1.8 Nm in flexion, extension, lateral bending, and axial torsion. The intact model also was validated experimentally under the same conditions. RESULTS: The moment-rotation responses of the intact unit were within the ranges of experimental data. Cervical rotations increased with the increased degree of facet resection. The greatest change occurred between 50% and 75% facet resections in bilateral facetectomy. Similar patterns were found for disc anulus stresses, but to a greater extent. The maximum increase in rotation (11%) and in anulus stress (30%) occurred in lateral bending. Torsion was the least affected loading mode. The effects of unilateral facetectomy were considerably less than those of 75% bilateral facetectomy. CONCLUSIONS: Facetectomy has a greater effect on anulus stress than on intervertebral joint stiffness. Significant increase in anulus stresses and segmental mobility may occur when bilateral facet resection exceeds 50%.

Importance of partitioning membranes of the brain and the influence of the neck in head injury modelling.

A head injury model consisting of the skull, the CSF, the brain and its partitioning membranes and the neck region is simulated by considering its near actual geometry. Three-dimensional finite-element analysis is carried out to investigate the influence of the partitioning membranes of the brain and the neck in head injury analysis through free-vibration analysis and transient analysis. In free-vibration analysis, the first five modal frequencies are calculated, and in transient analysis intracranial pressure and maximum shear stress in the brain are determined for a given occipital impact load.

Finite-element models of the human head.

A review is presented of the existing finite-element (FE) models for the biomechanics of human head injury. Finite element analysis can be an important tool in describing the injury biomechanics of the human head. Complex geometric and material properties pose challenges to FE modelling. Various assumptions and simplifications are made in model development that require experimental validation. More recent models incorporate anatomic details with higher precision. The cervical vertebral column and spinal cord are included. Model results have been more qualitative than quantitative owing to the lack of adequate experimental validation. Advances include transient stress distribution in the brain tissue, frequency responses, effects of boundary conditions, pressure release mechanism of the foramen magnum and the spinal cord, verification of rotation and cavitation theories of brain injury, and protective effects of helmets. These theoretical results provide a basic understanding of the internal biomechanical responses of the head under various dynamic loading conditions. Basic experimental research is still needed to be determine more accurate material properties and injury tolerance criteria, so that FE models can fully exercise their analytical and predictive power for the study and prevention of human head injury.

Finite element modeling of the cervical spine: role of intervertebral disc under axial and eccentric loads.

An anatomically accurate, three-dimensional, nonlinear finite element model of the human cervical spine was developed using computed tomography images and cryomicrotome sections. The detailed model included the cortical bone, cancellous core, endplate, lamina, pedicle, transverse processes and spinous processes of the vertebrae; the annulus fibrosus and nucleus pulposus of the intervertebral discs; the uncovertebral joints; the articular cartilage, the synovial fluid and synovial membrane of the facet joints; and the anterior and posterior longitudinal ligaments, interspinous ligaments, capsular ligaments and ligamentum flavum. The finite element model was validated with experimental results: force-displacement and localized strain responses of the vertebral body and lateral masses under pure compression, and varying eccentric anterior-compression and posterior-compression loading modes. This experimentally validated finite element model was used to study the biomechanics of the cervical spine intervertebral disc by quantifying the internal axial and shear forces resisted by the ventral, middle, and dorsal regions of the disc under the above axial and eccentric loading modes. Results indicated that higher axial forces (compared to shear forces) were transmitted through different regions of the disc under all loading modes. While the ventral region of the disc resisted higher variations in axial force, the dorsal region transmitted higher shear forces under all loading modes. These findings may offer an insight to better understand the biomechanical role of the human cervical spine intervertebral disc.

Finite element modeling of the C4-C6 cervical spine unit.

This study was conducted to develop a detailed, three-dimensional, anatomically accurate finite element model of the human cervical spine structure using close-up computed tomography scans and to validate against experimental data. The finite element model of the three vertebra segment C4-C6 unit consisted of 9178 solid elements and 1193 thin shell elements. The force-displacement response under axial compression correlated well with experimental data. Because of the inclusion of three levels in the spinal structure, it was possible to determine the internal mechanics of the various components at each level. The applicability of the model was illustrated by adopting appropriate material properties from literature. Results indicated that, the stresses in the anterior column were higher compared to the posterior column at the inferior level, while the opposite was found to be true at the superior level. The superior and inferior endplate stresses were higher in the middle vertebral body compared to the adjacent vertebrae. In addition, the stresses in the cancellous core of the middle, unconstrained vertebral body were higher. The present three-dimensional finite element model offers an additional facet to a better understanding of the biomechanics of the human cervical spine.

Biomechanics of the cervical spine Part 2. Cervical spine soft tissue responses and biomechanical modeling.

OBJECTIVE: The responses and contributions of the soft tissue structures of the human neck are described with a focus on mathematical modeling. Spinal ligaments, intervertebral discs, zygapophysial joints, and uncovertebral joints of the cervical spine are included. Finite element modeling approaches have been emphasized. Representative data relevant to the development and execution of the model are discussed. A brief description is given on the functional mechanical role of the soft tissue components. Geometrical characteristics such as length and cross-sectional areas, and material properties such as force-displacement and stress-strain responses, are described for all components. Modeling approaches are discussed for each soft tissue structure. The final discussion emphasizes the normal and abnormal (e.g., degenerative joint disease, iatrogenic alteration, trauma) behaviors of the cervical spine with a focus on all these soft tissue responses. A brief description is provided on the modeling of the developmental biomechanics of the pediatric spine with a focus on soft tissues. Relevance. Experimentally validated models based on accurate geometry, material property, boundary, and loading conditions are useful to delineate the clinical biomechanics of the spine. Both external and internal responses of the various spinal components, a data set not obtainable directly from experiments, can be determined using computational models. Since soft tissues control the complex structural response, an accurate simulation of their anatomic, functional, and biomechanical characteristics is necessary to understand the behavior of the cervical spine under normal and abnormal conditions such as facetectomy, discectomy, laminectomy, and fusion.

Finite element analysis of the cervical spine: a material property sensitivity study.

OBJECTIVE: The study determined the effect of variations in the material properties of the cervical spinal components on the output of the finite element analysis (external and internal responses of the cervical spine) under physiologic load vectors. DESIGN: A three-dimensional (3D) anatomically accurate finite element model comprising of the C4-C5-C6 cervical spine unit including the three vertebrae, two interconnecting intervertebral discs, and the anterior and posterior ligament complex is used. BACKGROUND: The effect of material property variations of spinal components on the human lumbar spine biomechanics is extensively studied. However, a similar investigation of the cervical spine is lacking. METHODS: Parametric studies on the variations in the material properties of all the cervical spine components including the cortical shell, cancellous core, endplates, intervertebral disc, posterior elements and ligaments were conducted by exercising the 3D finite element model under flexion, extension, lateral bending and axial torsion loading modes. Low, basic and high material property cases for each of the six components under all the four physiologic loading modes were considered in the finite element analysis. A total of 432 results were evaluated to analyze the external angular rotation, and the internal stresses in the middle vertebral body, the superior and inferior endplates and the two intervertebral discs. RESULTS: Variations in the material properties of the different cervical spinal components produced dissimilar changes in the external and internal responses. Variations in the material properties of the cancellous core, cortical shell, endplates and posterior element structures representing the hard tissues did not affect the external angular motion, and the internal stresses of the inferior and superior intervertebral discs under all four loading modes. In contrast, variations in the material properties of the intervertebral disc and ligament structures representing the soft tissues significantly altered the angular motion, and the stresses in the inferior and superior intervertebral discs of the cervical spine. CONCLUSION: The material properties of the soft tissue structures have a preponderant effect on the external and internal responses of the cervical spine compared with the changes in the material properties of the hard tissue structures. RELEVANCE: Bone remodeling (e.g., osteophyte) secondary to degeneration of the human cervical joints may be explained by a change in the material property of the soft tissues, coupled with an increase in stress (due to these material property variations) in the spinal components. Consequently, to accurately predict the biomedical effects of cervical spine degeneration, it is critical to accurately determine the material property of these components.

Finite element analysis of anterior cervical spine interbody fusion.

The present study investigated the external and the internal biomechanical responses of anterior cervical discectomy coupled with fusion. Five different types of interbody fusion materials were used: titanium core, titanium cage, tricortical iliac crest, tantalum core, and tantalum cage. Two different types of surgical procedures were analyzed: Smith-Robinson and Bailey-Badgley. A validated three-dimensional anatomically accurate finite element model of the human cervical spine was used in the study. The finite element model was exercised in compression, flexion, extension, and lateral bending for the intact case and for the two surgical procedures with five implant materials. The external response in terms of the stiffness and angular rotation, and the internal response in terms of the disc and the vertebral stresses were determined. The Smith-Robinson technique resulted in the highest increase in external response under all modes of loading for all implant materials. In contrast, the Bailey-Badgley technique produced a higher increase in the disc and the vertebral body stresses than the Smith-Robinson technique. As experimental human cadaver tests can only determine the external response of the non-fused spine simulating immediate post-operative structure, the present finite element studies assist in the understanding of biomechanics of interbody fusion by delineating the changes in the extrinsic and intrinsic characteristics of the cervical spine components due to surgery.