ABSTRACT
The purpose of the study was to examine the urinary levels of kidney injury molecule-1 (KIM-1) and angiopoietin-like protein-4 (ANGPTL-4) in individuals with diabetic kidney disease (DKD) and their association with established DKD diagnostic markers such as albuminuria and estimated glomerular filtration rate (eGFR). Levels of ANGPTL-4 and KIM-1 were estimated in urine samples. A total of 135 participants were recruited into three groups: 45 diabetes type 2 patients in the control group and 90 DKD patients in two disease groups. Concentrations of ANGPTL-4 and KIM-1 were conclusively related to the urinary albumin-creatinine ratio (UACR). Also, the levels of both ANGPTL-4 and KIM-1 were negatively associated with the eGFR. Multivariable Poisson regression analysis showed that urinary ANGPTL-4 (PR: 3.40; 95% CI: 2.32 to 4.98; p < 0.001) and KIM-1 (PR: 1.25; 95% CI: 1.14 to 1.38; p < 0.001) were prevalent in DKD patients. Receiver operating characteristic (ROC) analysis of urinary ANGPTL-4 and KIM-1 in the combined form resulted in an area under curve (AUC) of 0.967 (95%CI: 0.932-1.000; p < 0.0001) in the microalbuminuria group and 1 (95%CI: 1.000-1.000; p < 0.0001) in the macroalbuminuria group. The association of urinary levels of ANGPTL-4 and KIM-1 with UACR and eGFR and significant prevalence in the diabetic kidney disease population illustrates the diagnostic potential of these biomarkers.
ABSTRACT
Background: Conventional optimization techniques are based on the planning approach in which positions and weights are varied to generate the desired dose distribution. Inverse planning simulated annealing (IPSA) is an advanced optimization method developed to automatically determine a suitable combination of positions to design an acceptable plan. Objective: In this study, three optimization techniques namely IPSA, graphical optimization (GROPT), and geometrical optimization (GOPT) methods are compared in high-dose-rate interstitial brachytherapy of cervical carcinoma. Material and Methods: In this retrospective study, twenty computed tomography (CT) data sets of 10 cervical cancer patients treated with Martinez Universal Perineal Interstitial Template-based interstitial brachytherapy were studied. The treatment plans generated were optimized using the IPSA, and GOPT methods. The prescribed dose was 24 Gy in 4 fractions. Plans produced using IPSA, GrOPT, and GOPT techniques were analyzed for comparison of dosimetric parameters, including target coverage, homogeneity, conformity, and organs at risk (OAR) doses. Results: V100 values for IPSA, GrOPT and GOPT plans were 95.81±2.33%, 93.12±2.76% and 88.90±4.95%, respectively. The mean D90 values for the IPSA, GrOPT, and GOPT plans were 6.45±0.15 Gy, 6.12±0.21 Gy, and 5.85±0.57 Gy, respectively. Significantly lower doses of OAR were in the IPSA plans that were more homogeneous (HI=0.66). Conformity was comparatively higher in IPSA-based plans (CI=0.75). Conclusion: IPSA plans were superior and resulted in better target coverage, homogeneity, conformity, and minimal OAR doses.
ABSTRACT
Background: The interlimb coupling, coordination between the limbs, gets hampered in post-stroke hemiparesis. Most of the poststroke motor regimes primarily focus on the more affected limb.Objectives: To develop an interlimb coupling protocol and assess its feasibility and effect on motor recovery, gait and disability among post-stroke subjects.Design: A pilot randomized controlled, doubled blinded trialSetting: A rehabilitation instituteMethods: 50 post-stroke (> 6 months) hemiparetic subjects (Brunnstrom recovery stage ≥ 3) were randomly divided into experimental (n=26) and control (n=24) groups. The 8-week experimental intervention (3 sessions of 1 hour each, per week) comprised activities demanding coordinated, alternate, and rhythmic use of the affected as well as the less-affected limbs. The outcome measures were feasibility of activities, Fugl-Meyer assessment (FMA), Rivermead visual gait assessment (RVGA), Functional ambulation category (FAC) and modified Rankin scale (mRS).Results: The experimental protocol was found to be feasible by the participants. Post intervention, the experimental group exhibited highly significant difference for FMA (mean difference = 7.12, 95% CI = 5.71 - 8.53, p < 0.001), RVGA reduction (mean difference = - 6.32, 95% CI = 7.51 - 5.13, p < 0.001), and median FAC enhancement (p < 0.001) in comparison to the controls. However, the median mRS level of experimental group did not change significantly (p = 0.056) when compared with the controls.Conclusions: The interlimb coupling training, a feasible program may enhance recovery of the upper and lower limbs and gait in stroke. Further definitive randomized trials are warranted to validate the present findings.
