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PMC11278469_p2
|
PMC11278469
|
sec[0]/p[2]
|
1. Introduction
| 4.128906 |
biomedical
|
Review
|
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ADHD is a disorder of multifactorial origin, with the following most commonly described causal factors in the literature: genetic predispositions, gestational and perinatal factors, and environmental influences . Changes in brain structure and function are observed in individuals with ADHD, affecting mechanisms such as neurogenesis and synaptogenesis, which, in turn, disrupt attention and impulse control, core functions regulated by the central nervous system . The etiology of ADHD is diverse, with interactions between genetic and environmental factors contributing to the heterogeneous manifestation of the disorder among individuals and subsequently influencing their response to interventions .
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278469_p3
|
PMC11278469
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sec[0]/p[3]
|
1. Introduction
| 2.455078 |
biomedical
|
Other
|
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This disagreement on the causes can contribute to a clash in treatment processes, which, in turn, impacts both academic and familial spheres. In the academic realm, for instance, children with ADHD may struggle to concentrate, follow instructions, and complete tasks, thereby affecting their academic performance and self-esteem . Within the family, the lack of understanding about the nature of the disorder can generate stress and frustration, increasing tensions at home. This situation will affect the support networks available to a child with ADHD in their close environment since the specific needs of this population require collaborative efforts .
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278469_p4
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PMC11278469
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sec[0]/p[4]
|
1. Introduction
| 3.921875 |
biomedical
|
Review
|
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Individuals diagnosed with ADHD can encounter several challenges in their daily lives across various domains. In childhood and adolescence, ADHD can significantly impact academic achievement, social interactions, and overall well-being. Symptoms of ADHD, such as inattention and hyperactivity, often persist into adolescence, leading to difficulties in peer relationships, academic performance, and behavioral challenges. An estimated 72% of adolescents with ADHD present with sleep problems . This affects their daytime functioning and exacerbates symptoms of inattention and hyperactivity. Moreover, untreated ADHD in adolescence increases susceptibility to risky behaviors, substance misuse, and mental health issues, including depression .
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278469_p5
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PMC11278469
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1. Introduction
| 1.875 |
biomedical
|
Other
|
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In adulthood, individuals with ADHD can face occupational challenges, educational impairments, financial difficulties, and family instability . They are less likely to graduate from high school and college, have lower job stability, and demonstrate impaired job performance. ADHD also contributes to higher rates of substance abuse, mental health disorders, and financial stress, leading to increased reliance on public aid and decreased income .
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278469_p6
|
PMC11278469
|
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|
1. Introduction
| 4.046875 |
biomedical
|
Review
|
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Moreover, individuals with ADHD often experience comorbid conditions, such as anxiety disorders, significantly higher than the general population . Anxiety symptom severity is associated with lower social skills and higher social problems in young people with ADHD, exacerbating existing social difficulties. Additionally, challenges with emotional regulation are common among individuals with ADHD, characterized by difficulties in managing and expressing emotions effectively. Studies indicate that adults with ADHD exhibit lower emotional regulation scores compared to controls, utilizing non-adaptive emotion regulation strategies such as self-blame and rumination. Emotional dysregulation is associated with greater socio-functional impairment, impacting relationships, stress management, and coping abilities. Addressing comorbid conditions and emotional regulation challenges is crucial for comprehensive support and intervention to mitigate the impact of ADHD .
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278469_p7
|
PMC11278469
|
sec[0]/p[7]
|
1. Introduction
| 3.976563 |
biomedical
|
Review
|
[
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One of the most widely accepted theories explaining the essential cause of ADHD symptomatology states that children, adolescents, or adults with this disorder present an immature executive function development . Executive functions are a set of high-level mental abilities that help us plan, organize, and control behavior to achieve goals . There is no specific number of executive functions and there are proposals that consider them as a single factor or multiple skills that interact to achieve behavioral regulation . Different authors propose that there are different executive functions: inhibitory control, working memory, planning, verification, decision-making, emotional regulation, and cognitive flexibility .
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278469_p8
|
PMC11278469
|
sec[0]/p[8]
|
1. Introduction
| 3.621094 |
biomedical
|
Other
|
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[
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In ADHD, the main executive function that is thought to be affected is inhibitory control. This impairment generates a domino effect, causing difficulties with working memory capacity, internal language regulating behavior, reconstitution of new behaviors, regulation of emotion, and arousal and motivation . This alteration of the executive functions is what causes ADHD to present as a lack of regulation of behavior and cognition. This generates problems affecting individuals diagnosed with this disorder in different spheres, such as the educational, family, personal, social, work, and others .
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11278469_p9
|
PMC11278469
|
sec[0]/p[9]
|
1. Introduction
| 3.929688 |
biomedical
|
Review
|
[
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The need to work on executive functions in ADHD is a crucial aspect of the management of this neurodevelopmental disorder. Over the years, various strategies have been explored to address these functions, which play a fundamental role in the regulation of behavior, attention, planning, and decision-making in individuals with ADHD. Among the most common interventions is the use of stimulant medications such as psychostimulants, which have been shown to improve attention and reduce hyperactive and impulsive symptoms in many patients. However, while these medications may be effective for some individuals, they are not a definitive solution as they do not directly address executive function deficits .
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278469_p10
|
PMC11278469
|
sec[0]/p[10]
|
1. Introduction
| 3.873047 |
biomedical
|
Other
|
[
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[
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Another important approach is cognitive behavioral therapy (CBT), which focuses on identifying and changing dysfunctional patterns of thinking and behavior. CBT can be beneficial in improving skills such as self-regulation, problem-solving, and organization, which are directly related to executive functions. In addition, neuropsychological therapy, which focuses on rehabilitating specific areas of cognitive functioning, shows great potential for the treatment of ADHD. Through activities designed to improve working memory, cognitive flexibility, and inhibitory control, we seek to strengthen executive functions and improve overall functioning .
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278469_p11
|
PMC11278469
|
sec[0]/p[11]
|
1. Introduction
| 3.765625 |
biomedical
|
Review
|
[
0.990234375,
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[
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However, despite advances in these approaches, there is still no clear consensus on what is the best strategy for addressing impaired executive functions in ADHD. Research has shown mixed results leaving as a consequence many unanswered questions. Therefore, it is crucial to conduct a systematic review that integrates the most recent findings and evaluates the relative effectiveness of various interventions that address executive functions in people with ADHD.
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278469_p12
|
PMC11278469
|
sec[0]/p[12]
|
1. Introduction
| 3.615234 |
biomedical
|
Review
|
[
0.9794921875,
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0.0116424560546875
] |
[
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] |
This review could help inform clinical practice and guide the development of more effective and personalized future research that addresses the specific needs of each individual with ADHD. In addition, it would highlight the importance of further research in this field to improve the quality of life and functioning of individuals affected by this disorder.
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278469_p13
|
PMC11278469
|
sec[1]/p[0]
|
2. Materials and Methods
| 4.078125 |
biomedical
|
Study
|
[
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The scope of this research focuses on analyzing systematic reviews by applying the PRISMA method . The first stage involved identifying the research question and proceeding with data collection. Initially, a total of N = 739 articles were obtained. In the second stage, duplicate articles (N = 285) were identified and excluded. In the third stage, the remaining articles were assessed according to the inclusion criteria (human participation, treatment to improve executive functions, people diagnosed with ADHD, and articles in English and Spanish) and exclusion criteria (languages other than Spanish and English, systematic reviews, books or theses, paid access, or articles that proposed interventions not aimed at improving executive functions in ADHD), resulting in the exclusion of N = 406 articles. Consequently, in the fourth stage, a selection of N = 32 articles was made and used in this research. In the fifth stage, the statistical analysis is presented. Finally, in the sixth stage, the summary collation and dissemination of the results are carried out through the application of the analytical framework .
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278469_p14
|
PMC11278469
|
sec[1]/p[1]
|
2. Materials and Methods
| 4.035156 |
biomedical
|
Study
|
[
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] |
[
0.9990234375,
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] |
To achieve our research objective, we used the following databases: SCOPUS, Science Direct, and PUBMED using the keywords: executive functions, ADHD, treatment, and intervention, with the respective Boolean terms (OR, AND). During the research process, three reviewers supervised: titles, abstracts, and full texts considering the inclusion and exclusion criteria, thus accepting, or rejecting the discrepancies found in the papers. Consequently, each independent article was combined into a single file, thus adopting the results of the three reviewers by extracting the files with different results. The extraction table included data such as authors, research design, year of publication, the sample size used, type of intervention, intervention time, country of application, tests applied to assess executive functions, and results, among others. This investigation has been registered in the PROSPERO platform under the number 557,233. This information is presented in Appendix A .
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278469_p15
|
PMC11278469
|
sec[2]/p[0]
|
3. Results
| 3.806641 |
biomedical
|
Study
|
[
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[
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The process to obtain the results involved a series of meticulous steps that allowed for a comprehensive analysis and understanding of the data. Firstly, dynamic tables were used to organize the data in a structured manner. These tables provide a dynamic view of the items for each variable, facilitating the identification of patterns and key relationships among the data. Subsequently, specific ranges were generated to perform detailed and segmented tabulations of the results. These ranges enabled us to group similar data and establish relevant categories for deeper analysis. Once the data were organized and analyzed, the results were visualized through charts. These charts were designed to visually represent the trends and relationships identified in the data, thus facilitating their interpretation.
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278469_p16
|
PMC11278469
|
sec[2]/p[1]
|
3. Results
| 3.349609 |
biomedical
|
Study
|
[
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[
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Furthermore, key statistical measures, such as mean and standard deviation, were calculated for both subjects with ADHD for adults and children participating in the study. These measures provided us with a deeper understanding of the central tendency and dispersion of the data, enriching our analysis and conclusions. In summary, the process of obtaining results was a combination of descriptive and visual data analysis techniques that allowed us to explore and understand our research findings in depth.
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278469_p17
|
PMC11278469
|
sec[2]/sec[0]/p[0]
|
3.1. Research Design
| 2.019531 |
biomedical
|
Study
|
[
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[
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Feasibility studies, preliminary studies, and randomized controlled trials (RCTs) were the main research designs we encountered. RCTs stood out as the most prevalent. Check out Figure 2 to see their prominence.
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278469_p18
|
PMC11278469
|
sec[2]/sec[1]/p[0]
|
3.2. Research Countries
| 1.551758 |
biomedical
|
Other
|
[
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[
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China leads with 7 studies, followed by the United States with 5 and Norway with 4, among other countries. Discover this distribution of studies in Figure 3 .
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278469_p19
|
PMC11278469
|
sec[2]/sec[2]/p[0]
|
3.3. Participants Stage
| 2.123047 |
biomedical
|
Study
|
[
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[
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In terms of the life stage of individuals who underwent treatment, there were 21 studies involving children, followed by 7 studies in adults. Additionally, 2 studies encompassed adolescents and a combination of children and adolescents. These data are presented in Figure 4 .
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278469_p20
|
PMC11278469
|
sec[2]/sec[3]/p[0]
|
3.4. Treatment Implemented
| 3.691406 |
biomedical
|
Study
|
[
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[
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In the articles, various treatments were implemented to improve executive functions in individuals diagnosed with ADHD. The primary treatments included methylphenidate and mindfulness, followed by transcranial anodal direct current stimulation and viloxazine, among others. Psychological treatments were predominantly used, featured in 14 studies, followed by medication in 9 studies. Conversely, treatments such as polyamines and sports received the lowest number of studies. This distribution is visualized in Figure 5 .
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278469_p21
|
PMC11278469
|
sec[2]/sec[4]/p[0]
|
3.5. Test Administered in Previous Research
| 2.306641 |
biomedical
|
Study
|
[
0.99609375,
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[
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In the articles, various tests were administered, with the BRIEF used in 6 studies and the Stroop test used in 3 studies. These tests were used to identify the presence of ADHD and assess executive functions. Explore Figure 6 to visualize the distribution of these tests across the studies.
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278469_p22
|
PMC11278469
|
sec[2]/sec[5]/p[0]
|
3.6. Intervention Time
| 2.808594 |
biomedical
|
Study
|
[
0.9970703125,
0.0005698204040527344,
0.002593994140625
] |
[
0.99365234375,
0.005245208740234375,
0.0007905960083007812,
0.0001379251480102539
] |
There were four ranges used to identify the intervention duration of treatments in days. The range of 0–182 days included 21 studies, followed by 183–365 days and 731 days or more, each with 4 studies, and finally, 549–730 days with 1 study. Explore Figure 7 to visualize the distribution of treatment durations across the studies.
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278469_p23
|
PMC11278469
|
sec[2]/sec[6]/p[0]
|
3.7. Improved Executive Functions
| 4.03125 |
biomedical
|
Study
|
[
0.99853515625,
0.0002639293670654297,
0.0014095306396484375
] |
[
0.9990234375,
0.00017702579498291016,
0.0006647109985351562,
0.000034928321838378906
] |
In the analysis of the results, there was evidence of improvement in executive functions, although not uniformly across all aspects. Notably, working memory demonstrated the highest score in 15 studies, followed by inhibition in 12 studies, and cognitive flexibility in 5 studies. However, processing speed and sustained attention showed the lowest scores, each with only 1 study. To identify the efficacy of the treatment received with executive functions, a significant association was found between improving executive functioning and the type of psychological treatment ( x 2 = 11.82, p = 0.03). Explore these findings further in Figure 8 .
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278469_p24
|
PMC11278469
|
sec[3]/p[0]
|
4. Discussion
| 1.991211 |
biomedical
|
Other
|
[
0.98486328125,
0.004001617431640625,
0.01100921630859375
] |
[
0.002811431884765625,
0.98828125,
0.0078887939453125,
0.0008821487426757812
] |
ADHD is a neurodevelopmental disorder that affects the normal development of children, adolescents, and adults. It is one of the most prevalent mental health problems. For this reason, it is vital to continue the dialogue on this matter and its treatment processes, which currently lack consensus on proposals or results .
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11278469_p25
|
PMC11278469
|
sec[3]/p[1]
|
4. Discussion
| 4.027344 |
biomedical
|
Review
|
[
0.9951171875,
0.001483917236328125,
0.003444671630859375
] |
[
0.031829833984375,
0.0034275054931640625,
0.96435546875,
0.00035190582275390625
] |
Within the context of this article, the research based on a quantitative systematic review of treatment methods for executive functions in the ADHD population is presented. The importance of research on executive functions lies in the central role played by skills, such as inhibitory control, working memory, emotional regulation, cognitive flexibility, and planning in understanding the problems with the regulation of behavior and cognition that occur in this disorder .
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278469_p26
|
PMC11278469
|
sec[3]/p[2]
|
4. Discussion
| 4.097656 |
biomedical
|
Study
|
[
0.99951171875,
0.0003540515899658203,
0.0002810955047607422
] |
[
0.994140625,
0.00022614002227783203,
0.005390167236328125,
0.00010013580322265625
] |
The research began with 739 articles, and after analyzing the inclusion and exclusion criteria, 32 studies were included, allowing for the planned analyses to be carried out. The main results identified that randomized controlled trials were the most frequently performed research design. Regarding the temporality of studies, it was found that the last 5 years represent the highest scientific production in this line of research. Regarding the location of the research, it was found that the largest number of studies were conducted in Europe. As for the developmental level at which most studies were carried out, it was during childhood. The most frequently used treatment to support executive functions in ADHD was psychological interventions. The executive functions that benefit most from the identified treatments are working memory, inhibition, and cognitive flexibility. This study contributes to the understanding of ADHD by confirming the importance of executive functions when conducting interventions with individuals with this disorder. As previously mentioned, the roles of functions such as inhibitory control, working memory, and cognitive flexibility are crucial for individuals with ADHD to improve their behavioral regulation skills.
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278469_p27
|
PMC11278469
|
sec[3]/p[3]
|
4. Discussion
| 3.988281 |
biomedical
|
Review
|
[
0.9892578125,
0.007328033447265625,
0.00324249267578125
] |
[
0.00528717041015625,
0.0015583038330078125,
0.99267578125,
0.000522613525390625
] |
The findings of this systematic review underscore the breadth of research exploring interventions for ADHD, with particular emphasis on supporting executive functions, which tend to be affected by this neurodevelopmental disorder. Notably, both psychological interventions and pharmacotherapy have received substantial attention. For clinicians and healthcare providers navigating treatment options for individuals with ADHD, a thorough consideration of the available evidence must be conducted. Moreover, tailoring interventions to suit the developmental stage of the patient is essential to ensure the benefits seen in the patient’s quality of life. Furthermore, the combination of interventions, such as medication and psychological therapies, needs careful examination to ensure efficacy is grounded in empirical evidence.
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278469_p28
|
PMC11278469
|
sec[3]/p[4]
|
4. Discussion
| 3.914063 |
biomedical
|
Review
|
[
0.99658203125,
0.0010747909545898438,
0.0025234222412109375
] |
[
0.1810302734375,
0.048248291015625,
0.77001953125,
0.0005502700805664062
] |
Beyond treatment modalities, the cultural context emerges as a pivotal factor influencing intervention success. While existing research predominantly emanates from North America, Europe, and Asia, it is imperative to acknowledge and address the diversity of cultural backgrounds among individuals seeking treatment worldwide. Adapting interventions to local contexts is crucial for their applicability and efficacy . This adaptation process necessitates not only clinical adjustments but also rigorous research to elucidate the specific cultural nuances that impact treatment engagement and effectiveness . As such, bridging the gap between research and practice entails a comprehensive understanding of the multifaceted influences shaping the experiences of individuals with ADHD across diverse cultural landscapes.
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278469_p29
|
PMC11278469
|
sec[3]/p[5]
|
4. Discussion
| 3.044922 |
biomedical
|
Other
|
[
0.99267578125,
0.0009822845458984375,
0.006359100341796875
] |
[
0.0267333984375,
0.95751953125,
0.0152587890625,
0.0005283355712890625
] |
Future research motivates us to develop our own intervention for executive functions in the ADHD population. Our interest lies in technological aspects that may be useful, especially for children and adolescents with the disorder. Finally, it is essential to continue studying executive functions, as these high-level mental abilities are not only affected in ADHD but also in other pathologies that affect human mental and behavioral activity and their pharmacological, non-pharmacological, and multimodal treatments .
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278469_p30
|
PMC11278469
|
sec[3]/p[6]
|
4. Discussion
| 1.726563 |
biomedical
|
Other
|
[
0.9462890625,
0.0013866424560546875,
0.052490234375
] |
[
0.328857421875,
0.568359375,
0.10040283203125,
0.0022792816162109375
] |
The main limitation of this research lies in the lack of access to all the published articles, as several documents required payment to download. Another aspect is the language delimitation, as we only worked with studies published in English and Spanish; however, in future studies, we will review works published in other languages to cover the largest number of works on ADHD.
|
[
"Carlos Ramos-Galarza",
"Deyaneira Brito",
"Brayan Rodríguez",
"Brenda Guerrero",
"Jorge Cruz-Cárdenas",
"Mónica Bolaños-Pasquel"
] |
https://doi.org/10.3390/jcm13144208
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278481_p0
|
PMC11278481
|
sec[0]/p[0]
|
1. Introduction
| 3.912109 |
biomedical
|
Other
|
[
0.95068359375,
0.0474853515625,
0.001926422119140625
] |
[
0.0260467529296875,
0.85400390625,
0.11077880859375,
0.00933837890625
] |
Current practice in restorative rectal cancer surgery involves the creation of a (temporary) protecting diverting stoma with the purpose of minimising the severe septic consequences of an anastomotic leakage (AL). The presentation of ALs can vary, with some being clinically symptomatic despite the presence of a proximal stoma. Symptomatic ALs will require intervention, whilst asymptomatic leaks are only diagnosed radiologically later, prior to reversal, and do not necessarily require intervention.
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11278481_p1
|
PMC11278481
|
sec[0]/p[1]
|
1. Introduction
| 2.527344 |
biomedical
|
Other
|
[
0.99560546875,
0.0026416778564453125,
0.001819610595703125
] |
[
0.03424072265625,
0.8994140625,
0.06414794921875,
0.0022735595703125
] |
The incidence of AL is around 20% and is associated with severe complications and morbidity, reoperations, and mortality . AL has a significant impact on oncological outcomes and quality of life and is associated with significant healthcare costs .
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278481_p2
|
PMC11278481
|
sec[0]/p[2]
|
1. Introduction
| 3.96875 |
biomedical
|
Other
|
[
0.88623046875,
0.1121826171875,
0.0016107559204101562
] |
[
0.078369140625,
0.8837890625,
0.0248565673828125,
0.0128173828125
] |
Furthermore, the stoma itself can lead to significant discomfort, low self-image, decreased quality of life, dehydration, electrolyte imbalance, and other complications leading to readmission and/or reoperation . The presence of a stoma also necessitates costs for appliances, guidance from stoma nurses, and another surgical intervention (the stoma reversal), which increases the risk of an incisional hernia . After a 3-month period in which the anastomosis is deemed to have healed sufficiently, the stoma is usually reversed. This 3-month period is often exceeded due to delaying factors such as complications, adjuvant therapy, pressures on surgical waiting lists, a second surgical procedure, and late discoveries of (asymptomatic) AL.
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278481_p3
|
PMC11278481
|
sec[0]/p[3]
|
1. Introduction
| 3.912109 |
biomedical
|
Review
|
[
0.9970703125,
0.001766204833984375,
0.0012769699096679688
] |
[
0.174560546875,
0.0159149169921875,
0.80859375,
0.0008893013000488281
] |
In recent years, some centres have shifted from routine diversion (RD) towards a more selective use of diversion (SD), as more evidence seems to suggest that the benefits of RD may not outweigh its risks and could lead to an even higher permanent stoma rate with comparable AL rates . Recent studies have suggested that the presence of an ileostomy does not reduce the incidence of AL but only delays the diagnosis, with possibly reduced possibilities for restoring the anastomosis .
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11278481_p4
|
PMC11278481
|
sec[0]/p[4]
|
1. Introduction
| 4.0625 |
biomedical
|
Study
|
[
0.998046875,
0.0013685226440429688,
0.0005106925964355469
] |
[
0.479248046875,
0.2266845703125,
0.291015625,
0.0029315948486328125
] |
The advantages of a robotic platform for low rectal resection include the use of an advanced robotically controlled stapler for rectal transection that is able to evaluate and adapt stapling according to tissue thickness (i.e., Sureform, Intuitive Surgical, Sunnyvale, CA, USA), easy assessment of perfusion using indocyanine green (ICG) dye with the Firefly mode, and the possibility to easily perform suture reinforcements of the transverse rectal staple line at the superior and inferior ends (i.e., ‘dog ears’) and of the circular stapler line using interrupted sutures. This was described as the ‘KHANS’ technique (Key enhancement of the Anastomosis for No-Stoma Surgery) and was developed in 2015, aiming to reduce the incidence of AL and the need for diverting stomas in robot-assisted rectal resections .
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278481_p5
|
PMC11278481
|
sec[0]/p[5]
|
1. Introduction
| 3.867188 |
biomedical
|
Study
|
[
0.98828125,
0.010955810546875,
0.0008139610290527344
] |
[
0.99755859375,
0.0015659332275390625,
0.0003905296325683594,
0.0004382133483886719
] |
This study aims to evaluate the impact of shifting from RD to SD in a tertiary oncological colorectal centre by assessing the prevalence of AL and stoma-related outcomes between these groups.
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278481_p6
|
PMC11278481
|
sec[1]/sec[0]/p[0]
|
2.1. Study Design
| 4.078125 |
biomedical
|
Study
|
[
0.98876953125,
0.01092529296875,
0.0004291534423828125
] |
[
0.9970703125,
0.0014247894287109375,
0.0008778572082519531,
0.0006971359252929688
] |
This study retrospectively evaluated a consecutive series of rectal cancer resections with primary anastomosis performed between 2013 and 2021. Data were extracted from a prospectively maintained colorectal database containing data from three robotic and three laparoscopic colorectal surgeons. All surgeons were past their learning curves for their respective approaches at the time of data capture (estimated at 35 procedures based on the existing literature) . The switch from RD to SD was made in 2015. Two groups were defined and compared: the RD group and the SD group .
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278481_p7
|
PMC11278481
|
sec[1]/sec[0]/p[1]
|
2.1. Study Design
| 3.5 |
biomedical
|
Study
|
[
0.6943359375,
0.30029296875,
0.00553131103515625
] |
[
0.7734375,
0.2181396484375,
0.0016689300537109375,
0.006664276123046875
] |
The primary endpoint was to report on complication rate, including AL (with ISREC classification) . Secondary endpoints included reporting length of stay (LOS), stoma rate after 1 year, readmissions < 31 days, and reoperations < 31 days.
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278481_p8
|
PMC11278481
|
sec[1]/sec[0]/p[2]
|
2.1. Study Design
| 2.814453 |
biomedical
|
Study
|
[
0.9765625,
0.021697998046875,
0.0019521713256835938
] |
[
0.953125,
0.044891357421875,
0.0004780292510986328,
0.0016050338745117188
] |
Inclusion criteria were the following: (1) robotic approach; (2) rectosigmoid cancer resection; and (3) availability of stoma follow-up data.
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999994 |
PMC11278481_p9
|
PMC11278481
|
sec[1]/sec[0]/p[3]
|
2.1. Study Design
| 2.804688 |
biomedical
|
Study
|
[
0.9140625,
0.08392333984375,
0.0022220611572265625
] |
[
0.876953125,
0.11663818359375,
0.0011930465698242188,
0.0052642822265625
] |
Exclusion criteria were the following: (1) synchronous cancers; (2) abdominoperineal resection; (3) open approach; (4) hand-sewn anastomosis; (5) permanent colostomy; (6) lost to follow-up within a year.
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278481_p10
|
PMC11278481
|
sec[1]/sec[0]/p[4]
|
2.1. Study Design
| 1.518555 |
biomedical
|
Other
|
[
0.95947265625,
0.00528717041015625,
0.035125732421875
] |
[
0.109619140625,
0.88720703125,
0.0013151168823242188,
0.0019855499267578125
] |
Medical ethical approval was acquired from the Health Research Authority in the United Kingdom, and it was judged that written informed consent would not be necessary for this study because of its retrospective nature and subsequent anonymous analysis of the data.
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11278481_p11
|
PMC11278481
|
sec[1]/sec[1]/p[0]
|
2.2. Procedure
| 4.019531 |
biomedical
|
Study
|
[
0.865234375,
0.133544921875,
0.0010433197021484375
] |
[
0.9306640625,
0.059967041015625,
0.0029506683349609375,
0.006557464599609375
] |
Preoperative diagnostics included patient demographics, tumour histology and staging, computed tomography (CT) scans of the chest, abdomen, and pelvis, and magnetic resonance imaging (MRI) of the pelvis. Indications for neoadjuvant chemoradiation (neoCRT) were tumours with threatened/suspicious circumferential resection margin (CRM). Patients underwent short-course or long-course neoCRT after multidisciplinary team discussion, with clinical restaging and surgery performed 10–12 weeks thereafter. Neoadjuvant protocols in the neoCRT group were either short-course neoadjuvant radiotherapy (25 Gy in 5 fractions over 5 weekdays) or long-course neoadjuvant chemoradiotherapy (45–50 Gy in 25 fractions over 5 weeks), with concomitant chemotherapy (3 months of CAPOX (capecitabine and oxaliplatin) or FOLFOX (folinic acid, fluorouracil, and oxaliplatin)). Adjuvant therapy consisted of 45 Gy in 25 fractions. All patients underwent preoperative mechanical bowel preparation.
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278481_p12
|
PMC11278481
|
sec[1]/sec[1]/p[1]
|
2.2. Procedure
| 3.888672 |
biomedical
|
Study
|
[
0.7998046875,
0.1983642578125,
0.0019140243530273438
] |
[
0.5107421875,
0.451416015625,
0.0024261474609375,
0.035308837890625
] |
All operations were performed on the da Vinci Si/X/Xi ® platform according to availability. A five-port single-docking fully robotic approach with a two-left-hand setting was used . Before transection of the rectum, an intravenous bolus of ICG (3 mL, 7.5 mg) was administered to identify the perfusion status of the rectum. Optimal level of transection was decided upon consensus between surgeon and assistant. Where patients did not receive a stoma, the KHANS (Key enHancement of the Anastomosis for No Stoma) technique was used to reinforce the anastomosis .
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278481_p13
|
PMC11278481
|
sec[1]/sec[1]/p[2]
|
2.2. Procedure
| 3.748047 |
biomedical
|
Study
|
[
0.53466796875,
0.462890625,
0.0024929046630859375
] |
[
0.8154296875,
0.1639404296875,
0.003673553466796875,
0.0171966552734375
] |
In the RD group, patients predominantly received a diverting stoma, and the few instances where they were treated with a primary anastomosis were decided based on surgeon preference and opinion. In the SD group, the following factors were used to help determine whether a patient would not receive a diverting stoma: (1) medical and nutritional status (such as ASA < 4); (2) not requiring multivisceral resection or colo-anal anastomosis; and (3) non-obstructive cancer. In cases of diverting stoma formation, the anastomosis was checked twice prior to reversal: with gastrografin enema imaging and with sigmoidoscopy under anaesthesia at the time of reversal.
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278481_p14
|
PMC11278481
|
sec[1]/sec[2]/p[0]
|
2.3. Outcomes
| 3.859375 |
clinical
|
Study
|
[
0.486083984375,
0.51220703125,
0.0018520355224609375
] |
[
0.87109375,
0.0958251953125,
0.006237030029296875,
0.0267333984375
] |
Clinical and oncological outcomes were recorded, including AL, which was categorised according to the ISREC classification into type A, requiring no active intervention; type B, requiring an active therapeutic intervention, such as antibiotics or radiologic drainage; and type C, necessitating a return to theatre. ALs were classified as early leaks when discovered <30 days after surgery and late leaks when discovered >30 days post-surgery. Postoperatively, all patients were managed with the same enhanced recovery programme (ERAS) according to NHS standards, with a liquid diet for the first 48 h and regular laxatives (lactulose 10 mL twice a day) starting from the 3rd postoperative day .
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278481_p15
|
PMC11278481
|
sec[1]/sec[3]/p[0]
|
2.4. Statistical Analysis
| 4.085938 |
biomedical
|
Study
|
[
0.99755859375,
0.00231170654296875,
0.00023543834686279297
] |
[
0.998046875,
0.0011491775512695312,
0.00047969818115234375,
0.0002067089080810547
] |
Baseline characteristics were analysed for each group, including means and standard deviations for normally distributed data and medians and interquartile ranges for non-normally distributed data. Bivariate categorical data were analysed using Chi-square or Fisher’s exact test. Numerical data were analysed using either unpaired t -test or Mann–Whitney U test, depending on the distribution of data. Time-to-event (time to anastomotic failure and stoma-free survival) data were compared between the groups using the log-rank test (with Kaplan–Meier curves) or cox regression analysis. In the case of a secondary stoma, time was calculated from the date of surgery to the reversal of the second stoma. A p -value < 0.05 was considered statistically significant. All analyses were performed using IBM SPSS Statistics for Windows, version 28.0.0 (IBM Corp., Armonk, NY, USA). The STROBE guidelines for observational studies were followed .
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11278481_p16
|
PMC11278481
|
sec[2]/sec[0]/p[0]
|
3.1. Patient Characteristics
| 4.105469 |
biomedical
|
Study
|
[
0.97021484375,
0.0287933349609375,
0.0008106231689453125
] |
[
0.9921875,
0.005970001220703125,
0.0006604194641113281,
0.001377105712890625
] |
A total of 205 robotic rectal cancer patients were enrolled in this study : group A (RD), n = 70; and group B (SD), n = 135. The baseline characteristics are described in Table 1 . Both groups had mostly male patients, with a median age of 68.00 [62.75–74.25] vs. 69.00 [58.00–76.00] years. Most patients were ASA II. Group A had significantly more neoadjuvant chemoradiotherapy (17.1% vs. 7.4%, p = 0.011). Group B had more advanced tumours (T3/T4: 39.1% vs. 57.8%). The median tumour height measured on preoperative MRI was between 5 and 6 cm from the anorectal junction. There were no significant differences in other baseline variables.
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278481_p17
|
PMC11278481
|
sec[2]/sec[1]/p[0]
|
3.2. Operative Outcomes
| 4.097656 |
biomedical
|
Study
|
[
0.92333984375,
0.075439453125,
0.0011043548583984375
] |
[
0.9873046875,
0.00850677490234375,
0.0015344619750976562,
0.0024662017822265625
] |
Table 2 shows the operative and postoperative details. There were no conversions in both robotic cohorts. There was a statistically significant difference in stapler use, with group A using the laparoscopic stapler significantly more (95.7% vs. 32.0%, p < 0.001). Group A did not employ the robotic stapler at all, and it was used in 67.2% of cases for group B. There was also a significant difference in the number of firings, with group B having significantly fewer linear firings than group A ( p < 0.001). The operative time was 15 min shorter in group A, with 240 min vs. 255 min in group B ( p = 0.029). The operative time in group A was significantly shorter (240 vs. 255 min, p = 0.029). No cases involved more than three staple firings in group B. The LOS was comparable between the cohorts, with a median of 6 days ( p = 0.292). The complication rates ( p = 0.117), readmission rates (15.9% vs. 17.0%, p = 1.000), pathological T-staging ( p = 0.623), pathological R-staging (4.3% vs. 5.2%, p = 1.000), reoperation rates (2.9% vs. 6.7%, p = 0.342), and 90-day mortality rates ( p = 1.000) were all comparable between groups.
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278481_p18
|
PMC11278481
|
sec[2]/sec[2]/p[0]
|
3.3. Anastomotic Leakage
| 4.039063 |
biomedical
|
Study
|
[
0.85400390625,
0.144775390625,
0.0013322830200195312
] |
[
0.970703125,
0.0212249755859375,
0.0020294189453125,
0.006072998046875
] |
The complication rates and AL rates were comparable between the two cohorts (see Table 2 ). The AL rates were comparable, with 11.8% in group A vs. 17.8% in group B, p = 0.312. AL details are described in Table 3 . Of the class C leaks, the majority were managed with reoperation, and one in group B (14.3%) was managed with radiological drainage. All other leaks were treated conservatively with antibiotics. The median time until leakage was not statistically significantly different between the groups (31.50 [3.75–96.25] days in group A vs. 8.50 [4.00–65.50] days in group B). There was no mortality due to AL in either group.
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278481_p19
|
PMC11278481
|
sec[2]/sec[3]/p[0]
|
3.4. Stoma Formation
| 4.171875 |
biomedical
|
Study
|
[
0.97705078125,
0.0223388671875,
0.0006685256958007812
] |
[
0.9951171875,
0.003185272216796875,
0.001018524169921875,
0.0008211135864257812
] |
Table 4 displays the stoma-related variables and shows that the later selective diversion cohort, group B, underwent significantly less stoma formation than group A (72.6% vs. 90.0%, p = 0.004). There were no statistically significant differences in stoma closure rates (82.5% vs. 78.6%, p = 0.686), complications after stoma closure (40.0% vs. 50.8%, p = 0.329), LOS after stoma closure (4.00 [3.00–7.00] vs. 4.00 [4.00–6.25], p = 0.373), readmission after stoma closure (3.8% vs. 2.6%, p = 0.312), reoperation after stoma closure (3.8% vs. 2.6%, p = 1.000), secondary stoma rates (3.0% vs. 5.3%, p = 0.721), stoma-free survival at 1 year (71.9% vs. 71.6%, p = 1.000), or stoma-free survival at the end of follow-up (85.1% vs. 75.9%, p = 0.146) between the cohorts. The median time until closure was 284.0 [183.25–378.75] vs. 234.0 [148.00–332.00] days ( p = 0.307). The most common reasons for delayed reversal were adjuvant chemotherapy (58.8% vs. 40.7%), anastomotic leakage (17.6% vs. 22.2%), and the COVID-19 pandemic.
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278481_p20
|
PMC11278481
|
sec[2]/sec[3]/p[1]
|
3.4. Stoma Formation
| 3.53125 |
biomedical
|
Study
|
[
0.9921875,
0.007049560546875,
0.0006885528564453125
] |
[
0.99658203125,
0.0028743743896484375,
0.0003428459167480469,
0.0003635883331298828
] |
A subanalysis limiting cases to patients treated before 2019, the pre-COVID era, showed no statistically significant difference in stoma closure between the groups, with 74.3% closure in group A vs. 61.3% in group B ( p = 0.81) (not displayed).
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278481_p21
|
PMC11278481
|
sec[2]/sec[3]/p[2]
|
3.4. Stoma Formation
| 4.125 |
biomedical
|
Study
|
[
0.9931640625,
0.00609588623046875,
0.000537872314453125
] |
[
0.998046875,
0.0011377334594726562,
0.00037789344787597656,
0.00023102760314941406
] |
Table 5 compares the diverted with the non-diverted patients within the selective diversion group B. Less radiotherapy was administered in the no-stoma group compared to the stoma group (5.4% vs. 8.4%, p = 0.046), and more adjuvant chemotherapy was administered in the no-stoma group (32.4% vs. 18.4%, p = 0.011). The tumours in the no-stoma group were significantly higher at 8 cm from the anorectal junction compared to 5 cm in the stoma group ( p < 0.001).
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278481_p22
|
PMC11278481
|
sec[2]/sec[3]/p[3]
|
3.4. Stoma Formation
| 4.148438 |
biomedical
|
Study
|
[
0.9521484375,
0.04693603515625,
0.0009665489196777344
] |
[
0.98876953125,
0.00858306884765625,
0.00133514404296875,
0.0014982223510742188
] |
The no-stoma group had lower preoperative T-staging compared to the stoma group ( p = 0.021), with less positive or threatened CRM on MRI ( p = 0.022), but there were no differences in pathological T- ( p = 0.164) or R-staging (5.4% vs. 5.1%, p = 1.000). The LOS was significantly shorter in the no-stoma group, with 4 days compared to 6 days in the stoma group ( p < 0.001). The readmission ( p = 0.309), reoperation ( p = 1.000), and complication (0.154) rates were comparable. The AL rate was comparable ( p = 0.081), with 8.1% (n = 3) in the no-stoma group, all of which were early leaks, compared to 21.4% (n = 21) in the stoma group, of which 71.4% were early and 28.6% were late leaks. Of the three leaks in the no-stoma group, one was an ISREC type B leak, and two were type C leaks. In the stoma group, 5 were classified as type A leaks, 11 as type B leaks, and 5 as type C leaks. No mortality was seen in either group ( p = 1.000).
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278481_p23
|
PMC11278481
|
sec[3]/p[0]
|
4. Discussion
| 4.082031 |
biomedical
|
Study
|
[
0.99072265625,
0.00908660888671875,
0.0004134178161621094
] |
[
0.9970703125,
0.0015497207641601562,
0.0008592605590820312,
0.000637054443359375
] |
This observational, retrospective, single-centre cohort study evaluated the institutional change from routine diversion to selective diversion in robotic TME surgery for mid- to low-rectal cancer. We found that the use of selective diversion did not lead to an increase in anastomotic leakage or complications.
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11278481_p24
|
PMC11278481
|
sec[3]/p[1]
|
4. Discussion
| 4.007813 |
biomedical
|
Study
|
[
0.9853515625,
0.0138092041015625,
0.0008344650268554688
] |
[
0.9970703125,
0.0021762847900390625,
0.00041866302490234375,
0.0004336833953857422
] |
Despite a more selective approach to diversion, the selective diversion group did not show a significantly higher rate of stoma-free survival at the end of follow-up. In the present study, the main reasons for delayed reversal were adjuvant treatment, complications, and the COVID-19 pandemic. Because of COVID-19 admissions and reduced theatre time, many patients treated in and after 2019 had delayed reversal of their stomas. This is confirmed in our subanalysis limiting cases to patients treated before 2019, in which the stoma closure rate between the two groups was comparable ( p = 0.081).
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278481_p25
|
PMC11278481
|
sec[3]/p[2]
|
4. Discussion
| 4.144531 |
biomedical
|
Study
|
[
0.99755859375,
0.002269744873046875,
0.0002627372741699219
] |
[
0.99853515625,
0.0005049705505371094,
0.0005927085876464844,
0.0001977682113647461
] |
A reoperation and/or intervention is often necessary when an AL occurs. In our study, the AL rate (including both early and late leaks and asymptomatic leaks on gastrografin imaging) varies between 11.8% and 17.8%, with the latter being in group B but not reaching statistical significance; hence, no hard conclusions can be drawn about this outcome. When a stoma is created, a gastrografin imaging study to evaluate the anastomosis is usually performed just prior to reversal. This may lead, due to the reasons mentioned above, to underreporting in the literature when only counting early leaks. More recent studies report both early and late leaks, and leakage rates of 20% appear to be realistic . Also, anastomotic leakage occurrence seems to be multi-factorial, with one of those factors being a distal staple line . In our study, the median tumour height lies between 5 and 7 centimetres from the anorectal junction, which would be considered a low- to mid-rectum tumour and can be a risk factor for AL. Lastly, a relatively large percentage of the patients included received adjuvant chemotherapy, which is known to influence the wound healing process and be a risk factor for leakages as well.
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278481_p26
|
PMC11278481
|
sec[3]/p[3]
|
4. Discussion
| 4.105469 |
biomedical
|
Study
|
[
0.99755859375,
0.0023040771484375,
0.0003268718719482422
] |
[
0.9990234375,
0.000553131103515625,
0.00043964385986328125,
0.00015306472778320312
] |
Another point of interest is the relatively low number of significant (ISREC class C) leaks in the entire study population. The robotic cohort had a total of eight leaks in 205 patients (3.9%), which is low compared to the internationally published literature for mid- to low-rectal cancers. The GRECCAR group reported clinical leaks in 55 out of 449 patients, of which 35 required a reoperation or radiological intervention (7.8%), which would correlate with a class C leak in the ISREC classification . It does need to be mentioned that the patient characteristics described in the GRECCAR group show a higher rate of T3, N1/2, and M1 tumours compared to the present group, as well as a higher preoperative chemoradiotherapy rate (69.5%). The difference in significant leak rates may also be due to the selective use of neoadjuvant chemoradiotherapy in our unit compared to other sites and the use of robotic surgery.
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278481_p27
|
PMC11278481
|
sec[3]/p[4]
|
4. Discussion
| 2.708984 |
biomedical
|
Study
|
[
0.91259765625,
0.0841064453125,
0.0035648345947265625
] |
[
0.9599609375,
0.035308837890625,
0.0016679763793945312,
0.0031528472900390625
] |
Furthermore, there was no difference in the overall complication rate between the groups, despite a more selective approach to stoma diversion. The fact that there were fewer stomas and less stapling in group B but no difference in complications supports the safety of a more selective approach.
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278481_p28
|
PMC11278481
|
sec[3]/p[5]
|
4. Discussion
| 4.117188 |
biomedical
|
Study
|
[
0.986328125,
0.0131378173828125,
0.0006618499755859375
] |
[
0.99462890625,
0.004230499267578125,
0.0005354881286621094,
0.00045609474182128906
] |
We performed a subanalysis within group B to compare the diverting stomas to the non-diverting stomas after the implementation of a more selective approach. The differences in baseline characteristics found here are consistent with the criteria for SD as described in the Methods section. Although there were significant differences in preoperative T- and CRM-staging, it should be mentioned that there were no significant differences in pathological T- and R-staging, which reduces the risk of bias for these variables. The non-stoma group in this subanalysis had a significantly shorter operative time and LOS than the stoma group. The no-stoma group did not experience significantly more readmissions, reoperations, complications, or mortality than the stoma group, which supports the safety and feasibility of averting a diverting stoma.
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278481_p29
|
PMC11278481
|
sec[3]/p[6]
|
4. Discussion
| 4.027344 |
biomedical
|
Other
|
[
0.990234375,
0.00884246826171875,
0.0007429122924804688
] |
[
0.257080078125,
0.68896484375,
0.048919677734375,
0.0048980712890625
] |
When establishing an anastomosis, technique and instruments are key. Using a circular stapler for the anastomosis will cause the lateral areas of the transverse staple line to stand out, commonly referred to as “dog ears”, which can be a potential site for postoperative anastomotic leaks due to tissue ischemia. Colorectal surgeons rely on linear and circular staplers for their anastomoses, and whilst most minimal access surgeons will accept two firings of a linear stapler, stapling in the lower pelvis can be challenging and can require up to four firings to achieve complete rectal division, which might also increase the risk of anastomotic leakage . It is hypothesised that robotic staplers can reduce the number of firings needed to transect the rectum .
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278481_p30
|
PMC11278481
|
sec[3]/p[7]
|
4. Discussion
| 4.105469 |
biomedical
|
Study
|
[
0.9931640625,
0.0063629150390625,
0.00038051605224609375
] |
[
0.99755859375,
0.0015249252319335938,
0.0005335807800292969,
0.0003561973571777344
] |
In the present study, most robotic stapler rectal transections (n = 63) were successfully completed with two firings, 14 with one firing, and 7 with three firings. After firing, we used the KHANS technique to reinforce these weak spots using interrupted sutures. Compared to the ROLARR trial, which is, to date, the only randomised controlled trial performed on robotic vs. laparoscopic rectal cancer surgery, our cohort seems to have improved conversion rates (0% vs. 8.1%) and LOS (6.0 vs. 8.0 days) .
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278481_p31
|
PMC11278481
|
sec[3]/p[8]
|
4. Discussion
| 4.003906 |
biomedical
|
Study
|
[
0.99755859375,
0.002216339111328125,
0.00027751922607421875
] |
[
0.99853515625,
0.0006966590881347656,
0.0004260540008544922,
0.00021207332611083984
] |
There are a few limitations to this study, including the selective enrolment of patients for selective diversion. We considered patients with poor functional and nutritional status, immunosuppression, and a poor response to chemoradiotherapy to be at high risk for anastomotic leak, and this technique was not employed in such patients. However, with increasing surgeon experience, even these patients may benefit from this technique. Another potential limitation is that we were unable to do any multivariate or regressive analyses due to the limited number of inclusions. Lastly, the reduction in firings needed for the anastomosis in group B could potentially introduce bias as well, with recent studies showing a correlation between the number of firings and AL, though no robotic cases were included in these studies .
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278481_p32
|
PMC11278481
|
sec[4]/p[0]
|
5. Conclusions
| 2.589844 |
biomedical
|
Other
|
[
0.96484375,
0.0273590087890625,
0.007659912109375
] |
[
0.0161590576171875,
0.97119140625,
0.010406494140625,
0.00226593017578125
] |
A more selective approach to stoma diversion does not lead to more complications or leaks and can be considered in the treatment of rectal cancer tumours.
|
[
"Rauand Duhoky",
"Guglielmo Niccolò Piozzi",
"Marieke L. W. Rutgers",
"Ioannis Mykoniatis",
"Najaf Siddiqi",
"Syed Naqvi",
"Jim S. Khan"
] |
https://doi.org/10.3390/jpm14070725
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278493_p0
|
PMC11278493
|
sec[0]/p[0]
|
1. Introduction
| 4.023438 |
biomedical
|
Review
|
[
0.98876953125,
0.00795745849609375,
0.0030269622802734375
] |
[
0.005252838134765625,
0.01306915283203125,
0.98046875,
0.0009708404541015625
] |
Coronary artery calcium (CAC) scoring assessed by computed tomography (CT) is a widely used and reproducible tool to guide risk stratification, as well as a powerful surrogate marker for cardiovascular disease (CVD) . The CAC score has been extensively validated as a strong predictor of coronary events, and its superiority to risk factor-based paradigms such as the Framingham Risk Score, and individual risk factors has been demonstrated . Therefore, the CAC score is recommended for the assessment of asymptomatic middle-aged populations, particularly intermediate-risk cohorts, by various cardiovascular society guidelines across the world .
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278493_p1
|
PMC11278493
|
sec[0]/p[1]
|
1. Introduction
| 3.898438 |
biomedical
|
Review
|
[
0.9970703125,
0.0019092559814453125,
0.001094818115234375
] |
[
0.0408935546875,
0.0023193359375,
0.95654296875,
0.0004208087921142578
] |
The clinical utility of CAC scoring extends beyond initial risk assessment. Several studies have highlighted the clinical significance of CAC progression as determined by serial CT scans, with CAC progression significantly correlating with a worse prognosis compared to CAC non-progression . Additionally, CAC progression has been linked to various traditional risk factors , some of which—such as smoking or hyperlipidemia—are modifiable; this implies that changes in these factors may impact CAC progression over time. Despite the clinical relevance of monitoring CAC progression, there remains limited evidence regarding its correlation with changes in risk factors. Consequently, current guidelines do not specify the optimal timing for follow-up CAC scanning.
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11278493_p2
|
PMC11278493
|
sec[0]/p[2]
|
1. Introduction
| 3.876953 |
biomedical
|
Review
|
[
0.998046875,
0.0012865066528320312,
0.0005207061767578125
] |
[
0.133056640625,
0.212646484375,
0.65283203125,
0.001682281494140625
] |
Understanding the dynamics of CAC progression concerning modifiable risk factors is crucial for enhancing clinical outcomes. Early identification and management of individuals at high risk for CVD may potentially decrease the incidence of adverse cardiac events. Moreover, optimizing the utilization of CAC scoring from a public health perspective could result in more efficient allocation of healthcare resources by targeting preventive measures to those who stand to benefit the most.
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278493_p3
|
PMC11278493
|
sec[0]/p[3]
|
1. Introduction
| 3.953125 |
biomedical
|
Study
|
[
0.9990234375,
0.0008244514465332031,
0.00034046173095703125
] |
[
0.9990234375,
0.0004820823669433594,
0.0002340078353881836,
0.00009679794311523438
] |
Therefore, we aimed to assess CAC progression according to changes in risk factors through serial CT measurements in asymptomatic individuals.
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278493_p4
|
PMC11278493
|
sec[1]/sec[0]/p[0]
|
2.1. Study Design and Participants
| 4.058594 |
biomedical
|
Study
|
[
0.9970703125,
0.0026302337646484375,
0.0003135204315185547
] |
[
0.9990234375,
0.000743865966796875,
0.0002624988555908203,
0.00017762184143066406
] |
Based on the health screening data registry of the Seoul National University Bundang Hospital (SNUBH) between January 2006 and December 2012, patients who underwent serial CAC scoring at least two times with more than one-year intervals were assessed. All individuals were asked whether they had chest pain or equivalent symptoms according to the WHO Rose angina questionnaire . Physicians subsequently determined asymptomatic individuals who were free of coronary artery disease based on the patients’ history, including the answers from the questionnaire. We excluded participants who had a history of myocardial infarction, stroke, percutaneous coronary intervention, or coronary artery bypass graft. Finally, we enrolled 448 self-referred asymptomatic individuals who had undergone serial CAC scoring at least two times with more than one-year intervals.
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278493_p5
|
PMC11278493
|
sec[1]/sec[1]/p[0]
|
2.2. Risk Factor Assessment
| 3.537109 |
biomedical
|
Study
|
[
0.9970703125,
0.0027866363525390625,
0.00029921531677246094
] |
[
0.998046875,
0.0012693405151367188,
0.0003750324249267578,
0.0002932548522949219
] |
Basic demographic data were acquired from a database maintained by the SNUBH Health Promotion Center. Medical history of myocardial infarction, angina, hypertension, stroke, diabetes mellitus (DM), family history of CVD (myocardial infarction or stroke history in first-degree relatives), current medication profile, and smoking status were systematically determined by personal interviews during the patients’ hospital visits for initial and follow-up CAC scans.
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999994 |
PMC11278493_p6
|
PMC11278493
|
sec[1]/sec[1]/p[1]
|
2.2. Risk Factor Assessment
| 4.128906 |
biomedical
|
Study
|
[
0.99755859375,
0.002223968505859375,
0.00016832351684570312
] |
[
0.998046875,
0.0012350082397460938,
0.0006012916564941406,
0.00025916099548339844
] |
Body weight and height were also recorded during their visits, and blood samples were collected and analyzed. We recorded the mean blood pressure (BP) after the measurement of the resting BP three times with the participant in a seated position. Hypertension was defined as a systolic/diastolic BP ≥ 140/90 mmHg, respectively, or the current use of antihypertensive medication. Lipid profiles, including total cholesterol and triglycerides, and fasting plasma glucose were measured with blood sampling obtained after a 12-h fast. DM was defined as a fasting blood glucose level ≥126 mg/dL or current antidiabetic treatment. Hyperlipidemia was defined as a total cholesterol concentration of ≥240 mg/dL or current treatment with lipid-lowering drugs . Current smoking was considered if the participant had smoked regularly during the previous 3 months.
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278493_p7
|
PMC11278493
|
sec[1]/sec[2]/p[0]
|
2.3. Data Acquisition
| 3.992188 |
biomedical
|
Study
|
[
0.998046875,
0.001953125,
0.00019681453704833984
] |
[
0.9375,
0.0601806640625,
0.0010614395141601562,
0.0014591217041015625
] |
CT data were acquired using 64-multidetector cardiac CT (Brilliance 64; Philips Medical Systems, Best, The Netherlands) with collimation of 64 × 0.625 mm and rotation time of 420 ms. CT scans used 120 kVp with variable mA according to the patient’s body weight and non-overlapping sections, with 2.5 mm slice thickness .
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278493_p8
|
PMC11278493
|
sec[1]/sec[2]/p[1]
|
2.3. Data Acquisition
| 4.125 |
biomedical
|
Study
|
[
0.998046875,
0.0017309188842773438,
0.00015628337860107422
] |
[
0.9970703125,
0.0016965866088867188,
0.0009660720825195312,
0.00030040740966796875
] |
Calcium scoring was calculated using the Agatson score with a threshold of 130 Hounsfield Units (HU), with only contiguous voxels totaling ≥1 mm 2 in the area on pre-contrast CT images. The score for an individual lesion was obtained by multiplying the lesion area with the density weighting factor determined by the maximum CT attenuation in the specified lesion. The density weighting factor was determined as follows: lesions with a peak attenuation of 130–199 HU were assigned a value of 1, those with a peak attenuation of 200–299 HU were assigned a value of 2, those with a peak attenuation of 300–399 HU were assigned a value of 3, and those with a peak attenuation value > 400 HU were assigned a value of 4 . The total Agatston score was the summed score of all coronary lesions. According to the initial CAC score, patients were categorized into three groups, as follows: zero-CAC (CAC = 0), low-CAC (0.1 ≤ CAC score ≤ 100), and high-CAC (CAC score > 100) groups.
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278493_p9
|
PMC11278493
|
sec[1]/sec[3]/p[0]
|
2.4. Statistical Analysis
| 3.855469 |
biomedical
|
Study
|
[
0.99951171875,
0.0004067420959472656,
0.00016760826110839844
] |
[
0.99658203125,
0.0026702880859375,
0.0005407333374023438,
0.0001220703125
] |
Continuous parameters are presented as mean ± SD, and nominal or ordinal parameters are given as n (%). Continuous parameters among the three groups classified according to the initial CAC score were compared using one-way analysis of variance (ANOVA) with Scheffe’s post hoc test, whereas nominal data were evaluated using the chi-square or Fisher’s exact test.
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278493_p10
|
PMC11278493
|
sec[1]/sec[3]/p[1]
|
2.4. Statistical Analysis
| 4.078125 |
biomedical
|
Study
|
[
0.99853515625,
0.00106048583984375,
0.00017523765563964844
] |
[
0.99853515625,
0.0007653236389160156,
0.0004780292510986328,
0.00012564659118652344
] |
Annualized progression of the CAC score (ΔCAC/year) was calculated as the last CAC score minus the initial CAC score divided by the time between the initial and last CAC scan. The group with an initial CAC score of zero was divided into two groups by examining the changes in the follow-up CAC scan: a group with continuous zero CAC scores (zero-CAC last ) and a group with new calcium (new-CAC last ). Those with calcium present on the initial CT scan were divided into two groups based on an annual CAC increase of more than 20 (ΔCAC/year > 20). Differences between two groups were analyzed using Student’s t -test for continuous data and the chi-square test for nominal or ordinal data.
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278493_p11
|
PMC11278493
|
sec[1]/sec[3]/p[2]
|
2.4. Statistical Analysis
| 3.373047 |
biomedical
|
Study
|
[
0.99951171875,
0.00029921531677246094,
0.00039124488830566406
] |
[
0.99853515625,
0.0011911392211914062,
0.00028586387634277344,
0.00010335445404052734
] |
Finally, univariate and multivariate logistic regression analyses were assessed for independent predictors of ΔCAC/year > 20. SPSS 17.0 package (SPSS Inc., Chicago, IL, USA) was used for all statistical analyses, and a p -value < 0.05 was regarded as statistically significant.
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278493_p12
|
PMC11278493
|
sec[2]/sec[0]/p[0]
|
3.1. Basic Demographics of Enrolled Asymptomatic Individuals
| 4.105469 |
biomedical
|
Study
|
[
0.99853515625,
0.00139617919921875,
0.00024890899658203125
] |
[
0.9990234375,
0.00028443336486816406,
0.0003581047058105469,
0.00013303756713867188
] |
A total of 448 asymptomatic individuals underwent serial CAC scans two times, with an interval of more than one year. The initial CAC scores ranged from 0 to 758.3. Among them, the initial CAC score was zero in 336 patients (75.0%). The low-CAC group comprised 70 individuals (15.6%) with a CAC score of 31.6 ± 26.7, whereas 42 individuals (9.4%) with a mean CAC score of 250.6 ± 190.3 belonged to the high-CAC group. Table 1 summarizes the baseline demographic characteristics and risk factors of the study population in the three groups, classified according to the initial CAC score. Hypertension prevalence significantly increased according to the initial CAC score. Other demographic parameters—including age, prevalence of male sex, the presence of DM and hyperlipidemia, as well as statin and aspirin medication use—were significantly higher in the low- and high-CAC groups than in the zero-CAC group (all p < 0.05). However, these parameters were not significantly different between the low-CAC and high-CAC groups. Overall, the number of risk factors was higher in groups with CAC presence (low-CAC and high-CAC group) than in that with CAC absence (zero-CAC group).
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278493_p13
|
PMC11278493
|
sec[2]/sec[1]/p[0]
|
3.2. CAC Progression and Changes in Risk Factors during Follow-Up
| 4.128906 |
biomedical
|
Study
|
[
0.9970703125,
0.0028533935546875,
0.0002593994140625
] |
[
0.99853515625,
0.0007009506225585938,
0.0005249977111816406,
0.00021374225616455078
] |
During the mean 3.5 ± 1.3 years of follow-up (range 1.0–7.5 years), the mean annual progression in CAC score was 10.0 ± 29.6. The ΔCAC/year was >10 in 87 patients (19.4%), whereas ΔCAC/year was >20 in 61 patients (13.6%). The degree of annual CAC progression was significantly higher in the group with a higher initial CAC score ( p < 0.001).
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999994 |
PMC11278493_p14
|
PMC11278493
|
sec[2]/sec[1]/p[1]
|
3.2. CAC Progression and Changes in Risk Factors during Follow-Up
| 4.011719 |
biomedical
|
Study
|
[
0.9970703125,
0.0024318695068359375,
0.0003666877746582031
] |
[
0.9990234375,
0.0005040168762207031,
0.0003273487091064453,
0.00017154216766357422
] |
During the follow-up period, hypertension, DM, and hyperlipidemia were newly diagnosed in 14 individuals (3.1%), 7 individuals (1.6%), and 31 individuals (6.9%), respectively. In the smoking status survey, 22 individuals (4.9%) quit smoking, whereas 6 individuals (1.3%) started smoking. These new risk factors were more frequently recorded in the group with CAC presence than in that with CAC absence in the initial CAC scan. Table 2 presents CAC progression and changes in risk factors during the follow-up period among the three groups, classified according to the initial CAC score.
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278493_p15
|
PMC11278493
|
sec[2]/sec[2]/p[0]
|
3.3. Comparison of Changes in CAC Scores and Risk Factors in the Initial Zero-CAC Group: Zero-CAC last vs. New-CAC last
| 3.837891 |
biomedical
|
Study
|
[
0.99658203125,
0.002960205078125,
0.00035381317138671875
] |
[
0.998046875,
0.0013427734375,
0.0002887248992919922,
0.00024068355560302734
] |
Of the 336 individuals with an initial CAC score of zero, 43 individuals (12.8%) developed coronary artery calcifications during follow-up (new-CAC last group), whereas the remaining 293 individuals (87.2%) did not develop coronary artery calcifications (zero-CAC last group).
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278493_p16
|
PMC11278493
|
sec[2]/sec[2]/p[1]
|
3.3. Comparison of Changes in CAC Scores and Risk Factors in the Initial Zero-CAC Group: Zero-CAC last vs. New-CAC last
| 4.066406 |
biomedical
|
Study
|
[
0.99658203125,
0.0031909942626953125,
0.00036644935607910156
] |
[
0.9990234375,
0.00061798095703125,
0.00032806396484375,
0.0001894235610961914
] |
Table 3 compares the changes in CAC scores and risk factors between these two groups. Age, body mass index (BMI), and hyperlipidemia prevalence were significantly higher in the new-CAC last group than in the zero-CAC last group (all p < 0.05). During follow-up, hypertension developed significantly more frequently in the new-CAC last group; therefore, the prevalence rates of hypertension and hyperlipidemia at the time of the final CAC scan were higher in the new-CAC last group than in the zero-CAC last group (all p < 0.05).
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278493_p17
|
PMC11278493
|
sec[2]/sec[3]/p[0]
|
3.4. Comparison of Changes in CAC Scores and Risk Factors in the Group with Initial CAC Presence: Rapidly vs. Slowly Progressing-CAC Groups
| 4.136719 |
biomedical
|
Study
|
[
0.9970703125,
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[
0.99853515625,
0.0005893707275390625,
0.00043964385986328125,
0.0002008676528930664
] |
Among the 112 patients with CAC presence in the initial scan, 60 patients had rapid progression in CAC changes, with ΔCAC/year > 20; and 52 patients had slow progression, with ΔCAC/year ≤ 20. Table 4 compares the changes in CAC scores and risk factors between these two groups. BMI and prevalence of statin medication were higher in the rapidly progressing-CAC group than in the slowly progressing-CAC group (both p < 0.05). Likewise, the prevalence rates of newly developed hypertension and current smoking were higher in the rapidly progressing-CAC group than in the slowly progressing-CAC group (both p < 0.05). The initial CAC score was also higher in the rapidly progressing-CAC group than in the slowly progressing-CAC group (178.9 ± 190.5 vs. 38.5 ± 44.2, respectively; p < 0.001).
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278493_p18
|
PMC11278493
|
sec[2]/sec[4]/p[0]
|
3.5. Predictors of Rapid CAC Progression
| 4.101563 |
biomedical
|
Study
|
[
0.9990234375,
0.0006227493286132812,
0.00017976760864257812
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[
0.9990234375,
0.0002815723419189453,
0.0005750656127929688,
0.00010710954666137695
] |
Table 5 shows the results of univariate and multivariate logistic regression analyses for the predictors of rapid CAC progression in asymptomatic adults. Based on univariate analysis, the parameters of age, male sex, BMI, and all risk factors including hypertension, DM, hyperlipidemia, current smoking, and family history of CVD were significantly associated with rapid CAC progression, defined as △CAC/year > 20 (all p < 0.05). Variables associated with a p -value < 0.05 in the univariate analysis were included in the multivariate regression. Using multivariate analysis, strong predictors for rapid CAC progression were the presence of hypertension at the time of the last CAC scan (odds ratio [OR] 11.3; 95% confidence interval [CI] 1.33, 95.42) and the initial CAC score (OR 1.05; 95% CI 1.04, 1.07).
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11278493_p19
|
PMC11278493
|
sec[3]/p[0]
|
4. Discussion
| 4.136719 |
biomedical
|
Study
|
[
0.9990234375,
0.0010080337524414062,
0.00019848346710205078
] |
[
0.99853515625,
0.00036787986755371094,
0.0007586479187011719,
0.0001494884490966797
] |
This study evaluated CAC progression according to changes in risk factors based on serial CTs to calculate the Agatston score in asymptomatic individuals. The main findings of the study were as follows: (1) At the time of the initial CAC scan, the parameters of age, prevalence of male sex, and all risk factors were significantly higher in the group with CAC presence than in the no-CAC group; (2) during the mean 3.5 ± 1.3 years of follow-up, 43 (12.8%) of 336 individuals with an initial CAC score of zero developed coronary artery calcifications, and 60 (53.6%) of the 112 individuals with initial CAC presence showed rapid annual CAC progression of more than 20; (3) new-onset hypertension is more frequently noted in the new-CAC last group compared to in the zero-CAC last group in the initial zero-CAC group, while newly developed hypertension and smoking were higher in the rapidly progressing-CAC group than in the slowly progressing-CAC group in the initial CAC presence group; (4) Age, male sex, BMI, and all risk factors were significantly associated with ΔCAC/year > 20, but recently diagnosed hypertension (OR, 11.3) and initial CAC score (OR, 1.05) were significant independent predictors in multivariate regression analyses. This suggests that patients with higher initial CAC scores may benefit from more frequent follow-up scans compared to patients with lower initial scores. This also suggests that continuously checking the changes in risk factors is important, because most risk factors are modifiable and dynamic in response to treatment.
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278493_p20
|
PMC11278493
|
sec[3]/p[1]
|
4. Discussion
| 4.109375 |
biomedical
|
Study
|
[
0.99853515625,
0.0010919570922851562,
0.00021088123321533203
] |
[
0.9990234375,
0.00036454200744628906,
0.0005130767822265625,
0.00012671947479248047
] |
Our study was motivated by the lack of guideline-supported recommendations for repeat CAC scans, although an increase in CAC score on serial scans is a well-known and strong predictor of CVD and worse survival rates . Regarding the natural progression of CAC in asymptomatic populations with an initial CAC score of zero, limited prior studies have suggested not to repeat scans for at least 4–5 years because asymptomatic populations have a low incidence of CAC progression within 5 years . Similarly, we observed a minimal increase (0.6 ± 2.7) in CAC score in the initial zero-CAC group during a mean follow-up of 3.5 years. However, considering that the rate of new-onset hypertension was higher in the new-CAC last group than in the zero-CAC last group, an interval of 4–5 years between the next follow-up CAC scans is sufficient when the initial CAC is zero, but it seems desirable to conduct a faster follow-up test when a new risk factor occurs.
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278493_p21
|
PMC11278493
|
sec[3]/p[2]
|
4. Discussion
| 4.066406 |
biomedical
|
Study
|
[
0.99951171875,
0.0005211830139160156,
0.00016176700592041016
] |
[
0.99755859375,
0.0002779960632324219,
0.001995086669921875,
0.0001118779182434082
] |
Meanwhile, few studies have examined the natural progression of CAC in populations with an initial CAC score above zero, and no information exists on the optimal timing for follow-up scans in this population . Based on several studies , it is evident that individuals with higher initial CAC scores tend to exhibit more rapid CAC progression over time. This finding is supported by the fact that persons with higher initial CAC scores have a higher risk of developing atherosclerosis and, hence, experience more pronounced CAC progression over time. Our study also demonstrated that the initial CAC score is one of the independent predictors for CAC progression, even after adjusting for traditional risk factors. Accordingly, the optimal timing and frequency of follow-up scans for this population should be decided based on their initial CAC score. Therefore, patients with pre-existing calcium in their coronary arteries should undergo follow-up CAC scans at intervals of no more than 3 years, to monitor CAC progression. However, due to the retrospective single-center study, it does not establish standardized guidelines for follow-up CAC.
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278493_p22
|
PMC11278493
|
sec[3]/p[3]
|
4. Discussion
| 4.054688 |
biomedical
|
Study
|
[
0.99951171875,
0.00037407875061035156,
0.00016891956329345703
] |
[
0.99853515625,
0.00022089481353759766,
0.0013437271118164062,
0.00008767843246459961
] |
Previous studies have demonstrated that traditional risk factors—such as age, male sex, BMI, hypertension, DM, hyperlipidemia, current smoking, and family history of CVD—are associated with the presence and degree of CAC progression , which is consistent with our results. Furthermore, Lehmann et al. reported that recent risk factors assessed at the last follow-up—rather than initial risk factors—are the more influential predictors for coronary and cardiovascular event rates. Our study also demonstrates that new-onset hypertension and smoking was associated with rapid progression of CAC. This means that recent health conditions have the greatest impact on CAC progression because most clinical risk factors improve or worsen depending on lifestyle changes or medical treatment. Therefore, regular health checkups and risk factor control may be helpful for slowing down CAC progression.
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278493_p23
|
PMC11278493
|
sec[3]/p[4]
|
4. Discussion
| 4.042969 |
biomedical
|
Study
|
[
0.99951171875,
0.00033402442932128906,
0.00016176700592041016
] |
[
0.998046875,
0.0002493858337402344,
0.0013828277587890625,
0.00008803606033325195
] |
Regarding medications, the effectiveness of lipid-lowering drugs—such as statins—in slowing the CAC progression rate has been a topic of considerable interest. While initial studies showed that CAC regressed with statin therapy, more recent data showed the opposite . That is, recent studies have reported persistent CAC progression despite intensive lipid-lowering therapy . Our study also identified statin medication as one of the independent predictors for CAC progression. This can be explained by the ‘calcium paradox’ concept of improved clinical outcome despite plaque progression when plaque progression is characterized by a predominant increase in dense calcium and plaque stabilization .
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278493_p24
|
PMC11278493
|
sec[3]/p[5]
|
4. Discussion
| 3.953125 |
biomedical
|
Review
|
[
0.9990234375,
0.0007476806640625,
0.0003490447998046875
] |
[
0.26708984375,
0.01482391357421875,
0.71728515625,
0.0009775161743164062
] |
In terms of radiation exposure, the radiation dose of a CAC scan varied depending on the CAC scan protocol, the size of the individual’s heart, and CT equipment; but the average CAC scan has a radiation dose of 0.2–1 mSv, which is very low compared to contrast-enhanced coronary CT angiography (3–8 mSv). Therefore, CAC scans are recommended by the American Heart Association and the European Society of Cardiology as a screening tool for asymptomatic individuals. However, CAC scans are limited in assessing coronary artery stenosis and vulnerable plaques, which are composed of non-calcified lipid components. Therefore, early identification of rapid progression of CAC on serial CT scans offers an opportunity to highlight individuals with suspected coronary artery disease for a comprehensive CVD evaluation. This can facilitate early treatment for patients with coronary artery disease.
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278493_p25
|
PMC11278493
|
sec[3]/p[6]
|
4. Discussion
| 4.007813 |
biomedical
|
Study
|
[
0.99951171875,
0.0003666877746582031,
0.00019562244415283203
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[
0.9990234375,
0.00024580955505371094,
0.0004673004150390625,
0.0000813603401184082
] |
Our study has several limitations. First, our study has no information on cardiovascular events, as we aimed to assess CAC progression in relation to changes in risk factors. Second, we assessed major traditional risk factors such as hypertension and DM but did not include novel risk factors such as C-reactive protein or lipid profiles. Although there are no conclusive findings regarding their specific value for CAC progression, a prospective study would be needed to analyze more risk factors. Finally, as this is a single-center retrospective study using a single type of scanner, the generalizability of our findings to other populations and imaging settings may be limited. Hence, large-scale, multicenter, multivendor studies are needed to validate our results.
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11278493_p26
|
PMC11278493
|
sec[3]/p[7]
|
4. Discussion
| 3.380859 |
biomedical
|
Other
|
[
0.9990234375,
0.00040268898010253906,
0.0007147789001464844
] |
[
0.239501953125,
0.7080078125,
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0.0010318756103515625
] |
Future research should focus on validating whether repetitive CAC scanning can indeed reduce CVD incidence and mortality rates. Additionally, advancements in imaging techniques are necessary to decrease the cumulative radiation dose from repetitive CAC scanning.
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278493_p27
|
PMC11278493
|
sec[3]/p[8]
|
4. Discussion
| 4.058594 |
biomedical
|
Study
|
[
0.99853515625,
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] |
[
0.9970703125,
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] |
In conclusion, our study showed that CAC progression was affected by demographic and traditional risk factors; but adjusting for these factors, recently diagnosed risk factors and the initial CAC score were the most influential factors for rapid CAC progression. This suggests that patients with higher initial CAC scores may benefit from more frequent follow-up scans and need continuous checks regarding changes in risk factors. Although our retrospective single-center study is limited in establishing clear guidelines, it is likely that individuals with zero CAC may not require follow-up for at least 4 years, while those with presence of CAC should be monitored at intervals shorter than 3 years. Furthermore, more frequent follow-up CAC scans may be needed when new risk factors develop. This personalized approach to follow-up could help optimize the timing of repeat scans and facilitate early detection and management of CVD.
|
[
"Jin-Young Yoo",
"Se-Ri Kang",
"Eun-Ju Chun"
] |
https://doi.org/10.3390/jpm14070757
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278505_p0
|
PMC11278505
|
sec[0]/p[0]
|
1. Introduction
| 3.992188 |
biomedical
|
Study
|
[
0.99951171875,
0.0003371238708496094,
0.00031566619873046875
] |
[
0.5849609375,
0.0052337646484375,
0.4091796875,
0.0005440711975097656
] |
Oropharyngeal squamous cell carcinoma (OPSCC) is one of the most frequent and fastest-growing head and neck cancers (HNCs). Infection with high-risk human papillomavirus (HPV), particularly type 16, has been recognized as a risk factor in this type of cancer , as well as tobacco and alcohol consumption . In addition, many studies suggest that although both HPV-positive and HPV-negative OPSCCs refer to the same anatomical location, they demonstrate several biological and clinical differences . Consequently, the HPV status of the patient affects and determines not only the diagnosis but the therapy and the follow-up plan as well.
|
[
"Efstathia Petrou",
"Konstantinos Chatzipapas",
"Panagiotis Papadimitroulas",
"Gustavo Andrade-Miranda",
"Paraskevi F. Katsakiori",
"Nikolaos D. Papathanasiou",
"Dimitris Visvikis",
"George C. Kagadis"
] |
https://doi.org/10.3390/jpm14070737
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278505_p1
|
PMC11278505
|
sec[0]/p[1]
|
1. Introduction
| 3.947266 |
biomedical
|
Study
|
[
0.99951171875,
0.0003590583801269531,
0.00029015541076660156
] |
[
0.55859375,
0.017425537109375,
0.423095703125,
0.0006670951843261719
] |
Regarding the conventional treatment of OPSCC, surgery, radiotherapy, chemotherapy, and immunotherapy are the main options and are performed individually or in combination, depending on the TNM (Tumor Nodes Metastasis) class and the primary site. When it comes to the detection of HPV infection, the in situ hybridization (ISH) of viral DNA, HPV DNA, or RNA PCR and immunohistochemical (IHC) investigation for p16 overexpression are the most common methods . However, in cases of the latter, the testing requires a biopsy sample, which makes the procedure invasive, and thus, patients can be exposed to surgery-related complications and risks . As a result, there is a great need for non-invasive, yet accurate methods for the detection of the HPV infection.
|
[
"Efstathia Petrou",
"Konstantinos Chatzipapas",
"Panagiotis Papadimitroulas",
"Gustavo Andrade-Miranda",
"Paraskevi F. Katsakiori",
"Nikolaos D. Papathanasiou",
"Dimitris Visvikis",
"George C. Kagadis"
] |
https://doi.org/10.3390/jpm14070737
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278505_p2
|
PMC11278505
|
sec[0]/p[2]
|
1. Introduction
| 3.96875 |
biomedical
|
Study
|
[
0.99951171875,
0.0002818107604980469,
0.00042366981506347656
] |
[
0.81396484375,
0.04449462890625,
0.140869140625,
0.00055694580078125
] |
Due to tumor heterogeneity, which is a very common prognostic factor in HNC cases, a personalized treatment plan is deemed necessary to improve the survival rate and minimize possible side effects . In recent years, radiomics has emerged as a potential alternative tool and has attracted a lot of attention . It is a field of computational medicine that allows the automated high-throughput extraction of excessive amounts of quantitative features from two-dimensional or three-dimensional medical images, which can be combined with different pathology and molecular biomarkers, to evaluate the state of a tumor with great accuracy and create a personalized diagnosis and treatment plan for patients . For the analysis of such data, artificial intelligence (AI) techniques are usually employed such as machine learning (ML) algorithms.
|
[
"Efstathia Petrou",
"Konstantinos Chatzipapas",
"Panagiotis Papadimitroulas",
"Gustavo Andrade-Miranda",
"Paraskevi F. Katsakiori",
"Nikolaos D. Papathanasiou",
"Dimitris Visvikis",
"George C. Kagadis"
] |
https://doi.org/10.3390/jpm14070737
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278505_p3
|
PMC11278505
|
sec[0]/p[3]
|
1. Introduction
| 3.1875 |
biomedical
|
Other
|
[
0.99169921875,
0.0025463104248046875,
0.0059661865234375
] |
[
0.0079345703125,
0.9794921875,
0.0119781494140625,
0.000640869140625
] |
Over the past decade, increases in computational power and memory have led AI to significant strides in transforming the landscape of healthcare and medicine, using technologies that empower machines to interpret, analyze, and learn from complex medical data, leading to more accurate and efficient decision-making processes . These technologies include ML, neural networks (NNs), and Deep Learning (DL).
|
[
"Efstathia Petrou",
"Konstantinos Chatzipapas",
"Panagiotis Papadimitroulas",
"Gustavo Andrade-Miranda",
"Paraskevi F. Katsakiori",
"Nikolaos D. Papathanasiou",
"Dimitris Visvikis",
"George C. Kagadis"
] |
https://doi.org/10.3390/jpm14070737
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278505_p4
|
PMC11278505
|
sec[0]/p[4]
|
1. Introduction
| 4.136719 |
biomedical
|
Study
|
[
0.9990234375,
0.0005545616149902344,
0.0002551078796386719
] |
[
0.9990234375,
0.00022149085998535156,
0.0005502700805664062,
0.00008052587509155273
] |
The aim of the present study was to develop alternative and non-invasive approaches that analyze computed tomography (CT) data and radiomic features to classify the HPV status of patients with HNC. Usually, such classification is performed using and combining microscopic diagnosis methods results (Immunohistochemistry—IHC, in situ hybridization—ISH, Polymerase Chain Reaction—PCR), which are time consuming and add stress to the diagnosis procedure. The proposed approach aims to exploit additional imaging data, such as CT scans from patients, to support clinicians toward HPV detection. Initially, CT data were used to train a modified Residual Network with 18 layers (ResNet-18) to predict the HPV status, and secondly, 15 radiomic features were extracted from a ROI near the oropharynx and were utilized to train four different ML classifiers, aiming to achieve the same result. Various metrics were implemented to evaluate the performance of each model. Furthermore, the Weighted Ensemble method was employed on the predictions to combine the CT-based model with one of the radiomics-based models, to create improved predictions, and to calculate corresponding metrics. Finally, the predictive value of each technique was investigated to highlight the main challenges and to reach conclusions concerning the possibility of including such models in clinical routine as a supplementary tool for clinicians.
|
[
"Efstathia Petrou",
"Konstantinos Chatzipapas",
"Panagiotis Papadimitroulas",
"Gustavo Andrade-Miranda",
"Paraskevi F. Katsakiori",
"Nikolaos D. Papathanasiou",
"Dimitris Visvikis",
"George C. Kagadis"
] |
https://doi.org/10.3390/jpm14070737
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278505_p5
|
PMC11278505
|
sec[1]/p[0]
|
2. Materials and Methods
| 1.939453 |
biomedical
|
Study
|
[
0.974609375,
0.01336669921875,
0.01224517822265625
] |
[
0.64111328125,
0.340087890625,
0.015045166015625,
0.004032135009765625
] |
For completeness, the flowchart of the complete procedure is included in Figure 1 .
|
[
"Efstathia Petrou",
"Konstantinos Chatzipapas",
"Panagiotis Papadimitroulas",
"Gustavo Andrade-Miranda",
"Paraskevi F. Katsakiori",
"Nikolaos D. Papathanasiou",
"Dimitris Visvikis",
"George C. Kagadis"
] |
https://doi.org/10.3390/jpm14070737
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278505_p6
|
PMC11278505
|
sec[1]/sec[0]/p[0]
|
2.1. Patient Dataset
| 4.054688 |
biomedical
|
Study
|
[
0.9990234375,
0.0008778572082519531,
0.00028896331787109375
] |
[
0.99951171875,
0.00036597251892089844,
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0.0000947713851928711
] |
From the HECKTOR database , fifty (50) CT data that referred to patients with histopathologically confirmed oropharyngeal HNC who underwent treatment planning involving radiation therapy and/or chemotherapy were included in the study. The dataset includes FDG-PET and low-dose non-contrast-enhanced CT images that were acquired through combined PET/CT scanners, focusing on the HNC region, as well as the gross tumor volume (GTV) mask. In our study, we only used the CT data. In addition, as shown in Table 1 , there is also patient-specific information including positioning details, age, gender, primary tumor site, TNM stage, overall stage, HPV status, and the possibility of chemotherapy as an additional treatment after radiation therapy. In addition, the data are sourced from three different clinical centers to ensure multi-centric variability on the used dataset, being able to not overparameterize the proposed models on a specific clinical system. More specifically, those centers are as follows: Hôpital Général Juif (CHGJ) in Montréal, QC, Canada ( n = 12); Centre Hospitalier Universitaire de Sherbooke (CHUS), Sherbrooke, Canada ( n = 19); Centre Hospitalier Universitaire de Poitiers (CHUP), Poitiers, France ( n = 19).
|
[
"Efstathia Petrou",
"Konstantinos Chatzipapas",
"Panagiotis Papadimitroulas",
"Gustavo Andrade-Miranda",
"Paraskevi F. Katsakiori",
"Nikolaos D. Papathanasiou",
"Dimitris Visvikis",
"George C. Kagadis"
] |
https://doi.org/10.3390/jpm14070737
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278505_p7
|
PMC11278505
|
sec[1]/sec[0]/p[1]
|
2.1. Patient Dataset
| 3.703125 |
biomedical
|
Study
|
[
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0.00041794776916503906,
0.0004203319549560547
] |
[
0.998046875,
0.0017824172973632812,
0.00019752979278564453,
0.00009554624557495117
] |
In Table 1 , we analytically present the dataset used during the training and validation process of our models. The choice of data, as well as the pre-processing, aimed to create a heterogeneous and harmonized dataset. This dataset would not be limited to specific types of data, but a wider independent selection. That being said, the dataset would be independent of the hospital, or the system used, as well as independent of the status of the patient. Hybrid PET/CT scanners, Discovery ST by GE Healthcare (Chicago, Illinois, United States) for the CHGJ, GeminiGXL 16 by Philips (Amsterdam, Netherlands) for the CHUS, and Biograph mCT 40 ToF by Siemens (Erlangen, Germany) for the CHUP, were used for image acquisition. Data augmentation including a larger population of patients would improve the performance of the proposed models.
|
[
"Efstathia Petrou",
"Konstantinos Chatzipapas",
"Panagiotis Papadimitroulas",
"Gustavo Andrade-Miranda",
"Paraskevi F. Katsakiori",
"Nikolaos D. Papathanasiou",
"Dimitris Visvikis",
"George C. Kagadis"
] |
https://doi.org/10.3390/jpm14070737
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278505_p8
|
PMC11278505
|
sec[1]/sec[1]/p[0]
|
2.2. Radiomic Features Extraction and Selection
| 4.058594 |
biomedical
|
Study
|
[
0.9990234375,
0.0007333755493164062,
0.00020051002502441406
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[
0.99853515625,
0.0011806488037109375,
0.0002701282501220703,
0.00022399425506591797
] |
CT data were organized in an NIfTI format for convenient data management. 3D Slicer , which is a free and open-source software platform used for medical image processing and visualization, was used for radiomics extraction. 3D Slicer’s segmentation tools, and more specifically, the segment editor, was used to manually delineate regions of interest (ROIs) that needed to be analyzed. In this case, the ROI was the wider area of the oropharynx, and the segmentation was performed on ten slices and for every patient in the dataset. Those ten slices were chosen from the area of HNC, based on the malignancy, as well as on the probable position of lymph nodes. The area was not segmented in detail, but in a wider cubic region of interest (ROI), aiming to develop a method that will save time from clinicians using fixed ROIs . In Figure 3 , CT slices from an HPV-positive and an HPV-negative patient are presented. As shown in Figure 2 , the manual segmentation of the ROI was performed in one of the ten slices of these patients.
|
[
"Efstathia Petrou",
"Konstantinos Chatzipapas",
"Panagiotis Papadimitroulas",
"Gustavo Andrade-Miranda",
"Paraskevi F. Katsakiori",
"Nikolaos D. Papathanasiou",
"Dimitris Visvikis",
"George C. Kagadis"
] |
https://doi.org/10.3390/jpm14070737
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278505_p9
|
PMC11278505
|
sec[1]/sec[1]/p[1]
|
2.2. Radiomic Features Extraction and Selection
| 4.011719 |
biomedical
|
Study
|
[
0.99951171875,
0.00017559528350830078,
0.00033473968505859375
] |
[
0.92626953125,
0.06396484375,
0.00931549072265625,
0.0003867149353027344
] |
Furthermore, a radiomics extension of 3D Slicer named SlicerRadiomics, which encapsulates a Python package (v3.7.0) commonly used for radiomics analysis, called PyRadiomics , was utilized. Feature extraction within SlicerRadiomics involves utilizing algorithms and techniques to analyze medical data from different medical images, like CT and MRI scans. These methods identify and quantify characteristics like texture, shape, and intensity in the images, employing filters, segmentation, and statistical analysis. The extracted features can provide valuable information for tasks such as disease characterization, classification, treatment response evaluation, and outcome prediction.
|
[
"Efstathia Petrou",
"Konstantinos Chatzipapas",
"Panagiotis Papadimitroulas",
"Gustavo Andrade-Miranda",
"Paraskevi F. Katsakiori",
"Nikolaos D. Papathanasiou",
"Dimitris Visvikis",
"George C. Kagadis"
] |
https://doi.org/10.3390/jpm14070737
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |