Global epidemiology of mental disorder in atrial fibrillation between 1998-2021: A systematic review and meta-analysis.

BACKGROUND: As the burden of mental disorders among patients with atrial fibrillation (AF) increases, researchers are beginning to pay close attention to the risk and prevalence of these comorbidities. Although studies have independently analyzed the risk of comorbidity with depression and anxiety in patients with AF, no study has systematically focused on the global epidemiology of these two mental disorders. AIM: To explore the prevalence of depression and anxiety in patients with AF. METHODS: Five databases were searched from their date of establishment until January 2023. Observational studies reporting the comorbidity of AF with depression and anxiety, were included in this study. Basic information, such as the first author/ publication year, study year, study type, and prevalence of depression and anxiety, were extracted. STATA SE 15.1 was used to analyze the data. Subgroup, meta-regression, and sensitivity analyses were performed to estimate study heterogeneity. RESULTS: After a thorough search, 26 studies were identified and included in this meta-analysis. The prevalence rates of depression and anxiety in adults with AF were 24.3% and 14.5%, respectively. Among adult males with AF, the prevalence was 11.7% and 8.7%, respectively, whereas in females it was 19.8% and 10.1%, respectively. In older adults with AF, the prevalence rates of depression and anxiety were 40.3% and 33.6%, respectively. The highest regional prevalence of depression and anxiety was observed in European (30.2%) and North American (19.8%) patients with AF. CONCLUSION: In this study, we found that the prevalence of depression and anxiety among patients with AF varies with sex, region, and evaluation scales, suggesting the need for psychological interventions for patients with AF in clinical practice.

Corrigendum: Expanded CURB-65: a new score system predicts severity of community-acquired pneumonia with superior efficiency.

This corrects the article DOI: 10.1038/srep22911.

Micropapillary: A component more likely to harbour heterogeneous EGFR mutations in lung adenocarcinomas.

The micropapillary (MP) subtype has recently been established to be a distinct marker of poor prognosis in lung adenocarcinomas (LACs). According to the 2015 WHO classification system, LAC constituents are required to be precisely reported. T790M mutation and an insertion in exon 20 (E20ins) are associated with EGFR-TKI resistance. A total of 211 LAC patients were involved in this study, and EGFR mutations were determined using an amplification refractory mutation system (ARMS). Sex, smoking history, lymph node status, and clinical stage differed significantly between the EGFR wild type and mutant groups (p < 0.05). The EGFR mutation occurred more frequently in female, non-smokers, ACs with papillary (85.7%) or MP components (91.4%) (p < 0.001). Twenty ACs with naïve T790M or E20ins were microdissected. The AC constituents metastasizing to lymph nodes exhibited a phenotype and EGFR status that was consistent with the primary loci constituents. Glomerulus-like solid components exhibited the same EGFR status as the surrounding T790M-mutated MP components. The MP and glomerulus-like portions in AC tumours exhibited a congenial EGFR status, but the acinar cells with papillary cells were heterogeneous. The naïve T790M mutants, although minor in the MP component, dramatically increased after EGFR-TKI therapy and indicate that the MP components feature intrinsic heterogeneity.

Expanded CURB-65: a new score system predicts severity of community-acquired pneumonia with superior efficiency.

Aim of this study was to develop a new simpler and more effective severity score for community-acquired pneumonia (CAP) patients. A total of 1640 consecutive hospitalized CAP patients in Second Affiliated Hospital of Zhejiang University were included. The effectiveness of different pneumonia severity scores to predict mortality was compared, and the performance of the new score was validated on an external cohort of 1164 patients with pneumonia admitted to a teaching hospital in Italy. Using age ≥ 65 years, LDH > 230 u/L, albumin < 3.5 g/dL, platelet count < 100 × 10(9)/L, confusion, urea > 7 mmol/L, respiratory rate ≥ 30/min, low blood pressure, we assembled a new severity score named as expanded-CURB-65. The 30-day mortality and length of stay were increased along with increased risk score. The AUCs in the prediction of 30-day mortality in the main cohort were 0.826 (95% CI, 0.807-0.844), 0.801 (95% CI, 0.781-0.820), 0.756 (95% CI, 0.735-0.777), 0.793 (95% CI, 0.773-0.813) and 0.759 (95% CI, 0.737-0.779) for the expanded-CURB-65, PSI, CURB-65, SMART-COP and A-DROP, respectively. The performance of this bedside score was confirmed in CAP patients of the validation cohort although calibration was not successful in patients with health care-associated pneumonia (HCAP). The expanded CURB-65 is objective, simpler and more accurate scoring system for evaluation of CAP severity, and the predictive efficiency was better than other score systems.

Monte Carlo calculation of helical tomotherapy dose delivery.

Helical tomotherapy delivers intensity modulated radiation therapy using a binary multileaf collimator (MLC) to modulate a fan beam of radiation. This delivery occurs while the linac gantry and treatment couch are both in constant motion, so the beam describes, from a patient/phantom perspective, a spiral or helix of dose. The planning system models this continuous delivery as a large number (51) of discrete gantry positions per rotation, and given the small jaw/fan width setting typically used (1 or 2.5 cm) and the number of overlapping rotations used to cover the target (pitch often <0.5), the treatment planning system (TPS) potentially employs a very large number of static beam directions and leaf opening configurations to model the modulated fields. All dose calculations performed by the system employ a convolution/superposition model. In this work the authors perform a full Monte Carlo (MC) dose calculation of tomotherapy deliveries to phantom computed tomography (CT) data sets to verify the TPS calculations. All MC calculations are performed with the EGSnrc-based MC simulation codes, BEAMnrc and DOSXYZnrc. Simulations are performed by taking the sinogram (leaf opening versus time) of the treatment plan and decomposing it into 51 different projections per rotation, as does the TPS, each of which is segmented further into multiple MLC opening configurations, each with different weights that correspond to leaf opening times. Then the projection is simulated by the summing of all of the opening configurations, and the overall rotational treatment is simulated by the summing of all of the projection simulations. Commissioning of the source model was verified by comparing measured and simulated values for the percent depth dose and beam profiles shapes for various jaw settings. The accuracy of the MLC leaf width and tongue and groove spacing were verified by comparing measured and simulated values for the MLC leakage and a picket fence pattern. The validated source and MLC configuration were then used to simulate a complex modulated delivery from fixed gantry angle. Further, a preliminary rotational treatment plan to a delivery quality assurance phantom (the "cheese" phantom) CT data set was simulated. Simulations were compared with measured results taken with an A1SL ionization chamber or EDR2 film measurements in a water tank or in a solid water phantom, respectively. The source and MLC MC simulations agree with the film measurements, with an acceptable number of pixels passing the 2%/1 mm gamma criterion. 99.8% of voxels of the MC calculation in the planning target volume (PTV) of the preliminary plan passed the 2%/2 mm gamma value test. 87.0% and 66.2% of the voxels in two organs at risk (OARs) passed the 2%/2 mm tests. For a 3%/3 mm criterion, the PTV and OARs show 100%, 93.2%, and 86.6% agreement, respectively. All voxels passed the gamma value test with a criterion of 5%/3 mm. The Tomo-Therapy TPS showed comparable results.

Monte Carlo evaluation of a treatment planning system for helical tomotherapy in an anthropomorphic heterogeneous phantom and for clinical treatment plans.

Helical tomotherapy is an increasingly common form of intensity modulated radiation therapy that allows for image guided adaptive radiotherapy. Its treatment planning system (TPS) uses a convolution superposition algorithm for dose distribution calculations. The accuracy of this algorithm in the presence of heterogeneities was evaluated against Monte Carlo (MC) calculations and measurements. This work performed BEAMnrc-and DOSXYZnrc-based MC dose calculations of tomotherapy deliveries to a CIRS anthropomorphic heterogeneous phantom with typical clinical inverse planning and delivery settings. Point measurements with A1SL ion chambers and relative measurements with Kodak EDR2 film were carried out in the phantom. The experimental results were used to evaluate both the TPS and MC dose calculations. Furthermore, the dose distribution for a clinical head-and-neck cancer plan was calculated on the TPS and MC systems. The results support this MC system as a viable option for the accurate simulation of the tomotherapy process in the presence of heterogeneities where direct measurement may not be practical. Ion chamber measurements in the CIRS phantom suggested the TPS has an average relative difference of 2.3%, with the largest difference being -4.1% in one of the organs at risk. The MC system accurately predicted the dose to these measurement points within statistical uncertainty. The film measurements in the CIRS phantom demonstrated 90.7% (of pixels) agreed with the MC system using a +/-3%/3 mm acceptance criteria, where only 50.3% agreed with the TPS. In the clinical head-and-neck cancer plan evaluation where MC served as a reference against which to compare the TPS result, an average of 92.7% of the voxels within volumes of interest passed a 3%/3 mm criteria. The PTV54 showed the worst agreement with 85.4% of the volume passing the 3% /3 mm criteria. In general, the +/-3%/3 mm criterion was found to be a challenge for the TPS in the presence of lung inhomogeneity.