Category: Nevin Manimala

Ann Epidemiol. 2023 Apr 28:S1047-2797(23)00082-0. doi: 10.1016/j.annepidem.2023.04.017. Online ahead of print.

ABSTRACT

PURPOSE: A strength of SuperLearner is that it may accommodate key interactions between model variables without a priori specification. In prior research, protective associations between fruit intake and preeclampsia were stronger when estimated using SuperLearner with targeted maximum likelihood estimation (TMLE) compared with multivariable logistic regression without any interaction terms. We explored whether heterogeneity (i.e., differences in the effect estimate due to interactions between fruit intake and covariates) may partly explain differences in estimates from these two models.

METHODS: Using a US prospective pregnancy cohort (2010-2013, n=7781), we estimated preeclampsia risk differences (RDs) for higher versus lower fruit density using multivariable logistic regression and included 2-way statistical interactions between fruit density and each of the 25 model covariates. We compared the RDs with those from SuperLearner with TMLE (gold standard) and logistic regression with no interaction.

RESULTS: From the logistic regression models with 2-way statistical interactions, 48% of the preeclampsia RDs were ≤-0.02 (closer to SuperLearner with TMLE estimate); 40% equaled -0.01 (same as logistic regression with no interaction estimate); the minority were at or crossed the null.

CONCLUSIONS: Our exploratory analysis provided preliminary evidence that heterogeneity may partly explain differences in estimates from logistic regression versus SuperLearner with TMLE.

PMID:37121376 | DOI:10.1016/j.annepidem.2023.04.017

Urology. 2023 Apr 28:S0090-4295(23)00374-6. doi: 10.1016/j.urology.2023.04.017. Online ahead of print.

ABSTRACT

OBJECTIVES: To examine the extent to which the urologist performing biopsy contributes to variation in prostate cancer detection during fusion-guided prostate biopsy.

METHODS: All men in the Michigan Urological Surgery Improvement Collaborative (MUSIC) clinical registry who underwent fusion biopsy at Michigan Medicine from August 2017 to March 2019 were included. The primary outcomes were clinically significant cancer detection rate (defined as Gleason Grade ≥ 2) in targeted cores and clinically significant cancer detection on targeted cores stratified by PI-RADS score. Bivariate and multivariable logistic regression analyses were performed.

RESULTS: A total of 1,133 fusion biopsies performed by five providers were included. When adjusting for patient age, PSA, race, family history, prostate volume, clinical stage, and PI-RADS score, there was no significant difference in targeted clinically significant cancer detection rates across providers (range = 38.5-46.9%, adjusted p-value = 0.575). Clinically significant cancer detection rates ranged from 11.1-16.7% in PI-RADS 3 (unadjusted p = 0.838), from 24.6-43.4% in PI-RADS 4 (adjusted p = 0.003), and from 69.4-78.8% in PI-RADS 5 (adjusted p = 0.766) lesions.

CONCLUSIONS: There was a statistically significant difference in clinically significant prostate cancer detection in PI-RADS 4 lesions across providers. These findings suggest that even among experienced providers, variation at the urologist level may contribute to differences in clinically significant cancer detection rates within PI-RADS 4 lesions. However, the relative impact of biopsy technique, radiologist interpretation, and MR acquisition protocol requires further study.

PMID:37121355 | DOI:10.1016/j.urology.2023.04.017

Environ Res. 2023 Apr 28:116022. doi: 10.1016/j.envres.2023.116022. Online ahead of print.

ABSTRACT

BACKGROUND: Studies which analyse the joint effect of acoustic or chemical air pollution variables and different meteorological variables on neuroendocrine disease are practically nonexistent. This study therefore sought to analyse the impact of air pollutants and environmental meteorological variables on daily unscheduled admissions due to endocrine and metabolic diseases in the Madrid Region from January 01, 2013 to December 31, 2018.

MATERIAL AND METHODS: We conducted a longitudinal, retrospective, ecological study of daily time series analysed by Poisson regression, with emergency neuroendocrine-disease admissions in the Madrid Region as the dependent variable. The independent variables were: mean daily concentrations of PM₁₀, PM_2.5, NO₂ and O₃; acoustic pollution; maximum and minimum daily temperatures; hours of sunlight; relative humidity; wind speed; and air pressure above sea level. Estimators of the statistically significant variables were used to calculate the relative risks (RRs).

RESULTS: A statistically significant association was found between the increase in temperatures in heat waves, RR: 1.123 95% CI (1.001-1.018), and the number of emergency admissions, making it the main risk factor. An association between a decrease in sunlight and an increase in hospital admissions, RR: 1.005 95% CI (1.002 1.008), was likewise observed. Similarly, ozone, in the form of mean daily concentrations in excess of 44 μg/m³, had an impact on admissions due to neuroendocrine disease, RR: 1.010 95% CI (1.007-1.035). The breakdown by sex showed that in the case of women, NO₂ was also a risk factor, RR: 1.021 95% CI (1.007-1.035).

CONCLUSION: The results obtained in this study serve to identify risk factors for this disease, such as extreme temperatures in heat waves, O₃ or NO₂. The robust association found between the decrease in sunlight and increase in hospital admissions due to neuroendocrine disease serves to spotlight an environmental factor which has received scant attention in public health until now.

PMID:37121348 | DOI:10.1016/j.envres.2023.116022

Ann Vasc Surg. 2023 Apr 28:S0890-5096(23)00245-5. doi: 10.1016/j.avsg.2023.04.024. Online ahead of print.

ABSTRACT

BACKGROUND: Failure to rescue (FtR), or inpatient death following complication, is a publicly reported hospital quality measure. Previous work has demonstrated significant variation in the proportion of frail patients across hospitals. However, frailty is not incorporated into risk-adjustment algorithms for hospital quality comparisons and risk adjustment is made by comorbidity scores. Our aim was to assess the impact of frailty on FtR quality measurement and as a means of risk adjustment.

STUDY DESIGN: Patients undergoing open or endovascular aneurysm repair or lower extremity bypass in the Vascular Quality Initiative (VQI) at centers performing > 25 vascular procedures annually (2003-2019) were included. Multivariable logistic regression evaluated in-hospital death using scaled hierarchical modeling clustering at the center-level. Center FtR observed/expected (O/E) ratios were compared with expected values adjusted for either standard comorbidity profiles or frailty as measured by the VQI Risk Analysis Index (RAI). Centers were divided into quartiles using VQI-linked American Hospital Association data to describe the hospital characteristics of centers whose ranks changed.

RESULTS: A total of 63,143 patients (213 centers) were included; 1,630 patients (2.58%) were classified as FtR. After accounting for center-level variability, frailty was associated with FtR [scaled odds ratio 1.9 (1.8-2.0), p<0.001]. The comorbidity-centric and frailty-based models performed similarly in predicting FtR with C-statistics of 0.85 (0.84-0.86) and 0.82 (0.82-0.84), respectively. Overall changes in ranking based on O/E ratios were not statistically significant (p=0.48). High and low performing centers had similar ranking using comorbidity-centric and frailty-based methods; however, centers in the middle of the performance spectrum saw more variability in ranking alterations. Forty-nine (23%) of hospitals improved their ranking by 5 or more positions when using frailty vs comorbidity risk adjustment. The centers in Quartile 4, those who performed the highest number of vascular procedures annually, experience on average a significant improvement in hospital ranking when frailty was used for risk adjustment, whereas centers performing the fewest number of vascular procedures and the lowest proportion of vascular surgery cases annually (Quartile 1) saw a significant worsening of ranking position (all p < 0.05). However, total number of surgical procedures annually, total hospital beds, for-profit status and teaching hospital status were not significantly associated with changes in rank.

CONCLUSION: A simple frailty-adjusted model has similar predictive abilities as a comorbidity-focused model for predicting a common quality metric that influences reimbursement. In addition to distilling the risk-adjustment algorithm to a few variables, frailty can be assessed preoperatively to develop quality improvement efforts for rescuing frail patients. Centers treating a greater proportion of frail patients and those who perform higher volumes of vascular surgery benefit from a risk adjustment strategy based on frailty.

PMID:37121337 | DOI:10.1016/j.avsg.2023.04.024

Eur J Obstet Gynecol Reprod Biol. 2023 Apr 18;285:153-158. doi: 10.1016/j.ejogrb.2023.04.012. Online ahead of print.

ABSTRACT

OBJECTIVE(S): To measure the success rate of primary medical therapy in managing retained products of conception (RPOC) in women with secondary postpartum haemorrhage (PPH) and to identify factors associated with need for surgical management.

STUDY DESIGN: Postpartum patients presenting to a tertiary women’s hospital Emergency Department between July 2020 and December 2022 with secondary PPH and evidence of RPOC on ultrasound were recruited. Clinical information relating to the presentation was collected prospectively. Antenatal and intrapartum data were collected from medical record and Birthing Outcome System database review. The primary outcome was the success of medical management for RPOC, defined by the implementation of medical or expectant management without subsequent need for surgical intervention.

RESULTS: Forty-one patients with RPOC underwent primary medical or expectant management. Twelve patients (29%) were managed successfully with medical management, while twenty-nine (71%) proceeded to surgical management. Medical management involved antibiotics (n = 37, 90%), prostaglandin E1 analogue (n = 14, 34%) and other uterotonics (n = 3, 7%). A greater endometrial thickness on ultrasound was significantly associated with a requirement for secondary surgical intervention (p < 0.05). There was an association approaching statistical significance between a higher sonographic volume of RPOC and the failure of medical management (p = 0.07). There was no statistically significant association between the mode of delivery or the number of days postpartum with the success of medical management.

CONCLUSION(S): For patients presenting with secondary PPH and sonographic RPOC, over two thirds required surgical management. Increased endometrial thickness was associated with an increased requirement for surgical management.

PMID:37120911 | DOI:10.1016/j.ejogrb.2023.04.012

Poult Sci. 2022 Oct 22;102(6):102281. doi: 10.1016/j.psj.2022.102281. Online ahead of print.

ABSTRACT

The aim of the study was to analyze some slaughter traits in 3 breeds of geese: the commercial hybrids of White Kołuda (W-31), and birds of conservative flocks of Pomeranian (Po) and Kielecka (Ki) geese depending on sex and length of rearing period, and to determine the relationships between the analyzed traits and factors. A total of 19 traits divided into 2 groups-measured and calculated traits-were statistically analyzed. The measured traits (g) included 11 parameters: preslaughter weight, carcass weight, weights of breast muscle, thigh and drumstick, abdominal fat, skin with subcutanenous fat, neck without skin, skeleton with dorsal muscles, wings with skin, total muscles as the sum of all breast and leg muscles, and the trait broth elements as the total weight of neck, skin, skeleton and wings. The calculated traits included 8 parameters (%): dressing percentage-carcass weight to preslaughter weight, meatiness-total breast and leg muscle weight to carcass weight, abdominal fat weight to carcass weight, weight of skin with subcutaneous fat to carcass weight, weight of neck without skin to carcass weight, weight of skeleton with dorsal muscles to carcass weight, weight of wings with skin to carcass weight, as well as total weight of neck, skin, skeleton, and wings. The presented results concerning the analysis of selected slaughter traits of the Kielecka, Pomeranian and White Kołuda geese indicate that these birds exhibit good slaughter value (dressing percentage from 60.80 to 66.50%). The selected values of this parameter were influenced mainly by genotype and to a lesser extent by sex. The White Kołuda geese were characterized by significantly higher values of the majority of the analyzed slaughter traits, both measured and calculated ones. In turn, the lighter domestic geese of regional breeds were characterized by significantly higher carcass meat content (from 31.69 to 35.13 % vs. from 29.28 to 31.80 %) and lower carcass fatness (abdominal fat and skin with subcutaneous fat from 21.26 to 25.45 % vs. from 30.81 to 33.14 %). This points to the possibility of using these breeds of geese in breeding work aimed to produce a hybrid characterized by medium body weight (intermediate between these values for the White Kołuda geese and Kielecka or Pomeranian geese), good dressing percentage as well as high carcass meat content and low carcass fatness.

PMID:37120890 | DOI:10.1016/j.psj.2022.102281

Breast. 2023 Apr 24;69:410-416. doi: 10.1016/j.breast.2023.04.006. Online ahead of print.

ABSTRACT

This overview provides the historical perspective of external beam breast hypofractionation over the last 50 years. It highlights the serious harm suffered by patients with breast cancer in the 1970’s and 1980’s because of new hypofractionation regimens based on a theoretical radiobiology model being adopted into clinical practice to solve a resource issue without testing within clinical trials and without the essential radiotherapy quality assurance. It then describes the high-quality clinical trials comparing 3-week with 5-week standard of care regimens that were initiated based on a strong scientific rationale for hypofractionation in breast cancer. Today, there are still challenges with universal implementation of the results of these moderate hypofractionation studies, but there is now a substantial body of evidence to support 3-week breast radiotherapy with several large randomised trials still to report. The limit of breast hypofractionation is then explored and randomised trials investigating 1-week radiotherapy are described. This approach is now standard of care in many countries for whole or partial breast radiotherapy and chest wall radiotherapy without immediate reconstruction. It also has the advantage of reducing burden of treatment for patients and providing cost-effective care. Further research is needed to establish the safety and efficacy of 1-week breast locoregional radiotherapy and following immediate breast reconstruction. In addition, clinical studies are required to determine how a tumour bed boost for patients with breast cancer at higher risk of relapse can be incorporated simultaneously into a 1-week radiotherapy schedule. As such, the breast hypofractionation story is still unfolding.

PMID:37120889 | DOI:10.1016/j.breast.2023.04.006

J Geriatr Oncol. 2023 Apr 28;14(5):101499. doi: 10.1016/j.jgo.2023.101499. Online ahead of print.

ABSTRACT

INTRODUCTION: The aim of this study was to investigate risk factors for nutritional risk in older adults with gastrointestinal tumours.

MATERIALS AND METHODS: A total of 170 eligible hospitalised older adults with gastrointestinal tumours were included. Their clinical characteristics were collected, their nutritional risk was screened by NRS 2002, and then patients were divided into a nutritional risk group and a non-nutritional risk group. The observation indicators included body mass index (BMI), muscle mass, muscle strength, and calf circumference. The third lumbar skeletal muscle index (L3 SMI) was calculated using abdominal computed tomography (CT) scan results, and grip strength/muscle strength, 6-m walking speed and calf circumference were measured. Sarcopenia was diagnosed according to the criteria of the Asian Sarcopenia Working Group (AWGS). Finally, we analysed the relationship between nutritional risk and sarcopenia and other related factors (BMI, calf circumference, L3 SMI, grip strength/muscle strength, 6-m walking speed) in older adults with gastrointestinal tumours by multivariate logistic regression analysis.

RESULTS: Older adults with gastrointestinal tumours who were at nutritional risk accounted for 51.8% of patients in this study. The differences between sex, tumour stage, age, BMI, calf circumference, L3 SMI, grip strength/muscle strength, 6-m walking speed, and prevalence of sarcopenia were statistically significant in two groups (all P < 0.05). Multivariate logistic regression analysis showed that age, BMI, grip strength/muscle strength, and sarcopenia were risk factors of nutritional risk in older adults with gastrointestinal tumours (all P < 0.05).

DISCUSSION: Older adults with gastrointestinal cancer had a higher proportion of nutritional risk, and L3 SMI, grip strength/muscle strength were independent risk factors for nutritional risk. In clinical practice, attention to nutritional risk screening and sarcopenia development in older adults with gastrointestinal cancer is warranted.

PMID:37120888 | DOI:10.1016/j.jgo.2023.101499

Knee. 2023 Apr 28;42:289-296. doi: 10.1016/j.knee.2023.04.004. Online ahead of print.

ABSTRACT

BACKGROUND: Although bicruciate stabilized total knee arthroplasty (BCS-TKA) is expected to provide kinematics similar to those of the normal knee, there are limited data available for comparison of the kinematics of the knee after BCS-TKA with those of the normal knee. The purpose of this study was to confirm whether the knee after BCS-TKA are the same as those of the native knee.

METHODS: Seven fresh-frozen cadavers underwent TKA using a BCS-type prosthesis with navigation system. Anteroposterior translation of the femur and internal rotation of the tibia were evaluated using the navigation system.

RESULTS: There was no statistically significant difference in anteroposterior translation of the femur between the native knee and the knee after BCS-TKA in the early flexion phase (0°-30°) or in the deep flexion phase (over 100°). In the middle flexion phase (40°-90°), the knee after BCS-TKA was placed significantly more anteriorly than the native knee. The knee after BCS-TKA also showed a gradual internal rotation pattern similar to that of the native knee but the total tibial internal rotation angle was significantly smaller than that of the native knee. At each angle from 0° to 120° of flexion, internal rotation of the knee after BCS-TKA was significantly greater than that of the native knee.

CONCLUSION: Kinematics of BCS-TKA is close to that of the native knee. However, there is a statistically significant difference in AP position of the femur during mid flexion and initial rotational position of the tibia between the BCS-TKA knee and the native knee.

PMID:37120864 | DOI:10.1016/j.knee.2023.04.004

J Affect Disord. 2023 Apr 28;333:446. doi: 10.1016/j.jad.2023.04.018. Online ahead of print.

NO ABSTRACT

PMID:37120863 | DOI:10.1016/j.jad.2023.04.018