Category: Nevin Manimala

Dentomaxillofac Radiol. 2023 May 12:20230027. doi: 10.1259/dmfr.20230027. Online ahead of print.

ABSTRACT

OBJECTIVES: The objectives were to clarify if intraoral ultrasonography (USG) is: (1) more accurate than conventional periodontal examinations in detection of furcation involvement, and (2) comparable to conventional periodontal examinations in accurate horizontal classification of furcation involvement in comparison to cone beam computed tomography (CBCT).

METHODS: The buccal furcation in 61 lower first molars were evaluated with conventional periodontal examinations, intraoral USG and CBCT. The presence and classification of the horizontal depth of furcation involvement were defined clinically by assessment with a Nabers periodontal probe and a periapical radiograph with reference to the bone loss under the fornix. The horizontal depth of furcation involvement was measured in intraoral USG and CBCT images. Based on the measurements, presence diagnosis and horizontal classification were performed. Results from conventional periodontal examinationsand intraoral USG were compared with those from CBCT.

RESULTS: κ value (κ) for agreement of presence diagnosis of furcation involvement between intraoral USG and CBCT was 0.792, while agreement with conventional periodontal examinations was 0.225. Diagnostic accuracy of intraoral USG exhibited higher values (sensitivity: 98.3%, accuracy: 98.4 %) than conventional periodontal examinations (81.4% and 81.9 %). Weighted κ statistics showed substantial agreement in the classification between intraoral USG and CBCT (κ = 0.674). High agreement (ICC: 0.914) for the measurement of horizontal depth of furcation involvement was found between intraoral USG and CBCT.

CONCLUSIONS: Intraoral USG may be a reliable diagnostic tool for assessment of furcation involvement of mandibular molars with a similar performance to CBCT, but without ionizing radiation.

PMID:37172223 | DOI:10.1259/dmfr.20230027

Eur J Prev Cardiol. 2023 May 12:zwad160. doi: 10.1093/eurjpc/zwad160. Online ahead of print.

ABSTRACT

AIMS: To identify a group of metabolites associated with incident CVD in people with type 2 diabetes and assess its predictive performance over-and-above a current CVD risk score (QRISK3).

METHODS: A panel of 228 serum metabolites was measured at baseline in 1,066 individuals with type 2 diabetes (Edinburgh Type 2 Diabetes Study) who were then followed up for CVD over the subsequent 10 years. We applied 100 repeats of Cox LASSO (least absolute shrinkage and selection operator) to select metabolites with frequency >90% as components for a metabolites-based risk score (MRS). The predictive performance of the MRS was assessed in relation to a reference model which was based on QRISK3 plus prevalent CVD and statin use at baseline.

RESULTS: Of 1,021 available individuals, 255 (25.0%) developed CVD (median follow-up: 10.6 years). Twelve metabolites relating to fluid balance, ketone bodies, amino acids, fatty acids, glycolysis and lipoproteins were selected to construct the MRS which showed positive association with 10-year cardiovascular risk following adjustment for traditional risk factors [HR 2.67 (95%CI 1.96, 3.64)]. C-statistic was 0.709 (95%CI 0.679, 0.739) for the reference model alone, increasing slightly to 0.728 (95%CI 0.700, 0.757) following addition of the MRS. Compared with the reference model, the net reclassification index and integrated discrimination index for the reference model plus the MRS was 0.362 (95%CI 0.179, 0.506) and 0.041 (95%CI 0.020, 0.071), respectively.

CONCLUSIONS: Metabolomics data might improve predictive performance of current CVD risk scores based on traditional risk factors in people with type 2 diabetes. External validation is warranted to assess the generalizability of improved CVD risk prediction using the MRS.

PMID:37172216 | DOI:10.1093/eurjpc/zwad160

Environ Health Perspect. 2023 May;131(5):57005. doi: 10.1289/EHP11444. Epub 2023 May 12.

ABSTRACT

BACKGROUND: The health effects of heat are well documented; however, limited information is available regarding the health risks of hot nights. Hot nights have become more common, increasing at a faster rate than hot days, making it urgent to understand the characteristics of the hot night risk.

OBJECTIVES: We estimated the effects of hot nights on the cause- and location-specific mortality in a nationwide assessment over 43 y (1973-2015) using a unified analytical framework in the 47 prefectures of Japan.

METHODS: Hot nights were defined as days with a) minimum temperature ≥25°C (HN25) and b) minimum temperature ≥95th percentile (HN95th) for the prefecture. We conducted a time-series analysis using a two-stage approach during the hot night occurrence season (April-November). For each prefecture, we estimated associations between hot nights and mortality controlling for potential confounders including daily mean temperature. We then used a random-effects meta-analytic model to estimate the pooled cumulative association.

RESULTS: Overall, 24,721,226 deaths were included in this study. Nationally, all-cause mortality increased by 9%-10% [HN25 relative risk (RR)=1.09, 95% confidence interval (CI): 1.08, 1.10; HN95th RR=1.10, 95% CI: 1.09, 1.11] during hot nights in comparison with nonhot nights. All 11 cause-specific mortalities were strongly associated with hot nights, and the corresponding associations appeared to be acute and lasted a few weeks, depending on the cause of death. The strength of the association between hot nights and mortality varied among prefectures. We found a higher mortality risk from hot nights in early summer in comparison with the late summer in all regions.

CONCLUSIONS: Our findings support the evidence of mortality impacts from hot nights in excess of that explicable by daily mean temperature and have implications useful for establishing public health policy and research efforts estimating the health effects of climate change. https://doi.org/10.1289/EHP11444.

PMID:37172196 | DOI:10.1289/EHP11444

Stud Health Technol Inform. 2023 May 2;301:248-253. doi: 10.3233/SHTI230048.

ABSTRACT

BACKGROUND: The aging population’s need for treatment of chronic diseases is exhibiting a marked increase in urgency, with heart failure being one of the most severe diseases in this regard. To improve outpatient care of these patients and reduce hospitalization rates, the telemedical disease management program HerzMobil was developed in the past.

OBJECTIVE: This work aims to analyze the inter-annotator variability among two professional groups (healthcare and engineering) involved in this program’s annotation process of free-text clinical notes using categories.

METHODS: A dataset of 1,300 text snippets was annotated by 13 annotators with different backgrounds. Inter-annotator variability and accuracy were evaluated using the F1-score and analyzed for differences between categories, annotators, and their professional backgrounds.

RESULTS: The results show a significant difference between note categories concerning inter-annotator variability (p<0.0001) and accuracy (p<0.0001). However, there was no statistically significant difference between the two annotator groups, neither concerning inter-annotator variability (p=0.15) nor accuracy (p=0.84).

CONCLUSION: Professional background had no significant impact on the annotation of free-text HerzMobil notes.

PMID:37172189 | DOI:10.3233/SHTI230048

Stud Health Technol Inform. 2023 May 2;301:125-130. doi: 10.3233/SHTI230025.

ABSTRACT

BACKGROUND: There are many medical knowledge bases with potential for supporting medical professionals in their decision-making during routine care, yet usage of these sources remains low. Standardized linking of Clinical Decision Support (CDS) applications and existing medical knowledge bases is not a common practice.

OBJECTIVES: Using existing eHealth standards to increase the utilization of knowledge bases and implement a prototype.

METHODS: Linking an existing online knowledge base via a FHIR CodeSystem supplement to the Austrian national EHR (ELGA) terminology server and accessing these data using CDS Hooks and FHIR.

RESULTS: We tested the approach by incorporating photosensitivity data of medications into a local copy of the Austrian terminology server. These data are directly used by a CDS Hooks compliant CDS service.

CONCLUSION: The Austrian Terminology Server could be an important interface to access existing knowledge bases from within EHR systems. FHIR and CDS Hooks could lead the way for a simple and open integration of CDS services into EHR systems.

PMID:37172166 | DOI:10.3233/SHTI230025

Stud Health Technol Inform. 2023 May 2;301:54-59. doi: 10.3233/SHTI230011.

ABSTRACT

The Austrian nationwide EHR system ELGA can contribute valuable data for research due to its high volume of data and broad population coverage. In order to be applicable in international research projects, transformation to a standardized, research-oriented data model such as the OMOP common data model is essential. In this paper we describe our experience with the corresponding transformation task. Using Python scripts, we implemented a prototypical process that extracts, transforms, maps, and loads fully structured sections of ELGA documents to an OMOP database.

PMID:37172152 | DOI:10.3233/SHTI230011

JBJS Case Connect. 2023 May 12;13(2). doi: 10.2106/JBJS.CC.23.00060. eCollection 2023 Apr 1.

ABSTRACT

CASE: A 40-year-old man presented with progressive shoulder pain, associated with static posterior subluxation and mild eccentric glenohumeral osteoarthritis. Compared with a mean statistical shape model of a normal shoulder, the patient’s acromion was abnormally high and horizontal, and the glenoid abnormally inclined inferiorly and minimally retroverted. Restoration of normal scapular anatomy using 3-dimensional planned acromial and glenoid osteotomies led to recentering of the joint and full shoulder function up to 24 months postoperatively.

CONCLUSION: The correction of associated acromial and glenoid malformation can revert early static posterior subluxation of the shoulder. Whether successful recentering prevents progression of osteoarthritis remains to be established.

PMID:37172119 | DOI:10.2106/JBJS.CC.23.00060

J Bone Joint Surg Am. 2023 May 12. doi: 10.2106/JBJS.22.01330. Online ahead of print.

ABSTRACT

Artificial intelligence (AI) is a broad term that is widely used but inconsistently understood. It refers to the ability of any machine to exhibit human-like intelligence by making decisions, solving problems, or learning from experience. With its ability to rapidly process large amounts of information, AI has already transformed many industries such as entertainment, transportation, and communications through consumer-facing products and business-to-business applications. Given its potential, AI is also anticipated to impact the practice of medicine and the delivery of health care. Interest in AI-based techniques has grown rapidly within the orthopaedic community, resulting in an increasing number of publications on this topic. Topics of interest have ranged from the use of AI for imaging interpretation to AI-based techniques for predicting postoperative outcomes.The highly technical and data-driven nature of orthopaedic surgery creates the potential for AI, and its subdisciplines machine learning (ML) and deep learning (DL), to fundamentally transform our understanding of musculoskeletal care. However, AI-based techniques are not well known to most orthopaedic surgeons, nor are they taught with the same level of insight and critical thinking as traditional statistical methodology. With a clear understanding of the science behind AI-based techniques, orthopaedic surgeons will be able to identify the potential pitfalls of the application of AI to musculoskeletal health. Additionally, with increased understanding of AI, surgeons and their patients may have more trust in the results of AI-based analytics, thereby expanding the potential use of AI in clinical care and amplifying the impact it could have in improving quality and value. The purpose of this American Orthopaedic Association (AOA) symposium was to facilitate understanding and development of AI and AI-based techniques within orthopaedic surgery by defining common terminology related to AI, demonstrating the existing clinical utility of AI, and presenting future applications of AI in surgical care.

PMID:37172106 | DOI:10.2106/JBJS.22.01330

Sci Immunol. 2023 May 12;8(83):eadd3955. doi: 10.1126/sciimmunol.add3955. Epub 2023 May 12.

ABSTRACT

Dendritic cells (DCs) mature in an immunogenic or tolerogenic manner depending on the context in which an antigen is perceived, preserving the balance between immunity and tolerance. Whereas the pathways driving immunogenic maturation in response to infectious insults are well-characterized, the signals that drive tolerogenic maturation during homeostasis are still poorly understood. We found that the engulfment of apoptotic cells triggered homeostatic maturation of type 1 conventional DCs (cDC1s) within the spleen. This maturation process could be mimicked by engulfment of empty, nonadjuvanted lipid nanoparticles (LNPs), was marked by intracellular accumulation of cholesterol, and was highly specific to cDC1s. Engulfment of either apoptotic cells or cholesterol-rich LNPs led to the activation of the liver X receptor (LXR) pathway, which promotes the efflux of cellular cholesterol, and repressed genes associated with immunogenic maturation. In contrast, simultaneous engagement of TLR3 to mimic viral infection via administration of poly(I:C)-adjuvanted LNPs repressed the LXR pathway, thus delaying cellular cholesterol efflux and inducing genes that promote T cell-mediated immunity. These data demonstrate that conserved cellular cholesterol efflux pathways are differentially regulated in tolerogenic versus immunogenic cDC1s and suggest that administration of nonadjuvanted cholesterol-rich LNPs may be an approach for inducing tolerogenic DC maturation.

PMID:37172103 | DOI:10.1126/sciimmunol.add3955

Sci Adv. 2023 May 12;9(19):eadf6243. doi: 10.1126/sciadv.adf6243. Epub 2023 May 12.

ABSTRACT

From Mars rovers to buildings, objects eventually sink and tilt into a fluidized granular bed due to gravity. Despite the irregular shape of realistic granular intruders, most research focus on the settling of “perfect” objects like spheres and cylinders. Here, we systematically explore the penetration of “imperfect” solids-from stones to bodies with carefully controlled asymmetries-into granular beds. A cylinder with two halves of different roughnesses rotates toward the granular region next to the smoother surface and deviates from the vertical direction. We demonstrate that even small irregularities in the surface of an object may produce substantial changes in the penetration process. Using computer simulations, we show that defects concentrate granular force chains, thus producing decisive forces on the intruder. Furthermore, we demonstrate that tilting and migration of sinking bodies can be correctly predicted by a simple mechanical model based on a unified force law.

PMID:37172098 | DOI:10.1126/sciadv.adf6243