Category: Statistics

Kidney Res Clin Pract. 2024 Jun 20. doi: 10.23876/j.krcp.23.298. Online ahead of print.

ABSTRACT

Sepsis-associated acute kidney injury (SA-AKI) is a serious complication in critically ill patients, resulting in higher mortality, morbidity, and cost. The intricate pathophysiology of SA-AKI requires vigilant clinical monitoring and appropriate, prompt intervention. While traditional statistical analyses have identified severe risk factors for SA-AKI, the results have been inconsistent across studies. This has led to growing interest in leveraging artificial intelligence (AI) and machine learning (ML) to predict SA-AKI better. ML can uncover complex patterns beyond human discernment by analyzing vast datasets. Supervised learning models like XGBoost and RNN-LSTM have proven remarkably accurate at predicting SA-AKI onset and subsequent mortality, often surpassing traditional risk scores. Meanwhile, unsupervised learning reveals clinically relevant sub-phenotypes among diverse SA-AKI patients, enabling more tailored care. In addition, it potentially optimizes sepsis treatment to prevent SA-AKI through continual refinement based on patient outcomes. However, utilizing AI/ML presents ethical and practical challenges regarding data privacy, algorithmic biases, and regulatory compliance. AI/ML allows early risk detection, personalized management, optimal treatment strategies, and collaborative learning for SA-AKI management. Future directions include real-time patient monitoring, simulated data generation, and predictive algorithms for timely interventions. However, a smooth transition to clinical practice demands continuous model enhancements and rigorous regulatory oversight. In this article, we outlined the conventional methods used to address SA-AKI and explore how AI and ML can be applied to diagnose and manage SA-AKI, highlighting their potential to revolutionize SA-AKI care.

PMID:38934028 | DOI:10.23876/j.krcp.23.298

Food Chem X. 2024 May 29;23:101519. doi: 10.1016/j.fochx.2024.101519. eCollection 2024 Oct 30.

ABSTRACT

In the present study, the comprehensive quality of Congou black tea (CBT) including aroma, taste, and liquid color was investigated by a combination of gas chromatography electronic nose (GC-E-Nose), electronic tongue (E-tongue), and electronic eye (E-eye). An excellent discrimination of different quality grades of CBT was accomplished through the fusion of GC-E-Nose, E-tongue, and E-eye combined with orthogonal partial least squares discriminant analysis, with parameters of R²Y = 0.803 and Q² = 0.740. Moreover, the quantitative evaluation of CBT quality was successfully achieved by partial least squares regression analysis, with the absolute error within 1.39 point, and the relative error within 1.62%. Additionally, 12 key variables were screened out by stepwise multiple linear regression analysis, which significantly contributed to the comprehensive quality score of CBT. Our results suggest that the fusion of multiple intelligent sensory technologies offers great potential and practicability in the quality evaluation of black tea.

PMID:38933990 | PMC:PMC11200275 | DOI:10.1016/j.fochx.2024.101519

Cesk Slov Oftalmol. 2024;80(Ahead of print):1-7. doi: 10.31348/2024/19.

ABSTRACT

AIM: This retrospective clinical study evaluates the results of surgical treatment of patients diagnosed with intermittent exotropia of the divergence excess type. The study compares the results of surgery delayed due to the Covid-19 pandemic (patients underwent the surgery after the age of eight), versus a group of younger children.

MATERIALS AND METHODS: The objective angle of deviation and quality of binocular functions were examined. The follow-up period was six months after surgery. The patients were divided into two groups according to age: 4-7 years and 8-13 years. Each group included 20 patients. The second group comprised patients whose surgery was postponed due to restrictions on elective surgery during the ongoing pandemic. The surgery took place at the University Hospital in Pilsen. Angle of deviation and binocular functions were examined before surgery, postoperatively, and three and six months after surgery. Data were collected retrospectively and statistically processed. The main values were plotted in charts.

RESULTS: Accordance between the angle of deviation before surgery in both groups was statistically demonstrated. During the six-month follow-up period, the median angle of deviation was statistically without proof of disparity between the groups. Six months after surgery, an objective angle of deviation within the limit ±5 degrees was achieved in 65% of patients from the first group and in 75% from the second group. Binocular vision before surgery was statistically without proof of difference between both groups. However the statistical processing demonstrated a difference between the two groups six months after the surgery. Better binocular functions were achieved by the younger children in the first group.

CONCLUSION: The objective deviation angle was comparable in both study groups prior to surgery as well as six months after the surgery. The first group of younger patients attained a higher quality of binocular functions within the six-month follow-up period compared to children operated on after the age of eight. This claim was statistically verified.

PMID:38925902 | DOI:10.31348/2024/19

Cesk Slov Oftalmol. 2024;80(Ahead of print):1-5. doi: 10.31348/2024/26.

ABSTRACT

AIM: The primary aim of this study is to evaluate the repeatability of noninvasive break-up time (NIBUT) measurement by keratograph when it is determined from one, two or three partial measurements, and to recommend a suitable methodology for practice. Another goal is to verify that repeated measurements do not affect the measured value.

MATERIAL AND METHODS: Thirty-eight healthy volunteers (30 women and 8 men) aged between 19 and 50 years old were included in the study, in which only one eye of each volunteer was measured. The study was designed as a prospective one. Each subject adapted to the local conditions of the laboratory for 15 minutes and subsequently underwent two series of NIBUT measurements (test, retest) on an OCULUS 3 Keratograph. The minimum time interval between the two series was 10 minutes, in which each series contained three partial measurements approximately 3 three measurements in the given series. Repeatability was assessed by a Bland-Altman analysis and expressed as a repeatability coefficient. In every case, only the time of the first break-up of the tear film was monitored.

RESULTS: The statistical analysis did not show statistically significant differences both between partial measurements of NIBUT in the individual series (p = 0.92, p = 0.81) and when comparing all six measurements (p = 0.95). The mean values of the partial measurements ranged from 13.6 s to 14.4 s. The repeatability coefficients were found to be 15.0 s, 12.1 s and 10.0 s for methodologies A, B and C, respectively. A supplementary analysis for 12 eyes with low NIBUT (< 10 s) showed statistically significantly better repeatability in this group, with coefficients of 7.0 s (methodology A), 6.0 s (B) and 4.6 s (C).

CONCLUSION: Determination of NIBUT from three consecutive measurements (with a sufficient interval of ideally a few minutes) significantly improves repeatability. Such repeated NIBUT measurements do not have a significant effect on the measured value. The mentioned methodology for measuring NIBUT on a keratograph can be recommended for use in practice.

PMID:38925898 | DOI:10.31348/2024/26

Cesk Slov Oftalmol. 2024;80(Ahead of print):1-8. doi: 10.31348/2024/29.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the outcomes of Ozurdex® (DEX) implant in patients with diabetic macular edema (DME) in real-world clinical practice, and to determine the correlation between known OCT biomarkers and the effect of treatment.

MATERIAL AND METHODS: This retrospective study included 42 eyes of 33 patients (16 women, 17 men) treated with DEX at the Department of Ophthalmology, Faculty of Medicine and Dentistry of Palacký University and University Hospital Olomouc for DME indication between 2020 and 2023. Follow-up examinations were conducted at 1, 3, and 6 months after the first DEX application. The main assessed parameters were: best-corrected visual acuity (BCVA), intraocular pressure (IOP), central retinal thickness (CRT), OCT biomarkers. The results were subsequently statistically evaluated.

RESULTS: At the first follow-up after DEX application, there was an average decrease in CRT of 186 ±146µm and a gain of 3 ±7 letters. Positive morphological and functional responses were observed in 39 eyes (92.9%) and 23 eyes (54.8%) respectively. The disorganization of retinal inner layers (DRIL) biomarker was initially present in 41 eyes (97.6%), with reduction or disappearance observed in 13 eyes (31%) post-application. Eyes with ellipsoid zone disruption (EZ disruption) had an average initial BCVA of 49.6 letters, compared to 57.8 letters in the group without this biomarker. The mean gain in BCVA was +8.7 letters in treatment-naive eyes and +2.1 letters in previously treated eyes. Chronic DME was less frequent in treatment-naive (n = 1, 14.3%) compared to previously treated eyes (n = 28, 84.8%). All these results were statistically significant (p < 0.05). An increase in IOP post-DEX application occurred in 9 patients (21.4%).

CONCLUSION: Our results confirm DEX as a safe and effective treatment option for DME. Treatment-naive patients achieved better functional outcomes. We confirmed ellipsoid zone disruption (EZ disruption) as a negative biomarker. Additionally, we demonstrated the capacity of DEX to reduce disorganization of the retinal inner layers (DRIL).

PMID:38925895 | DOI:10.31348/2024/29

Cesk Slov Oftalmol. 2024;80(Ahead of print):1-6. doi: 10.31348/2024/31.

ABSTRACT

AIM: To compare functional and anatomical outcomes between the inverted flap technique and conventional removal of the internal limiting membrane (ILM) in the surgical management of idiopathic macular hole (IMH).

MATERIAL AND METHODS: We retrospectively evaluated the anatomical and functional results in 67 eyes of 65 patients operated on for IMH. The patients were operated on either using the conventional ILM peeling technique (first group) or with the inverted ILM flap technique (second group). 43 eyes of 41 patients were included in the first group, 24 eyes of 24 patients in the second group. We indicated for surgery only patients with IMH stage 2-4 according to the Gasse classification. Best corrected visual acuity (VA) was always determined before and two months after surgery. Furthermore, a comparison of both techniques was made according to the average letter gain after surgery, and the effect of surgery was evaluated using OCT with regard to whether IMH closure succeeded. For both techniques, 25G PPV with SF6 tamponade was performed.

RESULTS: Hole closure took place in 41 eyes with conventional ILM removal. In one eye, the hole did not close even after reoperation with the same technique. Median ETDRS letter gain was 7.0. VA remained the same in 2 eyes (4.7%), worsened in 7 cases (16.2%), and improved in all other cases (79.0%). In 16 eyes (37.2%), VA improved by 2 or more lines of ETDRS charts. Using the inverted flap technique, the hole was closed in all 24 monitored eyes. Median ETDRS letter gain was 9.5. VA remained the same in 2 eyes (8.3%), worsened in 2 cases (8.3%), and improved in all other cases (83.3%). In 12 eyes (50.0%), VA improved by 2 or more lines of ETDRS charts. There were no serious complications intraoperatively or postoperatively.

CONCLUSION: Our study demonstrated the safety and efficacy of both methods. Although the results were not statistically significant, the inverted flap technique recorded a greater ETDRS letter gain (9.5 vs. 7.0) and proportion of closed holes (100% vs. 95.3%) compared to the conventional ILM peeling technique in our set of eyes.

PMID:38925893 | DOI:10.31348/2024/31

Cesk Slov Oftalmol. 2024;80(Ahead of print):1-12. doi: 10.31348/2024/23.

ABSTRACT

AIMS: To investigate the concordance between the corneal power determined by various approaches with two tomographers (MS-39® and Galilei G6®) and the clinical history method (CHM) in patients undergoing photorefractive surgery with excimer laser for myopic errors.

MATERIAL AND METHODS: Prospective cohort study. Patients undergoing keratorefractive surgery, and having pre- and postoperative keratometries, and tomographies, were included.

RESULTS: In 90 eyes, the differences in the power estimated by the CHM and the one determined by four approaches with the corneal tomographers, which included measurements of the posterior cornea, did not show statistically significant differences in their averages. However, the 95% limits of agreement were very wide. After obtaining regression formulas to adjust the values of these four variables, the results of the agreement analysis were similar.

CONCLUSION: Although certain values either directly determined or derived from measurements with the Galilei® and MS-39®corneal tomographers, approximated the estimated value of postoperative corneal power according to the CHM, due to the amplitude of their limits of agreement, these calculations must be taken with care, because they may not be accurate in a given eye.

PMID:38925892 | DOI:10.31348/2024/23

Int J Geriatr Psychiatry. 2024 Jul;39(7):e6117. doi: 10.1002/gps.6117.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the efficacy of different repetitive transcranial magnetic stimulation (rTMS) modes in stroke patients with cognitive impairment, and to rank the best option according to the outcome measures.

METHODS: Literature was searched in PubMed, Cochrane Library, Web of Science, Embase, SinoMed, China National Knowledge Infrastructure, Wanfang Database, and VIP Database, from database inception to September 2023. We included randomized controlled trials (RCTs) investigating the efficacy of all rTMS modes for post-stroke cognitive impairment. The selected studies assessed at least one of the following outcome measures: Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), P300 latency and amplitude, and modified Barthel Index (MBI) or BI. Two researchers independently conducted data extraction. Quality assessment was performed using RevMan 5.3 software based on the Cochrane Collaboration’s tool, and statistical analysis was conducted by GeMTC 0.14.3 software and Stata 17.0 software.

RESULTS: The network meta-analysis included 74 RCTs with a total of 5478 patients. The best probability ranking indicated that intermittent theta burst stimulation (iTBS) was the most effective in enhancing MoCA, MMSE and MBI scores (85%, 54%, 42%, respectively), followed by 10 Hz rTMS (79%, 50%, 39%, respectively), for P300 amplitude, ≤1 Hz rTMS was ranked first (52%).

CONCLUSIONS: The current limited evidence suggests that iTBS may be the optimal approach for improving cognitive and daily life abilities of stroke patients, followed by 10 Hz rTMS, ≤1 Hz rTMS may be the preferred option for enhancing P300 amplitude.

TRAIL REGISTRATION: PROSPERO 2023 CRD42023424771 available from: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=424771.

PMID:38925887 | DOI:10.1002/gps.6117

Int J Spine Surg. 2024 Jun 26:8609. doi: 10.14444/8609. Online ahead of print.

ABSTRACT

BACKGROUND: Progenitor cells derived from intervertebral disc tissue demonstrated immunomodulatory and regenerative properties in preclinical studies. We report the safety and efficacy results of a US Food and Drug Administration-approved clinical trial of these cells for the treatment of symptomatic degenerative disc disease.

METHODS: Sixty patients with symptomatic single-level lumbar degenerative disc disease (mean age 37.9 years, 60% men) were enrolled in a randomized, double-blinded, placebo-controlled Phase I/Phase II study at 13 clinical sites. They were randomized to receive single intradiscal injections of either low-dose cells (N = 20), high-dose cells (N = 20), vehicle alone (N = 10), or placebo (N = 10). The primary endpoint was mean visual analog scale (VAS) pain improvement >30% at 52 weeks. Disc volume was radiologically assessed. Adverse events (AEs), regardless of whether they were related to treatment, were reported. Patients were assessed at baseline and at 4, 12, 26, 52, 78, and 104 weeks posttreatment.

RESULTS: At week 52, the high-dose group had a mean VAS percentage decrease from baseline (-62.8%, P = 0.0005), achieving the endpoint of back pain improvement >30%; the mean change was also significantly greater than the minimal clinically important difference of a 20-point decrease (-42.8, P = 0.001). This clinical improvement was maintained at week 104. The vehicle group had a smaller significant decrease in VAS (-52.8%, P = 0.044), while the low-dose and placebo groups showed nonsignificant improvements. Only the high-dose group had a significant change in disc volume, with mean increases of 249.0 mm³ (P = 0.028) at 52 weeks and 402.1 mm³ (P = 0.028) at 104 weeks. A minority of patients (18.3%) reported AEs that were severe. Overall, 6.7% of patients experienced serious AEs, all in the vehicle (n = 1) or placebo (n = 3) groups, none treatment related.

CONCLUSIONS: High-dose allogeneic disc progenitor cells produced statistically significant, clinically meaningful improvements in back pain and disc volume at 1 year following a single intradiscal injection and were safe and well tolerated. These improvements were maintained at 2 years post-injection.

CLINICAL TRIAL REGISTRATION: NCT03347708-Study to Evaluate the Safety and Preliminary Efficacy of Injectable Disc Cell Therapy, a Treatment for Symptomatic Lumbar Intervertebral Disc Degeneration.

PMID:38925869 | DOI:10.14444/8609

Can J Surg. 2024 Jun 26;67(3):E252-E260. doi: 10.1503/cjs.003723. Print 2024 May-Jun.

ABSTRACT

BACKGROUND: Prescription opioid use places a considerable economic burden on health care systems. Older patients undergoing surgical procedures for painful conditions commonly receive opioids pre- and postoperatively, and are susceptible to adverse reactions. This study explores predictors of prolonged postoperative opioid use among older patients after lumbar spine surgery and the consequences in terms of health care utilization and costs.

METHODS: We conducted a retrospective population-based cohort study using Ontario administrative data from older adults undergoing spine surgery between 2006 and 2017. Data were analyzed from 90 days preoperatively to 1 year after hospital discharge, with last postoperative opioid prescriptions stratified into 90-day increments. We used multivariable ordinal logistic regression to identify predictors of long-term opioid use and generalized linear modelling to examine resource utilization and health care costs (2021 Canadian dollars).

RESULTS: Of 15 109 patients included, 40.8% received preoperative opioid prescriptions. Preoperative opioid use strongly predicted prolonged postoperative use (odds ratio [OR] 4.47, 95% confidence interval [CI] 4.16-4.79), with 48.3% of patients who received preoperative opioids continuing to use opioids for longer than 9 months, relative to 12.7% of those without preoperative use. Several other risk factors for prolonged use were identified. Patients receiving long-term postoperative opioids incurred greater health care costs relative to those with opioids prescribed for fewer than 90 days (OR 1.49, 95% CI 1.44-1.54).

CONCLUSION: Among older adults undergoing spine surgery, preoperative opioid use was a strong predictor of prolonged postoperative use, which was associated with increased health care costs. These results form an important baseline for future studies evaluating strategies to reduce opioid use targeting older surgical populations.

PMID:38925858 | DOI:10.1503/cjs.003723