Category: Statistics

Intern Emerg Med. 2022 Aug 20. doi: 10.1007/s11739-022-03074-x. Online ahead of print.

ABSTRACT

Transient ischemic attack (TIA) is a neurologic emergency characterized by cerebral ischemia eliciting a temporary focal neurological deficit. Many clinical prediction scores have been proposed to assess the risk of stroke after TIA; however, studies on their clinical validity and comparisons among them are scarce. The objective is to compare the accuracy of ABCD², ABCD²-I, and OTTAWA scores in the prediction of a stroke at 7, 90 days, and 1 year in patients presenting with TIA. Single-centre, retrospective study including patients with TIA admitted to the Emergency Department of our third-level, University Hospital, between 2018 and 2019. Five hundred three patients were included. Thirty-nine (7.7%) had a stroke within 1 year from the TIA: 9 (1.7%) and 24 (4.7%) within 7 and 90 days, respectively. ABCD², ABCD²-I, and OTTAWA scores were significantly higher in patients who developed a stroke. AUROCs ranged from 0.66 to 0.75, without statistically significant differences at each time-point. Considering the best cut-off of each score, only ABCD² > 3 showed a sensitivity of 100% only in the prediction of stroke within 7 days. Among clinical items of each score, duration of symptoms, previous TIA, hemiparesis, speech disturbance, gait disturbance, previous cerebral ischemic lesions, and known carotid artery disease were independent predictors of stroke. Clinical scores have moderate prognostic accuracy for stroke after TIA. Considering the independent predictors for stroke, our study indicates the need to continue research and prompts the development of new tools on predictive scores for TIA.

PMID:35986834 | DOI:10.1007/s11739-022-03074-x

Intern Emerg Med. 2022 Aug 20. doi: 10.1007/s11739-022-03059-w. Online ahead of print.

ABSTRACT

Elevated aspartate aminotransferase-to-alanine aminotransferase ratio (AAR) has been associated with cardiovascular diseases and mortality. The clinical significance of AAR in the prognosis of stroke has yet to be established. We aimed to investigate the associations between AAR levels and clinical outcomes in acute ischemic stroke (AIS) or transient ischemic attack (TIA). Patients with AIS or TIA in the Third China National Stroke Registry (CNSR-III) were divided into four groups by quartiles of AAR, and two groups according to AAR < 1 and AAR ≥ 1. Multivariable Cox regression for all-cause mortality and logistic regression for poor functional outcome (modified Rankin Scale, mRS 3-6/2-6) were adopted to explore the associations between AAR and clinical outcomes at 3 months and 1 year. Among 10,877 included patients, the median AAR was 1.06 (interquartile range [IQR], 0.82 to 1.36). In the multivariable-adjusted model, patients in the fourth AAR quartile had higher risk of all-cause mortality within 3 months and 1 year (hazard ratio [HR] 2.08, 95% confidence interval [CI] 1.25 to 3.47; HR 2.26, 95% CI 1.55 to 3.27), and mRS 3-6/2-6 at 1 year (odds ratio [OR] 1.29, 95% CI 1.07 to 1.55; OR 1.20, 95% CI 1.02 to 1.42), compared with those in the first quartile. Similar associations were also observed when AAR ≥ 1 compared with AAR < 1. Elevated AAR was associated with higher risk of all-cause mortality and poor functional outcome after AIS or TIA, and should be carefully assessed after admission.

PMID:35986833 | DOI:10.1007/s11739-022-03059-w

Cancer Causes Control. 2022 Aug 20. doi: 10.1007/s10552-022-01621-7. Online ahead of print.

ABSTRACT

Unconditional (upfront) incentives are proposed to improve acceptance of cancer research among underrepresented, racial/ethnic minority populations, but few studies have tested incentive strategies among rural cancer survivors. Descriptive statistics summarized demographic characteristics of survey respondents, and response rates by arm were compared using Chi-square tests. We compared upfront ($2) and response-based ($10 conditional) incentives in a mailed survey of adult post-treatment rural survivors. Individuals meeting eligibility criteria from the electronic medical record (n = 2,830) were randomized into two incentive arms (n = 1,414 for the upfront arm and n = 1,416 for the contingent arm). Of the total delivered, presumed eligible participants (n = 1,304 upfront arm; n = 1,317 contingent arm), 67.8% were aged 65y+, 49.8% were female, and 95.1% were non-Hispanic white. The response rate for all participants was 18.5%. We received eligible surveys from 281 rural survivors in the first arm (response rate: 21.5%); and 205 surveys in the second arm (response rate: 15.6%). Participants who received the upfront incentive had a higher response rate than those receiving a response-based incentive, X² (1, 2,621) = 15.53, p < 0.0001. Incentivizing survey completion with an upfront $2 bill encouraged a higher survey response rate; other supplemental strategies are needed to achieve a higher response rate for this population.

PMID:35986825 | DOI:10.1007/s10552-022-01621-7

Clin Exp Med. 2022 Aug 20. doi: 10.1007/s10238-022-00872-7. Online ahead of print.

ABSTRACT

The aim of this study was to examine the relationship between the severity of fibrosis in lung tissue and epidermal growth factor receptor (EGFR) positivity in patients who died due to COVID-19 pneumonia, demographic characteristics, comorbidities, biochemical values, and treatments received. Fifty patients who died from COVID-19 pneumonia were included in the study. Demographic data for the patients, laboratory tests, thorax computerized tomography findings, comorbidities, length of stay in the intensive care unit (ICU), intubation times, and treatments given were noted. Postmortem Tru-cut lung biopsy was performed. EGFR positivity was examined and grouped as negative, mild, moderate, and severe. Data were analyzed statistically. EGFR involvement was negative in 11 (22%), mild in 20 (40%), moderate in 13 (26%), and severe in 6 (12%) patients. The mean C-reactive protein (CRP) values, D-dimer values, and mean length of stay in the ICU were found to be significantly different between the groups (p = 0.024; p = 0.003; p = 0.016, respectively). Methylprednisolone dose and the presence of comorbidity did not differ significantly in EGFR involvement (p = 0.79; p = 0.98, respectively). CRP and D-dimer values can be used as a guide to assess the severity of pulmonary fibrosis that develops in severe COVID-19 pneumonia patients. The dose of methylprednisolone used does not make a significant difference in the severity of fibrosis.Trail registration: Clinical Trials.gov identifier date and number 01/13/2022 NCT05290441.

PMID:35986823 | DOI:10.1007/s10238-022-00872-7

CVIR Endovasc. 2022 Aug 20;5(1):43. doi: 10.1186/s42155-022-00315-0.

ABSTRACT

BACKGROUND: Proximal splenic artery embolisation (PSAE) can be performed in stable patients with Association for the Surgery of Trauma (AAST) grade III-V splenic injury. PSAE reduces splenic perfusion but maintains viability of the spleen and pancreas via the collateral circulation. The hypothesized ideal location is between the dorsal pancreatic artery (DPA) and great pancreatic artery (GPA). This study compares the outcomes resulting from PSAE embolisation in different locations along the splenic artery.

MATERIALS AND METHODS: Retrospective review was performed of PSAE for blunt splenic trauma (2015-2020). Embolisation locations were divided into: Type I, proximal to DPA; Type II, DPA-GPA; Type III, distal to GPA. Fifty-eight patients underwent 59 PSAE: Type I (7); Type II (27); Type III (25). Data was collected on technical and clinical success, post-embolisation pancreatitis and splenic perfusion. Statistical significance was assessed using a chi-squared test.

RESULTS: Technical success was achieved in 100% of cases. Clinical success was 100% for Type I/II embolisation and 88% for Type III: one patient underwent reintervention and two had splenectomies for ongoing instability. Clinical success was significantly higher in Type II embolisation compared to Type III (p = 0.02). No episodes of pancreatitis occurred post-embolisation. Where post-procedural imaging was obtained, splenic perfusion remained 100% in Type I and II embolisation and 94% in Type III. Splenic perfusion was significantly higher in the theorized ideal Type II group compared to Type I and III combined (p = 0.01).

CONCLUSION: The results support the proposed optimal embolisation location as being between the DPA and GPA.

PMID:35986797 | DOI:10.1186/s42155-022-00315-0

J Math Biol. 2022 Aug 20;85(3):23. doi: 10.1007/s00285-022-01787-3.

ABSTRACT

Nonmonotone incidence and saturated treatment are incorporated into an SIRS model under constant and changing environments. The nonmonotone incidence rate describes the psychological or inhibitory effect: when the number of the infected individuals exceeds a certain level, the infection function decreases. The saturated treatment function describes the effect of infected individuals being delayed for treatment due to the limitation of medical resources. In a constant environment, the model undergoes a sequence of bifurcations including backward bifurcation, degenerate Bogdanov-Takens bifurcation of codimension 3, degenerate Hopf bifurcation as the parameters vary, and the model exhibits rich dynamics such as bistability, tristability, multiple periodic orbits, and homoclinic orbits. Moreover, we provide some sufficient conditions to guarantee the global asymptotical stability of the disease-free equilibrium or the unique positive equilibrium. Our results indicate that there exist three critical values [Formula: see text] and [Formula: see text] for the treatment rate r: (i) when [Formula: see text], the disease will disappear; (ii) when [Formula: see text], the disease will persist. In a changing environment, the infective population starts along the stable disease-free state (or an endemic state) and surprisingly continues tracking the unstable disease-free state (or a limit cycle) when the system crosses a bifurcation point, and eventually tends to the stable endemic state (or the stable disease-free state). This transient tracking of the unstable disease-free state when [Formula: see text] predicts regime shifts that cause the delayed disease outbreak in a changing environment. Furthermore, the disease can disappear in advance (or belatedly) if the rate of environmental change is negative and large (or small). The transient dynamics of an infectious disease heavily depend on the initial infection number and rate or the speed of environmental change.

PMID:35986794 | DOI:10.1007/s00285-022-01787-3

World J Urol. 2022 Aug 20. doi: 10.1007/s00345-022-04094-0. Online ahead of print.

ABSTRACT

PURPOSE: Renal cysts comprise benign and malignant entities. Risk assessment profits from CT/MRI imaging using the Bosniak classification. While Bosniak-IIF, -III, and -IV cover complex cyst variants, Bosniak-IIF and -III stand out due to notorious overestimation. Contrast-enhanced ultrasound (CEUS) is promising to overcome this deficit but warrants standardization. This study addresses the benefits of a combined CEUS and CT/MRI evaluation of renal cysts. The study provides a realistic account of kidney tumor boards’ intricacies in trying to validate renal cysts.

METHODS: 247 patients were examined over 8 years. CEUS lesions were graded according to CEUS-Bosniak (IIF, III, IV). 55 lesions were resected, CEUS-Bosniak- and CT/MRI-Bosniak-classification were correlated with histopathological diagnosis. Interobserver agreement between the classifications was evaluated statistically. 105 lesions were followed by ultrasound, and change in CEUS-Bosniak-types and lesion size were documented.

RESULTS: 146 patients (156 lesions) were included. CEUS classified 67 lesions as CEUS-Bosniak-IIF, 44 as CEUS-Bosniak-III, and 45 as CEUS-Bosniak-IV. Histopathology of 55 resected lesions revealed benign cysts in all CEUS-Bosniak-IIF lesions (2/2), 40% of CEUS-Bosniak-III and 8% of CEUS-Bosniak-IV, whereas malignancy was uncovered in 60% of CEUS-Bosniak-III and 92% of CEUS-Bosniak-IV. Overall, CEUS-Bosniak-types matched CT/MRI-Bosniak types in 58% (fair agreement, κ = 0.28). CEUS-Bosniak resulted in higher stages than CT/MRI-Bosniak (40%). Ultrasound follow-up of 105 lesions detected no relevant differences between CEUS-Bosniak-types concerning cysts size. 99% of lesions showed the same CEUS-Bosniak-type.

CONCLUSION: The CEUS-Bosniak classification is an essential tool in clinical practice to differentiate and monitor renal cystic lesions and empowers diagnostic work-up and patient care.

PMID:35986781 | DOI:10.1007/s00345-022-04094-0

Eur Radiol. 2022 Aug 20. doi: 10.1007/s00330-022-09083-w. Online ahead of print.

ABSTRACT

OBJECTIVES: To explore radiologists’ opinions regarding the shift from in-person oncologic multidisciplinary team meetings (MDTMs) to online MDTMs. To assess the perceived impact of online MDTMs, and to evaluate clinical and technical aspects of online meetings.

METHODS: An online questionnaire including 24 questions was e-mailed to all European Society of Oncologic Imaging (ESOI) members. Questions targeted the structure and efficacy of online MDTMs, including benefits and limitations.

RESULTS: A total of 204 radiologists responded to the survey. Responses were evaluated using descriptive statistical analysis. The majority (157/204; 77%) reported a shift to online MDTMs at the start of the pandemic. For the most part, this transition had a positive effect on maintaining and improving attendance. The majority of participants reported that online MDTMs provide the same clinical standard as in-person meetings, and that interdisciplinary discussion and review of imaging data were not hindered. Seventy three of 204 (35.8%) participants favour reverting to in-person MDTs, once safe to do so, while 7/204 (3.4%) prefer a continuation of online MDTMs. The majority (124/204, 60.8%) prefer a combination of physical and online MDTMs.

CONCLUSIONS: Online MDTMs are a viable alternative to in-person meetings enabling continued timely high-quality provision of care with maintained coordination between specialties. They were accepted by the majority of surveyed radiologists who also favoured their continuation after the pandemic, preferably in combination with in-person meetings. An awareness of communication issues particular to online meetings is important. Training, improved software, and availability of support are essential to overcome technical and IT difficulties reported by participants.

KEY POINTS: • Majority of surveyed radiologists reported shift from in-person to online oncologic MDT meetings during the COVID-19 pandemic. • The shift to online MDTMs was feasible and generally accepted by the radiologists surveyed with the majority reporting that online MDTMs provide the same clinical standard as in-person meetings. • Most would favour the return to in-person MDTMs but would also accept the continued use of online MDTMs following the end of the current pandemic.

PMID:35986772 | DOI:10.1007/s00330-022-09083-w

J Food Sci. 2022 Aug 20. doi: 10.1111/1750-3841.16281. Online ahead of print.

ABSTRACT

Spent coffee grounds (SCG) are a coproduct that causes environmental impacts worldwide. Thus, consciously reusing the SCG is an eminent need. This work aimed to encapsulate phenolic compounds and antioxidants obtained from SCG extracts through spray- and freeze-drying techniques using different isolated and combined wall materials. The dried powders produced were evaluated for moisture content, water activity, bulk density, hygroscopicity, color, content of phenolic compounds and antioxidants, and the results were compared. The results showed that all evaluated treatments resulted in a powdered product with low values of bulk density, moisture and water activity, especially for freeze-drying. The freeze-dried product also showed higher hygroscopicity. Regarding the content of phenolic compounds and antioxidants, both drying methods showed high levels of these compounds in the dried product and good encapsulation efficiency, reaching 83.43%. In most cases, spray-drying and freeze-drying did not differ statistically (p > 0.05) in relation to bioactive compound content and encapsulation efficiency. In relation to wall materials, albumin showed the worst performance in the retention of bioactive compounds. On the other hand, pure gum arabic combined with maltodextrin led to better preservation of these compounds. PRACTICAL APPLICATION: Spent coffee grounds are a coproduct generated in large quantities in the world. The encapsulation of phenolic and antioxidant compounds protects and enables their application in different food matrices. Therefore, the evaluation of different encapsulation methods and wall materials is important to define good process conditions.

PMID:35986622 | DOI:10.1111/1750-3841.16281

Clin Exp Allergy. 2022 Aug 20. doi: 10.1111/cea.14218. Online ahead of print.

NO ABSTRACT

PMID:35986607 | DOI:10.1111/cea.14218