Category: Statistics

Rofo. 2022 Jan 26. doi: 10.1055/a-1717-2703. Online ahead of print.

ABSTRACT

PURPOSE: Evaluation of machine learning-based fully automated artery-specific coronary artery calcium (CAC) scoring software, using semi-automated software as a reference.

METHODS: A total of 505 patients underwent non-contrast-enhanced calcium scoring computed tomography (CSCT). Automated, machine learning-based software quantified the Agatston score (AS), volume score (VS), and mass score (MS) of each coronary artery [right coronary artery (RCA), left main (LM), circumflex (CX) and left anterior descending (LAD)]. Identified CAC of readers who annotated the data with semi-automated software served as a reference standard. Statistics included comparisons of evaluation time, agreement of identified CAC, and comparisons of the AS, VS, and MS of the reference standard and the fully automated algorithm.

RESULTS: The machine learning-based software correlated strongly with the reference standard for the AS, VS, and MS (Spearman’s rho > 0.969) (p < 0.001), with excellent agreement (ICC > 0.919) (p < 0.001). The mean assessment time of the reference standard was 59 seconds (IQR 39-140) and that of the automated algorithm was 5.9 seconds (IQR 3.9-16) (p < 0.001). The Bland-Altman plots mean difference and 1.96 upper and lower limits of agreement for all arteries combined were: AS 0.996 (1.33 to 0.74), VS 0.995 (1.40 to 0.71), and MS 0.995 (1.35 to 0.74). The mean bias was minimal: 0.964-1.0429. Risk class assignment showed high accuracy for the AS in total (weighed κ = 0.99) and for each individual artery (κ = 0.96-0.99) with corresponding correct risk group assignment in 497 of 505 patients (98.4 %).

CONCLUSION: The fully automated artery-specific coronary calcium scoring algorithm is a time-saving procedure and shows excellent correlation and agreement compared with the clinically established semi-automated approach.

KEY POINTS: · Very high correlation and agreement between fully automatic and semi-automatic calcium scoring software.. · Less time-consuming than conventional semi-automatic methods.. · Excellent tool for artery-specific calcium scoring in a clinical setting..

CITATION FORMAT: · Winkelmann MT, Jacoby J, Schwemmer C et al. Fully Automated Artery-Specific Calcium Scoring Based on Machine Learning in Low-Dose Computed Tomography Screening. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1717-2703.

PMID:35081651 | DOI:10.1055/a-1717-2703

Z Geburtshilfe Neonatol. 2022 Jan 26. doi: 10.1055/a-1727-6309. Online ahead of print.

ABSTRACT

OBJECTIVE: Cystatin C (Cys-C) concentration has not been examined sufficiently among healthy newborn population, particularly in terms of reference values. This study aimed to establish gender-, postnatal age- and birth weight-specific Cys-C concentration for healthy term newborns. Its objective was also to examine if there were any differences between our measured concentration and the reference interval established by the CALIPER study.

METHODS: Serum samples from a total of 90 healthy term newborns were used to determine Cys-C concentration. Cys-C was measured within first three days of birth using particle-enhanced turbidimetric immunoassay (PETIA) on the Architect plus ci8200 analyzer.

RESULTS: Median concentration of the Cys-C was 2.05 mg/L. There were no statistically significant differences in Cys-C concentration regarding gender (p=0.779), birth weight (p=0.505), postnatal age (p=0.512) or Apgar score (p=0.799). The value of the 2.5th and 97.5th percentile for Cys-C concentrations for girls was 0.93-3.15 mg/L and for boys it was 1.5-3.36 mg/L.

CONCLUSION: Cys-C concentration in healthy term newborns does not depend on gender, birth weight, postnatal age, or Apgar score. Our measured concentration range of CyS-C in healthy newborns turned out to be slightly wider than the interval determined in the CALIPER study.

PMID:35081646 | DOI:10.1055/a-1727-6309

J Trauma Acute Care Surg. 2022 Jan 25. doi: 10.1097/TA.0000000000003549. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study was to assess pain and Quality of Life (QoL) outcomes in patients with multiple painful displaced fractured ribs with and without operative fixation. Rib fractures are common and can lead to significant pain and disability. There is minimal level 1 evidence for rib fixation in non-ventilator dependent patients with chest wall injuries. We hypothesized that surgical stabilization of rib fractures (SSRF) would reduce pain and improve QoL over 6 months.

METHODS: A prospective multi-centre randomised controlled trial comparing rib fixation to non-operative management of non-ventilated patients with at least three consecutive rib fractures. Inclusion criteria were rib fracture displacement and/or ongoing pain. Pain (McGill Questionnaire) and QoL (Short Form 12) at 3 and 6 months post injury were assessed. Surgeons enrolled patients in whom they felt there was clinical equipoise. Patients who were deemed to need surgical fixation, or who were deemed to be too well to be randomized to rib fixation were not enrolled.

RESULTS: 124 patients were enrolled at four sites between 2017 and 2020. 61 patients were randomised to operative management and 63 to non-operative management. No differences were seen in the primary endpoint of Pain Rating Index at 3 months, nor in the QoL measures. Return-to-work rates improved between 3 and 6 months, favouring the operative group.

CONCLUSIONS: In this study no improvements in pain or QoL at 3 and 6 months in patients undergoing rib fixation for non-flail, non-ventilator dependent rib fractures have been demonstrated.

LEVELS OF EVIDENCE: Level 1 Therapeutic.

PMID:35081599 | DOI:10.1097/TA.0000000000003549

Am J Epidemiol. 2022 Jan 27:kwac006. doi: 10.1093/aje/kwac006. Online ahead of print.

ABSTRACT

Simplified drug regimens may improve retention in care for chronic diseases. In April 2013, South Africa adopted a once-daily single-pill HIV treatment regimen as standard-of-care, replacing a multiple-pill regimen. Because the regimens had similar biological efficacy, the shift to single-pill therapy offers a real-world test of the impact of simplified drug delivery mechanisms on patient behavior. Using a quasi-experimental regression discontinuity design, we assessed retention in care among patients starting HIV treatment just before and just after the guideline change. The study included 4484 patients starting treatment at a large public sector clinic in Johannesburg, South Africa. The share of patients prescribed a single-pill regimen increased by over 40 percentage points between March and April 2013. Initiating after the policy change was associated with 11.7 percentage points higher retention at 12 months (95% CI: -2.2, 29.4). Findings were robust to different measures of retention, different bandwidths, and different statistical models. Patients starting treatment early in HIV infection – a key population in the test-and-treat era – experienced the greatest improvements in retention from single-pill regimens.

PMID:35081613 | DOI:10.1093/aje/kwac006

J Trauma Acute Care Surg. 2022 Jan 25. doi: 10.1097/TA.0000000000003551. Online ahead of print.

ABSTRACT

INTRODUCTION: Low titer group O whole blood (LTOWB) resuscitation is increasingly common in both military and civilian settings. Data regarding the safety and efficacy of prehospital LTOWB remains limited.

METHODS: We performed a single center, prospective, cluster randomized, prehospital thru in-hospital whole blood pilot trial for injured air medical patients. We compared standard prehospital air medical care including red cell transfusion and crystalloids followed by in-hospital component transfusion to prehospital and in-hospital LTOWB resuscitation. Prehospital vital signs were used as inclusion criteria (SBP ≤ 90 mmHg and HR ≥ 108 bpm) or (SBP ≤ 70 mmHg) for patients at risk of hemorrhage. Primary outcome was feasibility. Secondary outcomes included 28-day and 24 hour mortality, multiple organ failure, nosocomial infection, 24 hr transfusion requirements and arrival coagulation parameters.

RESULTS: Between November 2018 thru October 2020, 86 injured patients were cluster randomized by helicopter base. The trial has halted early at 77% enrollment. Overall, 28-day mortality for the cohort was 26%. Injured patients randomized to prehospital LTOWB (n = 40) relative to standard care (n = 46) were similar in demographics and injury characteristics. Intent to treat Kaplan-Meier survival analysis demonstrated no statistical mortality benefit at 28 days (25.0% vs. 26.1%, p = 0.85). Patients randomized to prehospital LTOWB relative to standard care had lower red cell transfusion requirements at 24 hours (p < 0.01) and a lower incidence of abnormal thromboelastographic measurements. No transfusion reactions during the prehospital or in-hospital phase of care were documented.

CONCLUSION: Prehospital through in-hospital LTOWB resuscitation is safe and may be associated with hemostatic benefits. A large-scale clinical trial is feasible with protocol adjustment and would allow the effects of prehospital LTOWB on survival and other pertinent clinical outcomes to be appropriately characterized.

LEVEL OF EVIDENCE: II, Cluster randomized pilot trial.

PMID:35081595 | DOI:10.1097/TA.0000000000003551

Ann Surg. 2022 Jan 25. doi: 10.1097/SLA.0000000000005395. Online ahead of print.

ABSTRACT

OBJECTIVE: This study investigates the use of serum DUPAN-2 in predicting the PC progression in CA19-9 nonsecretors.

BACKGROUND: Although we previously reported that serum CA19-9 >500 U/mL is a poor prognostic factor and an indication for enhanced neoadjuvant treatment, there is not a biomarker surrogate that equivalently predicts prognosis for CA19-9 nonsecretors.

METHODS: We evaluated consecutive PC patients who underwent pancreatectomy from 2005 to 2019. All patients were categorized as either nonsecretor or secretor (CA19-9 ≤ or >2.0 U/mL).

RESULTS: Of the 984 resected PC patients, 94 (9.6%) were nonsecretors and 890 (90.4%) were secretors. The baseline characteristics were not statistically different between the 2 groups except for the level of DUPAN-2 (720 vs. 100 U/mL, P < 0.001). Survival curves after resection were similar between the 2 groups (29.4 months vs. 31.3 months, P = 0.900). Survival curves of patients with DUPAN-2 >2000 U/mL in the nonsecretors and patients with CA19-9 >500 U/mL in the secretors were nearly equivalent as well (hazard ratio 2.08 vs. 1.89). In the multivariate analysis, DUPAN-2 >2000 U/mL (hazard ratio 2.53, P = 0.010) was identified as independent prognostic factor after resection.

CONCLUSION: DUPAN-2 >2000 U/mL in CA19-9 nonsecretors can be an unfavorable factor that corresponds to CA19-9 >500 U/mL in CA19-9 secretors which is an indicator for enhanced neoadjuvant treatment. The current results shed light on the subset of nonsecretors with poor prognosis that were traditionally categorized in a group with a more favorable prognosis group.

PMID:35081567 | DOI:10.1097/SLA.0000000000005395

J Occup Environ Med. 2022 Jan 25. doi: 10.1097/JOM.0000000000002491. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the risk of diseases among industrial workers with low and fractionated radiation exposures.

METHOD: 372,047 US male shipyard radiation and non-radiation workers were followed for 54 years and compared to US males using Standardized Mortality Ratio (SMR) method.

RESULTS: SMRs for both radiation and non-radiation workers had lower risks of death from all causes (0.74; 95% Confidence interval (CI) 0.74-0.75 and 0.77; 95% Cl 0.77-0.78, respectively) and from all cancers (0.92; 95% CI 0.91-0.93 and 0.90; 95% CI 0.89-0.91, respectively) compared to US males. Asbestos-related diseases including pleural cancers, mesothelioma, and asbestosis, but not lung cancers, were statistically higher in both radiation and non-radiation workers compared to the US males.

CONCLUSION: US shipyard male radiation and non-radiation workers did not show any elevated mortality risks that might be associated with radiation exposure.

PMID:35081587 | DOI:10.1097/JOM.0000000000002491

J Psychiatr Res. 2022 Jan 18;148:1-8. doi: 10.1016/j.jpsychires.2022.01.031. Online ahead of print.

ABSTRACT

Although preliminary neuroimaging research suggests that patients with hoarding disorder (HD) show widespread abnormal task-related activity in the brain, there has been no research on alterations in the white matter tracts in these patients. The aim of this study was to investigate the characteristics of the major white matter tracts in patients with HD. Tract-based spatial statistics were used to search for white matter tract abnormalities throughout the brain in 25 patients with HD and 36 healthy controls. Post hoc analysis of regions of interest was performed to detect correlations with clinical features. Compared with the controls, patients with HD showed decreased fractional anisotropy and increased radial diffusivity in anatomically widespread white matter tracts. Post hoc analysis of regions of interest revealed a significant negative correlation between the severity of hoarding symptoms and fractional anisotropy in the left anterior limb of the internal capsule and a positive correlation between the severity of these symptoms and radial diffusivity in the right anterior thalamic radiation. Patients with HD showed a broad range of alterations in the frontal white matter tracts, including the frontothalamic circuit, frontoparietal network, and frontolimbic pathway. The findings of this study indicate associations between frontal white matter abnormalities related to the severity of hoarding symptoms in HD and the cortical regions involved in cognitive dysfunction. The insights provided would be useful for understanding the neurobiological basis of HD.

PMID:35081485 | DOI:10.1016/j.jpsychires.2022.01.031

Eur J Radiol. 2022 Jan 19;148:110165. doi: 10.1016/j.ejrad.2022.110165. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the value of dual-energy CT imaging to discriminate low- from high- risk type II endoleaks (T2EL) after endovascular aneurysm repair (EVAR).

METHOD: Study participants were consecutive patients referred for CT at 1-month post-EVAR. CT imaging acquisition included a dual-energy CT angiography (DECTA) and a delayed single-energy CT (SECT) imaging. Patients diagnosed with T2EL were re-examined at 6-months post-EVAR to assess the aneurysm sac growth (ASG). Upon ASG recorded, patients were categorized as having low- (group A) or high- risk (group B) T2EL. DECTA image data were employed to calculate the normalized effective atomic number (NZ_eff), the normalized iodine concentration, the slope of HU_endoleak/HU_aorta against monochromatic energy, the dual-energy index and an improvised endoleak index (EI) for each T2EL. Statistical analysis was employed to compare all above parameters regarding their ability to differentiate low- from high- risk T2EL.

RESULTS: Among 40 patients examined at 1-month post-EVAR, 14 patients were diagnosed with T2EL. NZ_eff and EI were found to be significantly lower in group A. NZ_eff was found to have the highest power to discriminate high-risk T2EL with an area-under-curve of 86.7%, showing100% specificity and 60% sensitivity. The optimal contrast-to-noise ratio for T2EL demonstrated a median peak conspicuity level at 54-keV. The mean effective dose from DECTA and SECT scans was 27.8% lower compared to the sum of three SECT acquisitions.

CONCLUSIONS: NZ_eff and EI were found to have a significant power in predicting the aggressiveness of T2EL lesions. Virtual monochromatic images at 54-keV may enhance T2EL detection efficiency.

PMID:35081491 | DOI:10.1016/j.ejrad.2022.110165

J Neurol Sci. 2022 Jan 6;434:120142. doi: 10.1016/j.jns.2022.120142. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the impact of desmopressin acetate (DDAVP) on poor outcomes, hematoma expansion, and adverse events in patients diagnosed with a non-traumatic, antiplatelet-associated intracranial hemorrhage (ICH).

METHODS: This was a multicenter, retrospective, propensity-matched cohort study comparing DDAVP to control in patients diagnosed with a non-traumatic ICH previously on antiplatelet therapy. Notable exclusion criteria included admission to trauma service, subarachnoid hemorrhages, confounding coagulopathic factors, and hematoma evacuation. Poor outcome, defined as discharge to hospice or in-patient mortality, was the primary outcome. Secondary outcomes included intracranial hematoma expansion and occurrence of adverse events, which included hyponatremia and thromboembolic events.

RESULTS: A total of 49 patients receiving DDAVP were compared to 107 controls in the unmatched cohort. Thirty-seven patients treated with DDAVP and 55 controls were included in the propensity-matched analysis, which was adjusted for age, ethnicity, history of diabetes, receipt of platelet transfusion, and thromboembolism prophylaxis. Poor outcome (16.2% DDAVP vs 29% control, p = 0.13), rates of hematoma expansion (11.8% DDAVP vs 11.1% control, p = 0.99), and adverse events (21.6% DDAVP vs 20% control, p = 0.99) were statistically similar between the matched groups.

CONCLUSIONS: DDAVP administration in patients with spontaneous antiplatelet-associated ICH was not associated with a reduction in poor outcomes, hematoma expansion, or an increase in adverse events. Use of DDAVP in this patient population appears to be safe. Larger prospective studies are warranted to evaluate DDAVP utility in this patient population.

PMID:35081458 | DOI:10.1016/j.jns.2022.120142