Category: Statistics

Klin Padiatr. 2021 Mar;233(2):63-68. doi: 10.1055/a-1288-3670. Epub 2021 Mar 8.

ABSTRACT

OBJECTIVE: To summarize the clinical features of primary nephrotic syndrome (PNS) complicated by plastic bronchitis (PB) in children to provide guidance for treatment.

METHODS: We conducted a retrospective review of the clinical data of 25 children hospitalized with NS complicated by PB in our Hospital between 10/2016 and 03/2019, and summarized the clinical manifestations, imaging and fiberoptic bronchoscopy (FOB) examinations, treatment course and outcome of them.

RESULTS: 1). The 25 children, with a nephrotic syndrome (NS) course of one to 36 months, were all diagnosed with PB after FOB, among which 8 cases (32%) had respiratory failure and required ventilatory support. All of them started with respiratory symptoms such as fever and cough, and then suffered from dyspnea and progressive aggravation after 1-3 day(s) of onset, with rapid occurrence of bidirectional dyspnea and even respiratory failure in severe cases. 2). Laboratory test for pathogens: influenza A virus H1N1 (11 cases), influenza B virus (9 cases), adenovirus (3 cases) and mycoplasma pneumoniae (2 cases). There was no statistically significant difference (P>0.05) between children with common NS complicated by influenza virus (IV) infection (not accompanied by dyspnea) and those with kidney disease who developed PB in the white blood cell count, lymphocyte count, the inflammatory biomarkers C-reactive protein (CRP), procalcitonin (PCT) and humoral immunity (IgG level), yet the total IgG level was found significantly higher and the blood albumin level lower in the latter (P<0.05). 3). The 25 children were all examined with the FOB and treated with lavage, 15 of which had typical bronchial tree-like casts and 10 broken and stringy casts. Based on histopathological classification, all children were of Type I. 4). Twenty children (80%) with influenza were administered the antiviral drug Oseltamivir, 20 (80%) were treated with antibiotics, oral hormones were replaced with the same dosage of intravenous Methylprednisolone for 5 cases (20%), and 20 (80%) were intravenously administered gamma globulins (400-500 mg/kg x 3 days). These children showed a remarkable improvement after treatment and there were no deaths.

CONCLUSION: NS children are at high risk of influenza virus infection. Children with a severe case of NS are more susceptible to PB. If symptoms like shortness of breath, wheezing and progressive bidirectional dyspnea occur, FOB examination and lavage treatment should be performed as early as possible. Hyper-IgE-emia and hypoproteinemia may be the high risk factors for PNS complicated by PB in children. ZIEL: Ziel der Studie war es, durch Zusammenfassung der klinischen Merkmale des primären nephrotischen Syndroms (PNS) mit komplizierender plastischer Bronchitis (PB) im Kindesalter eine Orientierungshilfe für die Therapie der Erkrankung zu geben.

METHODIK: Wir führten eine retrospektive Prüfung der klinischen Daten von 25 Kindern durch, die zwischen Oktober 2016 und März 2019 in unser Krankhaus aufgenommen wurden, und erstellten eine Zusammenfassung der klinischen Symptome, Untersuchungen mit bildgebenden Verfahren und fiberoptischer Bronchoskopie (FOB), des Therapieverlaufs und des Outcomes der Patienten.

ERGEBNISSE: 1). Bei den 25 Kindern bestand ein nephrotisches Syndrom (NS) über einen Zeitraum von einem bis 36 Monaten. Bei allen Patienten wurde die Diagnose PB nach FOB gestellt, wobei in 8 Fällen (32%) eine beatmungspflichtige respiratorische Insuffizienz vorlag. Alle Patienten zeigten anfänglich Symptome einer Atemwegserkrankung wie Fieber und Husten, gefolgt von Atemnot und progredienter Verschlechterung 1 bis 3 Tage nach Erkrankungsbeginn. Dabei kam es rasch zum Auftreten bidirektionaler Atemnot, in schweren Fällen bis hin zur respiratorischen Insuffizienz. 2). Laboruntersuchung auf Erreger: Influenza-A-Virus H1N1 (11 Fälle), Influenza-B-Virus (9 Fälle), Adenovirus (3 Fälle) und Mycoplasma pneumoniae (2 Fälle). Es fand sich kein statistisch signifikanter Unterschied (P>0,05) zwischen Kindern, die ein “gewöhnliches” NS mit komplizierender Influenza-Virus (IV)-Infektion (ohne begleitende Atemnot) aufwiesen, und Kindern mit Nierenerkrankung, die eine PB entwickelten, hinsichtlich der Leukozyten- und Lymphozytenwerte sowie der Entzündungsmarker C-reaktives Protein (CRP), Procalcitonin (PCT) und humorale Immunität (IgG-Wert). Allerdings wurde bei der letzteren Patientengruppe ein signifikant höherer Gesamt-IgG-Wert und ein signifikant niedriger Albumin-Spiegel im Blut nachgewiesen (P<0.05). 3). Bei allen 25 Kindern erfolgte eine FOB und Therapie mit Lavage, bei 15 Kinder fanden sich typische verzweigte Ausgüsse der Bronchialäste und bei 10 Patienten desintegrierte und zähe Ausgüsse. Gemäß der histopathologischen Klassifikation waren alle Kinder vom Typ I. 4). Zwanzig Kinder (80%) mit Influenza erhielten das Virostatikum Oseltamivir, 20 Kinder (80%) eine Antibiotikatherapie, in 5 Fällen (20%) wurden oral gegebene Hormone durch intravenös in derselben Dosis verabreichtes Methylprednisolon ersetzt und 20 Kinder (80%) erhielten intravenös verabreichte Gammaglobuline (400-500 mg/kg Körpergewicht x 3 Tage). Diese Kinder zeigten eine bemerkenswerte Verbesserung nach der Therapie und es traten keine Todesfälle auf.

SCHLUSSFOLGERUNG: Bei Kindern mit NS besteht ein hohes Risiko für eine Influenza-Virus-Infektion. Kinder mit schwerem NS sind anfälliger für PB. Bei Auftreten von Symptomen wie Atemnot, Giemen und Brummern sowie progredienter bidirektionaler Dyspnoe sollte baldmöglichst eine FOB-Untersuchung und eine therapeutische Lavage durchgeführt werden. Erhöhte IgE-Werte im Blut und Hypoproteinämie stellen möglicherweise Risikofaktoren für PNS mit komplizierender PB im Kindesalter dar.

PMID:33684950 | DOI:10.1055/a-1288-3670

Environ Int. 2021 Mar 5;152:106464. doi: 10.1016/j.envint.2021.106464. Online ahead of print.

ABSTRACT

BACKGROUND: Ambient air pollution is likely a risk factor for asthma, and recent evidence suggests the possible relevance of road traffic noise.

OBJECTIVES: We examined the associations of long-term exposure to air pollution and road traffic noise with adult-asthma incidence.

METHODS: We followed 28,731 female nurses (age > 44 years) from the Danish Nurse Cohort, recruited in 1993 and 1999, for first hospital contact for asthma from 1977 until 2015. We estimated residential annual mean concentrations of particulate matter with diameter < 2.5 µm (PM_2.5) since 1990 and nitrogen dioxide (NO₂) since 1970 with the Danish DEHM/UBM/AirGIS modeling system, and road traffic noise (L_den) since 1970 with the Nord2000 model. Time-varying Cox regression models were used to associate air pollution and road traffic noise exposure with asthma incidence.

RESULTS: During 18.6 years’ mean follow-up, 528 out of 23,093 participants had hospital contact for asthma. The hazard ratios (HR) and 95% confidence intervals for asthma incidence associated with 3-year moving average exposures were 1.29 (1.03, 1.61) per 6.3 µg/m³ for PM_2.5, 1.16 (1.07, 1.27) per 8.2 µg/m³ for NO₂, and 1.12 (1.00, 1.25) per 10 dB for L_den. The HR for NO₂ remained unchanged after adjustment for either PM_2.5 or L_den, while the HRs for PM_2.5 and L_den attenuated to unity after adjustment for NO₂.

CONCLUSIONS: Long-term exposure to air pollution was associated with adult-asthma incidence independently of road traffic noise, with NO₂ most relevant. Road traffic noise was not independently associated with adult-asthma incidence.

PMID:33684733 | DOI:10.1016/j.envint.2021.106464

Sci Total Environ. 2021 Feb 28;777:146145. doi: 10.1016/j.scitotenv.2021.146145. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze the spatiotemporal dynamic distribution and detect the related meteorological factors of scarlet fever from an ecological perspective, which could provide scientific information for effective prevention and control of this disease.

METHODS: The data on scarlet fever cases in mainland China were downloaded from the Data Center of the China Public Health Science, while monthly meteorological data were extracted from the official website of the National Bureau of Statistics. Global Moran’s I, local Getis-Ord G_i^⁎ hotspot statistics, and Kulldorff’s retrospective space-time scan statistical analysis were used to detect the spatial and spatiotemporal clusters of scarlet fever across all settings. A spatial panel data model was conducted to estimate the impact of meteorological factors on scarlet fever incidence.

RESULTS: Scarlet fever in China had obvious spatial, temporal, and spatiotemporal clustering, high-incidence spatial clusters were located mainly in the north and northeast of China. Nine spatiotemporal clusters were identified. A spatial lag fixed effects panel data model was the best fit for regression analysis. After adjusting for spatial individual effects and spatial autocorrelation (ρ = 0.5623), scarlet fever incidence was positively associated with a one-month lag of average temperature, precipitation, and total sunshine hours (all P-values < 0.05). Each 10 °C, 2 cm, and 10 h increase in temperature, precipitation, and sunshine hours, respectively, was associated with a 6.41% increment and 1.04% and 1.41% decrement in scarlet fever incidence, respectively.

CONCLUSION: The incidence of scarlet fever in China showed an upward trend in recent years. It had obvious spatiotemporal clustering, with the high-risk areas mainly concentrated in the north and northeast of China. Areas with high temperature and with low precipitation and sunshine hours tended to have a higher scarlet fever incidence, and we should pay more attention to prevention and control in these places.

PMID:33684741 | DOI:10.1016/j.scitotenv.2021.146145

Sci Total Environ. 2021 Feb 28;777:146100. doi: 10.1016/j.scitotenv.2021.146100. Online ahead of print.

ABSTRACT

Arctic subsea permafrost contains more organic carbon than the terrestrial counterpart (~1400 Pg C vs. ~1000 Pg C) and is undergoing fast degradation (at rates of ~10 to 30 cm yr^-1 over the past 3 decades) in response to climate warming. Yet the flux of organic carbon sequestered in the sediments of subsea permafrost to overlying water column, which can trigger enormous positive carbon-climate feedbacks, remain unclear. In this study, we examined the dissolved organic matter (DOM) diffusion to bottom seawaters from East Siberian Sea (ESS) sediments, which was estimated at about 943-2240 g C m^-2 yr^-1 and 10-55 g C m^-2 yr^-1 at the continuous-discontinuous transition zone of subsea permafrost and the remainder shelf and slope sites, respectively. The released DOM is characterized by prevailing dominance (≥ 98%) of low molecular weight (M_n < 350 Da) fractions. A red-shifted (emission wavelength >500 nm) fluorescence fingerprint, a typical feature of sediment/soil DOM, accounts for 4-6% and 7-8% in the fluorescence distributions of seawaters and pore waters, respectively, on ESS shelf. Statistical analysis revealed that seawaters and pore waters possessed similar DOM composition. The estimated total benthic efflux of dissolved organic carbon (DOC) was ~0.7-1.0 Pg C yr^-1 when the estimate was scaled up to the entire Arctic shelf underlain with subsea permafrost assuming the width of continuous-discontinuous transition zone is 1 to 10 m. This estimation is consistent with the established ~10-30 cm yr^-1 degradation rates of subsea permafrost by estimating its thaw-out time. Compiled observation data suggested that subsea permafrost might be a major DOM source to the Arctic Ocean, which could release tremendous carbon upon remineralization via its degradation to CO₂ and CH₄ in the water column.

PMID:33684745 | DOI:10.1016/j.scitotenv.2021.146100

J Mech Behav Biomed Mater. 2021 Mar 3;118:104433. doi: 10.1016/j.jmbbm.2021.104433. Online ahead of print.

ABSTRACT

OBJECTIVE: To perform a systematic review of the literature focused to evaluate in vitro function of prefabricated fiber posts with and without customization by additional auxillary fiber posts and composite resin on the fracture strength of wide or enlarged canals and the failure pattern.

METHODS: Six databases were used as primary search sources (PubMed, Scopus, LILACS, SciELO, Science Direct, and Web of Science) and three databases (Open Grey, Open Thesis, and OATD) were used to partially capture the “grey literature”. The research included laboratory studies that used human upper anterior teeth aiming to assess the fracture strength and failure pattern of different glass fiber post customizations by additional auxiliary fiber posts or composite resin. The search had no restriction of year, language, and publication status. The risk of bias of the studies was assessed from the criteria established in systematic reviews of laboratory studies. Standardized mean differences were calculated by comparing the mean fracture strengths of customized and non-customized posts. Pooled estimates were calculated by Glass’ delta method using the random-effects model. Subtotal estimates were presented according to each type of relining procedure and an overall estimate was described considering all studies combined.

RESULTS: The search provided 2291 results, from which six met the eligibility criteria and were included in the qualitative assessment of the review. Only three studies presented a moderate risk of bias. The meta-analysis results showed that the use of auxiliary posts produced higher mean fracture strengths than non-customized posts (SMD = 2.21; 95%CI: 0.74; 3.68), and it was more effective than the use of composite resin to reline the posts.

CONCLUSION: Based on laboratories studies, even though has not been observed any difference to a statistically significant level on fracture strength and failure pattern of the customized and non-customized post, future studies should follow a standardized approach to implementation and reporting of data.

PMID:33684707 | DOI:10.1016/j.jmbbm.2021.104433

J Stroke Cerebrovasc Dis. 2021 Mar 5;30(5):105661. doi: 10.1016/j.jstrokecerebrovasdis.2021.105661. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Stroke outcome data in Uganda is lacking. The objective of this study was to capture 30-day mortality outcomes in patients presenting with acute and subacute stroke to Mbarara Regional Referral Hospital (MRRH) in Uganda.

METHODS: A prospective study enrolling consecutive adults presenting to MRRH with abrupt onset of focal neurologic deficits suspicious for stroke, from August 2014 to March 2015. All patients had head computed tomography (CT) confirmation of ischemic or hemorrhagic stroke. Data was collected on mortality, morbidity, risk factors, and imaging characteristics.

RESULTS: Investigators screened 134 potential subjects and enrolled 108 patients. Sixty-two percent had ischemic and 38% hemorrhagic stroke. The mean age of all patients was 62.5 (SD 17.4), and 52% were female. More patients had hypertension in the hemorrhagic stroke group than in the ischemic stroke group (53% vs. 32%, p = 0.0376). Thirty-day mortality was 38.1% (p = 0.0472), and significant risk factors were National Institutes of Health Stroke Scale (NIHSS) score, female sex, anemia, and HIV infection. A one unit increase of the NIHSS on admission increased the risk of death at 30 days by 6%. Patients with hemorrhagic stroke had statistically higher NIHSS scores (p = 0.0408) on admission compared to patients with ischemic stroke, and also had statistically higher Modified Rankin Scale (mRS) scores at discharge (p = 0.0063), and mRS score change from baseline (p = 0.04).

CONCLUSIONS: Our study highlights an overall 30-day stroke mortality of 38.1% in southwestern Uganda, and identifies NIHSS at admission, female sex, anemia, and HIV infection as predictors of mortality.

PMID:33684710 | DOI:10.1016/j.jstrokecerebrovasdis.2021.105661

Food Chem. 2021 Feb 23;352:129329. doi: 10.1016/j.foodchem.2021.129329. Online ahead of print.

ABSTRACT

A simple, novel, rapid, and non-destructive spectroscopic method that employs the deep spectral network for beef-freshness classification was developed. The deep-learning-based model classified beef freshness by learning myoglobin information and reflectance spectra over different freshness states. The reflectance spectra (480-920 nm) were measured from 78 beef samples for 17 days, and the datasets were sorted into three freshness classes based on their pH values. Myoglobin information showed statistically significant differences depending on the freshness; consequently, it was utilized as a crucial parameter for classification. The model exhibited improved performance when the reflectance spectra were combined with the myoglobin information. The accuracy of the proposed model improved to 91.9%, whereas that of the single-spectra model was 83.6%. Further, a high value for the area under the receiver operating characteristic curve (0.958) was recorded. This study provides a basis for future studies on the investigation of myoglobin information associated with meat freshness.

PMID:33684719 | DOI:10.1016/j.foodchem.2021.129329

Comput Med Imaging Graph. 2021 Feb 24;89:101885. doi: 10.1016/j.compmedimag.2021.101885. Online ahead of print.

ABSTRACT

Automatic liver and tumor segmentation play a significant role in clinical interpretation and treatment planning of hepatic diseases. To segment liver and tumor manually from the hundreds of computed tomography (CT) images is tedious and labor-intensive; thus, segmentation becomes expert dependent. In this paper, we proposed the multi-scale approach to improve the receptive field of Convolutional Neural Network (CNN) by representing multi-scale features that extract global and local features at a more granular level. We also recalibrate channel-wise responses of the aggregated multi-scale features that enhance the high-level feature description ability of the network. The experimental results demonstrated the efficacy of a proposed model on a publicly available 3Dircadb dataset. The proposed approach achieved a dice similarity score of 97.13 % for liver and 84.15 % for tumor. The statistical significance analysis by a statistical test with a p-value demonstrated that the proposed model is statistically significant for a significance level of 0.05 (p-value < 0.05). The multi-scale approach improves the segmentation performance of the network and reduces the computational complexity and network parameters. The experimental results show that the performance of the proposed method outperforms compared with state-of-the-art methods.

PMID:33684731 | DOI:10.1016/j.compmedimag.2021.101885

Clin Neurol Neurosurg. 2021 Mar 3;203:106583. doi: 10.1016/j.clineuro.2021.106583. Online ahead of print.

ABSTRACT

INTRODUCTION: The LACE+ (Length of Stay, Acuity of Admission, Charlson Comorbidity Index (CCI) Score, Emergency Department (ED) visits within the previous 6 months) index has never been tested in a purely spine surgery population. This study assesses the ability of LACE + to predict adverse patient outcomes following discectomy for far lateral disc herniation (FLDH).

PATIENTS AND METHODS: Data were obtained for patients (n = 144) who underwent far lateral lumbar discectomy at a single, multi-hospital academic medical center (2013-2020). LACE + scores were calculated for all patients with complete information (n = 100). The influence of confounding variables was assessed and controlled with stepwise regression. Logistic regression was used to test the ability of LACE + to predict risk of unplanned hospital readmission, ED visits, outpatient office visits, and reoperation after surgery.

RESULTS: Mean age of the population was 61.72 ± 11.55 years, 69 (47.9 %) were female, and 126 (87.5 %) were non-Hispanic white. Patients underwent either open (n = 92) or endoscopic (n = 52) surgery. Each point increase in LACE + score significantly predicted, in the 30-day (30D) and 30-90-day (30-90D) post-discharge window, higher risk of readmission (p = 0.005, p = 0.009; respectively) and ED visits (p = 0.045). Increasing LACE + also predicted, in the 30D and 90-day (90D) post-discharge window, risk of reoperation (p = 0.022, p = 0.016; respectively), and repeat neurosurgical intervention (p = 0.026, p = 0.026; respectively). Increasing LACE + score also predicted risk of reoperation (p = 0.011) within 30 days of initial surgery.

CONCLUSIONS: LACE + may be suitable for characterizing risk of adverse perioperative events for patients undergoing far lateral discectomy.

PMID:33684675 | DOI:10.1016/j.clineuro.2021.106583

Clin Neurol Neurosurg. 2021 Mar 2;203:106584. doi: 10.1016/j.clineuro.2021.106584. Online ahead of print.

ABSTRACT

OBJECTIVE: This study evaluated overlapping surgery on long-term outcomes following elective, single-level lumbar fusion on exact matched patients undergoing surgery with or without overlap.

PATIENTS AND METHODS: 3799 consecutive adult patients undergoing single-level, posterior-only lumbar fusion over a six-year period at a multi-hospital university health system were retrospectively followed. Reported outcomes included reoperation, emergency department (ED) visit, readmission, overall morbidity and mortality in the 90 days following surgery. Coarsened Exact Matching was used to match patients with and without overlap on key demographic factors. Patients were subsequently matched by both demographic data and by the attending surgeon performing the operation. Univariate analysis was carried out on the whole population, the demographic matched cohort, and demographic and surgeon matched cohort, with significance set at a p-value < 0.05.

RESULTS: Patients with overlap had a longer duration of surgery and were less likely to have an ED visit within 90 days of surgery (p < 0.03) but had no other significant differences. Within the demographic matched cohort and demographic/surgeon matched cohort, there was no significant difference in age, gender, history of prior surgery, ASA score, or CCI score, but patients with overlap had a longer duration of surgery (p < 0.01). Patients did not have significant differences with respect to any morbidity or mortality outcome in either the demographic or surgeon matched cohort.

CONCLUSIONS: Patients undergoing overlapping, single-level lumbar fusion were not at greater risk of long-term morbidity or mortality, despite having a significantly longer duration of surgery.

PMID:33684676 | DOI:10.1016/j.clineuro.2021.106584