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Nevin Manimala Statistics

Calibrated uncertainty estimation for interpretable proton computed tomography image correction using Bayesian deep learning

Phys Med Biol. 2021 Feb 24. doi: 10.1088/1361-6560/abe956. Online ahead of print.

ABSTRACT

Integrated-type proton computed tomography (pCT) measures proton stopping power ratio (SPR) images for proton therapy treatment planning, but its image quality is degraded due to noise and scatter. Although several correction methods have been proposed, techniques that include estimation of uncertainty are limited. This study proposes a novel uncertainty-aware pCT image correction method using a Bayesian convolutional neural network (BCNN). A DenseNet-based BCNN was constructed to predict both a corrected SPR image and its uncertainty from a noisy SPR image. A total 432 noisy SPR images of 6 non-anthropomorphic and 3 head phantoms were collected with Monte Carlo simulations, while true noise-free images were calculated with known geometric and chemical components. Heteroscedastic loss and deep ensemble techniques were performed to estimate aleatoric and epistemic uncertainties by training 25 unique BCNN models. 200-epoch end-to-end training was performed for each model independently. Feasibility of the predicted uncertainty was demonstrated after applying two post-hoc calibrations and calculating spot-specific path length uncertainty distribution. For evaluation, accuracy of head SPR images and water-equivalent thickness (WET) corrected by the trained BCNN models was compared with a conventional method and non-Bayesian CNN model. BCNN-corrected SPR images represent noise-free images with high accuracy. Mean absolute error in test data was improved from 0.263 for uncorrected images to 0.0538 for BCNN-corrected images. Moreover, the calibrated uncertainty represents accurate confidence levels, and the BCNN-corrected calibrated WET was more accurate than non-Bayesian CNN with high statistical significance. Computation time for calculating one image and its uncertainties with 25 BCNN models is 0.7 seconds with a consumer grade GPU. Our model is able to predict accurate pCT images as well as two types of uncertainty. These uncertainties will be useful to identify potential cause of SPR errors and develop a spot-specific range margin criterion, toward elaboration of uncertainty-guided proton therapy.

PMID:33626513 | DOI:10.1088/1361-6560/abe956

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Nevin Manimala Statistics

An Evaluation of Training Load Measures for Drills in Women’s Collegiate Lacrosse

Int J Sports Physiol Perform. 2021 Feb 24:1-8. doi: 10.1123/ijspp.2020-0029. Online ahead of print.

ABSTRACT

PURPOSE: To statistically evaluate the internal and external load metrics in different types of lacrosse drills.

METHODS: A total of 25 Division I collegiate female lacrosse players wore a heart rate monitor and a global positioning system during preseason training sessions. Seven measures determined training load, 2 internal measures and 5 external measures, across 5 different types of drills: stickwork, small-sided games, individual skills, conditioning, and team drills. Principal component analysis was used to determine which internal and external load variables were most associated with each drill type.

RESULTS: Stickwork extracted 2 principal components, explaining 45% and 17% of the variance. Small-sided games extracted 1 principal component, explaining 51% of the variance. Individual skills extracted 2 components, explaining 39% and 22% of the variance. Conditioning extracted 2 components, explaining 44% and 24% of the variance. Team drills extracted 2 components, explaining 52% and 18% of the variance.

CONCLUSIONS: In 4 out of 5 training modes, the inclusion of both internal and external training-load measures was necessary to accurately decipher training load. For most drills, the first component is related to measures of external load, and the second component described the balance between internal and external load measures. Small-sided games extracted only external measures including the following: accelerations, total distance, and average speed. These results show that a combination of internal and external load measures is required to determine training load during certain training modes. This information can help coaches make decisions about desired training load for practice sessions.

PMID:33626504 | DOI:10.1123/ijspp.2020-0029

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Nevin Manimala Statistics

Effects of Myofascial Self-Release on Range of Motion, Pressure Pain Threshold, and Hamstring Strength in Asymptomatic Individuals: A Randomized, Controlled, Blind Clinical Trial

J Sport Rehabil. 2021 Feb 24:1-6. doi: 10.1123/jsr.2020-0166. Online ahead of print.

ABSTRACT

CONTEXT: Myofascial self-release is performed using a roller to exert pressure on the soft tissues and to promote effects similar to those of traditional massage. However, there is no standardization regarding its application, mainly in relation to time.

OBJECTIVE: To evaluate the effects of myofascial self-release with a rigid roller on range of motion (ROM), pressure pain threshold (PPT), and hamstring strength in asymptomatic individuals following 2 different times of intervention.

DESIGN: Randomized, controlled, blind, clinical trial comparing preintervention and immediately postintervention within 2 groups.

SETTING: Institutional physiotherapy clinic.

PARTICIPANTS: A total of 40 university students (18-30 y), who had no symptoms, participated.

INTERVENTION: Foam roller for 30 seconds and 2 minutes for group 2.

MAIN OUTCOME MEASURES: Hamstring PPT, knee-extension ROM, and peak knee-flexion torque measured before and immediately after the intervention.

RESULTS: Both groups experienced a statistically significant increase in ROM compared with baseline (30 s and 2 min for group 2 P < .024). There were no statistically significant differences comparing peak knee-flexion torque or PPT.

CONCLUSIONS: Hamstring myofascial self-release using a roller for 30 seconds or 2 minutes produced an increase in ROM in healthy individuals. PPT and peak knee-flexion isometric torque showed no effects.

PMID:33626501 | DOI:10.1123/jsr.2020-0166

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Nevin Manimala Statistics

Continued decline in the prevalence of the Clostridioides difficile BI/NAP1/027 strain across the United States Veterans Health Administration

Diagn Microbiol Infect Dis. 2021 Jan 22;100(2):115308. doi: 10.1016/j.diagmicrobio.2021.115308. Online ahead of print.

ABSTRACT

In 2018, we demonstrated a decreased prevalence of the hypervirulent Clostridioides difficile BI/NAP1/027 strain across the United States (US) Veterans Health Administration (VHA) from 2011 through 2016. The objective of this retrospective study was to update the prevalence of the BI/NAP1/027 strain within the VHA from 2017 through 2020. Patients with positive tests for the presence of toxigenic C. difficile at any Veterans Affairs Medical Center found to also routinely test for BI/NAP1/027 strain presence were included between July 1, 2016 and June 30, 2020. In total, 7490 patients had 8148 positive C. difficile tests that had a corresponding BI/NAP1/027 test. Of those, there were 1031 (12.6%) presumptive positive tests for the BI/NAP1/027 strain. The overall prevalence of BI/NAP1/027 decreased from a high of 15.4% in 2017 to 8.21% in 2020. Statistically significant reductions in rates from 2017 to 2020 occurred in 4 of 9 US Census Bureau regions.

PMID:33626478 | DOI:10.1016/j.diagmicrobio.2021.115308

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Nevin Manimala Statistics

Multi-aquifer susceptibility analyses for supporting groundwater management in urban areas

J Contam Hydrol. 2021 Jan 22;238:103774. doi: 10.1016/j.jconhyd.2021.103774. Online ahead of print.

ABSTRACT

In the densely urbanised Milan Metropolitan area (northern Italy), the long history of anthropogenic activities still exerts a significant pressure on groundwater resource. One of the most serious threats to the water quality of urban aquifers is attributed to diffuse contamination, which is caused by a series of unknown small sources (i.e., multiple point sources) distributed over large areas. In the study area and in many industrialised regions of the world, tetrachloroethylene [PCE], trichloroethylene [TCE] and hexavalent chromium [Cr(VI)] represent the common example of long-standing and persistent pollution in groundwater. In the Milan Metropolitan area, high levels of PCE + TCE and Cr(VI) were detected in the shallow aquifer as well as in the deep aquifer. To assess and map the shallow and deep aquifers susceptibility to PCE + TCE and Cr(VI) contamination at a regional scale, the Weights of Evidence modelling technique has been applied. This method has been used to objectively evaluate the spatial correlation between the high presence of these pollutants in each aquifer and hydrogeological and land use factors that can potentially influence the contamination. Moreover, the results allowed us to quantify on a large scale the effect that preferential flowpaths, due to both thickness variation in the aquitard and the areal density of multi aquifer wells, have in reducing the protection of the underlying deep aquifer. The end-products of the study constitute a key tool to be used by water-resource managers and decision-makers for the improvement of groundwater management and protection strategies.

PMID:33626464 | DOI:10.1016/j.jconhyd.2021.103774

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Nevin Manimala Statistics

The modified Shriners Hospitals for Children Greenville (mSHCG) multi-segment foot model provides clinically acceptable measurements of ankle and midfoot angles: A dual fluoroscopy study

Gait Posture. 2021 Feb 13;85:258-265. doi: 10.1016/j.gaitpost.2021.02.004. Online ahead of print.

ABSTRACT

BACKGROUND: Several multi-segment foot models have been developed to evaluate foot and ankle motion using skin-marker motion analysis. However, few multi-segment models have been evaluated against a reference standard to establish kinematic accuracy.

RESEARCH QUESTION: How accurately do skin-markers estimate foot and ankle motion for the modified Shriners Hospitals for Children Greenville (mSHCG) multi-segment foot model when compared against the reference standard, dual fluoroscopy (DF), during gait, in asymptomatic participants?

METHODS: Five participants walked overground as full-body skin-marker trajectory data and DF images of the foot and shank were simultaneously acquired. Using the mSHCG model, ankle and midfoot angles were calculated throughout stance for both motion analysis techniques. Statistical parametric mapping assessed differences in joint angles and marker positions between skin-marker and DF motion analysis techniques. Paired t tests, and linear regression models were used to compare joint angles and range of motion (ROM) calculated from the two techniques.

RESULTS: In the coronal plane, the skin-marker model significantly overestimated ROM (p = 0.028). Further, the DF model midfoot ROM was significantly positively related to differences between DF and skin-marker midfoot angles (p = 0.035, adjusted R2 = 0.76). In the sagittal plane, skin-markers underestimated ankle angles by as much as 7.26°, while midfoot angles were overestimated by as much as 9.01°. However, DF and skin-marker joint angles were not significantly different over stance. Skin-markers on the tibia, calcaneus, and fifth metatarsal had significantly different positions than the DF markers along the direction of walking for isolated portions that were less than 10 % of stance. Euclidean distances between DF and skin-markers positions were less than 9.36 mm.

SIGNIFICANCE: As the accuracy of the mSHCG model was formerly unknown, the results of this study provide ranges of confidence for key angles calculated by this model.

PMID:33626450 | DOI:10.1016/j.gaitpost.2021.02.004

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Nevin Manimala Statistics

HPLC method for the determination of antiepileptic drugs in human saliva and its application in therapeutic drug monitoring

J Pharm Biomed Anal. 2021 Feb 10;197:113961. doi: 10.1016/j.jpba.2021.113961. Online ahead of print.

ABSTRACT

Epilepsy is one of the most prevalent neurological disorders, affecting approximately 1% of the world population. Despite the availability of dozens of antiepileptic drugs (AEDs) in clinical practice, the number of patients who do not respond to treatment and/or exhibit high pharmacokinetic variability remains significant, highlighting the importance of therapeutic drug monitoring (TDM). Plasma and serum are the main biological matrices applied for the TDM of AEDs, but the necessity of a specialized professional has been an obstacle to sample collection in ambulatory. Thus, drug quantification in saliva arises as a promising alternative. Herein, a novel highperformance liquid chromatographic (HPLC) technique with diode-array detection (DAD) was developed and fully validated, in order to simultaneously quantify carbamazepine, carbamazepine-10,11-epoxide, S-licarbazepine, lacosamide and levetiracetam in human saliva. The technique was linear in the following concentration ranges: 0.2-6 mg L-1 for carbamazepine and carbamazepine-10,11-epoxide; 0.3-9 mg L-1 for S- licarbazepine; 1-30 mg L-1 for lacosamide; and 0.8-24 mg L-1 for levetiracetam. The lower limits of the established calibration ranges are below therapeutic margins, attesting a sensitive drug quantification. Accuracy values ranged from -14.76 to 9.35 % and -12.87 and 11.18 % in intra-day and inter-day analysis, respectively. Intra-day values of precision varied between 3.45-10.76% and inter-day values ranged from 3.85 to 13.05 %. This method was subsequently applied to saliva samples of epileptic patients admitted to the Refractory Epilepsy Centre of Centro Hospitalar e Universitário de Coimbra (CHUC EPE, Coimbra). The results of saliva samples were correlated with drug concentrations in plasma from the same patients. Statistically significant correlations were observed (p < 0.05) for carbamazepine (r2 = 0.6887; r = 0.8299), carbamazepine-10,11-epoxide (r2 = 0.8633; r = 0.9291), S-licarbazepine (r2 = 0.5266; r = 0.7257) and levetiracetam (r2 = 0.7103; r = 0.8428). Our data support that this method can be used in TDM of AEDs using human saliva samples, constituting a new approach to establish individual therapeutic ranges and assess patient’s adherence to treatment.

PMID:33626445 | DOI:10.1016/j.jpba.2021.113961

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Prevalence of hypertensive disorders in pregnancy in China: A systematic review and meta-analysis

Pregnancy Hypertens. 2021 Feb 14;24:13-21. doi: 10.1016/j.preghy.2021.02.001. Online ahead of print.

ABSTRACT

Hypertensive disorders in pregnancy (HDP) are associated with various maternal and fetal adverse outcomes and become an increasingly significant threat to Chinese pregnant women. Yet, the prevalence of HDP in China is not clear. We conducted this meta-analysis to estimate the prevalence of HDP and specific subtypes in China. We searched PubMed, Embase, Web of Science, CNKI, Wangfang, and CMB for studies on prevalence of HDP and specific subtypes, published from 1990 to Jan 21, 2020, without language restrictions. We included all studies reported the prevalence of HDP and specific subtypes in Chinese pregnant women. We excluded qualitative studies, case reports, reviews, conference presentations, and studies only provided abstracts. We using a standard self-developed form to extract information from eligible studies. We did meta-analyses by random-effect models and estimated the pooled prevalence of HDP and specific subtypes. In order to explore potential sources of heterogeneity and subgroup effects, we did and meta-regression and subgroup analyses by pre-specified covariates. This study is registered with PROSPERO, number CRD42020166001. We initially identified 4179 records, of which 92 studies with 1,377,448 participants were eligible in the final systematic review and meta-analyses. The pooled prevalence (95% CI) of HDP, gestational hypertension, preeclampsia, mild preeclampsia, severe preeclampsia, eclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia were 7.30% (6.60%-8.00%), 3.30% (2.90%-3.70%), 4.50% (4.00%-5.00%), 2.00% (1.70%-2.30%), 2.60% (2.10%-3.00%), 0.11% (0.08%-0.15%), 0.60% (0.30%-0.90%), and 0.60% (0.40%-0.80%), respectively. No publication bias was identified, although heterogeneity was high (I2 statistics: 92.0%-99.3%). High prevalence of HDP and the subtypes frequently reported in Western and Northern China. Pregnant women who were aged 35 years and above had high prevalence of HDP and subtypes; women who were overweight or obese had high prevalence of HDP, gestational hypertension and preeclampsia. The prevalence of HDP and the subtypes vary in different areas in China. Given to increasingly prevalent of the risk factors, such as overweight, obesity, and advance maternal age, strategies to prevent and manage HDP need to be improved, especially for women living in Western and Northern China.

PMID:33626437 | DOI:10.1016/j.preghy.2021.02.001

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Nevin Manimala Statistics

A randomised controlled feasibility trial to evaluate Lawsonia inermis (henna)’s effect on palmar-plantar erythrodysesthesia induced by capecitabine or pegylated liposomal doxorubicin

Eur J Oncol Nurs. 2021 Feb 15;51:101908. doi: 10.1016/j.ejon.2021.101908. Online ahead of print.

ABSTRACT

PURPOSE: To test the effectiveness of henna in the management of palmar-plantar erythrodysesthesia (PPE) in patients receiving treatment with capecitabine or pegylated liposomal doxorubicin (PLD).

METHOD: This was a randomized controlled feasibility study in three specialized tertiary cancer centers with 56 patients with a PPE grade 1 or above and various cancer diagnoses. The intervention included the local application of henna to the affected areas. The control group followed the same process with a henna inert. Primary outcome was PPE grade and secondary outcomes were the EORTC QLQ-C30, PPE-related QoL (HFS-14), activities of daily living (ECOG) and pain. Patients in both groups were assessed at baseline and then weekly at four follow-ups.

RESULTS: PPE grade in the intervention group (1-3.8%) was lower compared to the control group (4-13.38%) and also lower levels of pain were reported by the patients in the intervention group (2.46 ± 1.17) compared to the control (5.57 ± 2.01). ECOG status in the intervention group was improved compared to the control (p = 0.039). The intervention group, experienced higher Global Health Status (p ≤ 0.008), Physical function (p ≤ 0.001), Emotional Function (p = 0.029), Social function (p ≤ 0.001) and lower Fatigue (p ≤ 0.001) and Pain (p ≤ 0.001) compared to the Control group. A statistically significant interaction was found between Group and Time over the weekly measurements of HFS-14 scores (F = 5,009, p ≤ 0.002) indicating the significant effect of the intervention throughout the weekly assessments.

CONCLUSION: The trial provided preliminary evidence on henna’s effectiveness for treating PPE during treatment with capecitabine or PLD, with lower PPE grades, better performance status and better HRQoL observed in the henna group. CLINICALTRIALS.

GOV IDENTIFIER: NCT01751893.

PMID:33626423 | DOI:10.1016/j.ejon.2021.101908

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Determination of the pathways of potential muscle damage and regeneration in response to acute and long-term swimming exercise in mice

Life Sci. 2021 Feb 21:119265. doi: 10.1016/j.lfs.2021.119265. Online ahead of print.

ABSTRACT

The objective of the current study was examining early and late (3, 24 h) responses to acute, chronic swimming exercise as muscle damage and regeneration in gastrocnemius-soleus muscle complexes. We also aimed to reveal the signaling pathways involved. 8-12 weeks old mice were grouped as control, exercise. Exercising groups were firstly divided into two as acute and chronic, later every group was again divided in terms of time (3, 24 h) passed from the last exercise session until exsanguination. Acute exercise groups swam 30 min, while chronic swimming groups exercised 30 min/day, 5 days/week, 6 weeks. Histological investigations were performed to determine muscle damage and regeneration. Whole-genome expression analysis was applied to total RNA samples. Microarray data was confirmed by quantitative real-time PCR. Exercising mice muscle revealed enhanced damage, leukocyte infiltration. Increments in acute and chronic 3 h groups were statistically significant. Car3, Neb, Obscn, Ttn, Igfbp5, Igfbp7, Gsk3β, and Usp2 were down-regulated in muscles of swimming mice. The exercise-induced signaling pathways involved in muscle damage and regeneration were drawn. Our findings demonstrate that swimming induces muscle damage. Samples were obtained at 3 and 24 h following exercise, this time duration seems not sufficient for the development of myofibrillogenesis.

PMID:33626393 | DOI:10.1016/j.lfs.2021.119265