Nevin Manimala

JCO Clin Cancer Inform. 2023 Jan;7:e2200101. doi: 10.1200/CCI.22.00101.

ABSTRACT

PURPOSE: Breast cancer is the most frequent cancer in women worldwide. However, its diagnosis mostly depends on visual examination of radiologic images, leading to an overdiagnosis with substantial costs. Therefore, a quantitative approach such as dynamic contrast enhanced (DCE)-magnetic resonance imaging (MRI) through pharmacokinetic (PK) modeling is required for reliable analysis. As PK parameters lack information on parameter heterogeneity, texture-based analysis is required to quantify PK parameter heterogeneity. Therefore, this study focused on determining the usefulness of fractal dimension (FD) as a potential imaging biomarker of tumor heterogeneity for discriminating benign and malignant breast lesions.

METHODS: Parametric maps for PK parameters, extravasation rate of contrast agent from blood plasma to extravascular extracellular space (K^trans) and volume fraction of extravascular extracellular space (v_e), were generated for the regions of interest (ROIs) under the standard model using 18 lesions. Then, tumor ROI and pixel DCE-MRI time-course data were analyzed to extract pixel values of K^trans and v_e. For each ROI, FD values of K^trans and v_e were computed using the blanket method.

RESULTS: The FD values of K^trans for benign and malignant lesions varied from 2.96 to 3.49 and from 2.37 to 3.16, respectively, whereas FD values of v_e for benign and malignant lesions varied from 3.01 to 5.15 and 2.42 to 3.44, respectively. There were significant differences in FD values derived from K^trans parametric maps (P = .0053) and v_e parametric maps (P = .0271) between benign and malignant lesions according to the statistical analysis.

CONCLUSION: Incorporating texture heterogeneity changes in breast lesions captured by FD with quantitative DCE-MRI parameters generated under the standard model is a potential marker for prediction of malignant lesions.

PMID:36745858 | DOI:10.1200/CCI.22.00101

J Cataract Refract Surg. 2023 Feb 1. doi: 10.1097/j.jcrs.0000000000001156. Online ahead of print.

ABSTRACT

PURPOSE: To determine the incidence of anterior vitreous detachment (AVD) and retrolental material occurrence in cataract surgery, determine the influence of surgical factors on it, and confirm the source of the material.

SETTING: Affiliated Hospital of Nantong University, Jiangsu Province, China.

DESIGN: This was a prospective, single-center study.

METHODS: Age, sex, eye condition, nuclear sclerosis grade, ultrasonic time, average longitudinal power, cumulative dissipated energy (CDE), total aspiration time, and estimated fluid usage were recorded for each patient. Retrolental anatomy was observed before and during surgery using real-time optical coherence tomography integrated into a microscope. The eyes with AVD were carefully observed and recorded during illumination with an optical fiber. Retrolental material was stained using immunohistochemistry.

RESULTS: This study included 205 eyes from 205 patients. Spontaneous AVD was found in five cases. Intraoperatively, AVD was identified in 115 eyes (56.1%). Retrolental material presence was observed in 75 eyes (36.6%). A logistic regression model showed that CDE and aspiration time had statistically significant effect on AVD (P<0.05, 95%OR:1.011∼1.558; P<0.05, 95%OR:1.026∼1.051), and CDE was positively correlated with retrolental material occurrence (P<0.05, 95%OR:1.052∼1.534). Samples from five cases expressed large amounts of crystallin alpha and beta proteins.

CONCLUSION: Spontaneous AVD is rare in phakic eyes. There was a marked increase in AVD during surgery, with retrolental material occurring in more than a third of cases. Higher CDE and longer total aspiration time were risk factors for AVD. Immunohistochemistry revealed that most of the retrolental materials were lens fragments.

PMID:36745848 | DOI:10.1097/j.jcrs.0000000000001156

Health Aff (Millwood). 2023 Feb;42(2):261-267. doi: 10.1377/hlthaff.2022.00656.

ABSTRACT

Using National Center for Health Statistics data (2016-20), we evaluated variation in low birthweight and prematurity among racial and ethnic subcategories. Disparities as large as 2.3-fold among rates of low birthweight for “multiple race” subcategories underscore the need for granular data stratification and analysis by racial and ethnic subcategories to address the root causes of inequities in infant outcomes.

PMID:36745826 | DOI:10.1377/hlthaff.2022.00656

Chin Med J (Engl). 2022 Dec 5;135(23):2878-2879. doi: 10.1097/CM9.0000000000002455.

NO ABSTRACT

PMID:36745768 | DOI:10.1097/CM9.0000000000002455

J Cardiovasc Nurs. 2023 Feb 3. doi: 10.1097/JCN.0000000000000975. Online ahead of print.

ABSTRACT

BACKGROUND: Most patients with heart failure find self-care difficult to perform and rely on family caregivers for support. Informal caregivers, however, often face insufficient psychological preparation and challenges in providing long-term care. Insufficient caregiver preparedness not only results in psychological burden for the informal caregivers but may also lead to a decline in caregiver contributions to patient self-care that affects patient outcomes.

OBJECTIVE: Our objective was to test (1) the association of baseline informal caregivers’ preparedness with psychological symptoms (anxiety and depression) and quality of life 3 months after baseline among patients with insufficient self-care and (2) the mediating effects of caregivers’ contributions to self-care of heart failure (CC-SCHF) on the relationship of caregivers’ preparedness with patients’ outcomes at 3 months.

METHODS: A longitudinal design was used to collect data between September 2020 and January 2022 in China. Data analyses were conducted using descriptive statistics, correlations, and linear mixed models. We used model 4 of the PROCESS program in SPSS with bootstrap testing to evaluate the mediating effect of CC-SCHF of informal caregivers’ preparedness at baseline with psychological symptoms or quality of life among patients with HF 3 months later.

RESULTS: Caregiver preparedness was positively associated with CC-SCHF maintenance (r = 0.685, P < .01), CC-SCHF management (r = 0.403, P < .01), and CC-SCHF confidence (r = 0.600, P < .01). Good caregiver preparedness directly predicted lower psychological symptoms (anxiety and depression) and higher quality of life for patients with insufficient self-care. The associations of caregiver preparedness with short-term quality of life and depression of patients with HF with insufficient self-care were mediated by CC-SCHF management.

CONCLUSIONS: Enhancing the preparedness of informal caregivers may improve psychological symptoms and quality of life of heart failure patients with insufficient self-care.

PMID:36745758 | DOI:10.1097/JCN.0000000000000975

Biometrics. 2023 Feb 6. doi: 10.1111/biom.13837. Online ahead of print.

ABSTRACT

We propose a doubly robust approach to characterizing treatment effect heterogeneity in observational studies. We develop a frequentist inferential procedure that utilizes posterior distributions for both the propensity score and outcome regression models to provide valid inference on the conditional average treatment effect even when high-dimensional or nonparametric models are used. We show that our approach leads to conservative inference in finite samples or under model misspecification, and provides a consistent variance estimator when both models are correctly specified. In simulations, we illustrate the utility of these results in difficult settings such as high-dimensional covariate spaces or highly flexible models for the propensity score and outcome regression. Lastly, we analyze environmental exposure data from NHANES to identify how the effects of these exposures vary by subject-level characteristics. This article is protected by copyright. All rights reserved.

PMID:36745745 | DOI:10.1111/biom.13837

Int J Environ Health Res. 2023 Feb 6:1-17. doi: 10.1080/09603123.2023.2173153. Online ahead of print.

ABSTRACT

Air pollution is a critical public health concern. The present study assessed the risk to human health of airborne Potentially Toxic Elements (PTE) arsenic, nickel and lead exposure in particulate matter (PM_10-2.5) in Sao Paulo, Brazil. Statistical analysis was performed using R Software and the risk assessment for human health was carried out according to the methods of the United States Environmental Protection Agency. The results for mean annual concentration of PTE (ng m^-3) were within the limits stipulated for air-quality by international agencies (arsenic <6, nickel <20 and lead <150). Airborne arsenic and lead showed higher mean concentrations during the winter than the other seasons (p < 0.05). However, the results showed a greater health risk for the adult population and during the winter season. These findings highlight the importance of air pollution as a risk factor for population health.

PMID:36745741 | DOI:10.1080/09603123.2023.2173153

Perspect Psychol Sci. 2023 Feb 6:17456916221141357. doi: 10.1177/17456916221141357. Online ahead of print.

ABSTRACT

There is growing evidence that the published psychological literature is marred by multiple errors and inaccuracies and often fails to reflect the changing nature of the knowledge base. At least four types of error are common-citation error, methodological error, statistical error, and interpretation error. In the face of the apparent inevitability of these inaccuracies, core scientific values such as openness and transparency require that correction mechanisms are readily available. In this article, I reviewed standard mechanisms in psychology journals and found them to have limitations. The effects of more widely enabling open postpublication critique in the same journal in addition to conventional peer review are considered. This mechanism is well established in medicine and the life sciences but rare in psychology and may assist psychological science to correct itself.

PMID:36745732 | DOI:10.1177/17456916221141357

Am J Epidemiol. 2023 Feb 3:kwad029. doi: 10.1093/aje/kwad029. Online ahead of print.

ABSTRACT

This paper describes a new method to present and interpret linear trends in health inequalities, and presents a proof-of-concept for inequalities in smoking among adolescents in Europe. We estimated the regression line of the assumed linear relationship between smoking prevalence in low and high socioeconomic status (SES) youth over time. Using simulation, we constructed a 95% confidence interval for the smoking prevalence in low SES youth for when this would be 0% in high SES youth, and calculated the likelihood of eradicating smoking inequality (<5% for both low and high SES). This method was applied to data of 15-16-year-olds (N=250,326) from 23 European countries, derived from the 2003-2015 ESPAD surveys. Smoking prevalence decreased more slowly in low than high SES adolescents. The estimated smoking prevalence was 9.4% (6.1;12.7) for boys and 5.4% (1.4;9.2) for girls in low SES when 0% in high SES. The likelihood of eradicating smoking inequality was <1% for boys and 37% for girls. We conclude that this novel methodological approach to trends in health inequalities is feasible in practice. Applying it to trends in smoking inequalities among adolescents in Europe, we found that Europe is currently not on track to eradicate youth smoking across SES groups.

PMID:36745706 | DOI:10.1093/aje/kwad029

J Am Acad Orthop Surg. 2023 Feb 3. doi: 10.5435/JAAOS-D-22-00554. Online ahead of print.

ABSTRACT

INTRODUCTION: The purpose of this study was to evaluate rates of rotator cuff tears (RCTs), repairs (RCRs), and revision RCR in patients who were prescribed testosterone replacement therapy (TRT) and compare these patients with a control group.

METHODS: The PearlDiver database was queried for patients who were prescribed testosterone for at least 90 days between 2011 and 2018 to evaluate the incidence of RCTs in this population. A second analysis evaluated patients who sustained RCTs using International Classification of Diseases, 9th/10th codes to evaluate these patients for rates of RCR and revision RCR. Chi square analysis and multivariate regression analyses were used to compare rates of RCTs, RCR, and subsequent or revision RCR between the testosterone and control groups, with a P-value of 0.05 representing statistical significance.

RESULTS: A total of 673,862 patients with RCT were included for analysis, and 9,168 of these patients were prescribed testosterone for at least 90 days before their RCT. The TRT group had a 3.6 times greater risk of sustaining an RCT (1.14% versus 0.19%; adjusted odds ratio (OR) 3.57; 95% confidence interval (CI) 3.57 to 3.96). A 1.6 times greater rate of RCR was observed in the TRT cohort (TRT, 46.4% RCR rate and control, 34.0% RCR rate; adjusted OR 1.60; 95% CI 1.54 to 1.67). The TRT cohort had a 26.7 times greater risk of undergoing a subsequent RCR, irrespective of laterality, within 1 year of undergoing a primary RCR when compared with the control group (TRT, 47.1% and control, 4.0%; adjusted OR 26.4; 95% CI 25.0 to 27.9, P < 0.001).

CONCLUSIONS: There is increased risk of RCTs, RCRs, and subsequent RCRs in patients prescribed testosterone. This finding may represent a musculoskeletal consequence of TRT and is important for patients and clinicians to understand. Additional research into the science of tendon injury in the setting of exogenous anabolic steroids remains of interest.

LEVEL OF EVIDENCE: Level Ⅲ, retrospective cohort study.

PMID:36745691 | DOI:10.5435/JAAOS-D-22-00554