Nevin Manimala

Cardiovasc Drugs Ther. 2022 Nov 16. doi: 10.1007/s10557-022-07399-9. Online ahead of print.

ABSTRACT

BACKGROUND: Mechanical ventilation (MV) is widely used to relieve respiratory failure in patients with congestive heart failure (CHF). Prolonged MV (PMV) is associated with a poor prognosis. We aimed to establish a prediction model based on machine learning (ML) algorithms for the early identification of patients with CHF requiring PMV.

METHODS: Twelve commonly used ML algorithms were used to build the prediction model. The least absolute shrinkage and selection operator (LASSO) regression was employed to select the key features. We examined the area under the curve (AUC) statistics to evaluate the prediction performance. Data from another database were used to conduct external validation.

RESULTS: We screened out 10 key features from the initial 65 variables via LASSO regression to improve the practicability of the model. The CatBoost model showed the best performance for predicting PMV among the 12 commonly used ML algorithms, with favorable discrimination (AUC = 0.790) and calibration (Brier score = 0.154). Moreover, hospital mortality could be accurately predicted using the CatBoost model as well (AUC = 0.844). In the external validation, the CatBoost model also showed satisfactory prediction performance (AUC = 0.780), suggesting certain generalizability of the model. Finally, a nomogram with risk classification of PMV was shown in this study.

CONCLUSION: The present study developed and validated a CatBoost model, which could accurately predict PMV in mechanically ventilated patients with CHF. Moreover, this model has a favorable performance in predicting hospital mortality in these patients.

PMID:36383267 | DOI:10.1007/s10557-022-07399-9

Neurol Sci. 2022 Nov 16. doi: 10.1007/s10072-022-06484-z. Online ahead of print.

ABSTRACT

BACKGROUND: Deep brain stimulation (DBS) is a common treatment for Parkinson’s disease. However, the clinical efficacy of short pulse width DBS (spDBS) compared with conventional DBS (cDBS) is still unknown.

OBJECTIVE: This meta-analysis investigated the effectiveness of spDBS versus cDBS in patients with PD.

METHODS: Four databases (PubMed, Cochrane, Web of Science, and Embase) were independently searched until October 2021 by two reviewers. We utilized the following scales and items: therapeutic windows (TW), efficacy threshold, side effect threshold, Movement Disorder Society-Sponsored Revision Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) part III off-medication score, Speech Intelligence Test (SIT), and Freezing of Gait Questionnaire (FOG-Q).

RESULTS: The analysis included seven studies with a total of 87 patients. The results indicated that spDBS significantly widened the therapeutic windows (0.99, 95% CI = 0.61 to 1.38) while increasing the threshold amplitudes of side effects (2.25, 95% CI = 1.69 to 2.81) and threshold amplitudes of effects (1.60, 95% CI = 0.84 to 2.36). There was no statistically significant difference in UPDRS part III, SIT, and FOG-Q scores between spDBS and cDBS groups, suggesting that treatment with both cDBS and spDBS may result in similar effects of improved dysarthria and gait disorders.

CONCLUSIONS: Compared with cDBS, spDBS is effective in expanding TW. Both types of deep brain stimulation resulted in improved gait disorders and speech intelligibility.

PMID:36383263 | DOI:10.1007/s10072-022-06484-z

Abdom Radiol (NY). 2022 Nov 16. doi: 10.1007/s00261-022-03652-9. Online ahead of print.

ABSTRACT

BACKGROUND: Risk stratification is challenging in the growing population of geriatric patients requiring emergency surgery. Sarcopenia, which assesses muscle bulk, is a surrogate for frailty and predicts 1-year mortality, but does not incorporate potentially valuable additional information about muscle quality.

OBJECTIVE: To describe five different CT methods of measuring sarcopenia and muscle quality and to determine which method has the greatest sensitivity for predicting 1-year mortality following emergency abdominal surgery in elderly patients.

METHODS: This retrospective study includes 297 patients 70 years and older who underwent “urgent” or “emergent” laparotomy or laparoscopy for acute abdominal disease between 2006 and 2011 at a single quaternary academic medical center. All patients received a CT abdomen and pelvis with intravenous contrast within 1 month of surgery. Five different methods were applied to the psoas muscles on CT: method 1 (total psoas index TPI, which is total psoas area TPA normalized by height), method 2 (“pseudoarea” = anterior-posterior × transverse dimensions), method 3 (average HU), method 4 (TPA × HU), and method 5 (“pseudoarea” × HU).

RESULTS: For all five CT measures, mortality was greatest for the lowest quartile by univariate and adjusted Cox proportional hazard analyses at all time points up to 1-year. The C-statistic was highest for Method 4, using a composite index of TPA and Hounsfield Units, indicating the greatest predictive ability to estimate mortality at all time points.

CONCLUSION: Muscle quality and muscle size can be used in tandem to refine risk assessment of older patients undergoing emergency abdominal surgery. Routine calculation of the composite score of psoas cross-sectional area and HU in the emergency room setting may provide surgeons and patients valuable insight on the risk of 1-year mortality to guide preoperative decision-making and counseling.

CLINICAL IMPACT: Muscle quality and size, both strong independent predictors of surgical outcomes in older patients undergoing emergency abdominal surgery, may be used in tandem to refine risk assessment. A composite score of psoas muscle cross-sectional area and Hounsfield units on CT may provide insight on 1-year mortality in this patient population.

PMID:36383241 | DOI:10.1007/s00261-022-03652-9

Ann Work Expo Health. 2022 Nov 16:wxac077. doi: 10.1093/annweh/wxac077. Online ahead of print.

ABSTRACT

OBJECTIVE: Asbestos use has decreased over time but occupational exposure still exists today due to the presence of asbestos in older buildings. The objective of this study was to update CAREX Canada’s prevalence of exposure estimate from 2006 to 2016, and to assess the level of occupational exposure by industry, occupation, province/territory, and sex.

METHODS: Estimates by occupation, industry, province/territory, and sex were calculated using labor force data from the 2016 Census of Population and proportions of workers exposed by occupation and industry, which were previously developed for the 2006 estimates and updated here to reflect new knowledge and changes in exposures. Statistics Canada concordance tables were used to account for changes between the 2006 and 2016 job and industry coding systems. Expert assessment was used to qualitatively assign levels of exposure (low, moderate, or high) for each occupation and industry, with consideration of workers’ proximity and access to asbestos-containing material, and the condition and content of asbestos.

RESULTS: Approximately 235 000 workers are exposed to asbestos on the job in Canada. The majority of Canadian workers exposed to asbestos are male (89%). Only 5% of all exposed workers are in the high-exposure category, while most workers are in the low (49%) or moderate (46%) exposure categories. The construction sector and associated jobs (e.g. carpenters, trades helpers and laborers, electricians) accounted for the majority of exposed workers.

CONCLUSIONS: Occupational exposure to asbestos continues to occur in Canada. Updating the prevalence of exposure estimate and adding exposure levels highlights the shift from high to lower-lever exposures associated with asbestos-containing materials remaining in the built environment.

PMID:36383235 | DOI:10.1093/annweh/wxac077

Eur J Trauma Emerg Surg. 2022 Nov 16. doi: 10.1007/s00068-022-02169-6. Online ahead of print.

ABSTRACT

PURPOSE: There is currently no consensus on nonoperative management in adult patients after a stable type B ankle fracture. The aim of this review is to compare a removable orthosis versus a cast regarding safety and functional outcome in the NOM of stable type B ankle fractures.

METHODS: A systematic review and meta-analysis were performed using randomized clinical trials and observational studies. The methodological quality of the included studies was assessed with the methodological index for non-randomized studies instrument. Nonoperative management was compared using the number of complications and functional outcome measured using the Olerud and Molander Score (OMAS) or the American Academy of Orthopaedic Surgeons Ankle Score.

RESULTS: Five studies were included. Two were randomized clinical trials, and three were observational studies, including a total of 516 patients. A meta-analysis showed statistically significant higher odds of developing complications in the cast group [odds ratio (OR), 4.67 (95% confidence interval (CI) 1.52-14.35)]. Functional outcome in OMAS did not vary significantly at 6 weeks, mean difference (MD) – 6.64 (95% CI – 13.72 to + 0.45), and at 12 weeks, MD – 6.91 (95% CI – 18.73 to + 4.91). The mean difference of functional outcome in OMAS at 26 weeks or longer was significantly better in the removable orthosis group; MD – 2.63 (95% CI – 5.01 to – 0.25).

CONCLUSION: Results of this systematic review and meta-analysis show that a removable orthosis is a safe alternative type of NOM, as complication numbers are significantly lower in the orthosis group. In addition, no statistically significant differences were found in terms of functional outcome between a removable orthosis and a cast at 6 and 12 weeks. The 6-week and the 26-week OMAS results show that in patients with stable type B ankle fractures, a removable orthosis is non-inferior to a cast in terms of functional outcome.

PMID:36383226 | DOI:10.1007/s00068-022-02169-6

Reprod Fertil Dev. 2022 Nov;34(18):1145. doi: 10.1071/RD21234_CO.

ABSTRACT

Mobile phones play an irreplaceable role in modern people’s lives. However, the radiofrequency electromagnetic radiation produced by mobile phones has also caused increasing concern. A cross-sectional study was conducted to investigate the effect of radiofrequency electromagnetic radiation produced by mobile phones on semen parameters in 1634 men who underwent semen examination at the Department of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, China. Analysis of variance and multivariate linear regression were used to explore differences among different groups. A P P = 0.004 and P = 0.007), rapid progressively motile spermatozoa (P = 0.012 and P = 0.006) and total motile spermatozoa (P = 0.004 and P = 0.046). After adjustments for the confounding effects of age and body mass index by multiple linear regression, the results showed that the daily duration of mobile phone use had a negative effect on sperm motility. However, there was no statistically significant correlation between daily phone call duration and sperm motility. Therefore, the daily duration of mobile phone use may negatively affect sperm motility and impair male fertility.

PMID:36383214 | DOI:10.1071/RD21234_CO

Acta Odontol Scand. 2022 Nov 16:1-13. doi: 10.1080/00016357.2022.2143422. Online ahead of print.

ABSTRACT

OBJECTIVE: A prospective cohort study on changes of health complaints after removal of amalgam restorations was carried out at the request of the Norwegian Directorate of Health. The aim was to provide and evaluate experimental treatment to patients with health complaints attributed to dental amalgam fillings.

METHODS: Patients (n = 32) with medically unexplained physical symptoms (MUPS), which were attributed to dental amalgam restorations had all their amalgam restorations removed and replaced with other dental restorative materials. Samples of blood were collected before and 1 year after removal of the fillings, and concentration of inorganic mercury (I-Hg), methylmercury (MeHg), silver (Ag) and selenium (Se) in serum was determined by inductively coupled plasma-sector field mass spectrometry. The comparison groups (one with MUPS but without attribution to amalgam [n = 28] and one group of healthy individuals [n = 19]) received no treatment. The participants responded to questionnaires at baseline and at follow-up after 1 and 5 years.

RESULTS: Concentration of I-Hg and Ag in serum decreased significantly after removal of all amalgam restorations. Concentration of MeHg and Se in serum were not changed. Intensity of health complaints was significantly reduced after amalgam removal, but there were no statistically significant correlations between exposure indicators and health complaints.

CONCLUSIONS: Removal of all amalgam restorations is followed by a decrease of concentration of I-Hg and Ag in serum. The results support the hypothesis that exposure to amalgam fillings causes an increase of the daily dose of both I-Hg and Ag. Even though intensity of health complaints decreased after removal of all amalgam restorations there was no clear evidence of a direct relationship between exposure and health complaints. Trial registration: The project is registered at Clinicaltrials.gov (NCT01682278).

PMID:36383213 | DOI:10.1080/00016357.2022.2143422

Am J Respir Crit Care Med. 2022 Nov 16. doi: 10.1164/rccm.202205-0963OC. Online ahead of print.

ABSTRACT

RATIONALE: The use of self-reported race/ethnicity to interpret lung function measurements has historically assumed that the observed differences in lung function between racial and ethnic group were due to thoracic cavity size differences relative to standing height. Very few studies have considered the influence of environmental and social determinants on pulmonary function. Consequently, the use of race and ethnicity specific reference equations may further marginalize disadvantaged populations.

OBJECTIVE: To develop a race-neutral reference equation for spirometry interpretation.

METHODS: NHANES III data (n=6,984) were re-analyzed with sitting height and the Cormic index to investigate whether body proportions were better predictors of lung function than race and ethnicity. Further, the original Global Lung Function Initiative (GLI) data (n= 74,185) were re-analyzed with inverse-probability weights to create race-neutral GLI Global (2022) equations.

MEASUREMENTS AND MAIN RESULTS: The inclusion of sitting height slightly improved statistical precision of reference equations compared with using standing height alone, but did not explain observed differences in spirometry between the NHANES III race and ethnic groups. GLI-Global (2022) equations, which do not require the selection of race and ethnicity, had similar fit to the GLI-2012 ‘other’ equations and wider limits of normal.

CONCLUSIONS: The use of a single “Global” spirometry equation reflects the wide range of lung function observed within and between populations. Given the inherent limitations of any reference equation, the use of GLI Global equations to interpret spirometry requires careful consideration of an individual’s symptoms and medical history when used to make clinical, employment, and insurance decisions.

PMID:36383197 | DOI:10.1164/rccm.202205-0963OC

J Feline Med Surg. 2022 Nov 16:1098612X221131270. doi: 10.1177/1098612X221131270. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to evaluate, using echocardiography, the effects of oral administration of a single dose of gabapentin on the physiologic variables (heart rate [HR], respiratory rate [RR] and systolic blood pressure [SBP]) and systolic and diastolic cardiac function of healthy cats.

METHODS: This was a prospective, randomized and blinded study with 40 healthy cats aged between 6 months and 2 years. The cats’ health status was assessed on the first appointment (T1) when they underwent a physical examination, complete blood count, biochemical profile, assessment of physiologic variables and echocardiogram. The echocardiogram was used to measure the left ventricle’s (LV) internal diameter during systole and diastole, isovolumic relaxation time, transmitral flow, E-wave deceleration time and HR. The cats were randomly divided into two groups: (1) a treatment group with 20 cats that received a single oral dose of gabapentin (100 mg/cat); and (2) a control group with 20 cats that received a single oral dose of placebo. All variables of the physiologic and echocardiographic variables were re-evaluated 1-3 weeks after T1 (T2), 90 mins after medication or placebo administration.

RESULTS: There was no difference in the physiologic variables evaluated in both groups. The proportion of cats in the treatment group that had their ventricular filling waves fused on T1 but did not have them fused on T2 was significantly higher (45%) compared with cats in the control group (15%; P = 0.0384).

CONCLUSIONS AND RELEVANCE: There was no difference between the groups in regard to SBP, HR, RR and echocardiographic variables. Gabapentin improved evaluation of diastolic function on echocardiogram because it reduced the fusion of ventricular filling waves during the evaluation of the diastolic function of the LV. Gabapentin did not cause adverse effects on the cardiovascular hemodynamics of young healthy cats.

PMID:36383193 | DOI:10.1177/1098612X221131270

Minerva Urol Nephrol. 2022 Nov 16. doi: 10.23736/S2724-6051.22.05011-X. Online ahead of print.

ABSTRACT

BACKGROUND: Since before the COVID-19 pandemic, hospital-acquired infections (HAIs) represented a global healthcare crisis. Few studies suggested that COVID-19-related basic hygiene measures (BHM) could lower HAIs rates, reaching inconclusive results. The aim of this study was to investigate the hypothetical benefit on HAIs rate of COVID-19-enhanced BHM systematic introduction after major elective urological surgery.

METHODS: Since the pandemic began, our hospital has implemented BHM to limit the spread of COVID-19. We compared patients operated in the pre-COVID-19 era (no-BHM period) with those operated after the pandemic started (BHM period). Outcomes were the incidence of HAIs and postoperative complications, and the length of hospital stay (LOS). Two balanced groups were generated by propensity score 1:1 matching.

RESULTS: Of 1053 major urological interventions, 604 were performed in the no-BHM period, and 449 in the BHM period. After matched analysis, the comparison groups consisted of 310 patients each. Of 107 recorded HAIs, 43 occurred during the BHM period (13.9%), and 64 during the no-BHM period (20.7%), with a statistically significant difference in multivariable analysis (OR 0.5 [95% CI 0.3-0.8], P=0.004). Postoperative complications rate was significantly lower in the BHM period than in the no-BHM period (29.0% versus 36.5%, OR 0.6 [95% CI 0.4-0.9], P=0.01). The LOS differed significantly between BHM and no-BHM periods: a median of 5 (5-8) days versus 6 (5-8), respectively (P<0.001).

CONCLUSIONS: The risk of infections, postoperative complications, and prolonged LOS after major urological surgery was significantly reduced with the systematic introduction of COVID-19-related BHM, their application could, therefore, be prolonged with lasting benefits.

PMID:36383183 | DOI:10.23736/S2724-6051.22.05011-X