Nevin Manimala

J Magn Reson Imaging. 2022 Sep 28. doi: 10.1002/jmri.28435. Online ahead of print.

ABSTRACT

BACKGROUND: Metastatic lymph nodal number (LNN) is associated with the survival of nasopharyngeal carcinoma (NPC); however, counting multiple nodes is cumbersome.

PURPOSE: To explore LNN threshold and evaluate its use in risk stratification and induction chemotherapy (IC) indication.

STUDY TYPE: Retrospective.

POPULATION: A total of 792 radiotherapy-treated NPC patients (N classification: N0 182, N1 438, N2 113, N3 59; training group: 396, validation group: 396; receiving IC: 390).

FIELD STRENGTH/SEQUENCE: T1-, T2- and postcontrast T1-weighted fast spin echo MRI at 1.5 or 3.0 T.

ASSESSMENT: Nomogram with (model B) or without (model A) LNN was constructed to evaluate the 5-year overall (OS), distant metastasis-free (DMFS), and progression-free survival (PFS) for the group as a whole and N1 stage subgroup. High- and low-risk groups were divided (above vs below LNN- or model B-threshold); their response to IC was evaluated among advanced patients in stage III/IV.

STATISTICAL TESTS: Maximally selected rank, univariate and multivariable Cox analysis identified the optimal LNN threshold and other variables. Harrell’s concordance index (C-index) and 2-fold cross-validation evaluated discriminative ability of models. Matched-pair analysis compared survival outcomes of adding IC or not. A P value < 0.05 was considered statistically significant.

RESULTS: Median follow-up duration was 62.1 months. LNN ≥ 4 was independently associated with decreased 5-year DMFS, OS, and PFS in entire patients or N1 subgroup. Compared to model A, model B (adding LNN, LNN ≥ 4 vs <4) presented superior C-indexes in the training (0.755 vs 0.727) and validation groups (0.676 vs 0.642) for discriminating DMFS. High-risk patients benefited from IC with improved post-IC response and OS, but low-risk patients did not (P = 0.785 and 0.690, respectively).

CONCLUSIONS: LNN ≥ 4 is an independent risk stratification factor of worse survival in entire or N1 staging NPC patients. LNN ≥ 4 or the associated nomogram has potential to identify high-risk patients requiring IC.

EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: 4.

PMID:36169976 | DOI:10.1002/jmri.28435

JAMA Netw Open. 2022 Sep 1;5(9):e2233649. doi: 10.1001/jamanetworkopen.2022.33649.

ABSTRACT

IMPORTANCE: Value in health care is quality per unit cost (V = Q/C), and an emergency department-based intensive care unit (ED-ICU) model has been associated with improved quality. To assess the value of this care delivery model, it is essential to determine the incremental direct cost of care.

OBJECTIVE: To determine the association of an ED-ICU with inflation-adjusted change in mean direct cost of care, net revenue, and direct margin per ED patient encounter.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective economic analysis evaluated the cost of care delivery to patients in the ED before and after deployment of the Joyce and Don Massey Family Foundation Emergency Critical Care Center, an ED-ICU, on February 16, 2015, at a large academic medical center in the US with approximately 75 000 adult ED visits per year. The pre-ED-ICU cohort was defined as all documented ED visits by patients 18 years or older with a complete financial record from September 8, 2012, through June 30, 2014 (660 days); the post-ED-ICU cohort, all visits from July 1, 2015, through April 21, 2017 (660 days). Fiscal year 2015 was excluded from analysis to phase in the new care model. Statistical analysis was performed March 1 through December 30, 2021.

EXPOSURES: Implementation of an ED-ICU.

MAIN OUTCOMES AND MEASURES: Inflation-adjusted direct cost of care, net revenue, and direct margin per patient encounter in the ED.

RESULTS: A total of 234 884 ED visits during the study period were analyzed, with 115 052 patients (54.7% women) in the pre-ED-ICU cohort and 119 832 patients (54.5% women) in the post-ED-ICU cohort. The post-ED-ICU cohort was older (mean [SD] age, 49.1 [19.9] vs 47.8 [19.6] years; P < .001), required more intensive respiratory support (2.2% vs 1.1%; P < .001) and more vasopressor use (0.5% vs 0.2%; P < .001), and had a higher overall case mix index (mean [SD], 1.7 [2.0] vs 1.5 [1.7]; P < .001). Implementation of the ED-ICU was associated with similar inflation-adjusted total direct cost per ED encounter (pre-ED-ICU, mean [SD], $4875 [$15 175]; post-ED-ICU, $4877 [$17 400]; P = .98). Inflation-adjusted net revenue per encounter increased by 7.0% (95% CI, 3.4%-10.6%; P < .001), and inflation-adjusted direct margin per encounter increased by 46.6% (95% CI, 32.1%-61.2%; P < .001).

CONCLUSIONS AND RELEVANCE: Implementation of an ED-ICU was associated with no significant change in inflation-adjusted total direct cost per ED encounter. Holding delivery costs constant while improving quality demonstrates improved value via the ED-ICU model of care.

PMID:36169958 | DOI:10.1001/jamanetworkopen.2022.33649

JAMA Netw Open. 2022 Sep 1;5(9):e2233667. doi: 10.1001/jamanetworkopen.2022.33667.

ABSTRACT

IMPORTANCE: Whether interprofessional collaboration is effective and safe in decreasing hospital length of stay remains controversial.

OBJECTIVE: To evaluate the outcomes and safety associated with an electronic interprofessional-led discharge planning tool vs standard discharge planning to safely reduce length of stay among medical inpatients with multimorbidity.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter prospective nonrandomized controlled trial used interrupted time series analysis to examine medical acute hospitalizations at 82 hospitals in Switzerland. It was conducted from February 2017 through January 2019. Data analysis was conducted from March 2021 to July 2022.

INTERVENTION: After a 12-month preintervention phase (February 2017 through January 2018), an electronic interprofessional-led discharge planning tool was implemented in February 2018 in 7 intervention hospitals in addition to standard discharge planning.

MAIN OUTCOMES AND MEASURES: Mixed-effects segmented regression analyses were used to compare monthly changes in trends of length of stay, hospital readmission, in-hospital mortality, and facility discharge after the implementation of the tool with changes in trends among control hospitals.

RESULTS: There were 54 695 hospitalizations at intervention hospitals, with 27 219 in the preintervention period (median [IQR] age, 72 [59-82] years; 14 400 [52.9%] men) and 27 476 in the intervention phase (median [IQR] age, 72 [59-82] years; 14 448 [52.6%] men) and 438 791 at control hospitals, with 216 261 in the preintervention period (median [IQR] age, 74 [60-83] years; 109 770 [50.8%] men) and 222 530 in the intervention phase (median [IQR] age, 74 [60-83] years; 113 053 [50.8%] men). The mean (SD) length of stay in the preintervention phase was 7.6 (7.1) days for intervention hospitals and 7.5 (7.4) days for control hospitals. During the preintervention phase, population-averaged length of stay decreased by -0.344 hr/mo (95% CI, -0.599 to -0.090 hr/mo) in control hospitals; however, no change in trend was observed among intervention hospitals (-0.034 hr/mo; 95% CI, -0.646 to 0.714 hr/mo; difference in slopes, P = .09). Over the intervention phase (February 2018 through January 2019), length of stay remained unchanged in control hospitals (slope, -0.011 hr/mo; 95% CI, -0.281 to 0.260 hr/mo; change in slope, P = .03), but decreased steadily among intervention hospitals by -0.879 hr/mo (95% CI, -1.607 to -0.150 hr/mo; change in slope, P = .04, difference in slopes, P = .03). Safety analyses showed no change in trends of hospital readmission, in-hospital mortality, or facility discharge over the whole study time.

CONCLUSIONS AND RELEVANCE: In this nonrandomized controlled trial, the implementation of an electronic interprofessional-led discharge planning tool was associated with a decline in length of stay without an increase in hospital readmission, in-hospital mortality, or facility discharge.

TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN83274049.

PMID:36169957 | DOI:10.1001/jamanetworkopen.2022.33667

Eur Thyroid J. 2022 Sep 1:ETJ-22-0142. doi: 10.1530/ETJ-22-0142. Online ahead of print.

ABSTRACT

OBJECTIVE: Thyroid disease in women of reproductive age is mainly of autoimmune origin, and thyroid peroxidase antibodies (TPO-Ab) as well as thyroglobulin antibodies (Tg-Ab) are key markers. Adding to this, much focus in pregnancy is on euthyroid women who are thyroid antibody positive. Evidence to substantiate the cut-offs for definition of thyroid autoantibody positivity in early pregnant women is warranted.

METHODS: Stored serum samples from 14,030 Danish pregnant women were used for measurement of TPO-Ab, Tg-Ab, TSH, and free thyroxine (ADVIA Centaur XPT, Siemens Healthineers, Erlangen, Germany). Among all women, a reference cohort of 10,905 individuals was identified for establishment of antibody cut-offs. Percentile cut-offs for TPO-Ab and Tg-Ab determined using Regression on Order Statistics (the reference cohort). The established cut-offs were then applied (the full cohort), and frequencies of early pregnancy as well as later diagnosis of hypothyroidism were evaluated.

RESULTS: The highest established cut-offs (95th, 97.5th, and 99th percentile) were 59, 68, and 81 U/mL for TPO-Ab, and 33, 41, and 52 U/mL for Tg-Ab. When the cut-offs were applied in the full cohort, 11.0%, 10.2%, and 9.7% were TPO-Ab positive, whereas 13.3%, 12.3%, and 11.2% were Tg-Ab positive. Antibody positive women (TPO-Ab and/or Tg-Ab) had higher median TSH and were more like to have hypothyroidism in early pregnancy and to be diagnosed with hypothyroidism during follow-up.

CONCLUSIONS: This large study established and evaluated pregnancy-specific cut-offs for TPO-Ab and Tg-Ab. The findings are important regarding classification of exposure in pregnancy and assessment of thyroid autoimmunity per se.

PMID:36169923 | DOI:10.1530/ETJ-22-0142

Endocrine. 2022 Sep 28. doi: 10.1007/s12020-022-03198-2. Online ahead of print.

ABSTRACT

PURPOSE: The present study aimed to assess whether treatment with combined resveratrol and myoinositol is more effective in ameliorating the altered parameters associated with PCOS when compared to the combined metformin and pioglitazone therapy.

METHOD: One hundred and ten obese, oligo-anovulatory PCOS women, aged 20-35 years were randomly assigned into two treatment arms. Participants in arm-1 (n = 55), received combination of metformin and pioglitazone (500 mg and 15 mg, respectively), twice daily, while those in arm-2 (n = 55) received combination of resveratrol and myoinositol (1000 mg and 1000 mg, respectively) twice daily for 12 weeks. Evaluations performed at baseline were repeated after 3 months of therapy. The endocrine and metabolic derangements were assessed by measuring serum levels of testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), adiponectin and insulin using ELISA. Cohen’s perceived stress scale (PSS) was employed as a subjective measure of stress.

RESULTS: Pre-treatment PCOS women in both the arms (arm-1 and arm-2) had remarkably elevated serum testosterone and insulin concentrations, low serum adiponectin and high perceived stress response scores. The treatment reduced the altered endocrine indices in arm-2 (resveratrol and myoinositol) participants, manifested by statistically significant reduction in serum testosterone level (p = 0.001) and notably increased serum adiponectin level (p = 0.001). Interestingly, the hormonal profile, including serum LH and FSH levels also decreased (p < 0.001) along with a marked reduction in the ovarian volume (p = 0.001) in arm-2 participants. There was a significant reduction in weight (<0.001), BMI (p < 0.001) and an improvement in waist-hip ratio (p < 0.001) in arm-2 participants compared to arm-1 group. The PSS scores of the arm-2 subjects improved significantly (p < 0.001) whereas, the Ferrimen-Gallwey score was improved in both the arms (arm-1 and arm-2; p = 0.010 and 0.008 respectively) however, the change was highly significant in arm-2. Interestingly, the menstrual regularity was 81.4% in arm-2 while 18.2% in arm-1. We conclude that the therapeutic intervention with combined resveratrol and myoinositol is more effective in ameliorating altered endocrine, metabolic indices and stress burden and could be of clinical importance in high risk group of obese, oligo-anovulatory married PCOS affected women.

TRIAL REGISTRATION: ClinicalTials.gov Trial No: NCT04867252. Registered 24 April, 2021, https://clinicaltrials.gov/ct2/show/NCT04867252.

PMID:36169918 | DOI:10.1007/s12020-022-03198-2

Methods Mol Biol. 2023;2558:207-220. doi: 10.1007/978-1-0716-2643-6_16.

ABSTRACT

Hansch-type regression analysis enables the derivation of quantitative structure-activity relationship (QSAR) equations correlating bioactivity data with physicochemical parameters accounting for hydrophobicity, electronic properties, and steric effects of molecules or functional groups (substituents). Two datasets of MAO A and B inhibitors were enrolled in prototypical workflows employing multiparametric stepwise regression analysis, which includes linear and nonlinear (generally quadratic) terms. The optimal choice of variables (and/or combinations thereof) along with statistical validation yielded two robust equations describing MAO B potency and B/A selectivity, which included three and one parameter(s), respectively, and explained more than 80% of y-variance (r²) with low standard deviation (s) and good statistical significance (F, Fisher value).

PMID:36169866 | DOI:10.1007/978-1-0716-2643-6_16

Environ Sci Pollut Res Int. 2022 Sep 28. doi: 10.1007/s11356-022-23237-9. Online ahead of print.

ABSTRACT

Bioretention column studies are commonly used in laboratory to assess the performance of such structures in removal of pollutants and to investigate different conceptions aiming to increase their efficiency. However, no studies were found recommending suitable diameters or sizes, or about the uncertainties related to the transfer of results among the different scales (i.e., among different experiments or from the laboratory to field scale). This study assessed the effect of the varying diameters in experimental bioretention columns on the retention and removal of pollutants from stormwater runoff. Three sets of columns with diameters of 400 mm, 300 mm, and 200 mm were assessed. The results showed that runoff retention (R) was affected by the time interval between stormwater events, but not by the bioretention diameter, although the diameter influenced the variability of R results. The removal of TSS (95%), nitrite (98%), and phosphate (96%) did present variability among the different bioretention diameters. However, the nitrate removal was statistically different among the bioretention columns, with removal efficiency above 50% in the 300-mm and 200-mm columns, while the 400-mm columns acted as a source of nitrate by increasing its concentration in the outflow stormwater by up to 285%, suggesting that the removal of this pollutant can be influenced by the scale effect of the bioretention columns and the experiments with small bioretention diameters may not provide reliable results.

PMID:36169844 | DOI:10.1007/s11356-022-23237-9

Environ Sci Pollut Res Int. 2022 Sep 28. doi: 10.1007/s11356-022-23246-8. Online ahead of print.

ABSTRACT

The objective of this study is to attempt to assess the effect of green finance in reducing carbon emissions in China, analyze the transformative role of policy impact in the development of green finance markets, and investigate the impact mechanisms of how green finance affects carbon dioxide emissions. Our time frame from 2007 to 2018 is selected for the empirical study by integrating the availability of data due to the scarcity of relevant statistics in the early days of green finance. Location of this study is in China where 30 provinces are included, excluding Tibet due to severe data shortage. As for methodology, we construct a green finance evaluation index system containing five indicators by entropy weight method, choose dynamic spatial Durbin model (DSDM) for empirical research, and perform mechanism analysis of restructuring industry and greening technology as intermediary channel. Our findings demonstrate that green finance in China does significantly reduce carbon emissions, and its spatial spillover effect and long-term effect are also verified. Furthermore, green finance tends to reduce CO₂ emissions through restructuring industry and greening technology. Correspondingly, policy implications are recommended. First, improving green financial market and strengthening information disclosure of green financial market are crucial to facilitate green finance development. Local governments formulate carbon emission reduction strategies focusing on space by joint conference or coordination mechanism like river head system. Lastly, a mechanism should be developed to strengthen the transformation of industrial structure and to promote greening technology.

PMID:36169832 | DOI:10.1007/s11356-022-23246-8

Anat Sci Int. 2022 Sep 28. doi: 10.1007/s12565-022-00687-2. Online ahead of print.

ABSTRACT

The anatomy of the superior orbital fissure is very important because of the spaces it connects, the regions it is adjacent to, and the structures it contains. We aimed to study the width, length and types of the structure, their change according to gender, body sides, and age. The fissure shape has many variations that are not easy to systematize. Therefore, it was aimed to classify them with various reference points determined for the first time, identify their types and determine their incidence. An objective and comprehensive classification was used on 3-dimensional images using multidetector computed tomography. We retrospectively evaluated the orbit and paranasal sinus computerized tomography images of 200 individuals (age range: 3 months-90 years;106 female, 94 male). The shape of fissure were identified and classified, it is length and width were measured. There was no statistical difference in the length of the fissure according to gender on both sides, and in width only on the left (p˃0.05). On the right side, it was statistically significantly wider in female (p˂0.05). While the fissure types were grouped based on observation in the literature, they were defined more comprehensively according to different shape features by giving a certain reference lines by us for the first time and evaluated over seven types. The most common shape for both sides was racket-shaped type (right: 24.5%, left: 26%), while the least common was narrow type (right: 1%, left: 2%). Thus, the shape variations of structure have gained a systematic typing criterion for the first time with the definitions in our study.

PMID:36169800 | DOI:10.1007/s12565-022-00687-2

Qual Life Res. 2022 Sep 28. doi: 10.1007/s11136-022-03262-4. Online ahead of print.

ABSTRACT

PURPOSE: In order to enable cost-utility analysis of shoulder pain conditions and treatments, this study aimed to develop and evaluate mapping algorithms to estimate the EQ-5D health index from the Oxford Shoulder Score (OSS) when health outcomes are only assessed with the OSS.

METHODS: 5437 paired OSS and EQ-5D questionnaire responses from four national multicentre randomised controlled trials investigating different shoulder pathologies and treatments were split into training and testing samples. Separate EQ-5D-3L and EQ-5D-5L analyses were undertaken. Transfer to utility (TTU) regression (univariate linear, polynomial, spline, multivariable linear, two-part logistic-linear, tobit and adjusted limited dependent variable mixture models) and response mapping (ordered logistic regression and seemingly unrelated regression (SUR)) models were developed on the training sample. These were internally validated, and their performance evaluated on the testing sample. Model performance was evaluated over 100-fold repeated training-testing sample splits.

RESULTS: For the EQ-5D-3L analysis, the multivariable linear and splines models had the lowest mean square error (MSE) of 0.0415. The SUR model had the lowest mean absolute error (MAE) of 0.136. Model performance was greatest in the mid-range and best health states, and lowest in poor health states. For the EQ-5D-5L analyses, the multivariable linear and splines models had the lowest MSE (0.0241-0.0278) while the SUR models had the lowest MAE (0.105-0.113).

CONCLUSION: The developed models now allow accurate estimation of the EQ-5D health index when only the OSS responses are available as a measure of patient-reported health outcome.

PMID:36169788 | DOI:10.1007/s11136-022-03262-4