Nevin Manimala

Am J Cardiovasc Drugs. 2023 Apr 15. doi: 10.1007/s40256-023-00580-x. Online ahead of print.

ABSTRACT

BACKGROUND: Atrial fibrillation (AF) frequently complicates hypertrophic cardiomyopathy (HCM), and anticoagulation significantly decreases the risk of stroke in this population. To date, no randomized controlled trials (RCTs) have compared direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs). The present study aimed to systematically compare the two anticoagulation strategies in terms of effectiveness and safety.

METHOD: We performed a systematic literature search and meta-analysis in the PubMed, MEDLINE, and EMBASE databases for studies reporting all-cause mortality, major bleeding, or thromboembolic events (TEs). Since no RCTs were available, we included observational studies only. The overall hazard ratio (HR) and 95% confidence interval (CI) for each analyzed parameter were pooled using a random-effects model.

RESULTS: Five observational studies including 6919 patients were eligible for inclusion. Compared with VKAs, DOACs were associated with statistically significant lower rates of all-cause mortality (HR 0.64, 95% CI 0.35-0.54; p < 0.00001), comparable major bleeding events (HR 0.64, 95% CI 0.40-1.03; p = 0.07), and TEs (HR 0.94, 95% CI 0.73-1.22; p = 0.65).

CONCLUSIONS: Compared with VKAs, a DOAC-based strategy might represent an effective and safe strategy regarding all-cause mortality, major/life-threatening bleeding complications, and TEs in HCM patients with concomitant AF. However, further prospective studies are necessary to reinforce a DOAC-based anticoagulation strategy in this population.

PMID:37061614 | DOI:10.1007/s40256-023-00580-x

Sci Rep. 2023 Apr 15;13(1):6139. doi: 10.1038/s41598-023-32668-4.

ABSTRACT

No cardiovascular risk score has included Latin American patients in its development. The ACC/AHA ASCVD risk score has not been validated in Latin America; consequently, its predictive capacity in the population of the region is unknown. The aim of this study is to evaluate the discrimination capacity and calibration of the ACC/AHA ASCVD score to predict the 10-year risk of a cardiovascular event in a primary prevention cohort followed in a Colombian hospital. A retrospective cohort study was conducted in primary prevention patients belonging to an intermediate/high-risk and low-risk cohort without established atherosclerotic disease. Cardiovascular risk was calculated at inclusion. The calibration was analyzed by comparing observed and expected events in the different risk categories. A discrimination analysis was made using the area under the ROC curve and C statistic. A total of 918 patients were included-202 from the intermediate/high-risk and 716 from the low-risk cohort. The median cardiovascular risk was 3.6% (IQR 1.7-8.5%). At the 10-year follow-up, 40 events (4,4%) occurred. The area under the ROC curve was 0.782 (95% CI 0.71-0.85). The Hosmer-Lemeshow test did not show differences between expected and observed events. The ACC/AHA ASCVD score is calibrated and has good discrimination capacity in predicting 10-year risk of cardiovascular events in a Colombian population.

PMID:37061603 | DOI:10.1038/s41598-023-32668-4

Forensic Sci Med Pathol. 2023 Apr 15. doi: 10.1007/s12024-023-00617-2. Online ahead of print.

ABSTRACT

There are many dental age estimation methods, but all the methods do not correspond, especially for aging methods for adults and mature individuals, to the reality of the forensic field, which favors simple, effective, and easy-to-use methods. Ruquet (2015) developed a method based on alveolar bone loss that predicts age for individuals between 25 and 60 years old and is even more accurate for those 25-40 years old. This study re-evaluated Ruquet’s alveolar bone loss method using three-dimensional imaging of individuals whose age and sex were known, without taking into account their medical conditions. Digital measurements, from the cemento-enamel junction (CEJ) to the alveolar bone crest (ABC), were performed on the mesial and distal surfaces of teeth on 243 patients, independent of the tridimensional imaging test. With these measurements, two alveolar bone loss averages (ABL) were calculated, one with all the teeth present on the arches and another with only Ramfjörd’s teeth. Bone loss showed a significant correlation with age (p < 0.001). The age estimation with all teeth and with only Ramfjörd’s teeth showed a statistically significant difference, and age estimation was more accurate when all teeth were used. The assessment of alveolar resorption appears to be an interesting tool for age estimation in adult individuals. However, the method still lacks precision, and the mean absolute errors (MAEs) obtained by age group were all greater than 5 years, except for the age group 35-39 years old, for the age estimation with all teeth. Further studies should explore this existing correlation between alveolar bone loss and age and refine this method to make it more accurate.

PMID:37061600 | DOI:10.1007/s12024-023-00617-2

Ann Biomed Eng. 2023 Apr 15. doi: 10.1007/s10439-023-03205-1. Online ahead of print.

NO ABSTRACT

PMID:37061596 | DOI:10.1007/s10439-023-03205-1

Sci Rep. 2023 Apr 15;13(1):6143. doi: 10.1038/s41598-023-33298-6.

ABSTRACT

After graphene was first exfoliated in 2004, research worldwide has focused on discovering and exploiting its distinctive electronic, mechanical, and structural properties. Application of the efficacious methodology used to fabricate graphene, mechanical exfoliation followed by optical microscopy inspection, to other analogous bulk materials has resulted in many more two-dimensional (2D) atomic crystals. Despite their fascinating physical properties, manual identification of 2D atomic crystals has the clear drawback of low-throughput and hence is impractical for any scale-up applications of 2D samples. To combat this, recent integration of high-performance machine-learning techniques, usually deep learning algorithms because of their impressive object recognition abilities, with optical microscopy have been used to accelerate and automate this traditional flake identification process. However, deep learning methods require immense datasets and rely on uninterpretable and complicated algorithms for predictions. Conversely, tree-based machine-learning algorithms represent highly transparent and accessible models. We investigate these tree-based algorithms, with features that mimic color contrast, for automating the manual inspection process of exfoliated 2D materials (e.g., MoSe₂). We examine their performance in comparison to ResNet, a famous Convolutional Neural Network (CNN), in terms of accuracy and the physical nature of their decision-making process. We find that the decision trees, gradient boosted decision trees, and random forests utilize physical aspects of the images to successfully identify 2D atomic crystals without suffering from extreme overfitting and high training dataset demands. We also employ a post-hoc study that identifies the sub-regions CNNs rely on for classification and find that they regularly utilize physically insignificant image attributes when correctly identifying thin materials.

PMID:37061576 | DOI:10.1038/s41598-023-33298-6

Eur J Orthop Surg Traumatol. 2023 Apr 16. doi: 10.1007/s00590-023-03550-w. Online ahead of print.

ABSTRACT

BACKGROUND: Aseptic loosening is a feared complication following total elbow arthroplasty (TEA); however, literature regarding factors that may contribute to this complication is limited. The aims of this investigation were to: (1) compare baseline demographics of patients who developed aseptic loosening following primary TEA; and (2) identify patient-specific risk factors for the development of loosening.

METHODS: Retrospective analysis using a nationwide claims database was performed to identify patients who underwent primary TEA and developed aseptic loosening within 2 years (study n = 307, control n = 10,741). Multivariate regression analysis generated odds ratio (OR), 95% confidence interval (95% CI), and p-value of risk factors. p < 0.05 was considered statistically significant.

RESULTS: Patients who developed aseptic loosening had significant differences in numerous demographics, including age (p = 0.0001), sex (p = 0.0251), and various comorbid conditions such as obesity (15.96% vs. 8.36%, p < 0.0001). Furthermore, the risk factors most associated with aseptic loosening were obesity (OR 1.65, 95% CI 1.18-2.28, p = 0.002), male sex (OR 1.51, 95% CI 1.13-2.00, p = 0.004), and concomitant opioid use disorder (OR 1.58, 95% CI 1.14-2.15, p = 0.004).

DISCUSSION: This study is the first to identify demographics and patient-related risk factors associated with aseptic loosening following primary TEA. This evidence could be applied to the clinical setting in order to educate at-risk patients of this potential complication as well as inform their post-operative clinical management.

LEVEL OF EVIDENCE: Level III: Prognostic.

PMID:37061573 | DOI:10.1007/s00590-023-03550-w

Neurol Sci. 2023 Apr 15. doi: 10.1007/s10072-023-06801-0. Online ahead of print.

ABSTRACT

OBJECTIVES: We aimed to evaluate the available evidence on the efficacy and safety outcomes of intravenous tenecteplase (TNK) compared with intravenous alteplase(ALT) for patients with acute ischemic stroke (AIS) in randomized controlled trials (RCTs).

METHODS: The MEDLINE/PubMed, Embase, Springer, Web of Science, Cochrane Collaboration database, China National Knowledge Infrastructure (CNKI) database, and Wanfang database were comprehensively searched for RCTs regarding the effects of TNK versus ALT among AIS patients in these English and Chinese electronic databases from inception dates to August 1, 2022. This meta-analysis followed PRISMA guidelines. Two reviewers independently retrieved RCTs and extracted relevant information. The methodological quality of the included trials was estimated using the Cochrane risk of bias tool. The pooled analyses were performed using RevMan 5.3 software. The primary outcome was functional outcome on the modified Rankin Scale (mRS) (range 0 to 5) and mortality at 90 days. The secondary outcomes included successful recanalization, early neurologic improvement < 48 h, any intracranial hemorrhage (ICH), and symptomatic ICH. The follow-up time of all studies was at least 3 months.

RESULTS: A total of nine RCTs involving 1958 patients in TNK group and 1731 patients in ALT group were finally included. For the efficacy outcomes, there were no significant differences between the two groups in terms of mRS score 0 ~ 2 (RR 1.00; 95% CI 0.88-1.13; P = 0.96), mRS score 0 ~ 1 (RR 1.03; 95% CI 0.96-1.10; P = 0.36), successful recanalization (RR 1.25; 95% CI 0.88-1.76; P = 0.21), and early neurologic improvement < 48 h (RR 1.08; 95% CI 0.92-1.26; P = 0.37). Similar results were seen for the safety outcomes, which have no statistical differences in terms of any ICH (RR 1.01; 95% CI 0.72-1.41; P = 0.96), symptomatic ICH (RR 1.19; 95% CI 0.81-1.76; P = 0.37), and mortality at 90 days (RR 0.99; 95% CI 0.83-1.19; P = 0.94).

CONCLUSION: Overall, the efficacy and safety outcomes of intravenous thrombolysis with TNK versus ALT for AIS were not statistically different. However, TNK at a dose of 0.25 mg/kg may be a reasonable alternative to ALT for thrombolysis.

PMID:37061572 | DOI:10.1007/s10072-023-06801-0

Urolithiasis. 2023 Apr 15;51(1):70. doi: 10.1007/s00240-023-01439-1.

ABSTRACT

In 2018, the Endourology Disease Group for Excellence (EDGE) published a prospective trial comparing dusting versus basketing during ureteroscopy. One hundred fifty-nine patients were included in the original analysis, which found no difference in stone-free rate at 3 months. We report the intermediate and long-term outcomes of patients included in the original trial. Two analyses were performed. At 1-year, a retrospective chart review was performed, and data collected on stone episodes, Emergency Department (ED) visits, hospital admissions and surgical interventions. To obtain long-term outcomes, the four sites with the largest initial accrual were included in a second phase of data collection with updated analyses. The patients from those sites were contacted, re-consented, and data were collected on stone surgical interventions, stone episodes, stone recurrences on imaging, emergency department (ED) visits, and hospital admissions for stone-related care since their original procedure. One-year follow-up data were collected in 111 of the original 159 (69.8%) patients from the nine sites. There were no statistically significant differences in the number of painful episodes, ED visits, hospital admissions, or surgical interventions. 94 patients from four sites were included in the long-term analysis. There were no statistically significant differences in surgical interventions, painful stone episodes, stone recurrence on imaging, ED visits or hospitalizations for stone-related events between the two groups. Long-term outcomes of dusting versus basketing during ureteroscopy indicate that there are no significant differences in clinical outcomes between the two surgical modalities.

PMID:37061554 | DOI:10.1007/s00240-023-01439-1

Sci Rep. 2023 Apr 15;13(1):6157. doi: 10.1038/s41598-023-33098-y.

ABSTRACT

A deep learning model (LCP CNN) for the stratification of indeterminate pulmonary nodules (IPNs) demonstrated better discrimination than commonly used clinical prediction models. However, the LCP CNN score is based on a single timepoint that ignores longitudinal information when prior imaging studies are available. Clinically, IPNs are often followed over time and temporal trends in nodule size or morphology inform management. In this study we investigated whether the change in LCP CNN scores over time was different between benign and malignant nodules. This study used a prospective-specimen collection, retrospective-blinded-evaluation (PRoBE) design. Subjects with incidentally or screening detected IPNs 6-30 mm in diameter with at least 3 consecutive CT scans prior to diagnosis (slice thickness ≤ 1.5 mm) with the same nodule present were included. Disease outcome was adjudicated by biopsy-proven malignancy, biopsy-proven benign disease and absence of growth on at least 2-year imaging follow-up. Lung nodules were analyzed using the Optellum LCP CNN model. Investigators performing image analysis were blinded to all clinical data. The LCP CNN score was determined for 48 benign and 32 malignant nodules. There was no significant difference in the initial LCP CNN score between benign and malignant nodules. Overall, the LCP CNN scores of benign nodules remained relatively stable over time while that of malignant nodules continued to increase over time. The difference in these two trends was statistically significant. We also developed a joint model that incorporates longitudinal LCP CNN scores to predict future probability of cancer. Malignant and benign nodules appear to have distinctive trends in LCP CNN score over time. This suggests that longitudinal modeling may improve radiomic prediction of lung cancer over current models. Additional studies are needed to validate these early findings.

PMID:37061539 | DOI:10.1038/s41598-023-33098-y

Sci Rep. 2023 Apr 15;13(1):6158. doi: 10.1038/s41598-023-31314-3.

ABSTRACT

Decreasing the conventional sources of oil reservoirs attracts researchers’ attention to the tertiary recovery of oil reservoirs, such as in-situ catalytic upgrading. In this contribution, the response surface methodology (RSM) approach and multi-objective optimization were utilized to investigate the effect of reaction temperature and catalysts soaking time on the concentration distribution of upgraded oil samples. To this end, 22 sets of experimental oil upgrading over Ni-W-Mo catalyst were utilized for the statistical modeling. Then, optimization based on the minimum reaction temperature, catalysts soaking time, gas, and residue wt.% was performed. Also, correlations for the prediction of concentration of different fractions (residue, vacuum gas oil (VGO), distillate, naphtha, and gases) as a function of independent factors were developed. Statistical results revealed that RSM model is in good agreement with experimental data and high coefficients of determination (R² = 0.96, 0.945, 0.97, 0.996, 0.89) are the witness for this claim. Finally, based on multi-objective optimization, 378.81 °C and 17.31 h were obtained as the optimum upgrading condition. In this condition, the composition of residue, VGO, distillate, naphtha, and gases are 6.798%, 39.23%, 32.93%, 16.865%, and 2.896%, respectively, and the optimum condition is worthwhile for the pilot and industrial application of catalyst injection during in-situ oil upgrading.

PMID:37061521 | DOI:10.1038/s41598-023-31314-3