Nevin Manimala

Biom J. 2022 Apr;64(4):771-804. doi: 10.1002/bimj.202000036. Epub 2022 Jan 23.

ABSTRACT

With the progressive technology, many medical researches are aimed to develop diagnostic tests that can detect diseases faster and accurately. The assessment of the accuracy of the diagnostic test for classifying two groups is through the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC). When a paired design is considered, the sample size determination requires the information about two AUC estimates and the corresponding variance and covariance of two AUC estimators. This paper derives the nonparametric estimators of the variance and covariance of two AUC estimators. The result is used to derive the sample size formula when the paired sample is planned. Since most of the results do not have a closed form, numerical results are provided under various scenarios.

PMID:35429054 | DOI:10.1002/bimj.202000036

Biom J. 2022 Apr 15. doi: 10.1002/bimj.202100231. Online ahead of print.

ABSTRACT

Abundance estimation from capture-recapture data is of great importance in many disciplines. Analysis of capture-recapture data is often complicated by the existence of one-inflation and heterogeneity problems. Simultaneously taking these issues into account, existing abundance estimation methods are usually constructed on the basis of conditional likelihood under one-inflated zero-truncated count models. However, the resulting Horvitz-Thompson-type estimators may be unstable, and the resulting Wald-type confidence intervals may exhibit severe undercoverage. In this paper, we propose a semiparametric empirical likelihood (EL) approach to abundance estimation under one-inflated binomial and Poisson regression models. To facilitate the computation of the EL method, we develop an expectation-maximization algorithm. We also propose a new score test for the existence of one-inflation and prove its asymptotic normality. Our simulation studies indicate that compared with existing estimators, the proposed score test is more powerful and the maximum EL estimator has a smaller mean square error. The advantages of our approaches are further demonstrated by analyses of prinia data from Hong Kong and drug user data from Bangkok.

PMID:35429047 | DOI:10.1002/bimj.202100231

J Adv Nurs. 2022 Apr 15. doi: 10.1111/jan.15249. Online ahead of print.

ABSTRACT

AIMS: To investigate Group B Streptococcus (GBS) colonization in pregnancy; adherence to antenatal GBS screening and adherence to the intrapartum antibiotics protocol within two models of care (midwifery and non-midwifery led).

DESIGN: This retrospective quantitative study has employed a descriptive design using administrative health data.

METHODS: Data from five maternity hospitals in metropolitan and regional Western Australia that included 22,417 pregnant women who gave birth between 2015 and 2019 were examined, applying descriptive statistics using secondary data analysis.

RESULTS: The study revealed an overall GBS colonization rate of 21.7% with similar rates in the different cohorts. A lower adherence to screening was found in the midwifery led model of care (MMC, 68.76%, n = 7232) when compared with the non-midwifery led model of care (NMMC, 90.49%, n = 10,767). Over the 5 years, screening rates trended down in the MMC with stable numbers in the counterpart. Adherence in relation to intrapartum antibiotic prophylaxis revealed discrepant findings between the study groups.

CONCLUSION: Adherence to screening and management guidelines of maternal GBS colonization in pregnancy is lower within the MMC when compared with the NMMC.

IMPACT: This is the first cohort study to describe the adherence to the recommended Western Australian GBS screening guidelines in the two different models of care. Findings may assist in the guidance and improvement of clinical protocols as well as the planning of clinical care in relation to GBS screening to reduce the risk of neonatal GBS infection.

PMID:35429021 | DOI:10.1111/jan.15249

Eur Geriatr Med. 2022 Apr 15. doi: 10.1007/s41999-022-00644-2. Online ahead of print.

ABSTRACT

PURPOSE: Geriatrician numbers are increasing year by year in Turkey. We aimed to obtain information on licensed geriatricians, trainees, and board of directors of the societies in Turkey and compare this information with other countries’ data.

METHODS: The study was conducted as a cross-sectional study. The gender, institution, and title of licensed geriatricians and trainees were documented by scanning websites of university, training and research, state hospitals, and the website of Academic Geriatrics Association. Information about the board of directors of the societies was obtained from the websites of the societies. The last day for data inclusion was August 31, 2021.

RESULTS: There were 90 licensed geriatricians and 77 trainees in Turkey as of 31 August 2021. While 52.2% (n = 47) of licensed geriatricians were female, the ratio of females among trainees was 76.6% (n = 59). The ratio of females among trainees was statistically higher than licensed geriatricians (p = 0.001). Females constitute 88.9% of the board of directors of the Academic Geriatrics Association and this ratio was higher than the ratio of females on the board of directors of local and international journals.

CONCLUSION: Best of our knowledge, our study is the first to examine the gender distribution in geriatrics. The dominance of females in geriatrics is very important in countries where geriatrics is relatively newly established as even countries with a deep-rooted history and structure in geriatrics are trying to increase the number of female geriatricians under their new administrations.

PMID:35428970 | DOI:10.1007/s41999-022-00644-2

Spine Deform. 2022 Apr 15. doi: 10.1007/s43390-022-00506-8. Online ahead of print.

ABSTRACT

OBJECTIVE: Adjacent segment disease, junctional kyphosis/failure and pseudarthrosis can negatively impact the mid to long-term outcome in spinal deformity surgery. These complications might be influenced by upper instrumented vertebra (UIV) fixation techniques. In this study we analyze key biomechanical properties of three different UIV fixation techniques and define their ideal clinical use based on patient-specific risk profiles using a finite element analysis (FEA) model.

METHODS: A T9-pelvis posterior instrumented spinal fusion was assumed. Three different FEA models were created based on the UIV fixation technique: T9 pedicle screws (PS); T9 cortical bone screws (CBS); T9 transverse process hooks (TPH). The three FEA models consisted of T8-T10 bone and ligamentous anatomy derived from a CT scan of a healthy patient as well as spinal implants consisting of either pedicle screws, cortical bone screws or transverse process hooks as well as cobalt chromium rods. The FEA models were constrained at T10, axial load as assumed for a healthy 80 kg male during flexion, extension and lateral bending were applied. As surrogate markers for risk of proximal junctional kyphosis, proximal junctional failure, adjacent segment disease and pseudarthrosis the following biomechanical parameters were calculated: UIV range of motion (ROM); intradiscal stress at UIV/UIV + 1; UIV intravertebral stress and screw pull out forces. One-way ANOVA analyses have been performed to compare biomechanical outcome parameters between the three construct variants under investigation.

RESULTS: UIV-ROM was restricted during flexion/extension/lateral bending by: PS: 73%/80%/86%, CBS: 71%/81%/85% and TPH: 62%/76%/85%. Average intradiscal stress at UIV/UIV + 1 during flexion/extension/lateral bending was (Mega Pascal, MPa): PS 0.42/0.44/0.38, CBS 0.49/0.4/0.44, TPH 0.66/0.51/0.58; average intravertebral stress of the UIV superior endplate during flexion/extension/lateral bending was (MPa): PS 2.23/2.12/2.21, CBS 1.87/1.98/1.8, TPH 1.67/0.98/1.53. Screw pull-out forces (N) at UIV during flexion/extension/lateral bending were: PS 476/320/375, CBS 444/245/308. Statistically significant differences were found for intradiscal stress as well as vertebral body average stress (p = 0.02 and p = 0.02).

CONCLUSION: Different UIV fixation techniques carry different biomechanical properties. Pedicle screw fixation is the most rigid, leading to the highest UIV stress and UIV screw pull out forces. Cortical bones screw fixation is similarly rigid; however, UIV stress and UIV screw pull out is significantly lower. Transverse process hook fixation is the least rigid, with the lowest UIV stress, however highest intradiscal stress at UIV/UIV + 1. Thus, these biomechanical differences may help select optimal UIV fixation techniques according to patient specific risk factors.

PMID:35428950 | DOI:10.1007/s43390-022-00506-8

Int J Implant Dent. 2022 Apr 15;8(1):19. doi: 10.1186/s40729-022-00415-5.

ABSTRACT

PURPOSE: Tooth extraction and the projection of the tooth roots into the maxillary sinus are reported to greatly reduce the bone height from the alveolar ridge to the maxillary sinus floor, while missing teeth are reported to lead to the expansion of the maxillary sinus, all of which are important considerations during dental implant treatment for the maxillary molar region. Therefore, assessing the anatomical characteristics of the maxillary sinus acting as complicating factors is crucial before sinus augmentation. We conducted a three-dimensional examination of the effects of missing teeth and nasal septal deviation (NSD) on maxillary sinus volume (MSV).

METHODS: We selected participants with two or more missing teeth from patients who underwent maxillary sinus augmentation for a unilateral free-end saddle between April 2019 and December 2020. We calculated the MSV and NSD using cone-beam computed tomography (CBCT). We compared the relationships of the presence/absence of teeth and NSD with MSV bilaterally in each patient using the Wilcoxon t-test. p-values < 0.05 denoted statistical significance.

RESULTS: This study included 30 patients (30 sinuses; 12 men, 18 women). The average patient age was 58.2 ± 10.2 years (men, 60.4 ± 3.7 years; women, 59.2 ± 4.5 years; range, 40-77 years). The mean number of missing teeth was 2.98 ± 1.01: 13 patients had two missing teeth and 17 had three or more missing teeth. Nine patients (30%) had NSD. The mean MSV on the ipsilateral and contralateral sides of the NSD was 21.50 ± 3.84 cm³ and 22.10 ± 3.56 cm³, respectively; thus, NSD did not affect MSV (p = 0.150). The mean MSV on the edentulous and non-edentulous sides was 21.58 ± 3.89 cm³ and 21.77 ± 4.30 cm³, respectively; thus, the MSV was significantly smaller on the edentulous side (p = 0.00036).

CONCLUSION: Although this study was a limited preoperative study, three-dimensional measurement of the maxillary sinus with CBCT in partially edentulous patients revealed that missing teeth lead to substantial reductions in MSV, while NSD was not associated with MSV.

PMID:35428947 | DOI:10.1186/s40729-022-00415-5

Cardiovasc Intervent Radiol. 2022 Apr 15. doi: 10.1007/s00270-022-03136-9. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze trends and differences of endovascular, surgical and hybrid revascularization approaches and the impact of comorbidity on characteristics, costs, and outcome of in-patients with peripheral artery disease (PAD) of the lower extremity.

METHODS: Analyzing data provided by the Research Data Center of the German Federal Statistical Office, we included all hospitalizations due to PAD Fontaine IIb (Rutherford 2-3) or higher in Germany between 2009-2011 and 2016-2018. According to the individually performed procedures encoded by the Operation and Procedure Classification System, we divided hospitalizations by revascularization procedures into sole endovascular, sole surgical, hybrid, two-step and no revascularization. Patient’s comorbidity was assessed using the linear van Walraven comorbidity score (vWs).

RESULTS: 1,067,671 hospitalizations (mean age 71.3 ± 11.1 years; 60.1% male) were analyzed. Between 2009-2011 and 2016-2018, reimbursement costs rose by 28.0% from €2.72 billion (€5,350/case) to €3.49 billion (€6,238/case). The share of hospitalizations with any revascularization increased by 8.9% (67.7-73.7%) driven by an increase in two-step (+ 63.3%), hybrid (+ 58.2%) and sole endovascular revascularizations (+ 32.6%), while sole surgical approaches declined (- 18.2%). Hospitalizations of more comorbid patients (vWs ≥ 20) rose by 46.8% (21,444-31,478 cases), showed an overproportionate increase in costs of 124.6% (+ €1,750/case) and were associated with more individual procedures (+ 90.6%).

CONCLUSIONS: In-patient treatment of PAD patients shows increasing numbers of hybrid and sole endovascular revascularizations and more patients with higher comorbidity, while sole surgical interventions and in-hospital mortality decrease. Consequently, associated costs are surging especially in more comorbid patients due to an increasing number of performed procedures and escalation of therapy.

PMID:35428938 | DOI:10.1007/s00270-022-03136-9

World J Urol. 2022 Apr 15. doi: 10.1007/s00345-022-03996-3. Online ahead of print.

ABSTRACT

BACKGROUND: Extracorporeal shock wave lithotripsy (ESWL) is considered one of the best choices for the treatment of various kinds of urinary tract calculi, although it might cause acute kidney injury.

OBJECTIVE: To measure the urinary long non-coding RNA-messenger RNA (LncRNA-mRNA) panel before and after ESWL to evaluate post-ESWL renal injury in a reliable and non-invasive method.

PATIENTS AND METHODS: The study included 60 patients with renal stones treated with ESWL and 30 healthy volunteers. Voided urine samples were obtained before, 2 h, and 1 day after ESWL. We measured the urinary level of LncRNA (SBF2-AS1, FENDRR-19) and mRNA (GBP1, NLRP3) by real-time qPCR and compared the results with serum creatinine and eGFR.

RESULTS: LncRNA (SBF2-AS1, FENDRR-19) and mRNA (GBP1, NLRP3) levels were higher in patients with renal stones when compared with healthy volunteers. They showed a statistically significant increase in the level of LncRNA-mRNA panel in baseline and after ESWL treatment.

CONCLUSION: LncRNA (SBF2-AS1, FENDRR-19) and mRNA (GBP1, NLRP3) levels were significantly elevated following ESWL treatment, highlighting the usefulness of urinary biomarkers in identifying patients at higher risk of developing renal injury after ESWL treatment.

PMID:35428927 | DOI:10.1007/s00345-022-03996-3

Eur Spine J. 2022 Apr 15. doi: 10.1007/s00586-022-07200-3. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to determine the discriminatory ability of age-adjusted alignment offset and the global alignment and proportion (GAP) score parameters to predict postoperative mechanical complications.

METHODS: Surgical patients from the Adult Symptomatic Lumbar Scoliosis cohort were reviewed at 2 year follow up. Age-adjusted alignment offsets and GAP parameters were calculated for each patient. A series of nonlinear logistic regression models were fit, and the odds of mechanical complications were calculated. The discriminatory ability of the GAP score, GAP score parameters, and age-adjusted alignment offsets were determined plotting receiver operative characteristic (ROC) with the C statistic (AUC).

RESULTS: A total of 165 patients were included. A total of 49 mechanical complications occurred in 41 patients (21 proximal junctional kyphosis and 28 pseudoarthrosis). The GAP score had no discriminatory ability in this cohort. Relative lumbar lordosis 15 degrees greater than ideal lumbar lordosis was associated with greater mechanical complications. A lumbar distribution index of 90% was associated with fewer mechanical complications compared to a lumbar distribution index of 65%. Age-adjusted offset alignment targets had no discriminatory ability to predict mechanical complications.

CONCLUSION: Radiographic alignment targets using either age-adjusted alignment target offset or GAP score parameters had minimal ability to predict mechanical complications in isolation. Mechanical complications following adult spinal deformity surgery are complex, and patient factors play a critical role. Clinical trial registeration This study was registered at ClinicalTrials.gov (number NCT00854828) in March 2009.

PMID:35428916 | DOI:10.1007/s00586-022-07200-3

J Clin Endocrinol Metab. 2022 Apr 16:dgac232. doi: 10.1210/clinem/dgac232. Online ahead of print.

ABSTRACT

CONTEXT: Premenopausal women with idiopathic osteoporosis (PreMenIOP) have marked deficits in bone density, microstructure and strength.

OBJECTIVE: To define effects of treatment with teriparatide followed by denosumab on Lumbar Spine (LS) volumetric BMD (vBMD) and stiffness by finite element analysis assessed on central QCT (cQCT) scans.

DESIGN, SETTINGS AND PARTICIPANTS: Ancillary analysis of baseline, post-teriparatide and post-denosumab cQCT scans from a randomized trial of 41 women allocated to teriparatide (20 mcg daily; N=28) or placebo (N=11). After 6 months (M), those on teriparatide continued for 18M and those on placebo switched to teriparatide for 24M. After completing teriparatide, 33 enrolled in a phase 2B extension with denosumab (60mg q6M) for 12M.

MAIN OUTCOME MEASURES: Primary outcomes were percent change from baseline in LS trabecular vBMD and stiffness after teriparatide, and between end of teriparatide and completing denosumab. Percent change from baseline in LS trabecular vBMD and stiffness after sequential teriparatide and denosumab were secondary outcomes.

FINDINGS: There were large increases (all p<0.001) in trabecular vBMD (25%), other vBMD parameters, and stiffness (21%) after teriparatide. Statistically significant increases in trabecular vBMD (10%; p<0.001) and other vBMD parameters (p=0.03-0.001) were seen after denosumab, while stiffness increased by 7% (p=0.068). Sequential teriparatide and denosumab led to highly significant (all p<0.001) increases LS trabecular vBMD (43%), other vBMD parameters (15-31%) and stiffness (21%).

CONCLUSIONS: The large and statistically significant increases in volumetric density and stiffness after sequential treatment with teriparatide followed by denosumab are encouraging and support use of this regimen in PreMenIOP.

PMID:35428889 | DOI:10.1210/clinem/dgac232