Nevin Manimala

Stat Med. 2022 Mar 7. doi: 10.1002/sim.9365. Online ahead of print.

ABSTRACT

To control the SARS-CoV-2 pandemic and future pathogen outbreaks requires an understanding of which nonpharmaceutical interventions are effective at reducing transmission. Observational studies, however, are subject to biases that could erroneously suggest an impact on transmission, even when there is no true effect. Cluster randomized trials permit valid hypothesis tests of the effect of interventions on community transmission. While such trials could be completed in a relatively short period of time, they might require large sample sizes to achieve adequate power. However, the sample sizes required for such tests in outbreak settings are largely undeveloped, leaving unanswered the question of whether these designs are practical. We develop approximate sample size formulae and simulation-based sample size methods for cluster randomized trials in infectious disease outbreaks. We highlight key relationships between characteristics of transmission and the enrolled communities and the required sample sizes, describe settings where trials powered to detect a meaningful true effect size may be feasible, and provide recommendations for investigators in planning such trials. The approximate formulae and simulation banks may be used by investigators to quickly assess the feasibility of a trial, followed by more detailed methods to more precisely size the trial. For example, we show that community-scale trials requiring 220 clusters with 100 tested individuals per cluster are powered to identify interventions that reduce transmission by 40% in one generation interval, using parameters identified for SARS-CoV-2 transmission. For more modest treatment effects, or when transmission is extremely overdispersed, however, much larger sample sizes are required.

PMID:35257398 | DOI:10.1002/sim.9365

Acta Neurol Scand. 2022 Mar 7. doi: 10.1111/ane.13609. Online ahead of print.

ABSTRACT

OBJECTIVES: To study factors that affected previous epileptic seizure control throughout pregnancy, during labour, and in the post-natal weeks.

MATERIALS & METHODS: Analysis of data concerning seizure freedom that was available at various stages of 2337 pregnancies in the Raoul Wallenberg Australian Pregnancy Register of Antiepileptic Drugs, mainly employing multiple variable logistic regression techniques.

RESULTS: Based on data available at the outset of pregnancy, the risk of seizure-affected that is, not seizure-free pregnancy was statistically significantly (p < .05) higher in pregnancies where there was previously uncontrolled epilepsy (78.1% vs. 20.8%) and focal epilepsy (51.3% vs. 39.7%), and decreased with later onset-age epilepsy (41.8% vs. 52.2% with onset before age 13 years), The risk did not differ between initially antiseizure medication (ASM)-treated or untreated pregnancies. For epilepsy receiving ASM therapy, 90.6% of 160 pregnancies of women with uncontrolled focal epilepsy that began before the age of 13 were seizure-affected. None of the above factors influenced the risk of seizures during labour, though having seizures during pregnancy increased the hazard (3.93 vs. 0.6%). Either ASM-treated pregnancy or labour being seizure-affected increased the risk of post-partum period seizures (33.0% vs. 6.67% for both stages being seizure-free). Use of particular ASMs had no statistically significant effect on the seizure control situation at any of the pregnancy stages studied.

CONCLUSIONS: Obtaining full seizure control before pregnancy appeared to be the main factor in maintaining seizure freedom during pregnancy, labour and the post-natal weeks.

PMID:35257362 | DOI:10.1111/ane.13609

Environ Sci Pollut Res Int. 2022 Mar 7. doi: 10.1007/s11356-022-19464-9. Online ahead of print.

ABSTRACT

Although a growing number of original epidemiological studies imply a link between ambient pollution exposure and mortality risk, the findings associated with carbon monoxide (CO) exposure are inconsistent. Thus, we conducted a systematic review and meta-analysis of epidemiological studies to evaluate the correlations between ambient CO and non-accidental, cardiovascular, and respiratory mortality in China. Eight databases were searched from inception to 15 May 2021. A random-effect model was used to calculate the pooled relative risks (RRs) and 95% confidence intervals (CIs). Subgroup analyses as well as sensitivity analyses were performed. The I square value (I²) was used to assess heterogeneity among different studies. The assessment of publication bias on included studies was examined by funnel plot and Egger’s test. The influence of a potential publication bias on findings was explored by using the trim-and-fill procedure. Ultimately, a total of 19 studies were included in our analysis. The pooled relative risk for each 1 mg/m³ increase of ambient carbon monoxide was 1.0220 (95%CI: 1.0102-1.0339) for non-accidental mortality, 1.0304 (95%CI:1.0154-1.0457) for cardiovascular mortality, and 1.0318 (95%CI:1.0132-1.0506) for respiratory mortality. None of subgroup analyses could explain the source of heterogeneity. Exclusion of any single study did not materially alter the pooled effect estimates. Although it was suggestive of publication bias, findings were generally similar with principal findings when we explored the influence of a potential publication bias using the trim-and-fill method. Our meta-analysis demonstrated that exposure to ambient CO was positive with risk of deaths from all non-accidental causes, total cardiovascular, and respiratory diseases. Based on these findings, tougher intervention policies and initiatives to reduce the health effects of CO exposure should be established.

PMID:35257337 | DOI:10.1007/s11356-022-19464-9

Environ Sci Pollut Res Int. 2022 Mar 7. doi: 10.1007/s11356-021-17777-9. Online ahead of print.

ABSTRACT

We performed a systematic and meta-analysis study to find the association between cadmium (Cd) exposure and blood pressure (BP)/hypertension (HTN) in exposed general populations. We searched main databases for literature published between year 2000 and April 15, 2021. Quality assessment was performed with the Joanna Briggs Institute (JBI) critical appraisal tools. Heterogeneity between studies was determined by I-squared (I²) statistic. The random effects model was used to determine the association between blood and urine Cd levels with hypertension. The overall standard differences in mean for Cd level in hypertensive and control groups were 3.34, 1.79, and 8.09 based on samples from blood, urine, and hair, respectively. The overall standard differences in mean for Cd level in the low and high exposure groups were – 0.795 and – 1.036 based on blood and urinary samples, respectively. Our findings indicate a positive relationship between blood and hair Cd levels and hypertension. We also found that hair is the optimal biological sample to find the relationship between Cd exposure and hypertension for both genders. However, more studies are needed to confirm these findings.

PMID:35257333 | DOI:10.1007/s11356-021-17777-9

Environ Sci Pollut Res Int. 2022 Mar 7. doi: 10.1007/s11356-022-19485-4. Online ahead of print.

ABSTRACT

Research on the poverty risk caused by geological disasters in disaster-prone areas is a useful exploration to coordinate social economic development with disaster prevention and reduction, and is of great significance to the regional sustainable development. Based on statistical data and spatial data, this paper takes Sichuan Province as the typical research area. Remote sensing and geographic information technology are used to study the poverty risk caused by disasters based on the quantitative evaluation of geological disasters risk and regional development level. The spatial differentiation characteristics of poverty risk caused by disasters are explored on the 1 km × 1 km grid scale. The results indicate that (1) the overall risk of geological disasters in Sichuan Province is relatively high, with high and relatively high risk areas accounting for more than 40% and low and relatively low risk areas accounting for less than 30%. The risks in Mountain and Ravine Areas are significantly higher than other areas. (2) The regional development level in Sichuan Province is relatively high, but with significant spatial differences. The development level of high-altitude areas and remote mountainous areas is quite different from that of the Chengdu Plain in the middle Sichuan Province. The uneven development in the east, middle, and west is a prominent problem. (3) The poverty risk caused by disasters is high, and the spatial pattern presents a characteristic of “high in the west and low in the east” with high positive spatial correlation. High-High Cluster Areas are mainly distributed in western and southwestern Sichuan. Low-Low Outlier Areas are mainly distributed in Chengdu Plain and Hilly Areas of Sichuan Basin. High-Low Outlier and Low-High Outlier Areas occupy a relatively small percentage with scattered distribution. This paper provides some theoretical support for policy formulation and management of coordinated development of regional socioeconomic and ecological environment.

PMID:35257329 | DOI:10.1007/s11356-022-19485-4

Can J Anaesth. 2022 Mar 7. doi: 10.1007/s12630-022-02222-3. Online ahead of print.

ABSTRACT

PURPOSE: The lack of evidence-based recommendations for Cesarean delivery under general anesthesia can lead to practice variability and morbidity, particularly concerning the use of opioids. The goal of this study was to describe the practice for Cesarean delivery performed under general anesthesia and identify predictive factors for opioid use at anesthesia induction and the need for neonatal resuscitation.

METHODS: We conducted a single-center historical cohort study. We included all adult parturients who underwent Cesarean delivery under general anesthesia between 1 January 2012 and 31 December 2016. We excluded patients who received general anesthesia after delivery or with known intrauterine fetal demise. We collected data on anesthetic medication use, maternal comorbidities, neonatal resuscitation, and anesthetic complications. We used logistic regression models to identify predictors of opioid use at anesthesia induction and predictors of neonatal resuscitation.

RESULTS: Two hundred and three patients were included. Propofol was the main induction agent (n = 195), 201 patients received neuromuscular blockers, and 67 received opioids. No maternal factors, including hypertensive disorders of pregnancy (odds ratio [OR], 1.94; 95% confidence interval [CI], 0.96 to 3.95; P = 0.06), were predictors of opioid use at induction of anesthesia. No statistical differences were detected between opioid administration groups, except for Cesarean indication, with preeclampsia being the main contributor. Low gestational age (OR, 0.75; 95% CI, 0.65 to 0.87; P = 0.002) was the only predictor of neonatal resuscitation.

CONCLUSION: Hypertensive disorders of pregnancy were not predictors of opioid use and opioid use was not a predictor of neonatal resuscitation. This suggests opioids could be used for maternal indications.

PMID:35257328 | DOI:10.1007/s12630-022-02222-3

Head Neck Pathol. 2022 Mar 7. doi: 10.1007/s12105-022-01426-9. Online ahead of print.

ABSTRACT

Human papillomavirus (HPV)-related benign papillary epithelial neoplasms are common lesions affecting any region of the oral cavity. This study evaluated the trends in frequency, location, and demographics of these lesions over 20 years in a large biopsy service. Following IRB approval, the archives of UF Oral Pathology Biopsy Service between 1995 and 2015 were queried. Cases diagnosed as squamous papilloma, verruca vulgaris, and condyloma acuminatum were included. Extraoral locations, inconclusive diagnoses, or syndrome-related HPV lesions were excluded. Age, gender, location, clinical presentation, and diagnoses were recorded. Data from one calendar year per 5-year span was assessed including the years 1995, 2000, 2005, 2010, and 2015. A total of 1458 cases were identified over the total 5 calendar years assessed. Papilloma as a percentage of total biopsies per year was as follows: 1995 (2.6%), 2000 (3.3%), 2005 (3.6%), 2010 (4.0%) and 2015 (4.5%), representing a 73% (1.9×) percentage increase. Males (56%) were affected more commonly; however, in patients under 19 years, a female predominance was observed. The overall percentage of lesions in females increased by 30.6% over the time frame. The mean age was 54 years (range 1-93 years) with an increase of 10 years over time. About 1.1% of patients had multifocal lesions and 0.2% had a recurrence. In descending order of frequency, the tongue, soft palate, and mandibular gingiva were most involved. Maxillary gingiva and lower lip were the most common locations in patients under 19. Location varied over time, however, the biggest increase was noted for lesions on the gingiva. Squamous papilloma was the most common histologic variant (93.6%). The incidence of benign HPV-related oral lesions increased substantially over the 2 decades studied. This increase was statistically significant with a p-value <0.00045. Other trends noted included increase in the following: the average age, female involvement, and gingival location. Our results indicate a trend for the overall increase in the prevalence of benign oral HPV lesions in our population.

PMID:35257322 | DOI:10.1007/s12105-022-01426-9

Biodegradation. 2022 Mar 7. doi: 10.1007/s10532-022-09977-y. Online ahead of print.

ABSTRACT

Compound-specific stable isotope analysis provides an alternative method to insight into the biotransformation mechanisms of diffuse organic pollutants in the environment, e.g., the endocrine disruptor herbicide atrazine. Biotic hydrolysis process catalyzed by chlorohydrolase AtzA and TrzN plays an important role in the detoxification of atrazine, while the catalytic mechanism of AtzA is still speculative. To investigate the catalytic mechanism of AtzA and answer whether both enzymes catalyze hydrolytic dechlorination of atrazine by the same mechanism, in this study, apparent kinetic isotope effects (AKIE) for carbon and nitrogen were observed by three atzA-harboring bacterial isolates and their membrane-free extracts. The AKIEs obtained from atzA-harboring bacterial isolates (AKIE_C = 1.021 ± 0.010, AKIE_N = 0.992 ± 0.003) were statistically different from that of trzN-harboring strains (AKIE_C = 1.040 ± 0.006, AKIE_N = 0.983 ± 0.006), confirming the different activation mechanisms of atrazine preceding to nucleophilic aromatic substitution of Cl atom in actual enzymatic reaction catalyzed by AtzA and TrzN, despite the limitation of variable dual-element isotope plots. The lower degree of normal carbon and inverse nitrogen isotope fractionation observed from atzA-harboring strains, suggesting AtzA catalyzing hydrolytic dechlorination of atrazine by coordination of Cl and one aromatic N to the Fe²⁺ drawing electron density from carbon-chlorine bond that facilitating the nucleophilic attack, rather than in TrzN case that protonation of aromatic N increasing nucleophilic substitution of Cl atom. This study suggests considering the potential influences of phylogenetic diversity of bacterial isolates and evolution of enzymes on the applications of CSIA method in future study.

PMID:35257297 | DOI:10.1007/s10532-022-09977-y

Int J Comput Assist Radiol Surg. 2022 Mar 7. doi: 10.1007/s11548-022-02570-x. Online ahead of print.

ABSTRACT

PURPOSE: Non-contrast computed tomography (NCCT) is a first-line imaging technique for determining treatment options for acute ischemic stroke (AIS). However, its poor contrast and signal-to-noise ratio limit the diagnosis accuracy for radiologists, and automated AIS lesion segmentation using NCCT also remains a challenge. In this paper, we propose R2U-RNet, a novel model for AIS lesion segmentation using NCCT.

METHODS: We used an in-house retrospective NCCT dataset with 261 AIS patients with manual lesion segmentation using follow-up diffusion-weighted images. R2U-RNet is based on an R2U-Net backbone with a novel residual refinement unit. Each input image contains two image channels from separate preprocessing procedures. The proposed model incorporates multiscale focal loss to mitigate the class imbalance problem and to leverage the importance of different levels of details. A proposed noisy-label training scheme is utilized to account for uncertainties in the manual annotations.

RESULTS: The proposed model outperformed several iconic segmentation models in AIS lesion segmentation using NCCT, and our ablation study demonstrated the efficacy of the proposed model. Statistical analysis of segmentation performance revealed significant effects of regional stroke occurrence and side of the stroke, suggesting the importance of region-specific information for automated segmentation, and the potential influence of the hemispheric difference in clinical data.

CONCLUSION: This study demonstrated the potentials of R2U-RNet model for automated NCCT AIS lesion segmentation. The proposed model can serve as a tool for accelerating AIS diagnoses and improving the treatment quality of AIS patients.

PMID:35257285 | DOI:10.1007/s11548-022-02570-x

Int J Clin Oncol. 2022 Mar 8. doi: 10.1007/s10147-022-02118-8. Online ahead of print.

NO ABSTRACT

PMID:35257278 | DOI:10.1007/s10147-022-02118-8