Nevin Manimala

Contemp Clin Trials. 2021 Mar 5:106347. doi: 10.1016/j.cct.2021.106347. Online ahead of print.

ABSTRACT

BACKGROUND: The D-Health Trial aims to determine whether monthly high-dose vitamin D supplementation can reduce the mortality rate and prevent cancer. We did not have adequate statistical power for subgroup analyses, so could not justify the high cost of collecting blood samples at baseline. To enable future exploratory analyses stratified by baseline vitamin D status, we developed models to predict baseline serum 25 hydroxy vitamin D [25(OH)D] concentration.

METHODS: We used data and serum 25(OH)D concentrations from participants who gave a blood sample during the trial for compliance monitoring and were randomised to placebo. Data were partitioned into training (80%) and validation (20%) datasets. Deseasonalised serum 25(OH)D concentrations were dichotomised using cut-points of 50, 60 and 75 nmol/L. We fitted boosted regression tree models, based on 13 predictors, and evaluated model performance using the validation data.

RESULTS: The training and validation datasets had 1788 (10.5% <50 nmol/L, 23.1% <60 nmol, 48.8 <75 nmol/L) and 447 (11.9% <50 nmol/L, 25.7% <60 nmol/L, and 49.2% <75 nmol/L) samples, respectively. Ambient UV radiation and total intake of vitamin D were the strongest predictors of ‘low’ serum 25(OH)D concentration. The area under the receiver operating characteristic curves were 0.71, 0.70, and 0.66 for cut-points of <50, <60 and <75 nmol/L respectively.

CONCLUSIONS: We exploited compliance monitoring data to develop models to predict serum 25(OH)D concentration for D-Health participants at baseline. This approach may prove useful in other trial settings where there is an obstacle to exhaustive data collection.

PMID:33684596 | DOI:10.1016/j.cct.2021.106347

World Neurosurg. 2021 Mar 5:S1878-8750(21)00321-1. doi: 10.1016/j.wneu.2021.02.128. Online ahead of print.

ABSTRACT

BACKGROUND: Low back pain (LBP) is one of the most common disorders with many possible causes including intervertebral disc degeneration (IVDD) and Modic changes. In this study we aimed to analyze whether the distribution pattern of Modic changes in the vertebral end-plates was associated with the severity of IVDD.

METHODS: We conducted a cross-sectional analysis of a retrospective database. Patients with constant LBP were evaluated in terms of IVDD and Modic changes on lumbar spine MRIs. Statistical analyses were specifically performed for the lower lumbar levels.

RESULTS: We evaluated 527 patients. Modic changes were detected in 25% of the patients. Severe IVDD was detected in 90% and 88% of patients with Modic changes through the whole end-plates at L4-L5 and L5-S1 levels, respectively. Patients with Modic changes at L5-S1 level had significantly lower lumbar lordosis. Presence of severe IVDD at L4-L5 and L5-S1 levels was associated with 2.7- and 2.9-times higher risk of more widely distributed Modic changes in those vertebral end-plates, respectively.

CONCLUSIONS: Severe IVDD was significantly more common in patients with Modic changes through the whole end-plate and in those with Modic type I changes.

PMID:33684588 | DOI:10.1016/j.wneu.2021.02.128

World Neurosurg. 2021 Mar 5:S1878-8750(21)00320-X. doi: 10.1016/j.wneu.2021.02.127. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess trends in gender, racial, and ethnic diversity of applicant pools and subsequent resident cohorts in neurosurgical residency programs in the United States.

METHODS: Applicant and residency data from 2009 to 2018 were analyzed from the Electronic Residency Application Service, Journal of the American Medical Association, and National Resident Matching Program to evaluate trends in diversity.

RESULTS: There was no statistically significant difference between applicant sex from 2009 to 2013 compared to 2014 to 2018 (p>.05). From 2009 to 2018, the percentage of female residents saw a statistically significant increase from 12.9% to 17.5% but remained less reflective of women’s representativeness in the United States (50.8%). The percentage of Black and Hispanic applicants decreased across the observed period (4% and 1%, respectively). While Black people represented 5.2% of the resident pool in 2009, this decreased to (4.95%) by 2018. Hispanic residents saw a less than two percentage net increase (5.5% to 7.2%) in resident representation, but still fall behind when compared to census statistics. The application pool did not see a significant change in the percentage of White and Asian applicants; however, the percentage of residents did decrease slightly over the observed decade.

CONCLUSIONS: Current efforts to improve racial and ethnic diversity have not been sufficient in generating parity in the recruitment and retention of racially underrepresented groups in neurosurgery. Although the presence of women in applicant and resident pools has increased, not much is known about the impact on women who also identify within racially underrepresented groups.

PMID:33684577 | DOI:10.1016/j.wneu.2021.02.127

Int J Infect Dis. 2021 Mar 5:S1201-9712(21)00210-1. doi: 10.1016/j.ijid.2021.03.005. Online ahead of print.

ABSTRACT

Following the announcement on December 2020 about the emergence of a new variant (VOC 202012/01, B.1.1.7 lineage) in the United Kingdom a targeted surveillance was put in place in Abruzzo region (Italy), which allowed to detect 313 persons affected by lineage B.1.1.7, up to the 20^th of February 2021. We investigated the results of RT-PCR on nasopharyngeal swabs tested from December 2020 to February 2021, to verify any difference on the viral load and persistence between people infected by lineage B.1.1.7 and others. Statistically significant lower values of C_T associated with the detection of the N protein encoding gene (C_T N) were observed in persons with lineage B.1.1.7 infection (median C_T N = 15.8) in comparison to those infected by other lineages (median C_T N = 16.9). A significant longer duration of the persistence of SARS-CoV-2 RNA in nasopharyngeal swabs was observed in persons with lineage B.1.1.7 infection (16 days) in comparison to those infected by other lineages (14 days).

PMID:33684558 | DOI:10.1016/j.ijid.2021.03.005

Horm Mol Biol Clin Investig. 2021 Mar 9. doi: 10.1515/hmbci-2020-0056. Online ahead of print.

ABSTRACT

OBJECTIVES: The objective of the study was to determine the level of antibodies (AB) of Ig classes A and G to estradiol (E2), progesterone (P) and benzo [a] pyrene (Bp) in patients with endometriosis of various severity and estimate their threshold values as a risk factor for the development of endometriosis.

METHODS: A retrospective case-control study was performed. The study involved 200 women. Group I: women with endometriosis (n=100), Group II: patients with tubal-peritoneal infertility (n=100). All patients underwent immunological studies of blood serum; and the levels of steroid hormones (P, E2), antibodies to them and Bp were determined. A ROC analysis was carried out to identify threshold values of antibodies levels.

RESULTS: Women with endometriosis were found to have statistically significantly higher levels of antibodies IgA and IgG to E2, P and benzo [a] pyrene compared to women of Group II. The threshold levels of IgA-Bp, IgA-E2 and IgA-P are >5 CU (conventional unit), IgG-Bp, IgG-E2>9 CU and IgG-P>8 CU. The level of IgG-P in patients with severe forms of endometriosis is statistically significantly higher than in minor forms of the disease. In case of severe forms, there is a tendency to increasing other classes of antibodies.

CONCLUSIONS: Patients with endometriosis usually have a higher level of IgA and IgG to Bp, E2, P. Their threshold values, which are risk factors for the development of the disease, are estimated.

PMID:33684279 | DOI:10.1515/hmbci-2020-0056

Biomed Tech (Berl). 2021 Mar 9. doi: 10.1515/bmt-2020-0295. Online ahead of print.

ABSTRACT

The feasibility of using time-frequency (TF) ridges estimation is investigated on multi-channel electroencephalogram (EEG) signals for emotional recognition. Without decreasing accuracy rate of the valence/arousal recognition, the informative component extraction with low computational cost will be examined using multivariate ridge estimation. The advanced TF representation technique called multivariate synchrosqueezing transform (MSST) is used to obtain well-localized components of multi-channel EEG signals. Maximum-energy components in the 2D TF distribution are determined using TF-ridges estimation to extract instantaneous frequency and instantaneous amplitude, respectively. The statistical values of the estimated ridges are used as a feature vector to the inputs of machine learning algorithms. Thus, component information in multi-channel EEG signals can be captured and compressed into low dimensional space for emotion recognition. Mean and variance values of the five maximum-energy ridges in the MSST based TF distribution are adopted as feature vector. Properties of five TF-ridges in frequency and energy plane (e.g., mean frequency, frequency deviation, mean energy, and energy deviation over time) are computed to obtain 20-dimensional feature space. The proposed method is performed on the DEAP emotional EEG recordings for benchmarking, and the recognition rates are yielded up to 71.55, and 70.02% for high/low arousal, and high/low valence, respectively.

PMID:33684278 | DOI:10.1515/bmt-2020-0295

Environ Microbiol. 2021 Mar 8. doi: 10.1111/1462-2920.15453. Online ahead of print.

ABSTRACT

The structure and diversity of all open microbial communities are shaped by individual births, deaths, speciation and immigration events; the precise timings of these events are unknowable and unpredictable. This randomness is manifest as ecological drift in the population dynamics, the importance of which has been a source of debate for decades. There are theoretical reasons to suppose that drift would be imperceptible in large microbial communities, but this is at odds with circumstantial evidence that effects can be seen even in huge, complex communities. To resolve this dichotomy we need to observe dynamics in simple systems where key parameters, like migration, birth and death rates can be directly measured. We monitored the dynamics in the abundance of two genetically modified strains of Escherichia coli, with tuneable growth characteristics, that were mixed and continually fed into 10 identical chemostats. We demonstrated that the effects of demographic (non-environmental) stochasticity are very apparent in the dynamics. However, they do not conform to the most parsimonious and commonly applied mathematical models, where each stochastic event is independent. For these simple models to reproduce the observed dynamics we need to invoke an “effective community size”, which is smaller than the census community size. This article is protected by copyright. All rights reserved.

PMID:33684262 | DOI:10.1111/1462-2920.15453

J Surg Oncol. 2021 Mar 8. doi: 10.1002/jso.26455. Online ahead of print.

ABSTRACT

BACKGROUND: This study evaluates the achievability of CT volumetry of pancreatic cancer and its correlation with pTNM stage and survival.

METHODS: Tumor volume was measured from contrast enhanced CT images of 58 patients who undergo curative resection for pancreatic cancer using the Segment Editor module implemented in 3D-Slicer-a free open source software platform. Receiver operating characteristic (ROC) analysis was used to evaluate correlation between Tvol and pTNM staging.

RESULTS: The preoperative images of 58 pancreatic adenocarcinoma patients were included. The mean Tvol of pancreatic cancer is an increasing trend with T stage (The mean T1vol = 1.75 cm³ , the mean T2vol = 11.43 cm³ , the mean T3vol = 14.98 cm³ , the mean T4vol = 19.6 cm³ ). There were statistical differences between volumes (p = .000). On ROC analysis, the area under the ROC curve (Az) of Tvol to differentiate T1 stage from ≥T2 stage was 0.966 (p = .000). At a cut-off value of 3.050 cm³ , sensitivity of 92.3%, and specificity of 83.3% were achieved. Az value of Tvol to differentiate ≤T2 from ≥T3 stage was 0.750 (p = .010). At a cut-off value of 10.250 cm³ , sensitivity of 72.7% and specificity of 66% were achieved. In addition Az value of Tvol to differentiate ≤T3 from ≥T4 stage was 0.652 and was not significant (p = .380). At a cut-off value of 11.2 cm³ , sensitivity of 66.7% and specificity of 63.6% were achieved.

CONCLUSION: CT volumetry in pancreatic cancer is feasible with excellent reproducibility. It is one of the prognostic factors affecting survival in operated patients with pancreatic cancer.

PMID:33684252 | DOI:10.1002/jso.26455

J Surg Oncol. 2021 Mar 8. doi: 10.1002/jso.26392. Online ahead of print.

ABSTRACT

BACKGROUND: For patients with bilateral pulmonary metastases, staged resections have historically been the preferred surgical intervention. During the spring of 2020, the COVID-19 pandemic made patient travel to the hospital challenging and necessitated reduction in operative volume so that resources could be conserved. We report our experience with synchronous bilateral metastasectomies for the treatment of disease in both lungs.

METHODS: Patients with bilateral pulmonary metastases who underwent simultaneous bilateral resections were compared with a cohort of patients who underwent staged resections. We used nearest-neighbor propensity score (1:1) matching to adjust for confounders. Perioperative outcomes were compared between groups using paired statistical analysis techniques.

RESULTS: Between 1998 and 2020, 36 patients underwent bilateral simultaneous metastasectomies. We matched 31 pairs of patients. The length of stay was significantly shorter in patients undergoing simultaneous resection (median 3 vs. 8 days, p < .001) and operative time was shorter (156 vs. 235.5 min, p < .001) when compared to the sum of both procedures in the staged group. The groups did not significantly differ with regard to postoperative complications.

CONCLUSION: In a carefully selected patient population, simultaneous bilateral metastasectomy is a safe option. A single procedure confers benefits for both the patient as well as the hospital resource system.

PMID:33684226 | DOI:10.1002/jso.26392

Int Health. 2021 Mar 3:ihab007. doi: 10.1093/inthealth/ihab007. Online ahead of print.

ABSTRACT

BACKGROUND: We sought to determine the prevalence and factors associated with the use of skilled assistance during delivery in Papua New Guinea.

METHODS: We analysed nationally representative data from 5210 women in Papua New Guinea using the 2016-2018 Demographic and Health survey. Both bivariate and multivariable analyses were performed. Statistical significance was set at p<0.05.

RESULTS: The prevalence of skilled assistance during delivery was 57.6%. The richest women (adjusted OR [AOR]=3.503, 95% CI 2.477 to 4.954), working women (AOR=1.221, 95% CI 1.037 to 1.439), women with primary (AOR=1.342, 95% CI 1.099 to 1.639), secondary or higher education (AOR=2.030, 95% CI 1.529 to 2.695), women whose partners had a secondary or higher level of education (AOR=1.712, 95% CI 1.343 to 2.181], women who indicated distance was not a big problem in terms of healthcare (AOR=1.424, 95% CI 1.181 to 1.718), women who had ≥4 antenatal care (ANC) visits (AOR=10.63, 95% CI 8.608 to 13.140), women from the Islands region (AOR=1.305, 95% CI 1.045 to 1.628), those who read newspapers or magazines (AOR=1.310, 95% CI 1.027 to 1.669) and women who watched television (AOR=1.477, 95% CI 1.054 to 2.069) less than once a week had higher odds of utilising skilled attendants during delivery. On the contrary, women in the Momase region (AOR=0.543, 95% CI 0.438 to 0.672), women in rural areas (AOR=0.409, 95% CI 0.306 to 0.546), as well as women with a parity of 3 (AOR=0.666, 95% CI 0.505 to 0.878) or ≥4 (AOR=0.645, 95% CI 0.490 to 0.850) had lower odds of utilising skilled attendance during delivery.

CONCLUSION: There is relatively low use of skilled delivery services in Papua New Guinea. Wealth, employment status, educational level, parity and number of ANC visits, as well as access to healthcare and place of residence, influence the utilisation of skilled delivery services.

PMID:33684205 | DOI:10.1093/inthealth/ihab007