JAMA Netw Open. 2022 Jun 1;5(6):e2217653. doi: 10.1001/jamanetworkopen.2022.17653.
NO ABSTRACT
PMID:35727584 | DOI:10.1001/jamanetworkopen.2022.17653
JAMA Netw Open. 2022 Jun 1;5(6):e2217686. doi: 10.1001/jamanetworkopen.2022.17686.
ABSTRACT
IMPORTANCE: Value-based purchasing creates pressure to examine whether newer technologies and care processes, including new surgical techniques, yield any economic advantage.
OBJECTIVE: To compare health care costs and utilization between participants randomized to receive endoscopic vein harvesting (EVH) or open vein harvesting (OVH) during a coronary artery bypass grafting (CABG) procedure.
DESIGN, SETTING, AND PARTICIPANTS: This secondary economic analysis was conducted alongside the 16-site Randomized Endo-Vein Graft Prospective (REGROUP) clinical trial funded by the Department of Veterans Affairs (VA) Cooperative Studies Program. Adults scheduled for urgent or elective bypass involving a vein graft were eligible. The first participant was enrolled in September 2013, with most sites completing enrollment by March 2014. The last participant was enrolled in April 2017. A total of 1150 participants were randomized, with 574 participants receiving OVH and 576 receiving EVH. For this secondary analysis, cost and utilization data were extracted through September 30, 2020. Participants were linked to administrative data in the VA Corporate Data Warehouse and activity-based cost data starting with the index procedure.
INTERVENTIONS: EVH vs OVH, with comparisons based on intention to treat.
MAIN OUTCOMES AND MEASURES: Discharge costs for the index procedure as well as follow-up costs (including intended and unintended events; mean [SD] follow-up time, 33.0 [19.9] months) were analyzed, with results from different statistical models compared to test for robustness (ie, lack of variation across models). All costs represented care provided or paid by the VA, standardized to 2020 US dollars.
RESULTS: Among 1150 participants, the mean (SD) age was 66.4 (6.9) years; most participants (1144 [99.5%] were male. With regard to race and ethnicity, 6 participants (0.5%) self-reported as American Indian or Alaska Native, 10 (0.9%) as Asian or Pacific Islander, 91 (7.9%) as Black, 62 (5.4%) as Hispanic, 974 (84.7%) as non-Hispanic White, and 6 (0.5%) as other race and/or ethnicity; data were missing for 1 participant (0.1%). The unadjusted mean (SD) costs for the index CABG procedure were $76 607 ($43 883) among patients who received EVH and $75 368 ($45 900) among those who received OVH, including facility costs, insurance costs, and physician-related costs (commonly referred to as provider costs in Centers for Medicare and Medicaid and insurance data). No significant differences were found in follow-up costs; per 90-day follow-up period, EVH was associated with a mean (SE) added cost of $302 ($225) per patient. The results were highly robust to the statistical model.
CONCLUSIONS AND RELEVANCE: In this study, EVH was not associated with a reduction in costs for the index CABG procedure or follow-up care. Therefore, the choice to provide EVH may be based on surgeon and patient preferences.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01850082.
PMID:35727582 | DOI:10.1001/jamanetworkopen.2022.17686
Indian J Pediatr. 2022 Jun 21. doi: 10.1007/s12098-022-04151-x. Online ahead of print.
ABSTRACT
OBJECTIVES: To determine sleep disorders and quality of life (QOL) in children with cerebral palsy (CP) and to find the association between them.
METHODS: This cross-sectional study included children (4-12 y) with CP (n = 117) and age- and gender-matched healthy controls (n = 117). Pediatric Sleep Questionnaire (PSQ) was used to record sleep-related symptoms. Sleep-related breathing disorder (SRBD) scale and sleep disturbance scale for children (SDSC) were used to evaluate sleep disorders. Cerebral palsy quality-of-life questionnaire for children (CPQOL-CHILD) was used to assess QOL.
RESULTS: Sleep disorders by SRBD scale (score ≥ 0.33) were significantly more in CP (n = 7, 6%) than controls [(n = 0, 0%) (p value 0.014, OR 15.95)]. Using T score > 70 by SDSC scale, sleep disorders were seen in 7.7% (n = 9) CP children and 0% (n = 0) in controls (p value 0.04, OR 20.6). Using T score ≥ 51, 43.6% CP children and 17% controls had sleep disorders (p value 0.001, CI 2.1, 6.9). About 43.6% CP children had abnormal T score on at least one SDSC factor. Presence of epilepsy, motor disabilities, intellectual disabilities, and type of CP significantly correlated with sleep disorders. The overall SRBD scores and SDSC T scores of CP children were negatively correlated with QOL (r = -0.489, p < 0.001 and r = -0.445, p < 0.001, respectively).
CONCLUSION: Sleep disorders are more common in CP which adversely affect QOL. Routine screening and appropriate treatment are suggested.
PMID:35727526 | DOI:10.1007/s12098-022-04151-x
Environ Sci Pollut Res Int. 2022 Jun 21. doi: 10.1007/s11356-022-21604-0. Online ahead of print.
NO ABSTRACT
PMID:35727519 | DOI:10.1007/s11356-022-21604-0
Environ Sci Pollut Res Int. 2022 Jun 21. doi: 10.1007/s11356-022-21456-8. Online ahead of print.
ABSTRACT
Noise has become an important environmental risk factor. Some studies have shown that exposure to noise can cause coronary artery disease, high blood pressure, and stroke. At present, the relationship between noise exposure and the risk of atrial fibrillation (AF) is inconsistent. Based on previous studies, we proposed the hypothesis that noise exposure is associated with a higher risk of AF. Eight databases, such as PubMed, Embase, Cochrane Library, and Web of Science, were searched from inception until January 5, 2022. The pooled relative risk (RR) with its 95% confidence interval (CI) was used to estimate the association between AF and highest noise level and per 10 dB (A) increment of noise. According to the size of heterogeneity, the random or fixed effects model was adopted as the pooling method. A total of 5 articles comprising 3,866,986 participants were identified, providing 7 estimates of highest noise level and 6 estimates of per 10 dB (A) increment of noise exposure. For the highest noise level, there was a statistically significant association between noise exposure and the risk of AF (RR = 1.05; 95% CI: 1.02-1.09; I2 = 44.1%). In addition, we found the risk of AF for per 10 dB (A) increment of noise exposure was 1.01 (95% CI: 1.00-1.02; I2 = 81.3%). In summary, our study found that noise exposure was associated with a higher risk of AF. More high-quality studies are needed in the future to confirm these conclusions given the limitations of study.
PMID:35727516 | DOI:10.1007/s11356-022-21456-8
Hepatol Int. 2022 Jun 21. doi: 10.1007/s12072-022-10359-y. Online ahead of print.
ABSTRACT
BACKGROUND: The Baveno VI criteria (B6C) have been recommended to screen high-risk varices (HRV) in patients with liver cirrhosis to avoid the use of esophagogastroduodenoscopy (EGD). Due to conservative nature of B6C and the general unavailability of transient elastography in the medical institutions, clinical application of B6C is restricted. We aimed to optimize B6C and attempted to replace the liver stiffness (LS) score with other parameters that could help patients avoid EGD.
METHODS: A total of 1,188 patients with compensated cirrhosis were analyzed and divided into the training cohort (TC) and validating cohort (VC) by the split-sample method. Variables were selected to develop new criteria in the TC before verification in the VC.
RESULTS: The parameters of age ≥ 50 years, LS, platelet count (PLT), and spleen area (SA) were independently associated with HRV. The risk of HRV was 2.39 times greater in patients over 50 years, hence alternative B6C (AB6C) and modified B6C (MB6C) criteria were built based on age. MB6C was built by adjusting the cut-off value of LS and PLT (patients aged < 50 years with PLT > 100 × 109/L and LS < 30 kPa; patients aged ≥ 50 years with a combined PLT > 125 × 109/L and LS < 20 kPa). MB6C helped avoid EGD in 310 (51.2%) patients, whereas 7 (2.3%) cases of HRV were missed. The predicting performance HRV showed no statistical difference between PLT, SA, or LS. SA was selected to replace LS and in the built AB6C (patients aged < 50 years with PLT > 100 × 109/L and SA < 55 cm2; patients aged ≥ 50 years with a combined PLT > 125 × 109/L and SA < 44 cm2). Using AB6C avoided 297 (49.1%) EGDs with a total of 8 (2.7%) cases of HRV that were missed.
CONCLUSIONS: Our novel MB6C and AB6C were stratified by age and provided excellent performance for ruling out HRV, which performed better than B6C and EB6C (expanded B6C) in helping to avoid EGD screening.
CLINICAL TRIAL REGISTRATION NUMBER: ChiCTR-DDD-17013845.
PMID:35727500 | DOI:10.1007/s12072-022-10359-y
Neurotherapeutics. 2022 Jun 21. doi: 10.1007/s13311-022-01235-6. Online ahead of print.
NO ABSTRACT
PMID:35727488 | DOI:10.1007/s13311-022-01235-6
Jpn J Radiol. 2022 Jun 21. doi: 10.1007/s11604-022-01298-7. Online ahead of print.
ABSTRACT
PURPOSE: To develop a support vector machine (SVM) classifier using CT texture-based analysis in differentiating focal-type autoimmune pancreatitis (AIP) and pancreatic duct carcinoma (PD), and to assess the radiologists’ diagnostic performance with or without SVM.
MATERIALS AND METHODS: This retrospective study included 50 patients (20 patients with focal-type AIP and 30 patients with PD) who underwent dynamic contrast-enhanced CT. Sixty-two CT texture-based features were extracted from 2D images of the arterial and portal phase CTs. We conducted data compression and feature selections using principal component analysis (PCA) and produced the SVM classifier. Four readers participated in this observer performance study and the statistical significance of differences with and without the SVM was assessed by receiver operating characteristic (ROC) analysis.
RESULTS: The SVM performance indicated a high performance in differentiating focal-type AIP and PD (AUC = 0.920). The AUC for all 4 readers increased significantly from 0.827 to 0.911 when using the SVM outputs (p = 0.010). The AUC for inexperienced readers increased significantly from 0.781 to 0.905 when using the SVM outputs (p = 0.310). The AUC for experienced readers increased from 0.875 to 0.912 when using the SVM outputs, however, there was no significant difference (p = 0.018).
CONCLUSION: The use of SVM classifier using CT texture-based features improved the diagnostic performance for differentiating focal-type AIP and PD on CT.
PMID:35727458 | DOI:10.1007/s11604-022-01298-7
Curr Med Sci. 2022 Jun 21. doi: 10.1007/s11596-022-2595-3. Online ahead of print.
ABSTRACT
OBJECTIVE: To determine the clinical characteristics and prognosis of primary tracheobronchial tumors (PTTs) in children, and to explore the most common tumor identification methods.
METHODS: The medical records of children with PTTs who were hospitalized at the Children’s Hospital of Chongqing Medical University from January 1995 to January 2020 were reviewed retrospectively. The clinical features, imaging, treatments, and outcomes of these patients were statistically analyzed. Machine learning techniques such as Gaussian naïve Bayes, support vector machine (SVM) and decision tree models were used to identify mucoepidermoid carcinoma (ME).
RESULTS: A total of 16 children were hospitalized with PTTs during the study period. This included 5 (31.3%) children with ME, 3 (18.8%) children with inflammatory myofibroblastic tumors (IMT), 2 children (12.5%) with sarcomas, 2 (12.5%) children with papillomatosis and 1 child (6.3%) each with carcinoid carcinoma, adenoid cystic carcinoma (ACC), hemangioma, and schwannoma, respectively. ME was the most common tumor type and amongst the 3 ME recognition methods, the SVM model showed the best performance. The main clinical symptoms of PPTs were cough (81.3%), breathlessness (50%), wheezing (43.8%), progressive dyspnea (37.5%), hemoptysis (37.5%), and fever (25%). Of the 16 patients, 7 were treated with surgery, 8 underwent bronchoscopic tumor resection, and 1 child died. Of the 11 other children, 3 experienced recurrence, and the last 8 remained disease-free. No deaths were observed during the follow-up period.
CONCLUSION: PTT are very rare in children and the highest percentage of cases is due to ME. The SVM model was highly accurate in identifying ME. Chest CT and bronchoscopy can effectively diagnose PTTs. Surgery and bronchoscopic intervention can both achieve good clinical results and the prognosis of the 11 children that were followed up was good.
PMID:35727419 | DOI:10.1007/s11596-022-2595-3
Basic Res Cardiol. 2022 Jun 21;117(1):31. doi: 10.1007/s00395-022-00938-3.
ABSTRACT
Remote ischaemic preconditioning (RIPC) using transient limb ischaemia failed to improve clinical outcomes following cardiac surgery and the reasons for this remain unclear. In the ERIC-GTN study, we evaluated whether concomitant nitrate therapy abrogated RIPC cardioprotection. We also undertook a post-hoc analysis of the ERICCA study, to investigate a potential negative interaction between RIPC and nitrates on clinical outcomes following cardiac surgery. In ERIC-GTN, 185 patients undergoing cardiac surgery were randomized to: (1) Control (no RIPC or nitrates); (2) RIPC alone; (3); Nitrates alone; and (4) RIPC + Nitrates. An intravenous infusion of nitrates (glyceryl trinitrate 1 mg/mL solution) was commenced on arrival at the operating theatre at a rate of 2-5 mL/h to maintain a mean arterial pressure between 60 and 70 mmHg and was stopped when the patient was taken off cardiopulmonary bypass. The primary endpoint was peri-operative myocardial injury (PMI) quantified by a 48-h area-under-the-curve high-sensitivity Troponin-T (48 h-AUC-hs-cTnT). In ERICCA, we analysed data for 1502 patients undergoing cardiac surgery to investigate for a potential negative interaction between RIPC and nitrates on clinical outcomes at 12-months. In ERIC-GTN, RIPC alone reduced 48 h-AUC-hs-cTnT by 37.1%, when compared to control (ratio of AUC 0.629 [95% CI 0.413-0.957], p = 0.031), and this cardioprotective effect was abrogated in the presence of nitrates. Treatment with nitrates alone did not reduce 48 h-AUC-hs-cTnT, when compared to control. In ERICCA there was a negative interaction between nitrate use and RIPC for all-cause and cardiovascular mortality at 12-months, and for risk of peri-operative myocardial infarction. RIPC alone reduced the risk of peri-operative myocardial infarction, compared to control, but no significant effect of RIPC was demonstrated for the other outcomes. When RIPC and nitrates were used together they had an adverse impact in patients undergoing cardiac surgery with the presence of nitrates abrogating RIPC-induced cardioprotection and increasing the risk of mortality at 12-months post-cardiac surgery in patients receiving RIPC.
PMID:35727392 | DOI:10.1007/s00395-022-00938-3