Tag: pubmed

Sci Rep. 2022 Jun 3;12(1):9304. doi: 10.1038/s41598-022-13346-3.

ABSTRACT

Disseminated intravascular coagulation (DIC) is one of the major organ dysfunctions associated with sepsis. This retrospective secondary analysis comprised data from a prospective multicenter study to investigate the age-related differences in the survival benefit of anticoagulant therapy in sepsis according to the DIC diagnostic criteria. Adult patients with severe sepsis based on the Sepsis-2 criteria were enrolled and divided into the following groups: (1) anticoagulant group (patients who received anticoagulant therapy) and (2) non-anticoagulant group (patients who did not receive anticoagulant therapy). Patients in the former group were administered antithrombin, recombinant human thrombomodulin, or their combination. The increases in the risk of hospital mortality were suppressed in the high-DIC-score patients aged 60-70 years receiving anticoagulant therapy. No favorable association of anti-coagulant therapy with hospital mortality was observed in patients aged 50 years and 80 years. Furthermore, anticoagulant therapy in the lower-DIC-score range increased the risk of hospital mortality in patients aged 50-60 years. In conclusion, anticoagulant therapy was associated with decreased hospital mortality according to a higher DIC score in septic patients aged 60-70 years. Anticoagulant therapy, however, was not associated with a better outcome in relatively younger and older patients with sepsis.

PMID:35660774 | DOI:10.1038/s41598-022-13346-3

Sci Rep. 2022 Jun 3;12(1):9312. doi: 10.1038/s41598-022-13015-5.

ABSTRACT

Machine learning is increasingly being used to predict clinical outcomes. Most comparisons of different methods have been based on empirical analyses in specific datasets. We used Monte Carlo simulations to determine when machine learning methods perform better than statistical learning methods in a specific setting. We evaluated six learning methods: stochastic gradient boosting machines using trees as the base learners, random forests, artificial neural networks, the lasso, ridge regression, and linear regression estimated using ordinary least squares (OLS). Our simulations were informed by empirical analyses in patients with acute myocardial infarction (AMI) and congestive heart failure (CHF) and used six data-generating processes, each based on one of the six learning methods, to simulate continuous outcomes in the derivation and validation samples. The outcome was systolic blood pressure at hospital discharge, a continuous outcome. We applied the six learning methods in each of the simulated derivation samples and evaluated performance in the simulated validation samples. The primary observation was that neural networks tended to result in estimates with worse predictive accuracy than the other five methods in both disease samples and across all six data-generating processes. Boosted trees and OLS regression tended to perform well across a range of scenarios.

PMID:35660759 | DOI:10.1038/s41598-022-13015-5

Comput Methods Programs Biomed. 2022 May 19;221:106893. doi: 10.1016/j.cmpb.2022.106893. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: The fetal face is an essential source of information in the assessment of congenital malformations and neurological anomalies. Disturbance in early stages of development can lead to a wide range of effects, from subtle changes in facial and neurological features to characteristic facial shapes observed in craniofacial syndromes. Three-dimensional ultrasound (3D US) can provide more detailed information about the facial morphology of the fetus than the conventional 2D US, but its use for pre-natal diagnosis is challenging due to imaging noise, fetal movements, limited field-of-view, low soft-tissue contrast, and occlusions.

METHODS: In this paper, we propose the use of a novel statistical morphable model of newborn faces, the BabyFM, for fetal face reconstruction from 3D US images. We test the feasibility of using newborn statistics to accurately reconstruct fetal faces by fitting the regularized morphable model to the noisy 3D US images.

RESULTS: The results indicate that the reconstructions are quite accurate in the central-face and less reliable in the lateral regions (mean point-to-surface error of 2.35 mm vs 4.86 mm). The algorithm is able to reconstruct the whole facial morphology of babies from US scans while handle adverse conditions (e.g. missing parts, noisy data).

CONCLUSIONS: The proposed algorithm has the potential to aid in-utero diagnosis for conditions that involve facial dysmorphology.

PMID:35660764 | DOI:10.1016/j.cmpb.2022.106893

Thromb Res. 2022 May 27;216:1-7. doi: 10.1016/j.thromres.2022.05.012. Online ahead of print.

ABSTRACT

INTRODUCTION: Splanchnic vein thrombosis (SVT) occurs in a heterogenous group of patients secondary to a variety of risk factors including liver disease. Minimal data regarding natural history and outcomes of SVT exists to inform management decisions. As such, there is equipoise regarding the utility of anticoagulation in cirrhotic patients with SVT. We sought to identify clinical factors predictive of new or progressive thrombosis in a cohort of patients with untreated SVT.

METHODS: We conducted a retrospective cohort study of cirrhotic patients over 18 years of age diagnosed with SVT at the Oregon Health & Science University from 2015 to 2020, excluding those initially treated with anticoagulation. The primary study endpoint was a composite of the following: imaging-confirmed progression of SVT, development of cavernous transformation, intestinal ischemia, portal cholangiopathy or new venous or arterial thrombosis.

RESULTS: 261 patients were included in the analysis (median age 61 years, 68% male, 32% female). Forty percent of all patients experienced the primary composite endpoint. Multivariable logistic regression found that only the presence of pancreatitis or abdominal infection at diagnosis was associated with an increased likelihood of experiencing thrombus progression in patients with untreated SVT (OR 3.61, P = 0.02). There was a statistically significant overall survival difference between patients that did and did not experience the primary composite endpoint after controlling for confounding variables. (p = 0.0068).

CONCLUSIONS: Overall, only the presence of pancreatitis or intrabdominal infection were found to be significantly associated with thrombotic progression, with varices identified as marginally non-significant risk factor. Notably, thrombotic progression was associated with a significant reduction in overall survival.

PMID:35660708 | DOI:10.1016/j.thromres.2022.05.012

J UOEH. 2022;44(2):191-196. doi: 10.7888/juoeh.44.191.

ABSTRACT

We introduced the da Vinci Xi surgical system (Intuitive Surgical G.K. CA) in January 2018, and here we report clinical statistics on outpatients, inpatients, and surgical procedures for the 3-year period from January 2017 to December 2019. The number of new outpatients since 2017 has remained almost unchanged at 1,406, 1,530, and 1,494 per year. There was an increasing trend in the number of inpatients, from 862 to 1,021 to 1,239. The main diseases of the inpatients over the 3-year period were bladder cancer in 676 (21.7%), renal cancer in 374 (12.0%), prostate cancer in 268 (8.6%), and urolithiasis in 263 (8.4%). The total number of surgeries in the three years was 1,931. The numbers of transurethral surgeries and laparoscopic surgeries, including robotic surgeries, were 1,063 (55.0%) and 396 (20.5%), respectively. The numbers of inpatients and surgery have been increasing year by year. Medical resources are limited and need to be distributed more efficiently.

PMID:35660685 | DOI:10.7888/juoeh.44.191

J Acad Consult Liaison Psychiatry. 2022 Jun 2:S2667-2960(22)00273-7. doi: 10.1016/j.jaclp.2022.05.005. Online ahead of print.

ABSTRACT

INTRODUCTION: COVID-19 has been a devastating pandemic with little known of its neuropsychiatric complications. Delirium is one of the most common neuropsychiatric syndromes among hospitalized cancer patients with incidence ranging from 25%-40% and rates of up to 85% in the terminally ill. Data on the incidence, risk factors, duration, and outcomes of delirium in critically ill cancer patients with COVID-19 are lacking.

METHODS: Retrospective single center study evaluating delirium frequency and outcomes in all critically ill cancer patients with COVID-19 admitted between March 1 and July 10, 2020. Delirium was assessed by Confusion Assessment Method – Intensive Care Unit (CAM-ICU), performed twice daily by trained ICU nursing staff. Patients were considered to have a delirium positive day if CAM-ICU was positive at least once per day.

RESULTS: A total of 70 patients were evaluated. Of those 53 (75.7%) were found to be positive for delirium. Patients with delirium were significantly older compared to patients without delirium (median 67.5 vs 60.3, p=0.013). There were no significant differences in demographic characteristics, chronic medical conditions, neuropsychiatric history, cancer type, or application of prone positioning between the two groups. Delirium patients were less likely to receive cancer-directed therapies (58.5% vs 88.2%, p=0.038), but more likely to receive antipsychotics (81.1% vs 41.2%; p=0.004), dexmedetomidine (79.3% vs 11.8%; p<0.001), steroids (84.9% vs 58.8%; p=0.039), and vasopressors (90.6% vs 58.8%; p=0.006). Delirium patients were more likely to be intubated (86.8% vs 41.2%; p<0.001) and all tracheostomies (35.9%) occurred in patients with delirium. ICU length of stay (LOS) (19 vs 8 days; p<0.001) and hospital LOS (37 vs 12 days; p<0.001) were significantly longer in delirium patients but there was no statistically significant difference in hospital mortality (43.4% vs 58.8%; p=0.403) or ICU mortality (34% vs 58.8%; p=0.090) CONCLUSION: Delirium in critically ill cancer patients with COVID-19 was associated with less cancer directed therapies, and increased hospital and ICU LOS. However, the presence of delirium was not associated with an increase in hospital or ICU mortality.

PMID:35660676 | DOI:10.1016/j.jaclp.2022.05.005

J Acad Consult Liaison Psychiatry. 2022 Jun 2:S2667-2960(22)00274-9. doi: 10.1016/j.jaclp.2022.05.006. Online ahead of print.

ABSTRACT

BACKGROUND: Delirium prediction can augment and optimize care of older adults. Mayo delirium prediction (MDP) tool is a robust tool, developed from a large retrospective data set. MDP tool predicts delirium risk for hospitalized older adults, within 24 hours of hospital admission, based on risk factor information available from electronic health record. We intend to validate the prediction performance of this tool and optimize the tool for clinical use.

DESIGN: Observational cohort study SETTINGS: Mayo Clinic Hospitals, Rochester, MN PARTICIPANTS: All Hospitalized older adults (age >50 years) from December 2019 to June 2020. Patients with an admitting diagnosis of substance use disorder were excluded.

INTERVENTION: Original MDP tool was modified to adjust for the fall risk variable as a binary variable that will facilitate broader applicability across different fall risk tools. The modified MDP tool was validated in the retrospective derivation and validation data set which yielded similar prediction capability (AUROC = 0.85, 0.83 respectively).

MEASUREMENTS: Diagnosis of delirium was captured by flowsheet diagnosis of delirium documented by nursing staff in medical record. Predictive variable data were collected daily.

RESULTS: 8055 patients were included in the study (median age 71 years). The modified MDP tool delirium prediction compared to delirium occurrence was 4% in the low-risk group, 17.8% in the medium-risk group, and 45.3% in the high-risk group (AUROC of 0.80). Recalibration of the tool was attempted to further optimize the tool that resulted in both simplification and increased performance (AUROC 0.82). The simplified tool was able to predict delirium in hospitalized patients admitted to both medical and surgical services.

CONCLUSIONS: Validation of modified MDP tool revealed good prediction capabilities. Recalibration resulted in simplification with increased performance of the tool in both medical and surgical hospitalized patients.

PMID:35660677 | DOI:10.1016/j.jaclp.2022.05.006

World Neurosurg. 2022 Jun 2:S1878-8750(22)00770-7. doi: 10.1016/j.wneu.2022.05.130. Online ahead of print.

ABSTRACT

Ping-pong fractures (PPF) have become less frequent and no definite predictors to determine which fractures will elevate spontaneously and which should undergo surgical treatment have not been clearly defined. Herein, the authors present a revision of the literature, in which 54 papers were included, with a total of 228 children studied. Patients who underwent surgery accounted for 30%; elevation through obstetrical vacuum or other aspiration systems was applied in 30%, spontaneous resolution occurred in 40%; in 4 patients percutaneous microscrew elevation was applied. Overall, in 96.4% of patients the outcome was favorable since we found no significant increase in the incidence of post-traumatic seizures or neurologic sequelae with no significant differences between treated patients and spontaneous elevation. Statistical analysis showed no significant differences among the different treatment methods (P=0.53). Our results suggest that simple compound PPFs without brain compression, hematomas or dural tears could benefit from conservative management. In cases of non-spontaneous resolution after 6 months, operative strategies should be performed, considering that there is no evidence of differences between vacuum elevation and surgical elevation.

PMID:35660672 | DOI:10.1016/j.wneu.2022.05.130

J Glob Antimicrob Resist. 2022 Jun 2:S2213-7165(22)00132-1. doi: 10.1016/j.jgar.2022.05.027. Online ahead of print.

ABSTRACT

BACKGROUND: The Mycobacterium avium complex (MAC), comprising a series of subspecies, has a worldwide distribution, with differences in drug susceptibility among subspecies. This study aimed to assess the composition of MAC and susceptibility differences among subspecies in mainland China.

METHODS: A total of 287 MAC clinical strains were included in the study. Multitarget sequences were applied to accurately identify subspecies, and a microdilution method was used to evaluate minimum inhibitory concentrations (MICs) among subspecies using Sensititre SLOMYCO plates.

RESULTS: M. intracellular (N=169), M. avium (N=52), M. chimaera (N=22), M. marseillense (N=25), M. colombiense (N=14), M. yongonense (N=4), M. vulneris (N=3) and M. timonense (N=2) were isolated from MAC. Clarithromycin, amikacin and rifabutin showed lower MIC₅₀ and MIC₉₀ values than other drugs, and the resistance rates of clarithromycin, amikacin, linezolid and moxifloxacin were 6.3%, 10.5%, 51.9% and 46.3%, respectively. The resistance rates of clarithromycin and moxifloxacin in the initial treatment group were significantly lower than those in the retreatment group (4.09% vs. 12.94%; 30.41% vs. 75.29%; p<0.05). Drug susceptibility differences were observed in clarithromycin and moxifloxacin among the 5 major subspecies (p<0.05); however, those statistically significant differences disappeared when MACs were divided into two groups according to previous anti-TB treatment history.

CONCLUSIONS: This study revealed that MAC, primarily comprising M. intracellulare, was susceptible to clarithromycin, amikacin and rifabutin. Drug susceptibility among subspecies did not exhibit intrinsic differences in our study. Previous anti-TB treatment patients are more resistant to drugs; thus, attention should be given to those patients in the clinic.

PMID:35660663 | DOI:10.1016/j.jgar.2022.05.027

Neurosci Lett. 2022 Jun 2:136705. doi: 10.1016/j.neulet.2022.136705. Online ahead of print.

ABSTRACT

Since 1967, spinal cord stimulation (SCS) has been used to manage chronic intractable pain of the trunk and limbs. Low-intensity, paresthesia-free, 10 kHz SCS has demonstrated statistically- and clinically-superior long-term pain relief compared to conventional SCS. 10 kHz SCS has been proposed to operate via selective activation of inhibitory interneurons in the superficial dorsal horn. In contrast, 40 Hz SCS is presumed to operate largely via dorsal column fiber activation. To determine if these mechanisms may be implemented synergistically, we examined the effect of each type of stimulation both independently and simultaneously on putatively inhibitory and putatively excitatory neurons in the superficial dorsal horn. When 10 kHz SCS was applied relatively caudally to the measured spinal segment, simultaneous with 40 Hz SCS applied relatively rostrally to that spinal segment, inhibitory interneurons demonstrated a median increase of 26 spikes/s compared to their baseline firing rates. Median firing rate increases of inhibitory interneurons were 8.7 and 5.1 spikes/s during 40 Hz SCS applied rostrally and 10 kHz SCS applied caudally, respectively. By comparison, the median firing rate of excitatory interneurons increased by 4.1 spikes/s during simultaneous 40 Hz SCS applied rostrally and 10 kHz SCS applied caudally. Median firing rate increases of excitatory interneurons were 13 and 0.8 spikes/s during 40 Hz SCS applied rostrally and 10 kHz SCS applied caudally, respectively. This suggests that simultaneously applying 10 kHz SCS caudally and 40 Hz SCS rostrally may provide greater pain relief than either type of SCS alone by increasing the firing rates of inhibitory interneurons, albeit with greater excitatory interneuron activation.

PMID:35660650 | DOI:10.1016/j.neulet.2022.136705