Tag: pubmed

Int Urol Nephrol. 2022 Jul 9. doi: 10.1007/s11255-022-03277-3. Online ahead of print.

ABSTRACT

BACKGROUND: Deceased donor kidneys with acute kidney injury (AKI) are often discarded because of concerns about inferior transplant outcomes. A means of grading the quality of such kidneys is the performance of procurement biopsies.

METHODS: This is a retrospective study of 221 brain death donors with marginal kidneys transplanted in 223 recipients in Germany. Marginal kidneys were defined as kidneys with procurement biopsies done exceptionally to assess suitability for transplantation in otherwise potentially discarded organs. The impact of deceased donor AKI on patient survival and death-censored graft survival at 1, 3 and 5 years and graft function at 1 and 3 years after transplantation was investigated.

RESULTS: Recipients of kidneys with stage 3 AKI had a greater incidence of delayed graft function [DGF; OR_{Stage 1}: 1.435 (95% CI 0.438-0.702), OR_{Stage 2}: 2.463 (95% CI 0.656-9.245), OR_{Stage 3}: 4.784 (95% CI 1.421-16.101)] but a similar graft and patient survival compared to recipients of donors without AKI and with AKI stage 1 and 2 as well. The coexistence of recipient DGF and donor AKI was associated with the lowest graft survival and function rates.

CONCLUSION: The transplantation of deceased donor marginal kidneys with AKI confers a higher risk for DGF but is associated with acceptable graft and patient outcomes, which do not differ in comparison with marginal donor kidneys without AKI. Graft prognosis is especially poor if donor AKI and recipient DGF concur. Donor AKI was a risk factor independent of the histological lesions of procurement biopsies.

PMID:35809204 | DOI:10.1007/s11255-022-03277-3

Drugs Real World Outcomes. 2022 Jul 9. doi: 10.1007/s40801-022-00303-9. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic generated a massive amount of clinical data, which potentially hold yet undiscovered answers related to COVID-19 morbidity, mortality, long-term effects, and therapeutic solutions.

OBJECTIVES: The objectives of this study were (1) to identify novel predictors of COVID-19 any cause mortality by employing artificial intelligence analytics on real-world data through a hypothesis-agnostic approach and (2) to determine if these effects are maintained after adjusting for potential confounders and to what degree they are moderated by other variables.

METHODS: A Bayesian statistics-based artificial intelligence data analytics tool (bAIcis^®) within the Interrogative Biology^® platform was used for Bayesian network learning and hypothesis generation to analyze 16,277 PCR+ patients from a database of 279,281 inpatients and outpatients tested for SARS-CoV-2 infection by antigen, antibody, or PCR methods during the first pandemic year in Central Florida. This approach generated Bayesian networks that enabled unbiased identification of significant predictors of any cause mortality for specific COVID-19 patient populations. These findings were further analyzed by logistic regression, regression by least absolute shrinkage and selection operator, and bootstrapping.

RESULTS: We found that in the COVID-19 PCR+ patient cohort, early use of the antiemetic agent ondansetron was associated with decreased any cause mortality 30 days post-PCR+ testing in mechanically ventilated patients.

CONCLUSIONS: The results demonstrate how a real-world COVID-19-focused data analysis using artificial intelligence can generate unexpected yet valid insights that could possibly support clinical decision making and minimize the future loss of lives and resources.

PMID:35809196 | DOI:10.1007/s40801-022-00303-9

J Appl Clin Med Phys. 2022 Jul 9:e13719. doi: 10.1002/acm2.13719. Online ahead of print.

ABSTRACT

PURPOSE: We have developed a software to automatically find the contrast-detail (C-D) curve based on the statistical low-contrast detectability (LCD) in images of computed tomography (CT) phantoms at multiple cell sizes and to generate minimum detectable contrast (MDC) characteristics.

METHODS: A simple graphical user interface was developed to set the initial parameters needed to create multiple grid region of interest of various cell sizes with a 2-pixel increment. For each cell in the grid, the average CT number was calculated to obtain the standard deviation (SD). Detectability was then calculated by multiplying the SD of the mean CT numbers by 3.29. This process was automatically repeated as many times as the cell size was set at initialization. Based on the obtained LCD, the C-D curve was obtained and the target size at an MDC of 0.6% (i.e., 6-HU difference) was determined. We subsequently investigated the consistency of the target sizes for a 0.6% MDC at four locations within the homogeneous image. We applied the software to images with six noise levels, images of two modules of the American College of Radiology CT phantom, images of four different phantoms, and images of four different CT scanners. We compared the target sizes at a 0.6% MDC based on the statistical LCD and the results from a human observer.

RESULTS: The developed system was able to measure C-D curves from different phantoms and scanners. We found that the C-D curves follow a power-law fit. We found that higher noise levels resulted in a higher MDC for a target of the same size. The low-contrast module image had a slightly higher MDC than the distance module image. The minimum size of an object detected by visual observation was slightly larger than the size using statistical LCD.

CONCLUSIONS: The statistical LCD measurement method can generate a C-D curve automatically, quickly, and objectively.

PMID:35808971 | DOI:10.1002/acm2.13719

J Appl Clin Med Phys. 2022 Jul 9:e13714. doi: 10.1002/acm2.13714. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to dosimetrically compare volumetric-modulated arc therapy (VMAT) with intensity-modulated radiotherapy (IMRT) techniques using either 6- or 10-MV photon beam energies in lung stereotactic body radiation therapy (SBRT) plans.

METHODS: Thirty patients with primary or metastatic lung tumors eligible for SBRT were randomly selected. VMAT and IMRT treatment plans using either 6- or 10-MV photon energies were generated through automatic SBRT planning software in the RayStation treatment planning system.

RESULTS: For planning target volume, there was no difference in D_95% for all plans, whereas D_2% and D_50% were significantly increased by 5.22%-5.98% and 2.47%-2.59%, respectively, using VMAT_6/10-MV plans compared to IMRT_6/10-MV plans. When comparing the D_max of organs at risk (OARs), VMAT_6/10-MV was 18.32%-47.95% lower than IMRT_6/10-MV for almost all OARs. VMAT_6/10-MV obviously decreased D_mean , V_5Gy , V_10Gy , and V_20Gy of whole lung by 9.68%-20.92% than IMRT_6/10-MV . Similar results were found when comparing VMAT_6-MV with IMRT_10-MV or VMAT_10-MV with IMRT_6-MV . The differences in the D_2% , heterogeneity index, and conformity index between 6- and 10-MV plans are not statistically significant. Plans using 6-MV performed 4.68%-8.91% lower levels of D_max of spinal cord, esophagus, great vessels, and trachea and proximal bronchial tree than those using 10-MV plans. Similarly, D_mean , V_5Gy , V_10Gy , and V_20Gy of whole lung were also reduced by 2.79%-5.25% using 6-MV. For dose fall-off analysis, the D_2cm and R_50% of VMAT_6/10-MV were lower than those of IMRT_6/10-MV . Dose fall-off curve based on 10 rings was steeper for VMAT plans than IMRT plans regardless of the energy used.

CONCLUSIONS: For lung SBRT plans, VMAT-based plans significantly reduced OARs dose and steepened dose fall-off curves compared to IMRT-based plans. A 6-MV energy level was a better choice than 10-MV for lung SBRT. In addition, the dose differences between different techniques were more obvious than those between different energy levels.

PMID:35808973 | DOI:10.1002/acm2.13714

Health Serv Res. 2022 Jul 9. doi: 10.1111/1475-6773.14028. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify the association between strained intensive care unit (ICU) capacity during the COVID-19 pandemic and hospital racial and ethnic patient composition, federal pandemic relief, and other hospital characteristics.

DATA SOURCES: We used government data on hospital capacity during the pandemic and Provider Relief Fund (PRF) allocations, Medicare claims and enrollment data, hospital cost reports, and Social Vulnerability Index data.

STUDY DESIGN: We conducted cross-sectional bivariate analyses relating strained capacity and PRF award per hospital bed with hospital patient composition and other characteristics, with and without adjustment for hospital referral region (HRR).

DATA COLLECTION: We linked PRF data to CMS Certification Numbers based on hospital name and location. We used measures of racial and ethnic composition generated from Medicare claims and enrollment data. Our sample period includes the weeks of 9/18/2020 through 11/5/2021, and we restricted our analysis to short-term, general hospitals with at least one intensive care unit (ICU) bed. We defined “ICU strain share” as the proportion of ICU days occurring while a given hospital had an ICU occupancy rate ≥90%.

PRINCIPAL FINDINGS: After adjusting for HRR, hospitals in the top tercile of Black patient shares had higher ICU strain shares than did hospitals in the bottom tercile (30% versus 22%, p<0.05) and received greater PRF amounts per bed ($118,864 versus $92,407, p<0.05). Having high versus low ICU occupancy relative to pre-pandemic capacity was associated with a modest increase in PRF amounts per bed after adjusting for HRR ($107,319 versus $96,627, p<0.05), but there were no statistically significant differences when comparing hospitals with high versus low ICU occupancy relative to contemporaneous capacity.

CONCLUSIONS: Hospitals with large Black patient shares experienced greater strain during the pandemic. Although these hospitals received more federal relief, funding was not targeted overall towards hospitals with high ICU occupancy rates.

PMID:35808952 | DOI:10.1111/1475-6773.14028

Health Serv Res. 2022 Jul 9. doi: 10.1111/1475-6773.14035. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the association between adoption of presumptive eligibility for pregnancy Medicaid in Kansas in 2016 and timely prenatal care access.

DATA SOURCE: 2012-2019 National Center for Health Statistics natality files.

STUDY DESIGN: We used difference-in-differences to compare outcomes before (2012-2015) and after (2017-2019) presumptive eligibility in Kansas relative to seven control group states overall and stratified by maternal education. Outcomes included first trimester prenatal care, month of first prenatal visit, and adequate prenatal care.

DATA COLLECTION/EXTRACTION METHODS: All live births among adults aged 20 or older in Kansas, Idaho, Missouri, Nebraska, Tennessee, Utah, Wisconsin, and Wyoming.

PRINCIPAL FINDINGS: Among all births, we found no evidence that presumptive eligibility in Kansas resulted in changes in prenatal care use. Among individuals with high school education or less, presumptive eligibility was associated with a 1.92 percentage-point increase (95% CI: 0.64, 4.35) in first trimester prenatal care, driven by earlier month of first prenatal care visit.

CONCLUSIONS: Presumptive eligibility in Medicaid non-expansion states may lead to small improvements in early prenatal care among individuals with lower education; but other interventions may be needed. This article is protected by copyright. All rights reserved.

PMID:35808941 | DOI:10.1111/1475-6773.14035

J Clin Lab Anal. 2022 Jul 9:e24573. doi: 10.1002/jcla.24573. Online ahead of print.

ABSTRACT

BACKGROUND: Immune thrombocytopenia purpura (ITP) is an autoimmune disease that leads to accelerated platelet clearance. The objective of this study was to examine the clinical role of cytokines in ITP patients and to correlate them with disease stages.

MATERIALS AND METHODS: A total of 110 ITP patients were enrolled, including 55 with active ITP, 55 with remission ITP, and 55 with healthy controls. The enzyme-linked immunosorbent assay technique was used to examine IL-10 and IL-22 serum levels in all subjects. Real-time quantitative PCR was used to assess the mRNA expression of IL-10 and IL-22 in PBMC. The clinical significance of both cytokines was assessed using ROC analysis.

RESULTS: IL-10 serum levels in active ITP patients were significantly lower than in control and remission ITP subjects (p < 0.05). IL-22 serum levels were elevated in active ITP patients compared to the control and remission group (p < 0.05). mRNA expressions of IL-10 and IL-22 in active ITP patients were also having a significant difference from than control and remission ITP group (p < 0.05). ROC analysis showed that IL-10 and IL-22 can differentiate the ITP patients from controls. A positive correlation between serum IL-10 and PBMC IL-10 with statistical significance was observed. Similarly, the serum IL-22 and PBMC IL-22 were correlated positively with statistical significance.

CONCLUSION: IL-10 and IL-22 seem to predict the clinical course of ITP, as a significant imbalance of these cytokines was detected in active ITP patients.

PMID:35808925 | DOI:10.1002/jcla.24573

Echocardiography. 2022 Jul 9. doi: 10.1111/echo.15416. Online ahead of print.

ABSTRACT

OBJECTIVE: To study the value of fetal epicardial fat thickness (EFT) in gestational diabetes mellitus in the third trimester of pregnancy and its relationship with clinical parameters and perinatal outcomes.

METHODS: A total of 80 participants, including 40 with diagnosed GDM and 40 healthy pregnant women, were included in the study. Demographic data were obtained from medical records. Sonographic examinations were performed, such as amniotic fluid value, fetal biometric measurements, and Doppler parameters of the umbilical artery. Fetal EFT values were measured at the free wall of the right ventricle using a reference line with echocardiographic methods. Correlation tests were performed to evaluate the relationship between fetal EFT and clinical and perinatal parameters. p < .05 were interpreted as statistically significant.

RESULTS: The fetal EFT value was statistically higher in the GDM group than in the control group (p: .000). Spearman and Pearson correlation tests revealed statistically significant but weak positive correlations between fetal EFT value, 1-h 100-g OGTT, birth weight, and BMI (r: .198, p: .047; r: .395, p: .012; r: .360, p: .042, respectively). The optimal fetal EFT threshold for predicting GDM disease was found as 1.55 mm, with a specificity of 74.4% and sensitivity of 75.0%. Statistically significant differences between the two groups in umbilical artery Doppler resistance index (RI), pulsatility index (PI), and systolic/diastolic ratio (S/D) were not found (p: .337; p: .503; p: .155;). BMI and amniotic fluid volume were higher in the GDM group compared to the control group (p: .009; p < .01).

CONCLUSION: This study demonstrated that increased fetal EFT may occur as a reflection of changes in glucose metabolism in intrauterine life. Future studies with larger series, including the study of neonatal metabolic parameters, will contribute to the understanding of the importance of fetal EFT in determining the metabolic status of the fetus.

PMID:35808919 | DOI:10.1111/echo.15416

Dermatol Ther. 2022 Jul 9:e15699. doi: 10.1111/dth.15699. Online ahead of print.

ABSTRACT

BACKGROUND: Cutaneous leishmaniasis (CL) is a skin disease caused by intracellular protozoa, which is endemic in Iran. The goal of this study was to compare biophysical characteristics in CL lesions with uninvolved skin.

METHODS: Stratum corneum hydration, transepidermal water loss, surface friction, pH, sebum, melanin, erythema, temperature, elasticity parameters (R0, R2, and R5), thickness and echo-density of epidermis and dermis were measured on the active erythematous indurated part of a typical CL lesion in 20 patients, and compared with the same location on the other side of the body as control. Paired t- test was used for statistical analyses and a P<0.05 was considered significant.

RESULTS: Melanin content, R2 and echo-density of dermis were significantly lower, whereas transepidermal water loss, friction index, pH, erythema index, temperature and the thickness of dermis were significantly higher in CL lesions. There was no significant difference in stratum corneum hydration, sebum, R0, R5, thickness of epidermis and density of epidermis between CL and normal skin.

CONCLUSIONS: CL lesions are characterized by certain changes in biophysical and ultrasonographic properties, which are mostly correlated with histological features. These changes are likely to be useful in the non-invasive early detection of CL and also as treatment outcome measures for clinical trials of new treatment modalities for CL in the future. This article is protected by copyright. All rights reserved.

PMID:35808917 | DOI:10.1111/dth.15699

J Magn Reson Imaging. 2022 Jul 9. doi: 10.1002/jmri.28331. Online ahead of print.

ABSTRACT

BACKGROUND: Determination of preoperative soft tissue sarcoma (STS) margin is crucial for patient prognosis.

PURPOSE: To evaluate diagnostic performance of radiomics model using T2-weighted Dixon sequence for infiltration degree of STS margin.

STUDY TYPE: Retrospective.

POPULATION: Seventy-two STS patients consisted of training (n = 58) and test (n = 14) sets.

FIELD STRENGTH/SEQUENCE: A 3.0 T; T2-weighted Dixon images.

ASSESSMENT: Pathologic result of marginal infiltration in STS (circumscribed margin; n = 27, group 1, focally infiltrative margin; n = 31, group 2-A, diffusely infiltrative margin; n = 14, group 2-B) was the reference standard. Radiomic volume and shape (VS) and other (T2) features were extracted from entire tumor volume and margin, respectively. Twelve radiomics models were generated using four combinations of classifier algorithms (R, SR, LR, LSR) and three different inputs (VS, T2, VS + T2 [VST2] features) to differentiate the three groups. Three radiologists (reader 1, 2, 3) analyzed the marginal infiltration with 6-scale confidence score.

STATISTICAL TESTS: Area under the receiver operating characteristic curve (AUC) and concordance rate.

RESULTS: Averaged AUCs of R, SR, LR, LSR models were 0.438, 0.466, 0.438, 0.466 using VS features, 0.596, 0.584, 0.814, 0.815 using T2 features, and 0.581, 0.587, 0.821, 0.821 using VST2 features, respectively. The LR and LSR models constructed with T2 or VST2 features showed higher AUC and concordance rate compared to radiologists’ analysis (AUC; 0.730, 0.675, 0.706, concordance rate; 0.46, 0.43, 0.47 in reader 1, 2, 3).

DATA CONCLUSION: Radiomics model constructed with features from tumor margin on T2-weighted Dixon sequence is a promising method for differentiating infiltration degree of STS margin.

EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 2.

PMID:35808915 | DOI:10.1002/jmri.28331