Tag: pubmed

Leg Med (Tokyo). 2021 May 1;52:101901. doi: 10.1016/j.legalmed.2021.101901. Online ahead of print.

ABSTRACT

One of the most common ways to assess the age in subadults using dental records is the Demirjian method. As the number of the studies using this method increased significantly in the recent years, and as their results were often conflicting, we investigated the accuracy of the method. We performed a systematic review and meta-analysis of observational studies obtained from Pubmed, using a random-effects model with the DerSimonian-Laird estimator, and raw mean difference for effect size measure. Prediction intervals (at 95%) were used to assess the presence of significant statistical differences between chronological and dental age. Our meta-analysis showed that Demirijan’s method overestimated dental age by 0.48 years in girls and 0.51 in boys. Depending on the location and sex, in girls the smallest average overestimation was found in Asia (except India), with a value of 0.36 years, and the largest overestimation in Turkey/Arabia, with a value of 0.66 years. In boys, the smallest average overestimation was found in India (0.45 years), but Asia (except India), Africa – both with 0.46 years and Oceania – with 0.47 years were close, while the largest overestimation was found in Turkey/Arabia, with an average value of 0.63 years. The Demirjian method overestimated the age by about half a year for both sexes. Even if there are some geographical/ethnic differences, they are rather small, making the method useful irrespective of the ethnic profile of the subjects.

PMID:33964679 | DOI:10.1016/j.legalmed.2021.101901

Am J Emerg Med. 2021 Apr 29;48:177-182. doi: 10.1016/j.ajem.2021.04.075. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE: To develop a novel predictive model for emergency department (ED) hourly occupancy using readily available data at time of prediction with a time series analysis methodology.

METHODS: We performed a retrospective analysis of all ED visits from a large academic center during calendar year 2012 to predict ED hourly occupancy. Due to the time-of-day and day-of-week effects, a seasonal autoregressive integrated moving average with external regressor (SARIMAX) model was selected. For each hour of a day, a SARIMAX model was built to predict ED occupancy up to 4-h ahead. We compared the resulting model forecast accuracy and prediction intervals with previously studied time series forecasting methods.

RESULTS: The study population included 65,132 ED visits at a large academic medical center during the year 2012. All adult ED visits during the first 265 days were used as a training dataset, while the remaining ED visits comprised the testing dataset. A SARIMAX model performed best with external regressors of current ED occupancy, average department-wide ESI, and ED boarding total at predicting up to 4-h-ahead ED occupancy (Mean Square Error (MSE) of 16.20, and 64.47 for 1-hr- and 4-h- ahead occupancy, respectively). Our 24-SARIMAX model outperformed other popular time series forecasting techniques, including a 60% improvement in MSE over the commonly used rolling average method, while maintaining similar prediction intervals.

CONCLUSION: Accounting for current ED occupancy, average department-wide ESI, and boarding total, a 24-SARIMAX model was able to provide up to 4 h ahead predictions of ED occupancy with improved performance characteristics compared to other forecasting methods, including the rolling average. The prediction intervals generated by this method used data readily available in most EDs and suggest a promising new technique to forecast ED occupancy in real time.

PMID:33964692 | DOI:10.1016/j.ajem.2021.04.075

Arch Oral Biol. 2021 Apr 25;127:105130. doi: 10.1016/j.archoralbio.2021.105130. Online ahead of print.

ABSTRACT

OBJECTIVES: This study was designed to establish a Reference Data Set for Dental Age Estimation of young Kuwaiti subjects.

DESIGN: Dental Panoramic Tomographs of 1393 Kuwaiti children, adolescents, and young adults aged between 3 and 26 years were re-used to establish a Reference Data Set. The Tooth Development Stages described by Demirjian et al. in 1973 was used to assess all the teeth on the left side of the Maxilla and the Mandible. The Accuracy and Precision of Dental Age Estimation for Kuwaiti children and adolescents was investigated by calculating the age of children using 50 females and 50 males of known age separate from the main study sample. This was the Validation Sample. Summary data for the individual Tooth Development Stages, comprising the number, mean, and standard deviation were used to estimate the age of the subjects in the Validation Sample using the Simple Average Method to calculate the Dental Age.

RESULTS: There was no statistically significant difference between the Chronological Age and the Dental Age in males with a mean difference of 0.14 years (1.75 months). The difference in females was significant at -0.33 years (-4.1 months).

CONCLUSIONS: These data demonstrate that estimated Dental Age in Kuwaiti females is close, just over 4 months, and is very close, in males within 1.75 months of the Chronologic Age.

PMID:33964647 | DOI:10.1016/j.archoralbio.2021.105130

Prostaglandins Leukot Essent Fatty Acids. 2021 Apr 24;169:102283. doi: 10.1016/j.plefa.2021.102283. Online ahead of print.

ABSTRACT

BACKGROUND: The roles of omega-3 (n3) fatty acids [eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)] and low-dose aspirin in the primary prevention of ischemic cardiovascular disease (CVD) are controversial. Since omega-3 (n3) fatty acids and aspirin affect cyclooxygenase activity in platelets, there could be a clinically-relevant effect of aspirin combined with a particular n3 fatty acid level present in each individual.

METHODS: RBC EPA+DHA, arachidonic acid (AA) and docosapentaenoic acid (DPA) were measured in 2500 participants without known CVD in the Framingham Heart Study. We then tested for interactions with reported aspirin use (1004 reported use and 1494 did not) on CVD outcomes. The median follow-up was 7.2 years.

RESULTS: Having RBC EPA+DHA in the second quintile (4.2-4.9% of total fatty acids) was associated with significantly reduced risk for future CVD events (relative to the first quintile, <4.2%) in those who did not take aspirin (HR 0.54 (0.30, 0.98)), but in those reporting aspirin use, risk was significantly increased (HR 2.16 (1.19, 3.92)) in this quintile. This interaction remained significant when adjusting for confounders. Significant interactions were also present for coronary heart disease and stroke outcomes using the same quintiles. Similar findings were present for EPA and DHA alone but not for DPA and AA.

CONCLUSIONS: There is a complex interaction between aspirin use and RBC EPA+DHA levels on CVD outcomes. This suggests that aspirin use may be beneficial in one omega-3 environment but harmful in another, implying that a personalized approach to both aspirin use and omega-3 supplementation may be needed.

PMID:33964664 | DOI:10.1016/j.plefa.2021.102283

Environ Int. 2021 May 5;155:106590. doi: 10.1016/j.envint.2021.106590. Online ahead of print.

ABSTRACT

It has been known for a long time that incomplete combustion processes produce by-products that are harmful to human health. Particularly high concentrations of such by-products can arise in indoor environments when operating open flames without venting. The emission behavior of many combustion sources, including candles, has already been examined in detail. However, to date there are no studies in which the chemical composition of the candles is known exactly or where the candles were specifically manufactured for comparative measurements. In this respect, the study presented here, which was designed in collaboration with candle manufacturers and fragrance houses, demonstrates new insights into the emissions of burning candles depending on their composition. All investigations were carried out under controlled climatic conditions in an 8 m³ stainless steel chamber. Combinations of four different fuels (waxes) and five different fragrances in addition to one set of unscented control candles were examined. This resulted in 24 experiments, 20 with scented candles and four with unscented candles. The typical combustion gases carbon monoxide, carbon dioxide and NO_x, organic compounds, such as formaldehyde, benzene, and polycyclic aromatic hydrocarbons, PM_2.5 and ultrafine particles were monitored in the chamber air and the emission rates were determined. The data were statistically evaluated using parametric and non-parametric methods as well as hierarchical cluster analysis. Exposure scenarios typical for indoor environments were calculated from the emission rates and the results were compared with indoor guidance and reference values. As expected, a multitude of gaseous and particulate emissions were detected. These were typical combustion products as well as evaporated constituents of the fragrance mixtures. In most cases, the calculated indoor concentrations were well below the respective guidance and reference values. The exceptions observed in some cases for nitrogen dioxide, acrolein and benzo[a]pyrene are discussed critically.

PMID:33964641 | DOI:10.1016/j.envint.2021.106590

J Surg Res. 2021 May 5;265:265-271. doi: 10.1016/j.jss.2021.03.057. Online ahead of print.

ABSTRACT

OBJECTIVE: The Script Concordance Test (SCT) is a test of clinical decision-making that relies on an expert panel to create its scoring key. Existing literature demonstrates the value of specialty-specific experts, but the effect of experience among the expert panel is unknown. The purpose of this study was to explore the role of surgeon experience in SCT scoring.

DESIGN: An SCT was administered to 29 general surgery residents and 14 staff surgeons. Staff surgeons were stratified as either junior or senior experts based on years since completing residency training (<15 versus >25 years). The SCT was scored using the full expert panel, the senior panel, the junior panel, and a subgroup junior panel in practice <5 years. A one-way ANOVA was used to compare the scores of first (R1) and fifth (R5) year residents using each scoring scheme. Cognitive interviews were analyzed for differences between junior and senior expert panelist responses.

RESULTS: There was no statistically significant difference between the mean score of six R1s and five R5s using the full expert panel (R1 69.08 versus R5 67.06, F_1,9 = 0.10, P = 0.76), the junior panel (R1 66.73 versus R5 62.50, F_1,9 = 0.35, P = 0.57), or the subgroup panel in practice <5 years (R1 61.07 versus R5 58.79, F_1,9 = 0.18, P = 0.75). However, the average score of R1s was significantly lower than R5s when using the senior faculty panel (R1 52.04 versus R5 63.26, F_1,9 = 26.90, P = 0.001). Cognitive interview data suggests that some responses of junior experts demonstrate less confidence than those of senior experts.

CONCLUSIONS: SCT scores are significantly affected by the responses of the expert panel. Expert differences between first and fifth year residents were only demonstrated when using an expert panel consisting of senior faculty members. Confidence may play a role in the response selections of junior experts. When constructing an SCT expert panel, consideration must be given to the experience of panel members.

PMID:33964636 | DOI:10.1016/j.jss.2021.03.057

J Surg Res. 2021 May 5;265:272-277. doi: 10.1016/j.jss.2021.03.054. Online ahead of print.

ABSTRACT

INTRODUCTION: Iatrogenic ureteral injury (IUI) is an uncommon complication in colorectal surgery. Prophylactic ureteral stenting (PUS) gained acceptance to aid in intraoperative identification of the ureter. Despite its use, the benefit of pus to avoid IUI remains debatable. We sought to analyze the rates of IUI after colorectal surgery in veterans and to compare the outcomes after PUS using a large matched cohort.

METHODS: The veterans affairs surgical quality improvement program database was queried for patients who underwent colorectal surgery from 2008-2015. To analyze the outcomes of PUS, we created two matched groups using propensity-score matching accounting for demographical and clinical cofactors to assess variable outcomes. Cross-tabulation was used to calculate rates of IUI and univariate and multivariate analyses were performed to evaluate risk factors associated with IUI.

RESULTS: 27,448 patients were identified and 458 underwent PUS placement (1.6%). The majority of procedures were performed electively and with an open approach. Mean age was 65 y, 96.3% were male, and colorectal cancer was the most common indication. 45 patients (0.2%) were diagnosed with IUI. IUI incidence was higher in female patients, after left-sided colorectal resection, and in those undergoing open procedures. After matching, PUS use was associated with longer length of stay and operative time and increased creatinine levels from baseline.

CONCLUSION: We demonstrated that the use of PUS is independently associated with increased operative time and change in creatinine levels. Although no IUI occurred in the PUS group, this finding was not statistically significant. The risk and/or benefit ratio of PUS should be considered for each individual case, with its selective use based on the presence of risk factors for IUI, such as female patients and left-sided resections.

PMID:33964637 | DOI:10.1016/j.jss.2021.03.054

J Surg Res. 2021 May 5;265:259-264. doi: 10.1016/j.jss.2021.02.048. Online ahead of print.

ABSTRACT

BACKGROUND: The American Association for the Surgery of Trauma (AAST) appendicitis severity grading criteria use independent subscales for radiologists (Rad), surgeons (Surg), and pathologists (Path). We reviewed the EAST Multicenter Study of the Treatment of Appendicitis in America: Acute, Perforated, and Gangrenous (MUSTANG) database to determine rates of discordance and clinical consequences of inaccuracy.

MATERIALS AND METHODS: A confusion matrix was constructed for pairs among Rad, Surg, and Path. Accuracy was reported using chronologically latest diagnosis as gold standard. “Concordance” (C) was achieved when both agreed on the severity grade and “Discordance”(D) when they disagreed. A composite endpoint(“COMP”= 30-d incidence of surgical site infection, abscess, wound complication, Clavien-Dindo complication, secondary intervention, ED[Emergency Department] visit, hospital readmission, and mortality) was compared between C versus D groups via χ² test with Bonferroni correction to define statistical significance(P = 0.05/9 = 0.005).

RESULTS: For each pair and diagnosis, subjects were categorized as C or D and compared for the incidence of COMP. Incidence of COMP for Surg and/or Path in C versus D: 16% versus. 26% (p = 0.006, NS by Bonferroni) for acute (A), 39% versus 33% (p = 0.39) for gangrenous (G), and 48% versus 37% (p = 0.035, NS by Bonferroni) for perforated (P). For Rad and/or Path in C versus. D: 17% versus 42% (p < 0.001) for A, 27% versus 31% (p = 0.95) for G, and 56% versus 48% (p = 0.48) for P. For C versus D: 17% versus 40% (p < 0.001) for A, 36% versus 26% (p = 0.43) for G, and 51% versus 39% (p = 0.29) for P.

CONCLUSIONS: In appendicitis treated by appendectomy, surgeons are most accurate at diagnosing acute appendicitis and least accurate at diagnosing gangrenous. Radiologists are less accurate for all categories. When the surgeon is wrong, clinical outcomes are not significantly worse. However, when the radiologist is wrong about acute appendicitis, patients have worse clinical outcomes.

PMID:33964635 | DOI:10.1016/j.jss.2021.02.048

Scand J Pain. 2021 May 10. doi: 10.1515/sjpain-2020-0176. Online ahead of print.

ABSTRACT

OBJECTIVES: Labour is one of the most painful experiences in a woman’s life. Epidural analgesia using low-concentration local anaesthetics and lipophilic opioids is the gold standard for pain relief during labour. Pregnancy in general, particularly labour, is associated with changes in maternal haemodynamic variables, such as cardiac output and heart rate, which increase and peak during uterine contractions. Adrenaline is added to labour epidural solutions to enhance efficacy by stimulating the α2-adrenoreceptor. The minimal effective concentration of adrenaline was found to be 2 μg mL^-1 for postoperative analgesia. The addition of adrenaline may also produce vasoconstriction, limiting the absorption of fentanyl into the systemic circulation, thereby reducing foetal exposure. However, adrenaline may influence the haemodynamic fluctuations, possibly adding to the strain on the circulatory system. The aim of this study was to compare the haemodynamic changes after application of labour epidural analgesia with or without adrenaline 2 μg mL^-1.

METHODS: This was a secondary analysis of a single-centre, randomised double-blind trial. Forty-one nulliparous women in labour requesting epidural analgesia were randomised to receive epidural solution of bupivacaine 1 mg mL^-1, fentanyl 2 μg mL^-1 with or without adrenaline 2 μg mL^-1. The participants were monitored using a Nexfin CC continuous non-invasive blood pressure and cardiac output monitor. The primary outcomes were changes in peak systolic blood pressure and cardiac output during uterine contraction within 30 min after epidural activation. The effect of adrenaline was tested statistically using a linear mixed-effects model of the outcome variables’ dependency on time, adrenaline, and their interaction.

RESULTS: After excluding three patients due to poor data quality and two due to a malfunctioning epidural catheter, 36 patients (18 in each group) were analysed. The addition of adrenaline to the solution had no significant effect on the temporal changes in peak systolic blood pressure (p=0.26), peak cardiac output (0.84), or heart rate (p=0.91). Furthermore, no significant temporal changes in maternal haemodynamics (peak systolic blood pressure, p=0.54, peak cardiac output, p=0.59, or heart rate p=0.55) were associated with epidural analgesia during 30 min after epidural activation in both groups despite good analgesia.

CONCLUSIONS: The addition of 2 μg mL^-1 adrenaline to the epidural solution is not likely to change maternal haemodynamics during labour.

PMID:33964196 | DOI:10.1515/sjpain-2020-0176

J Complement Integr Med. 2021 May 10. doi: 10.1515/jcim-2020-0276. Online ahead of print.

ABSTRACT

OBJECTIVES: Stress responses vary throughout pregnancy and impact of late gestational variable stress (LGVS) with vitamin C supplementation on uterine contractility is barely explored. This study investigates fetal weight outcome and in-vitro uterine contractile responses to pharmacological agents during LGVS exposure.

METHODS: Twenty four nulliparous pregnant rats were divided into four groups of six. During gestation days 10-19, groups 1 & 2 received normal saline and vitamin C (10 mg/kg) respectively. Groups 3 and 4 were exposed to stress (sleep deprivation, predator exposure, immobility, rapid cage changes, noise, and foreign object) with group 4 concurrently supplemented with vitamin C (10 mg/kg). Serum cortisol, oxidative bio-markers, fetal weights and in-vitro contractile responses of excised uterine tissue to acetylcholine (Ach), oxytocin, calcium chloride (CaCl₂), potassium chloride (KCl), diclofenac, and magnesium ions were determined.

RESULTS: Malondialdehyde activity and cortisol were significantly increased in variable stress only exposed group when compared with control and vitamin C supplemented groups. Fetal body weights, superoxide dismutase and catalase activity were significantly reduced in variable stress only exposed group. Significantly impaired contractile responses to Ach, CaCl₂ & KCl in variable stress only exposed group were modulated in vitamin C supplemented groups. Impaired contractile response to oxytocin was however not reversed. Relaxation responses to diclofenac and magnesium ions were statistically unaltered across groups.

CONCLUSIONS: Impaired fetal weights and uterine contractile activity to Ach, CaCl₂ and KCl during LGVS was modulated by vitamin C supplementation. Impaired oxytocin contractile activity was however unreversed.

PMID:33964203 | DOI:10.1515/jcim-2020-0276