Tag: pubmed

Comput Methods Programs Biomed. 2021 May 21;207:106190. doi: 10.1016/j.cmpb.2021.106190. Online ahead of print.

ABSTRACT

Cardiovascular disease (CVD) is the leading cause of death worldwide and is a global health issue. Traditionally, statistical models are used commonly in the risk prediction and assessment of CVD. However, the adoption of artificial intelligent (AI) approach is rapidly taking hold in the current era of technology to evaluate patient risks and predict the outcome of CVD. In this review, we outline various conventional risk scores and prediction models and do a comparison with the AI approach. The strengths and limitations of both conventional and AI approaches are discussed. Besides that, biomarker discovery related to CVD are also elucidated as the biomarkers can be used in the risk stratification as well as early detection of the disease. Moreover, problems and challenges involved in current CVD studies are explored. Lastly, future prospects of CVD risk prediction and assessment in the multi-modality of big data integrative approaches are proposed.

PMID:34077865 | DOI:10.1016/j.cmpb.2021.106190

Respir Med. 2021 May 25;185:106481. doi: 10.1016/j.rmed.2021.106481. Online ahead of print.

ABSTRACT

Non-invasive respiratory support (NRS) outside of the ICU has played an important role in the management of COVID-19 pneumonia. There is little data to guide selection of NRS modality. We present outcomes of NRS outside the ICU and discuss the effects of NRS on gas exchange with implications for management.

PMID:34077874 | DOI:10.1016/j.rmed.2021.106481

Oral Oncol. 2021 May 30;119:105328. doi: 10.1016/j.oraloncology.2021.105328. Online ahead of print.

ABSTRACT

OBJECTIVE: Alcohol use among survivors of head and neck cancer (HNC) negatively impacts patient outcomes and is an important risk factor for recurrent and second primary tumors. Despite recommendations from several cancer societies, alcohol consumption remains a common problem in this population.

METHODS: A cross-sectional study was performed with the Alcohol Use Disorders Identification Test (AUDIT) Self-Report questionnaire. Patients with HNC completed surveys at pre-treatment and follow-up appointments every 3-6 months for at least 2-years after treatment.

RESULTS: 796 surveys were available for analysis. Most participants were male (75.7%) and had either oropharyngeal (34.5%) or laryngeal (16.7%) cancer. The percentage of alcohol drinkers decreased from 56.1% at pre-treatment to 40.4% at 0-3 months post-treatment, but then increased and surpassed baseline levels by 24 + months post-treatment (64.4%, p = 0.0079). Concurrently, moderate drinkers (AUDIT = 1 – 3) decreased from 34.2% at pre-treatment to 25.2% at 0-3 months post-treatment, but then increased and surpassed baseline levels at 24 + months post-treatment (39.7%, p = 0.0129). Trends among heavy (AUDIT > 3), and heaviest (AUDIT > 6) drinkers were similar, but not statistically significant. At 24 + months post-therapy, we observed a statistically significant increase in female users (39.1% to 63.2%, p = 0.0213) and moderate drinkers < 55 years old (43.4% to 61.9%, p = 0.0184).

CONCLUSION: Alcohol consumption in survivors of HNC transiently decreases in the immediate months after treatment, but then increases and remains largely stable by 24 months. This pattern is particularly concerning and highlights the need for timely interventions.

PMID:34077813 | DOI:10.1016/j.oraloncology.2021.105328

J Stroke Cerebrovasc Dis. 2021 May 30;30(8):105870. doi: 10.1016/j.jstrokecerebrovasdis.2021.105870. Online ahead of print.

ABSTRACT

OBJECTIVES: Systemic inflammatory response syndrome (SIRS) and hematoma expansion are independently associated with worse outcomes after intracerebral hemorrhage (ICH), but the relationship between SIRS and hematoma expansion remains unclear.

MATERIALS AND METHODS: We performed a retrospective review of patients admitted to our hospital from 2013 to 2020 with primary spontaneous ICH with at least two head CTs within the first 24 hours. The relationship between SIRS and hematoma expansion, defined as ≥6 mL or ≥33% growth between the first and second scan, was assessed using univariable and multivariable regression analysis. We assessed the relationship of hematoma expansion and SIRS on discharge mRS using mediation analysis.

RESULTS: Of 149 patients with ICH, 83 (56%; mean age 67±16; 41% female) met inclusion criteria. Of those, 44 (53%) had SIRS. Admission systolic blood pressure (SBP), temperature, antiplatelet use, platelet count, initial hematoma volume and rates of infection did not differ between groups (all p>0.05). Hematoma expansion occurred in 15/83 (18%) patients, 12 (80%) of whom also had SIRS. SIRS was significantly associated with hematoma expansion (OR 4.5, 95% CI 1.16 – 17.39, p= 0.02) on univariable analysis. The association remained statistically significant after adjusting for admission SBP and initial hematoma volume (OR 5.72, 95% CI 1.40 – 23.41, p= 0.02). There was a significant indirect effect of SIRS on discharge mRS through hematoma expansion. A significantly greater percentage of patients with SIRS had mRS 4-6 at discharge (59 vs 33%, p=0.02).

CONCLUSION: SIRS is associated with hematoma expansion of ICH within the first 24 hours, and hematoma expansion mediates the effect of SIRS on poor outcome.

PMID:34077823 | DOI:10.1016/j.jstrokecerebrovasdis.2021.105870

Environ Int. 2021 May 30;155:106667. doi: 10.1016/j.envint.2021.106667. Online ahead of print.

ABSTRACT

INTRODUCTION: Asthma is a complex, heterogeneous disease and one of the most common chronic diseases among children. Exposure to ambient air pollution in early life and childhood may influence asthma aetiology, but it is uncertain which specific components of air pollution and exposure windows are of importance. The role of socio-economic status (SES) is also unclear. The aims of the present study are, therefore, to investigate how various exposure windows of different pollutants affect risk-induced asthma in early life and to explore the possible effect SES has on that relationship.

METHODS: The study population was constructed using register data on all singleton births in the greater Stockholm area between 2006 and 2013. Exposure to ambient black carbon (BC), fine particulate matter (PM_2.5), primary organic carbon (pOC) secondary organic aerosols (SOA), secondary inorganic aerosols, and oxidative potential at the residential address was modelled as mean values for the entire pregnancy period, the first year of life and the first three years of life. Swedish national registers were used to define the outcome: asthma diagnosis assessed at hospital during the first six years of life. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were modelled with Cox proportional hazards model with age as the underlying time-scale, adjusting for relevant potential confounding variables.

RESULTS: An increased risk for developing childhood asthma was observed in association with exposure to PM_2.5, pOC and SOA during the first three years of life. With an interquartile range increase in exposure, the HRs were 1.06 (95% CI: 1.01-1.10), 1.05 (95% CI: 1.02-1.09) and 1.02 (95% CI: 1.00-1.04), for PM_2.5, pOC and SOA, respectively, in the fully adjusted models. Exposure during foetal life or the first year of life was not associated with asthma risk, and the other pollutants were not statistically significantly associated with increased risk. Furthermore, the increase in risk associated with PM_2.5 and the components BC, pOC and SOA were stronger in areas with lower SES.

CONCLUSION: Our results suggest that exposure to air pollution during the first three years of life may increase the risk for asthma in early childhood. The findings further imply a possible increased vulnerability to air pollution-attributed asthma among low SES children.

PMID:34077855 | DOI:10.1016/j.envint.2021.106667

J Clin Epidemiol. 2021 May 30:S0895-4356(21)00170-0. doi: 10.1016/j.jclinepi.2021.05.018. Online ahead of print.

ABSTRACT

Covid-19 research made it painfully clear that the scandal of poor medical research, as denounced by Altman in 1994, persists today. The overall quality of medical research remains poor, despite longstanding criticisms. The problems are well known, but the research community fails to properly address them. We suggest most problems stem from an underlying paradox: although methodology is undeniably the backbone of qualitative and responsible research, science consistently undervalues methodology. The focus remains more on the destination (research claims and metrics) than on the journey. Notwithstanding, research should serve society more than the reputation of those involved. While we notice that many initiatives are being established to improve components of the research cycle, these initiatives are too disjointed. The overall system is monolithic and slow to adapt. We assert that a top-down action is needed from journals, universities, funders and governments to break the cycle and put methodology first. These actions should involve the widespread adoption of registered reports, balanced research funding between innovative, incremental and methodological research projects, full recognition and demystification of peer review, mandatory statistical review of reports, adherence to reporting guidelines, and investment in methodological education and research. Currently, the scientific enterprise is doing a major disservice to patients and society.

PMID:34077797 | DOI:10.1016/j.jclinepi.2021.05.018

J Dent. 2021 May 30:103706. doi: 10.1016/j.jdent.2021.103706. Online ahead of print.

ABSTRACT

OBJECTIVES: This study evaluated the importance of defining the reference and the test object during 3D surface comparisons to assess the trueness of an intraoral scanner.

MATERIALS AND METHODS: A maxillary complete-arch cast with interdental spaces was digitized with a high-resolution scanner to obtain the ground truth dataset [GT]. Fifteen intraoral scanning datasets [IOS] were obtained with an intraoral scanner. The trueness of the [IOS] datasets were evaluated by two different comparison procedures using a 3D analysis software: In the first comparison [REF-GT], the [GT] dataset was set as reference object and the [IOS] dataset was defined as test object. In the second comparison [REF-IOS], the [IOS] dataset were set as reference object and the [GT] dataset was defined as test object. The mean trueness of both comparisons was calculated with absolute mean deviation, (90-10)/2 percentile, and root-mean-squared (RMS) error method. Statistical significance was analyzed using the t-test (α=.05).

RESULTS: The mean trueness values of [REF-GT] were 31.4(±6.1) µm for (90-10)/2 percentile, 77.0(±5.3) µm for absolute mean deviation, and 203.1(±4.8) µm for RMS error method. [REF-IOS] revealed 23.9(±4.8) µm, 28.3(±6.3) µm, and 39.6(±9.5) µm, respectively. The results differed significantly.

CONCLUSION: The datasets obtained from the intraoral scanner captured more adequately interproximal spaces in comparison to the [GT] dataset. Therefore, the [GT] dataset defined as reference object in the analysis software for 3D comparisons revealed misleading results.

CLINICAL SIGNIFICANCE: The selection of the reference object and of the areas to be compared have to be defined carefully regarding complete arch scanning accuracy analysis.

PMID:34077800 | DOI:10.1016/j.jdent.2021.103706

J Dent. 2021 May 30:103708. doi: 10.1016/j.jdent.2021.103708. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate the effect of rapid high-intensity light-curing on the marginal integrity of four bulk-fill composites, including two materials specifically designed for high-intensity curing.

METHODS: Class V cavities were prepared on buccal surfaces of intact human molars with simulated pulpal pressure, filled in a single increment and light-cured using a conventional (10 s @ 1,340 mW/cm²) or high-intensity (3 s @ 3,440 mW/cm²) protocol. The restorations were subjected to thermo-mechanical loading (TML) comprising 1,200,000 mechanical loading cycles and 3,000 thermocycles. Quantitative margin analysis was performed before and after TML using a scanning electron microscope, and the marginal integrity was expressed as percentage of continuous margin (PCM).

RESULTS: All PCM values measured before TML were statistically similar regardless of the material and curing protocol (p>0.05). A statistically significant effect of the curing protocol (p=0.021) was identified only after TML for one material. PCM was significantly diminished by TML (p<0.001) for most combinations of material and curing protocol. The PCM values of the sculptable composites after TML were statistically similar regardless of the curing protocol (p>0.05). Compared to these values, significantly lower PCM after TML was identified for the flowable composites cured with the high-intensity protocol (p=0.001-0.045).

CONCLUSION: In most cases, high-intensity and conventional curing generally led to similar marginal integrity. Although all of the investigated composites initially performed similarly well, the flowable composites light-cured using the high-intensity protocol showed a significantly inferior marginal integrity compared to the sculptable composites after loading.

CLINICAL SIGNIFICANCE: Rapid high-intensity light-curing cannot be recommended for flowable bulk-fill composites since it may compromise the tooth-restoration interface.

PMID:34077801 | DOI:10.1016/j.jdent.2021.103708

Can J Cardiol. 2021 May 30:S0828-282X(21)00285-3. doi: 10.1016/j.cjca.2021.05.009. Online ahead of print.

ABSTRACT

The COVID-19 crisis led to a flurry of clinical trials activity. The COVID-Evidence database shows 2,814 COVID-19 randomized trials registered as of February 16, 2021. Most were small (only 18% have a planned sample size >500) and the rare completed ones have not provided published results promptly (only 283 trial publications as of 2/2021). Small randomized trials and observational, non-randomized analyses have not had a successful track record and have generated misleading expectations. Different large trials on the same intervention have generally been far more efficient in producing timely and consistent evidence. The rapid generation of evidence and accelerated dissemination of results have led to new challenges for systematic reviews and meta-analyses (e.g. rapid, living, and scoping reviews). Pressure to regulatory agencies has also mounted with massive emergency authorizations, but some of them have had to be revoked. Pandemic circumstances have disrupted the way trials are conducted; therefore, new methods have been developed and adopted more widely to facilitate recruitment, consent, and overall trial conduct. Based on the COVID-19 experience and its challenges, planning of several large, efficient trials, and wider use of adaptive designs may change the future of clinical research. Pragmatism, integration in clinical care, efficient administration, promotion of collaborative structures, and enhanced integration of existing data and facilities may be several of the legacies of COVID-19 on future randomized trials.

PMID:34077789 | DOI:10.1016/j.cjca.2021.05.009

Am J Hum Genet. 2021 May 25:S0002-9297(21)00189-0. doi: 10.1016/j.ajhg.2021.05.005. Online ahead of print.

ABSTRACT

Cupping of the optic nerve head, a highly heritable trait, is a hallmark of glaucomatous optic neuropathy. Two key parameters are vertical cup-to-disc ratio (VCDR) and vertical disc diameter (VDD). However, manual assessment often suffers from poor accuracy and is time intensive. Here, we show convolutional neural network models can accurately estimate VCDR and VDD for 282,100 images from both UK Biobank and an independent study (Canadian Longitudinal Study on Aging), enabling cross-ancestry epidemiological studies and new genetic discovery for these optic nerve head parameters. Using the AI approach, we perform a systematic comparison of the distribution of VCDR and VDD and compare these with intraocular pressure and glaucoma diagnoses across various genetically determined ancestries, which provides an explanation for the high rates of normal tension glaucoma in East Asia. We then used the large number of AI gradings to conduct a more powerful genome-wide association study (GWAS) of optic nerve head parameters. Using the AI-based gradings increased estimates of heritability by ∼50% for VCDR and VDD. Our GWAS identified more than 200 loci associated with both VCDR and VDD (double the number of loci from previous studies) and uncovered dozens of biological pathways; many of the loci we discovered also confer risk for glaucoma.

PMID:34077762 | DOI:10.1016/j.ajhg.2021.05.005