Tag: statistics

Int Urol Nephrol. 2022 Jul 23. doi: 10.1007/s11255-022-03299-x. Online ahead of print.

ABSTRACT

PURPOSE: Differentiating between diabetic kidney disease (DKD) and non-diabetic kidney disease (NDKD) in patients with Type 2 diabetes mellitus (T2DM) is important due to implications on treatment and prognosis. Clinical methods to accurately distinguish DKD from NDKD are lacking. We aimed to develop and validate a novel nomogram to predict DKD in patients with T2DM and proteinuric kidney disease to guide decision for kidney biopsy.

METHODS: A hundred and two patients with Type 2 Diabetes Mellitus (T2DM) who underwent kidney biopsy from 1st January 2007 to 31st December 2016 were analysed. Univariate and multivariate analyses were performed to identify predictive variables and construct a nomogram. The discriminative ability of the nomogram was assessed by calculating the area under the receiver operating characteristic curve (AUROC), while calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test and calibration plot. Internal validation of the nomogram was assessed using bootstrap resampling.

RESULTS: Duration of T2DM, HbA1c, absence of hematuria, presence of diabetic retinopathy and absence of positive systemic biomarkers were found to be independent predictors of DKD in multivariate analysis and were represented as a nomogram. The nomogram showed excellent discrimination, with a bootstrap-corrected C statistic of 0.886 (95% CI 0.815-0.956). Both the calibration curve and the Hosmer-Lemeshow goodness-of-fit test (p = 0.242) showed high degree of agreement between the prediction and actual outcome, with the bootstrap bias-corrected curve similarly indicating excellent calibration.

CONCLUSIONS: A novel nomogram incorporating 5 clinical parameters is useful in predicting DKD in type 2 diabetes mellitus patients with proteinuric kidney disease.

PMID:35870041 | DOI:10.1007/s11255-022-03299-x

Environ Monit Assess. 2022 Jul 23;194(9):609. doi: 10.1007/s10661-022-10248-9.

ABSTRACT

Failure Mode and Effects Analysis (FMEA) is one of the most used methods in risk assessment and prioritization. This study was conducted to identify, evaluate, prioritize, and analyze risks associated with the physical processes of Sahand municipal wastewater plant using traditional and fuzzy FMEA methods. The present research was a cross-sectional analytical study that was conducted to prioritize the risks of unit operations of screening and grit removal in Sahand municipal wastewater treatment plant for 6 months. First, a team of five experts was formed and the traditional FMEA worksheet was completed. Then, the fuzzy membership functions were determined according to experts’ opinions and using the MATLAB program, and the severity, occurrence, detection, and risk priority number (RPN) became fuzzy and risks were prioritized according to the fuzzy logic outputs. A total of 53 failure modes were identified for screening (26 failures) and grit removal units (27 failures) using the traditional FMEA risk assessment technique. The results of the traditional FMEA method showed that among the 53 identified failure modes, in physical treatment equipment of Sahand municipal wastewater, 51 failures (96.2%) were in the low-risk levels and two failures (3.8%) were in the medium-risk levels. According to the results of the fuzzy FMEA, 5 failures (9.4%) were in the low-risk levels, 43 failures (81.2%) were in the medium-risk levels, and 5 failures (9.4%) were in the high-risk levels. Based on the traditional FMEA, the highest and lowest level of risk belonged to manual screening clogging and conveyor cutting of mechanical screening with RPN of 540 and 12, respectively, whereas in the fuzzy FMEA, the highest and lowest level of risk were related to manual screening clogging and fracture of pump pipes with RPN of 894 and 105, respectively. The finding showed that risk assessment using fuzzy FMEA provides more accurate and better results than traditional FMEA. In the fuzzy FMEA, the involvement of the experts’ opinions in risk assessment and fuzzy models leads to more realistic results, as well as corrective action prioritization is better performed.

PMID:35870035 | DOI:10.1007/s10661-022-10248-9

Ann Intensive Care. 2022 Jul 23;12(1):70. doi: 10.1186/s13613-022-01046-0.

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) is a frequent complication in patients with severe respiratory failure receiving extracorporeal membrane oxygenation (ECMO). However, little is known of long-term kidney function in ECMO survivors. We aimed to assess the long-term mortality and kidney outcomes in adult patients treated with veno-venous ECMO (VV-ECMO).

METHODS: This was a single-centre retrospective study of adult patients (≥ 18 years old) who were treated with VV-ECMO at a commissioned ECMO centre in the UK between 1st September 2010, and 30th November 2016. AKI was defined and staged using the serum creatinine and urine output criteria of the Kidney Diseases: Improving Global Outcomes (KDIGO) classification. The primary outcome was 1-year mortality. Secondary outcomes were long-term mortality (up to March 2020), 1-year incidence of end-stage kidney disease (ESKD) or chronic kidney disease (CKD) among AKI patients who received renal replacement therapy (AKI-RRT), AKI patients who did not receive RRT (AKI-no RRT) and patients without AKI (non-AKI).

RESULTS: A total of 300 patients [57% male; median age 44.5; interquartile range (IQR) 34-54] were included in the final analysis. Past medical histories included diabetes (12%), hypertension (17%), and CKD (2.3%). The main cause of severe respiratory failure was pulmonary infection (72%). AKI occurred in 230 patients (76.7%) and 59.3% received renal replacement therapy (RRT). One-year mortality was 32% in AKI-RRT patients vs. 21.4% in non-AKI patients (p = 0.014). The median follow-up time was 4.35 years. Patients who received RRT had a higher risk of 1-year mortality than those who did not receive RRT (adjusted HR 1.80, 95% CI 1.06, 3.06; p = 0.029). ESKD occurred in 3 patients, all of whom were in the AKI-RRT group. At 1-year, 41.2% of survivors had serum creatinine results available. Among these, CKD was prevalent in 33.3% of AKI-RRT patients vs. 4.3% in non-AKI patients (p = 0.004).

CONCLUSIONS: VV-EMCO patients with AKI-RRT had high long-term mortality. Monitoring of kidney function after hospital discharge was poor. In patients with follow-up creatinine results available, the CKD prevalence was high at 1 year, especially in AKI-RRT patients. More awareness about this serious long-term complication and appropriate follow-up interventions are required.

PMID:35870022 | DOI:10.1186/s13613-022-01046-0

Clin Oral Investig. 2022 Jul 23. doi: 10.1007/s00784-022-04625-4. Online ahead of print.

ABSTRACT

OBJECTIVES: Resin-based materials are applied in every branch of dentistry. Due to their tendency to release substances in the oral environment, doubts have been raised about their actual safety. This review aims to provide a comprehensive analysis of the last decade literature regarding the concentrations of elutable substances released from dental resin-based materials in different type of solvents.

MATERIALS AND METHODS: All the literature published on dental journals between January 2010 and April 2022 was searched using international databases (PubMed, Scopus, Web of Science). Due to strict inclusion criteria, only 23 papers out of 877 were considered eligible. The concentration of eluted substances related to surface and volume of the sample was analyzed, considering data at 24 h as a reference. The total cumulative release was examined as well.

RESULTS: The most eluted substances were HEMA, TEGDMA, and BPA, while the less eluted were Bis-GMA and UDMA. Organic solvents caused significantly higher release of substances than water-based ones. A statistically significant inverse correlation between the release of molecules and their molecular mass was observed. A statistically significant positive correlation between the amount of released molecule and the specimen surface area was detected, as well as a weak positive correlation between the release and the specimen volume.

CONCLUSIONS: Type of solvent, molecular mass of eluates, and specimen surface and volume affect substances release from materials.

CLINICAL RELEVANCE: It could be advisable to rely on materials based on monomers with a reduced elution tendency for clinical procedures.

PMID:35870020 | DOI:10.1007/s00784-022-04625-4

Eur Arch Otorhinolaryngol. 2022 Jul 23. doi: 10.1007/s00405-022-07537-x. Online ahead of print.

ABSTRACT

PURPOSE: We aimed to clarify the clinical features of delayed-onset swelling around cochlear implants (CI), and to present our experience on how to avoid and address this problem.

METHODS: We performed a retrospective review of all CI cases at our institution between June 2001 and June 2020. Information on postoperative complications of swelling in the receiver area > 3 months after implantation were analyzed, and clinical data sheets were drawn.

RESULTS: Twenty-six of 1425 patients (1.82%) with an age at implantation ranging from 1 to 9 years experienced delayed-onset swelling around the implant. Swelling episodes occurred as early as 4 months, and as late as 178 months after implantation (median, 79.7 months). The predisposing factor in 12 cases was unclear, 7 cases were caused by trauma at the implantation site, 5 cases were without predisposing factors, and 2 cases were related to infection. We found the frequency of delayed-onset swelling after cochlear implantation with different incision was statistically insignificant (P = 0.423). Nineteen patients (73.1%) were cured after one treatment, and five patients (19.2%) relapsed. Follow-up examinations at least 18 months after surgery revealed that all patients experienced a complete recovery.

CONCLUSIONS: Delayed-onset swelling at the receiver site is a long term but not exactly uncommon complication after cochlear surgery and long-term follow-up is eagerly required. It can recur more than once, causing more complex treatment strategies in clinical practice. Conservative treatment first recommended, while needle aspiration should initially be considered in recurrent cases also when the effusion swelling is > 3 ml.

PMID:35870003 | DOI:10.1007/s00405-022-07537-x

Arch Gynecol Obstet. 2022 Jul 23. doi: 10.1007/s00404-022-06677-z. Online ahead of print.

ABSTRACT

OBJECTIVE: Excessive gestational weight gain (eGWG) is associated with adverse long-term maternal outcomes. Most lifestyle interventions that incorporate physical activity have been ineffective at reducing eGWG. The purpose of this study was to determine if sleep modified the relationships between physical activity change from the 2nd to 3rd trimester and the odds of excessive gestational weight gain (eGWG).

METHODS: This was a secondary data analysis of a prospective cohort study of pregnant birthing people with overweight or obesity (n = 105). We estimated physical activity energy expenditure (PAEE) in the 2nd and 3rd trimesters of pregnancy and sleep characteristics (i.e., sleep quality, daytime dysfunction, sleep efficiency, sleep duration) in the 2nd trimester of pregnancy with validated measures. We used regression models with sleep and PAEE change (increase/stable vs. decrease) interaction terms to examine the impact of sleep on PAEE change and eGWG.

RESULTS: Mean GWG was 37.02 ± 16.76 lbs. and 80% of participants experienced eGWG. Eighteen percent of participants increased their PAEE from the 2nd to the 3rd trimester. Increasing (vs. decreasing) PAEE was associated with lower log-odds of eGWG only among participants that slept at least 8 h/night (p = 0.06), had at least 85% sleep efficiency (p = 0.03), or reported less daytime dysfunction (p = 0.08). Sleep quality did not moderate the association between PAEE change and eGWG.

CONCLUSIONS: Weight management interventions in pregnancy should consider screening for and addressing poor sleep in the second trimester.

PMID:35870008 | DOI:10.1007/s00404-022-06677-z

Surg Radiol Anat. 2022 Jul 23. doi: 10.1007/s00276-022-02992-x. Online ahead of print.

ABSTRACT

BACKGROUND: Recent studies have described the finding of the Arc of Riolan (AoR) crossing the inferior mesenteric vein (IMV) seen during high ligation of IMV while performing minimally invasive colectomies. However, the AoR usually has a medial course, and this variant AoR anatomic course and the clinical importance of its preservation during splenic flexure takedown in anterior resection remains controversial.

METHODS: After institutional approval (QA-5775), radiological identification of and mapping of the vessel horizontally crossing the IMV under the pancreas, when present, was performed at a single institution (Westmead Hospital, New South Wales, Australia). One hundred consecutive computed tomographic (CT) mesenteric angiograms conducted in 2018 were reviewed retrospectively to determine the presence of a vessel horizontally crossing the IMV. 3D reconstructions were used to map out its course to understand its origin and full course. Baseline characteristics, including demographic and comorbidity data, were obtained from the medical record.

RESULTS: On 3D mesenteric angiogram reconstructions, a vessel crossing anterior to the IMV was present in 11 of 98 cases (11.2%). Two cases were excluded as the presence of this vessel was indeterminate. Eight of 11 patients (72.7%) were male, and the mean age was 49.3 years (range: 21-80 years). There was no statistically significant difference in age and comorbidities between the groups. Importantly, in all 11 cases, there was an arterial vessel crossing the IMV originating from the SMA and communicating with the IMA or a branch of the IMA, proving definitively that this vessel was by definition the AoR.

CONCLUSION: This 3D mesenteric angiogram mapping study has shown definitively that the vessel horizontally crossing anterior to the IMV and inferior to the pancreas is an arterial vessel from the SMA to IMA, and by definition the Arc of Riolan. When present, identification and preservation of this collateral arterial vessel during splenic flexure takedown in anterior resection may be important in reducing the risk of post-operative bowel ischaemia.

PMID:35870000 | DOI:10.1007/s00276-022-02992-x

Graefes Arch Clin Exp Ophthalmol. 2022 Jul 23. doi: 10.1007/s00417-022-05774-8. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to compare the results of vitrectomy performed in patients’ worse eyes with diabetic macular edema to the results of continuous anti-VEGF treatment performed in patients’ fellow eyes.

METHODS: A retrospective interventional study of 14 patients with diabetic macular edema in both eyes. The better eye was always qualified for aflibercept injections (group 1), and the worse eye was scheduled for vitrectomy (group 2). The follow-up lasted 12 months. The following parameters were measured: visual acuity (V), central retinal thickness (CRT), maximum retinal thickness (MRT), central choroidal thickness (CCT), superficial fovea avascular zone (sFAZ) and deep fovea avascular zone (dFAZ), and vessel density at the level of superficial (sVD) and deep (dVD) retinal vessels.

RESULTS: None of the analyzed factors differed between groups with statistical significance at any timepoint. The time of recovery of vision was identical in both eyes (F = 0.91, p = 0.449). The final sFAZ was significantly smaller for group 2 (median 196 μm) than for group 1 (median 375 μm; U = 101.0; p = 0.022; r = 0.44).

CONCLUSION: Both techniques resulted in similar improvements in visual acuity and decreases in CRT after 1 year. sFAZ decreased in all eyes, with a higher extent after vitrectomy.

PMID:35869998 | DOI:10.1007/s00417-022-05774-8

Rheumatol Int. 2022 Jul 23. doi: 10.1007/s00296-022-05168-3. Online ahead of print.

ABSTRACT

Despite many approaches, diagnosis of fibromyalgia (FM) remains a difficult clinical task, especially in the case of comorbidity of FM with other rheumatic diseases, such as ankylosing spondylitis (AS). The prevalence of FM among the population is 2.9-4.7%; whereas in patients with AS, it increases to 12.6-28.5%. The aim of the study was to evaluate the prevalence of FM in AS patients according to different criteria and to characterize them. 143 patients with AS, according to the modified New York Criteria, were examined. The FiRST used for screening of a possible FM. The FM was detected using the ACR 1990 criteria, mARC 2010, ACR 2016 and AAPT 2019 diagnostic criteria. All data were analyzed using IBM Statistics SPSS 22 software. The study was carried out in compliance with bioethical standards. According to ACR 1990, mACR 2010, ACR 2016, and AAPT 2019, the prevalence of FM in patients with AS ranged from 21.0% to 35.7%. The strongest correlation was observed in the mACR 2010 and ACR 2016 criteria (Cohen’s κ = 0.871, p < 0.001); ACR 1990 and mACR 2010 as well as ACR 2016 criteria also demonstrated quite a strong level of agreement (Cohen’s κ = 0.675 and 0.684, p < 0.001). Our results showed a high prevalence of FM in AS patients. mACR 2010 and ACR 2016 criteria are optimal for clinical practice to diagnose FM in AS patients.

PMID:35869993 | DOI:10.1007/s00296-022-05168-3

Psychopharmacology (Berl). 2022 Jul 23. doi: 10.1007/s00213-022-06172-y. Online ahead of print.

ABSTRACT

RATIONALE: Oral tobacco-derived nicotine products include on!® nicotine pouches (NPs) which are tobacco-leaf free and available in multiple flavors and nicotine levels. Switching completely to NPs from cigarettes and moist smokeless tobacco (MST) has the potential to reduce harm for adult tobacco consumers. However, the dependence potential of NPs is not established. Therefore, we characterized the abuse potential of NPs with different nicotine levels compared to cigarettes and MST.

OBJECTIVES: To evaluate nicotine pharmacokinetics (PK) and subjective effects of NPs (ranging from 1.5 to 8 mg nicotine) compared to own brand cigarettes (OBCs) and MST (OBMST).

METHODS: We used a randomized, in-clinic, partial single-blind, 7-way crossover design to assess nicotine PK and subjective effects in dual users of cigarettes and MST.

RESULTS: The mean nicotine C_max for NPs increased with nicotine level, ranging from 3.5 ng/mL (1.5 mg NP) to 15.4 ng/mL (8 mg NP), compared with 12.2 ng/mL for OBCs and 9.8 ng/mL for OBMST. Nicotine t_max was much longer for all NPs and OBMST (32.5-34.4 min) compared to OBCs (8.5 min). Reductions in urges to smoke after use of the 2 mg, 3.5 mg, and 8 mg NPs were not statistically different (p > 0.05) relative to OBC. Also, NPs resulted in lower ratings of positive subjective effects relative to OBCs and OBMST.

CONCLUSIONS: Overall, based on the study results and literature reported nicotine PK values for cigarettes and MST, the abuse potential of NPs is not likely to be higher than OBCs and OBMST. NPs may be potentially acceptable switching products for users of cigarettes and MST products.

PMID:35869988 | DOI:10.1007/s00213-022-06172-y