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Rikken QGH, Aalders MB, Dahmen J, Sierevelt IN, Stufkens SAS, Kerkhoffs GMMJ. Ten-Year Survival Rate of 82% in 262 Cases of Arthroscopic Bone Marrow Stimulation for Osteochondral Lesions of the Talus. J Bone Joint Surg Am 2024:00004623-990000000-01097. [PMID: 38728384 DOI: 10.2106/jbjs.23.01186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND The long-term sustainability of arthroscopic bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLT) remains a matter of debate. The primary aim of the present study was to assess the 10-year survival free from revision in ankles that had undergone arthroscopic BMS for an OLT. The secondary aim was to evaluate the influence of baseline patient and lesion characteristics on survival. METHODS Patients who underwent arthroscopic BMS for a symptomatic OLT and had a minimum follow-up of 10 years were included to assess procedure survival. The primary outcome, the 10-year cumulative survival rate, was analyzed by the Kaplan-Meier survival method. Secondary outcomes were the median time to revision and the effects of baseline factors (lesion size, primary or non-primary lesion type, preoperative cysts, and obesity as defined by a body mass index [BMI] of ≥30 kg/m2) on survival, analyzed with a Cox regression model and reported using hazard ratios (HRs). RESULTS The 262 included patients had a mean follow-up of 15.3 ± 4.8 years. The 10-year cumulative survival rate of the arthroscopic BMS procedures was 82% (95% confidence interval [CI]: 77% to 87%). At 15 years of follow-up, the cumulative survival rate was 82% (95% CI: 76% to 86%). The median time to revision was 2.4 years (interquartile range: 1.3 to 5.1 years). Of the baseline factors, obesity (HR: 3.0 [95% CI: 1.44 to 6.43], p < 0.01) was associated with decreased survival. Lesion size (HR: 0.9 [95% CI: 0.5 to 1.8], p = 0.8), non-primary lesion type (HR: 1.8 [95% CI: 0.9 to 3.4], p = 0.1), and the presence of preoperative cysts (HR: 1.0 [95% CI: 0.6 to 1.9], p = 0.9) were not significantly associated with survival. CONCLUSIONS At a minimum follow-up of 10 years, the survival rate of arthroscopic BMS for OLT was 82%. At 15 and 20 years of follow-up, survival appeared to remain stable. Obesity (BMI ≥ 30 kg/m2) was associated with a higher likelihood of revision surgery. This risk factor should be incorporated into the treatment algorithm for OLT when counseling patients regarding surgery. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Quinten G H Rikken
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Sports and Musculoskeletal Health Programs, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Margot B Aalders
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Sports and Musculoskeletal Health Programs, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Sports and Musculoskeletal Health Programs, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Inger N Sierevelt
- Orthopedic Department, Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | - Sjoerd A S Stufkens
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Sports and Musculoskeletal Health Programs, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Sports and Musculoskeletal Health Programs, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
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Nishioka N, Yamada T, Nakao S, Yoshiya K, Park C, Nishimura T, Ishibe T, Yamakawa K, Kiguchi T, Kishimoto M, Ninomiya K, Ito Y, Sogabe T, Morooka T, Sakamoto H, Hironaka Y, Onoe A, Matsuyama T, Okada Y, Matsui S, Yoshimura S, Kimata S, Kawai S, Makino Y, Zha L, Kiyohara K, Kitamura T, Iwami T. External Validation of Updated Prediction Models for Neurological Outcomes at 90 Days in Patients With Out-of-Hospital Cardiac Arrest. J Am Heart Assoc 2024; 13:e033824. [PMID: 38700024 DOI: 10.1161/jaha.123.033824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/04/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Few prediction models for individuals with early-stage out-of-hospital cardiac arrest (OHCA) have undergone external validation. This study aimed to externally validate updated prediction models for OHCA outcomes using a large nationwide dataset. METHODS AND RESULTS We performed a secondary analysis of the JAAM-OHCA (Comprehensive Registry of In-Hospital Intensive Care for Out-of-Hospital Cardiac Arrest Survival and the Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest) registry. Previously developed prediction models for patients with cardiac arrest who achieved the return of spontaneous circulation were updated. External validation was conducted using data from 56 institutions from the JAAM-OHCA registry. The primary outcome was a dichotomized 90-day cerebral performance category score. Two models were updated using the derivation set (n=3337). Model 1 included patient demographics, prehospital information, and the initial rhythm upon hospital admission; Model 2 included information obtained in the hospital immediately after the return of spontaneous circulation. In the validation set (n=4250), Models 1 and 2 exhibited a C-statistic of 0.945 (95% CI, 0.935-0.955) and 0.958 (95% CI, 0.951-0.960), respectively. Both models were well-calibrated to the observed outcomes. The decision curve analysis showed that Model 2 demonstrated higher net benefits at all risk thresholds than Model 1. A web-based calculator was developed to estimate the probability of poor outcomes (https://pcas-prediction.shinyapps.io/90d_lasso/). CONCLUSIONS The updated models offer valuable information to medical professionals in the prediction of long-term neurological outcomes for patients with OHCA, potentially playing a vital role in clinical decision-making processes.
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Affiliation(s)
- Norihiro Nishioka
- Department of Preventive Services Kyoto University School of Public Health Kyoto Japan
| | - Tomoki Yamada
- Emergency and Critical Care Medical Center Osaka Police Hospital Osaka Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Kazuhisa Yoshiya
- Department of Emergency and Critical Care Medicine Kansai Medical University, Takii Hospital Moriguchi Japan
| | - Changhwi Park
- Department of Emergency Medicine Tane General Hospital Osaka Japan
| | - Tetsuro Nishimura
- Department of Traumatology and Critical Care Medicine Osaka Metropolitan University Osaka Japan
| | - Takuya Ishibe
- Department of Emergency and Critical Care Medicine Kindai University School of Medicine Osaka-Sayama Japan
| | - Kazuma Yamakawa
- Department of Emergency and Critical Care Medicine Osaka Medical and Pharmaceutical University Takatsuki Japan
| | - Takeyuki Kiguchi
- Critical Care and Trauma Center Osaka General Medical Center Osaka Japan
| | - Masafumi Kishimoto
- Osaka Prefectural Nakakawachi Medical Center of Acute Medicine Higashi-Osaka Japan
| | | | - Yusuke Ito
- Senri Critical Care Medical Center Saiseikai Senri Hospital Suita Japan
| | - Taku Sogabe
- Traumatology and Critical Care Medical Center National Hospital Organization Osaka National Hospital Osaka Japan
| | - Takaya Morooka
- Emergency and Critical Care Medical Center Osaka City General Hospital Osaka Japan
| | - Haruko Sakamoto
- Department of Pediatrics Osaka Red Cross Hospital Osaka Japan
| | - Yuki Hironaka
- Emergency and Critical Care Medical Center Kishiwada Tokushukai Hospital Osaka Japan
| | - Atsunori Onoe
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine Kyoto Prefectural University of Medicine Kyoto Japan
| | - Yohei Okada
- Department of Preventive Services Kyoto University School of Public Health Kyoto Japan
- Health Services and Systems Research Duke-NUS Medical School Singapore
| | - Satoshi Matsui
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine Osaka University Osaka Japan
| | - Satoshi Yoshimura
- Department of Preventive Services Kyoto University School of Public Health Kyoto Japan
| | - Shunsuke Kimata
- Department of Preventive Services Kyoto University School of Public Health Kyoto Japan
| | - Shunsuke Kawai
- Department of Preventive Services Kyoto University School of Public Health Kyoto Japan
| | - Yuto Makino
- Department of Preventive Services Kyoto University School of Public Health Kyoto Japan
| | - Ling Zha
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine Osaka University Osaka Japan
| | - Kosuke Kiyohara
- Department of Food Science Otsuma Women's University Tokyo Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine Osaka University Osaka Japan
| | - Taku Iwami
- Department of Preventive Services Kyoto University School of Public Health Kyoto Japan
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Vornholt E, Liharska LE, Cheng E, Hashemi A, Park YJ, Ziafat K, Wilkins L, Silk H, Linares LM, Thompson RC, Sullivan B, Moya E, Nadkarni GN, Sebra R, Schadt EE, Kopell BH, Charney AW, Beckmann ND. Characterizing cell type specific transcriptional differences between the living and postmortem human brain. medRxiv 2024:2024.05.01.24306590. [PMID: 38746297 PMCID: PMC11092720 DOI: 10.1101/2024.05.01.24306590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Single-nucleus RNA sequencing (snRNA-seq) is often used to define gene expression patterns characteristic of brain cell types as well as to identify cell type specific gene expression signatures of neurological and mental illnesses in postmortem human brains. As methods to obtain brain tissue from living individuals emerge, it is essential to characterize gene expression differences associated with tissue originating from either living or postmortem subjects using snRNA-seq, and to assess whether and how such differences may impact snRNA-seq studies of brain tissue. To address this, human prefrontal cortex single nuclei gene expression was generated and compared between 31 samples from living individuals and 21 postmortem samples. The same cell types were consistently identified in living and postmortem nuclei, though for each cell type, a large proportion of genes were differentially expressed between samples from postmortem and living individuals. Notably, estimation of cell type proportions by cell type deconvolution of pseudo-bulk data was found to be more accurate in samples from living individuals. To allow for future integration of living and postmortem brain gene expression, a model was developed that quantifies from gene expression data the probability a human brain tissue sample was obtained postmortem. These probabilities are established as a means to statistically account for the gene expression differences between samples from living and postmortem individuals. Together, the results presented here provide a deep characterization of both differences between snRNA-seq derived from samples from living and postmortem individuals, as well as qualify and account for their effect on common analyses performed on this type of data.
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Bengtson AM, Dice ALE, Clark MA, Gutman R, Rouse D, Werner E. Predicting Progression from Gestational Diabetes to Impaired Glucose Tolerance Using Peridelivery Data: An Observational Study. Am J Perinatol 2024; 41:e282-e289. [PMID: 35709723 DOI: 10.1055/a-1877-9587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This article aimed to develop a predictive model to identify persons with recent gestational diabetes mellitus (GDM) most likely to progress to impaired glucose tolerance postpartum. STUDY DESIGN We conducted an observational study among persons with GDM in their most recent pregnancy, defined by Carpenter-Coustan criteria. Participants were followed up from delivery through 1-year postpartum. We used lasso regression with k-fold cross validation to develop a multivariable model to predict progression to impaired glucose tolerance, defined as HbA1c≥5.7%, at 1-year postpartum. Predictive ability was assessed by the area under the curve (AUC), sensitivity, specificity, and positive and negative predictive values (PPV and NPV). RESULTS Of 203 participants, 71 (35%) had impaired glucose tolerance at 1-year postpartum. The final model had an AUC of 0.79 (95% confidence interval [CI]: 0.72, 0.85) and included eight indicators of weight, body mass index, family history of type 2 diabetes, GDM in a prior pregnancy, GDM diagnosis<24 weeks' gestation, and fasting and 2-hour plasma glucose at 2 days postpartum. A cutoff point of ≥ 0.25 predicted probability had sensitivity of 80% (95% CI: 69, 89), specificity of 58% (95% CI: 49, 67), PPV of 51% (95% CI: 41, 61), and NPV of 85% (95% CI: 76, 91) to identify women with impaired glucose tolerance at 1-year postpartum. CONCLUSION Our predictive model had reasonable ability to predict impaired glucose tolerance around delivery for persons with recent GDM. KEY POINTS · We developed a predictive model to identify persons with GDM most likely to develop IGT postpartum.. · The final model had an AUC of 0.79 (95% CI: 0.72, 0.85) and included eight clinical indicators.. · If validated, our model could help prioritize diabetes prevention efforts among persons with GDM..
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Affiliation(s)
- Angela M Bengtson
- Department of Epidemiology, Brown School of Public Health, Providence, Rhode Island
| | | | - Melissa A Clark
- Department of Health Services, Policy and Practice; Brown School of Public Health, Providence, Rhode Island
- Department of Obstetrics and Gynecology, Women and Infants Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Roee Gutman
- Department of Biostatistics, Brown School of Public Health, Providence, Rhode Island
| | - Dwight Rouse
- Department of Epidemiology, Brown School of Public Health, Providence, Rhode Island
- Department of Obstetrics and Gynecology, Women and Infants Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Erika Werner
- Department of Epidemiology, Brown School of Public Health, Providence, Rhode Island
- Department of Obstetrics and Gynecology, Women and Infants Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Arunpongpaisal S, Assanangkornchai S, Chongsuvivatwong V. Developing a risk prediction model for death at first suicide attempt-Identifying risk factors from Thailand's national suicide surveillance system data. PLoS One 2024; 19:e0297904. [PMID: 38598456 PMCID: PMC11006158 DOI: 10.1371/journal.pone.0297904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/15/2024] [Indexed: 04/12/2024] Open
Abstract
More than 60% of suicides globally are estimated to take place in low- and middle-income nations. Prior research on suicide has indicated that over 50% of those who die by suicide do so on their first attempt. Nevertheless, there is a dearth of knowledge on the attributes of individuals who die on their first attempt and the factors that can predict mortality on the first attempt in these regions. The objective of this study was to create an individual-level risk-prediction model for mortality on the first suicide attempt. We analyzed records of individuals' first suicide attempts that occurred between May 1, 2017, and April 30, 2018, from the national suicide surveillance system, which includes all of the provinces of Thailand. Subsequently, a risk-prediction model for mortality on the first suicide attempt was constructed utilizing multivariable logistic regression and presented through a web-based application. The model's performance was assessed by calculating the area under the receiver operating curve (AUC), as well as measuring its sensitivity, specificity, and accuracy. Out of the 3,324 individuals who made their first suicide attempt, 50.5% of them died as a result of that effort. Nine out of the 21 potential predictors demonstrated the greatest predictive capability. These included male sex, age over 50 years old, unemployment, having a depressive disorder, having a psychotic illness, experiencing interpersonal problems such as being aggressively criticized or desiring plentiful attention, having suicidal intent, and displaying suicidal warning signals. The model demonstrated a good predictive capability, with an AUC of 0.902, a sensitivity of 84.65%, a specificity of 82.66%, and an accuracy of 83.63%. The implementation of this predictive model can assist physicians in conducting comprehensive evaluations of suicide risk in clinical settings and devising treatment plans for preventive intervention.
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Affiliation(s)
- Suwanna Arunpongpaisal
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
- Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sawitri Assanangkornchai
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Virasakdi Chongsuvivatwong
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Reusing JO, Agena F, Kotton CN, Campana G, Pierrotti LC, David-Neto E. QuantiFERON-CMV as a Predictor of CMV Events During Preemptive Therapy in CMV-seropositive Kidney Transplant Recipients. Transplantation 2024; 108:985-995. [PMID: 37990351 DOI: 10.1097/tp.0000000000004870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND Prevention of cytomegalovirus (CMV) infection after kidney transplantation is costly and burdensome. METHODS Given its promising utility in risk stratification, we evaluated the use of QuantiFERON-CMV (QFCMV) and additional clinical variables in this prospective cohort study to predict the first clinically significant CMV infection (CS-CMV, ranging from asymptomatic viremia requiring treatment to CMV disease) in the first posttransplant year. A cost-effectiveness analysis for guided prevention was done. RESULTS One hundred adult kidney transplant recipients, CMV IgG + , were given basiliximab induction and maintained on steroid/mycophenolate/tacrolimus with weekly CMV monitoring. Thirty-nine patients developed CS-CMV infection (viral syndrome, n = 1; end-organ disease, n = 9; and asymptomatic viremia, n = 29). A nonreactive or indeterminate QFCMV result using the standard threshold around day 30 (but not before transplant) was associated with CS-CMV rates of 50% and 75%, respectively. A higher QFCMV threshold for reactivity (>1.0 IU interferon-γ/mL) outperformed the manufacturer's standard (>0.2 IU interferon-γ/mL) in predicting protection but still allowed a 16% incidence of CS-CMV. The combination of recipient age and type of donor, along with posttransplant QFCMV resulted in a prediction model that increased the negative predictive value from 84% (QFCMV alone) to 93%. QFCMV-guided preemptive therapy was of lower cost than preemptive therapy alone ( P < 0.001, probabilistic sensitivity analysis) and was cost-effective (incremental net monetary benefit of 210 USD) assuming willingness-to-pay of 2000 USD to avoid 1 CMV disease. CONCLUSIONS Guided CMV prevention by the prediction model with QFCMV is cost-effective and would spare from CMV surveillance in 42% of patients with low risk for CS-CMV.
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Affiliation(s)
- José O Reusing
- Renal Transplant Service, Instituto Central, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fabiana Agena
- Renal Transplant Service, Instituto Central, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Camille N Kotton
- Immunocompromised Host Infectious Diseases, Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Ligia Camera Pierrotti
- Medical Director Department, Dasa, Barueri, Brazil
- Division of Infectious Disease, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
| | - Elias David-Neto
- Renal Transplant Service, Instituto Central, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Wang D, Niu Y, Chen D, Li C, Liu F, Feng Z, Cao X, Zhang L, Cai G, Chen X, Li P. Acute kidney injury in hospitalized patients with nonmalignant pleural effusions: a retrospective cohort study. BMC Nephrol 2024; 25:118. [PMID: 38556867 PMCID: PMC10983765 DOI: 10.1186/s12882-024-03556-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/21/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Nonmalignant pleural effusion (NMPE) is common and remains a definite health care problem. Pleural effusion was supposed to be a risk factor for acute kidney injury (AKI). Incidence of AKI in NMPE patients and whether there is correlation between the size of effusions and AKI is unknown. OBJECTIVE To assess the incidence of AKI in NMPE inpatients and its association with effusion size. STUDY DESIGN AND METHOD We conducted a retrospective cohort study of inpatients admitted to the Chinese PLA General Hospital with pleural effusion from 2018-2021. All patients with pleural effusions confirmed by chest radiography (CT or X-ray) were included, excluding patients with diagnosis of malignancy, chronic dialysis, end-stage renal disease (ESRD), community-acquired AKI, hospital-acquired AKI before chest radiography, and fewer than two serum creatinine tests during hospitalization. Multivariate logistic regression and LASSO logistic regression models were used to identify risk factors associated with AKI. Subgroup analyses and interaction tests for effusion volume were performed adjusted for the variables selected by LASSO. Causal mediation analysis was used to estimate the mediating effect of heart failure, pneumonia, and eGFR < 60 ml/min/1.73m2 on AKI through effusion volume. RESULTS NMPE was present in 7.8% of internal medicine inpatients. Of the 3047 patients included, 360 (11.8%) developed AKI during hospitalization. After adjustment by covariates selected by LASSO, moderate and large effusions increased the risk of AKI compared with small effusions (moderate: OR 1.47, 95%CI 1.11-1.94 p = 0.006; large: OR 1.86, 95%CI 1.05-3.20 p = 0.028). No significant modification effect was observed among age, gender, diabetes, bilateral effusions, and eGFR. Volume of effusions mediated 6.8% (p = 0.005), 4.0% (p = 0.046) and 4.6% (p < 0.001) of the effect of heart failure, pneumonia and low eGFR on the development of AKI respectively. CONCLUSION The incidence of AKI is high among NMPE patients. Moderate and large effusion volume is independently associated with AKI compared to small size. The effusion size acts as a mediator in heart failure, pneumonia, and eGFR.
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Affiliation(s)
- Danni Wang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, 100853, China
| | - Yue Niu
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, 100853, China
| | - Dinghua Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, 100853, China
| | - Chaofan Li
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, 100853, China
| | - Fei Liu
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, 100853, China
- Department of Urology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhe Feng
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, 100853, China
| | - Xueying Cao
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, 100853, China
| | - Li Zhang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, 100853, China
| | - Guangyan Cai
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, 100853, China
| | - Xiangmei Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, 100853, China
| | - Ping Li
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, 100853, China.
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Ajmera Y, Paul K, Khan MA, Kumari B, Kumar N, Chatterjee P, Dey AB, Chakrawarty A. The evaluation of frequency and predictors of delirium and its short-term and long-term outcomes in hospitalized older adults'. Asian J Psychiatr 2024; 94:103990. [PMID: 38447233 DOI: 10.1016/j.ajp.2024.103990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/25/2024] [Accepted: 02/28/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Delirium is a common complication in hospitalized older adults with multifactorial etiology and poor health outcomes. AIM To determine the frequency and predictors of delirium and its short-term and long-term outcomes in hospitalized older adults. METHODS A prospective observational study was performed in patients aged ≥60 years consecutively admitted to geriatric ward. Potential risk factors were assessed within 24 hours of hospital admission. Delirium screening was performed on admission and daily thereafter throughout the hospital stay using Confusion Assessment Method (CAM). Patients were followed up at 1-year post-discharge. RESULTS The study included 200 patients with mean age 73.1 ± 8.83 years. Incidence and prevalence rate of delirium were 5% and 20% respectively. Multivariable regression analysis revealed emergency admission (OR= 5.12 (1.94-13.57), p=0.001), functional dependency (Katz index of Independence in Activities of Daily Living (Katz-ADL) score <5) 2 weeks before admission (OR= 3.08 (1.30-7.33), p=0.011) and more psychopathological symptoms (higher Brief Psychiatric Rating Scale (BPRS) total score) (OR=1.12 (1.06-1.18), p=0.001) to be independently associated with delirium. Patients in delirium group had significantly high in-hospital mortality (OR= 5.02 (2.12-11.8), p=0.001) and post-discharge mortality (HR= 2.02 (1.13-3.61), p=0.017) and functional dependency (Katz-ADL score <5) (OR= 5.45 (1.49-19.31), p=0.01) at 1-year follow up. CONCLUSION Delirium is quite frequent in geriatric inpatients and is associated with high in-hospital and post-discharge mortality risk and long-term functional dependency. Emergency admission, pre-hospitalization functional dependency, and more general psychopathological symptoms are independently associated factors. Hence, earliest identification and treatment with early implementation of rehabilitation services is warranted.
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Affiliation(s)
- Yamini Ajmera
- Department of Geriatric Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Karandeep Paul
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Maroof Ahmad Khan
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Bharti Kumari
- Department of Geriatric Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Prasun Chatterjee
- Department of Geriatric Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Aparajit Ballav Dey
- Department of Geriatric Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Avinash Chakrawarty
- Department of Geriatric Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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Murakami T, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Hatori M, Tamanaha Y, Kasahara T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Development of a simple prediction model for mechanical complication in ST-segment elevation myocardial infarction patients after primary percutaneous coronary intervention. Heart Vessels 2024; 39:288-298. [PMID: 38008806 DOI: 10.1007/s00380-023-02336-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/01/2023] [Indexed: 11/28/2023]
Abstract
Mechanical complication (MC) is a rare but serious complication in patients with ST-segment elevation myocardial infarction (STEMI). Although several risk factors for MC have been reported, a prediction model for MC has not been established. This study aimed to develop a simple prediction model for MC after STEMI. We included 1717 patients with STEMI who underwent primary percutaneous coronary intervention (PCI). Of 1717 patients, 45 MCs occurred after primary PCI. Prespecified predictors were determined to develop a tentative prediction model for MC using multivariable regression analysis. Then, a simple prediction model for MC was generated. Age ≥ 70, Killip class ≥ 2, white blood cell ≥ 10,000/µl, and onset-to-visit time ≥ 8 h were included in a simple prediction model as "point 1" risk score, whereas initial thrombolysis in myocardial infarction (TIMI) flow grade ≤ 1 and final TIMI flow grade ≤ 2 were included as "point 2" risk score. The simple prediction model for MC showed good discrimination with the optimism-corrected area under the receiver-operating characteristic curve of 0.850 (95% CI: 0.798-0.902). The predicted probability for MC was 0-2% in patients with 0-4 points of risk score, whereas that was 6-50% in patients with 5-8 points. In conclusion, we developed a simple prediction model for MC. We may be able to predict the probability for MC by this simple prediction model.
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Affiliation(s)
- Tsukasa Murakami
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan.
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Masashi Hatori
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Yusuke Tamanaha
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Taku Kasahara
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
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Zhang H, Luo JQ, Zhao GD, Huang Y, Yang SC, Chen PS, Li J, Wu CL, Qiu J, Chen XT, Huang G. Concurrent JCPyV-DNAemia Is Correlated With Poor Graft Outcome in Kidney Transplant Recipients with Polyomavirus-associated Nephropathy. Transplantation 2024:00007890-990000000-00696. [PMID: 38499506 DOI: 10.1097/tp.0000000000004995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Co-infection of JC polyomavirus (JCPyV) and BK polyomavirus (BKPyV) is uncommon in kidney transplant recipients, and the prognosis is unclear. This study aimed to investigate the effect of concurrent JCPyV-DNAemia on graft outcomes in BKPyV-infected kidney transplant recipients with polyomavirus-associated nephropathy (PyVAN). METHODS A total of 140 kidney transplant recipients with BKPyV replication and PyVAN, 122 without concurrent JCPyV-DNAemia and 18 with JCPyV-DNAemia were included in the analysis. Least absolute shrinkage and selection operator regression analysis and multivariate Cox regression analysis were used to identify prognostic factors for graft survival. A nomogram for predicting graft survival was created and evaluated. RESULTS The median tubulitis score in the JCPyV-DNAemia-positive group was higher than in JCPyV-DNAemia-negative group (P = 0.048). At last follow-up, the graft loss rate in the JCPyV-DNAemia-positive group was higher than in the JCPyV-DNAemia-negative group (50% versus 25.4%; P = 0.031). Kaplan-Meier analysis showed that the graft survival rate in the JCPyV-DNAemia-positive group was lower than in the JCPyV-DNAemia-negative group (P = 0.003). Least absolute shrinkage and selection operator regression and multivariate Cox regression analysis demonstrated that concurrent JCPyV-DNAemia was an independent risk factor for graft survival (hazard ratio = 4.808; 95% confidence interval: 2.096-11.03; P < 0.001). The nomogram displayed favorable discrimination (C-index = 0.839), concordance, and clinical applicability in predicting graft survival. CONCLUSIONS Concurrent JCPyV-DNAemia is associated with a worse graft outcome in BKPyV-infected kidney transplant recipients with PyVAN.
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Affiliation(s)
- Hui Zhang
- Organ Transplant Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Jin-Quan Luo
- Organ Transplant Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Guo-Dong Zhao
- Organ Transplant Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Yang Huang
- Organ Transplant Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Shi-Cong Yang
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
- Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Pei-Song Chen
- Department of Clinical Laboratory, Department of Laboratory Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Li
- Organ Transplant Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Cheng-Lin Wu
- Organ Transplant Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Jiang Qiu
- Organ Transplant Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Xu-Tao Chen
- Organ Transplant Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Gang Huang
- Organ Transplant Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
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Yang JJ, Liang Y, Wang XH, Long WY, Wei ZG, Lu LQ, Li W, Shao X. Prediction of vascular complications in free flap reconstruction with machine learning. Am J Transl Res 2024; 16:817-828. [PMID: 38586098 PMCID: PMC10994789 DOI: 10.62347/zxjv8062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 03/06/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE This study aims to explore the risk factors of vascular complications following free flap reconstruction and to develop a clinical auxiliary assessment tool for predicting vascular complications in patients undergoing free flap reconstruction leveraging machine learning methods. METHODS We reviewed the medical data of patients who underwent free flap reconstruction at the Affiliated Hospital of Zunyi Medical University retrospectively from January 1, 2019, to December 31, 2021. Statistical analysis was used to screen risk factors. A training data set was generated and augmented using the synthetic minority oversampling technique. Logistic regression, random forest and neural network, models were trained, using this dataset. The performance of these three predictive models was then evaluated and compared using a test set, with four metrics, area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity. RESULTS A total of 570 patients who underwent free flap reconstruction were included in this study, 46 of whom developed postoperative vascular complications. Among the models tested, the neural network model exhibited superior performance on the test set, achieving an AUC of 0.828. Multivariate logistic regression analysis identified that preoperative hemoglobin levels, preoperative fibrinogen levels, operation duration, smoking history, the number of anastomoses, and peripheral vascular injury as statistically significant independent risk factors for vascular complications post-free flap reconstruction. The top five predictive factors in the neural network were fibrinogen content, operation duration, donor site, body mass index (BMI), and platelet count. CONCLUSION Hemoglobin levels, fibrinogen levels, operation duration, smoking history, and anastomotic veins are independent risk factors for vascular complications following free flap reconstruction. These risk factors enhance the ability of machine learning models to predict the occurrence of vascular complications and identify high-risk patients. The neural network model outperformed the logistic regression and random forest models, suggesting its potential to aid clinicians in early identification of high-risk patients thereby mitigating patient suffering and improving prognosis.
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Affiliation(s)
- Ji-Jin Yang
- Nursing Department, Affiliated Hospital of Zunyi Medical UniversityZunyi, Guizhou, China
- School of Nursing, Zunyi Medical UniversityZunyi 563000, Guizhou, China
| | - Yan Liang
- School of Nursing, Zunyi Medical UniversityZunyi 563000, Guizhou, China
| | - Xiao-Hua Wang
- Nursing Department, Affiliated Hospital of Zunyi Medical UniversityZunyi, Guizhou, China
- Information Department of Affiliated Hospital of Zunyi Medical UniversityZunyi, Guizhou, China
- School of Medical Informatics and Engineering, Zunyi Medical UniversityZunyi, Guizhou, China
| | - Wen-Yan Long
- School of Nursing, Zunyi Medical UniversityZunyi 563000, Guizhou, China
| | - Zhen-Gang Wei
- School of Nursing, Zunyi Medical UniversityZunyi 563000, Guizhou, China
| | - Li-Qin Lu
- School of Nursing, Zunyi Medical UniversityZunyi 563000, Guizhou, China
| | - Wen Li
- School of Nursing, Zunyi Medical UniversityZunyi 563000, Guizhou, China
| | - Xing Shao
- Department of Burn and Plastic, Affiliated Hospital of Zunyi Medical UniversityZunyi, Guizhou, China
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Zhang G, Shao F, Yuan W, Wu J, Qi X, Gao J, Shao R, Tang Z, Wang T. Predicting sepsis in-hospital mortality with machine learning: a multi-center study using clinical and inflammatory biomarkers. Eur J Med Res 2024; 29:156. [PMID: 38448999 PMCID: PMC10918942 DOI: 10.1186/s40001-024-01756-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/28/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND This study aimed to develop and validate an interpretable machine-learning model that utilizes clinical features and inflammatory biomarkers to predict the risk of in-hospital mortality in critically ill patients suffering from sepsis. METHODS We enrolled all patients diagnosed with sepsis in the Medical Information Mart for Intensive Care IV (MIMIC-IV, v.2.0), eICU Collaborative Research Care (eICU-CRD 2.0), and the Amsterdam University Medical Centers databases (AmsterdamUMCdb 1.0.2). LASSO regression was employed for feature selection. Seven machine-learning methods were applied to develop prognostic models. The optimal model was chosen based on its accuracy, F1 score and area under curve (AUC) in the validation cohort. Moreover, we utilized the SHapley Additive exPlanations (SHAP) method to elucidate the effects of the features attributed to the model and analyze how individual features affect the model's output. Finally, Spearman correlation analysis examined the associations among continuous predictor variables. Restricted cubic splines (RCS) explored potential non-linear relationships between continuous risk factors and in-hospital mortality. RESULTS 3535 patients with sepsis were eligible for participation in this study. The median age of the participants was 66 years (IQR, 55-77 years), and 56% were male. After selection, 12 of the 45 clinical parameters collected on the first day after ICU admission remained associated with prognosis and were used to develop machine-learning models. Among seven constructed models, the eXtreme Gradient Boosting (XGBoost) model achieved the best performance, with an AUC of 0.94 and an F1 score of 0.937 in the validation cohort. Feature importance analysis revealed that Age, AST, invasive ventilation treatment, and serum urea nitrogen (BUN) were the top four features of the XGBoost model with the most significant impact. Inflammatory biomarkers may have prognostic value. Furthermore, SHAP force analysis illustrated how the constructed model visualized the prediction of the model. CONCLUSIONS This study demonstrated the potential of machine-learning approaches for early prediction of outcomes in patients with sepsis. The SHAP method could improve the interoperability of machine-learning models and help clinicians better understand the reasoning behind the outcome.
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Affiliation(s)
- Guyu Zhang
- Emergency Medicine Clinical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, 100020, China
| | - Fei Shao
- Emergency Medicine Clinical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, 100020, China
| | - Wei Yuan
- Emergency Medicine Clinical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, 100020, China
| | - Junyuan Wu
- Emergency Medicine Clinical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, 100020, China
| | - Xuan Qi
- Emergency Medicine Clinical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, 100020, China
| | - Jie Gao
- Emergency Medicine Clinical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, 100020, China
| | - Rui Shao
- Emergency Medicine Clinical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, 100020, China
| | - Ziren Tang
- Emergency Medicine Clinical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, 100020, China.
| | - Tao Wang
- Emergency Medicine Clinical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, 100020, China.
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Kirkham AM, Candeliere J, Mai T, Nagpal SK, Brandys TM, Dubois L, Shorr R, Stelfox HT, McIsaac DI, Roberts DJ. Risk Factors for Surgical Site Infection after Lower Limb Revascularisation Surgery: a Systematic Review and Meta-Analysis of Prognostic Studies. Eur J Vasc Endovasc Surg 2024; 67:455-467. [PMID: 37925099 DOI: 10.1016/j.ejvs.2023.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/27/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE To systematically review and meta-analyse adjusted risk factors for surgical site infection (SSI) after lower limb revascularisation surgery. DATA SOURCES MEDLINE, Embase, Evidence Based Medicine Reviews, and the Cochrane Central Register of Controlled Trials (inception to 28 April 2022). REVIEW METHODS Systematic review and meta-analysis conducted according to PRISMA guidelines. After protocol registration, databases were searched. Studies reporting adjusted risk factors for SSI in adults who underwent lower limb revascularisation surgery for peripheral artery disease were included. Adjusted odds ratios (ORs) were pooled using random effects models. GRADE was used to assess certainty. RESULTS Among 6 377 citations identified, 50 studies (n = 271 125 patients) were included. The cumulative incidence of SSI was 12 (95% confidence interval [CI] 10 - 13) per 100 patients. Studies reported 139 potential SSI risk factors adjusted for a median of 12 (range 1 - 69) potential confounding factors. Risk factors that increased the pooled adjusted odds of SSI included: female sex (pooled OR 1.41, 95% CI 1.20 - 1.64; high certainty); dependent functional status (pooled OR 1.18, 95% CI 1.03 - 1.35; low certainty); being overweight (pooled OR 1.82, 95% CI 1.29 - 2.56; moderate certainty), obese (pooled OR 2.20, 95% CI 1.44 - 3.36; high certainty), or morbidly obese (pooled OR 1.65, 95% CI 1.08 - 2.52; moderate certainty); chronic obstructive pulmonary disease (pooled OR 1.42, 95% CI 1.17 - 1.71; high certainty); chronic limb threatening ischaemia (pooled OR 1.67, 95% CI 1.22 - 2.29; moderate certainty); chronic kidney disease (pooled OR 2.13, 95% CI 1.18 - 3.83; moderate certainty); intra-operative (pooled OR 1.23, 95% CI 1.02 - 1.49), peri-operative (pooled OR 1.92, 95% CI 1.27 - 2.90), or post-operative (pooled OR 2.21, 95% CI 1.44 - 3.39) blood transfusion (moderate certainty for all); urgent or emergency surgery (pooled OR 2.12, 95% CI 1.22 - 3.70; moderate certainty); vein bypass and or patch instead of endarterectomy alone (pooled OR 1.86, 95% CI 1.33 - 2.59; moderate certainty); an operation lasting ≥ 3 hours (pooled OR 1.86, 95% CI 1.33 - 2.59; moderate certainty) or ≥ 5 hours (pooled OR 1.60, 95% CI 1.18 - 2.17; moderate certainty); and early or unplanned re-operation (pooled OR 4.50, 95% CI 2.18 - 9.32; low certainty). CONCLUSION This systematic review identified evidence informed SSI risk factors following lower limb revascularisation surgery. These may be used to develop improved SSI risk prediction tools and to identify patients who may benefit from evidence informed SSI prevention strategies.
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Affiliation(s)
- Aidan M Kirkham
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jasmine Candeliere
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Trinh Mai
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Sudhir K Nagpal
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Timothy M Brandys
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Luc Dubois
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Vascular Surgery, Department of Surgery, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Faculty of Medicine, Western University, London, Ontario, Canada
| | - Risa Shorr
- Learning Services, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Henry T Stelfox
- The O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Departments of Critical Care Medicine, Medicine, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Daniel I McIsaac
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Derek J Roberts
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; The O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
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Thombre A, Ghosh I, Agarwal A. Examining factors influencing the severity of motorized two-wheeler crashes in Delhi. Int J Inj Contr Saf Promot 2024; 31:111-124. [PMID: 37882684 DOI: 10.1080/17457300.2023.2267040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 10/02/2023] [Indexed: 10/27/2023]
Abstract
Failure to meet road safety targets has necessitated urgent actions from stakeholders worldwide, especially in developing countries like India. Road safety of motorized two-wheelers (MTWs), one of India's most preferred travel modes for urban commutes, is in danger and witnessing threatening figures of fatalities and injuries. Most of the studies in the domain of MTW safety were conducted in developed countries, with very limited research in countries having a significant proportion of MTWs. The present work investigates police-reported crash data to identify the contributory factors of motorized two-wheeler crash severity. Data from MTW crash-prone areas were selected from Delhi, which is leading in road traffic fatalities among the million-plus urban cities in India. A binary logistic regression model was developed using the data for 2016-2018 period. The model results show that the odds of fatal motorized two-wheeler crashes increase when the following circumstances apply: crash occurs on underpasses; involves bus, truck, heavy motor vehicle (lorry, crane) as the striking vehicle; when hit-and-run type of crash occurs and when older age-group (> = 55) riders are involved. Finally, based on the findings, countermeasures were suggested to facilitate policymakers and traffic enforcement agencies, in improving the road safety situation of MTW users.
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Affiliation(s)
- Anurag Thombre
- Department of Civil Engineering, Indian Institute of Technology Roorkee, Roorkee, India
| | - Indrajit Ghosh
- Department of Civil Engineering, Indian Institute of Technology Roorkee, Roorkee, India
| | - Amit Agarwal
- Department of Civil Engineering, Indian Institute of Technology Roorkee, Roorkee, India
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Killingmo RM, Tveter AT, Pripp AH, Tingulstad A, Maas E, Rysstad T, Grotle M. Modifiable prognostic factors of high societal costs among people on sick leave due to musculoskeletal disorders: findings from an occupational cohort study. BMJ Open 2024; 14:e080567. [PMID: 38431296 PMCID: PMC10910429 DOI: 10.1136/bmjopen-2023-080567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/15/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVES The objective was to identify modifiable prognostic factors of high societal costs among people on sick leave due to musculoskeletal disorders, and to identify modifiable prognostic factors of high costs related to separately healthcare utilisation and productivity loss. DESIGN A prospective cohort study with a 1-year follow-up. PARTICIPANTS AND SETTING A total of 549 participants (aged 18-67 years) on sick leave (≥ 4 weeks) due to musculoskeletal disorders in Norway were included. OUTCOME MEASURES AND METHOD The primary outcome was societal costs aggregated for 1 year of follow-up and dichotomised as high or low, defined by the top 25th percentile. Secondary outcomes were high costs related to separately healthcare utilisation and productivity loss aggregated for 1 year of follow-up. Healthcare utilisation was collected from public records and included primary, secondary and tertiary healthcare use. Productivity loss was collected from public records and included absenteeism, work assessment allowance and disability pension. Nine modifiable prognostic factors were selected based on previous literature. Univariable and multivariable binary logistic regression analyses were performed to identify associations (crude and adjusted for selected covariates) between each modifiable prognostic factor and having high costs. RESULTS Adjusted for selected covariates, six modifiable prognostic factors associated with high societal costs were identified: pain severity, disability, self-perceived health, sleep quality, return to work expectation and long-lasting disorder expectation. Depressive symptoms, work satisfaction and health literacy showed no prognostic value. More or less similar results were observed when high costs were related to separately healthcare utilisation and productivity loss. CONCLUSION Factors identified in this study are potential target areas for interventions which could reduce high societal costs among people on sick leave due to musculoskeletal disorders. However, future research aimed at replicating these findings is warranted. TRIAL REGISTRATION NUMBER NCT04196634, 12 December 2019.
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Affiliation(s)
- Rikke Munk Killingmo
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Anne Therese Tveter
- Center for treatment of rheumatic and musculoskeletal diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Oslo Centre of Biostatistics and Epidemiology Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Alexander Tingulstad
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Esther Maas
- Department of Health Sciences, Vrije University Amsterdam, Amsterdam, The Netherlands
- The Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
| | - Tarjei Rysstad
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Margreth Grotle
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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16
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Li X, Zhang Y, Zhang S, Zhao Q, Jin Q, Duan A, Huang Z, Gao L, Wang Y, Li S, Zhao Z, Luo Q, Liu Z. Tumor biomarkers in evaluating the severity and prognosis of idiopathic pulmonary arterial hypertension: A comprehensive analysis. Clin Transl Sci 2024; 17:e13751. [PMID: 38450983 PMCID: PMC10918713 DOI: 10.1111/cts.13751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/10/2024] [Accepted: 02/16/2024] [Indexed: 03/08/2024] Open
Abstract
Inflammation contributes to development of idiopathic pulmonary arterial hypertension (IPAH), and tumor biomarkers can reflect inflammatory and immune status. We aimed to determine the value of tumor biomarkers in IPAH comprehensively. We enrolled 315 patients with IPAH retrospectively. Tumor biomarkers were correlated with established indicators of pulmonary hypertension severity. Multivariable Cox regression found that AFP (hazard ratio [HR]: 1.587, 95% confidence interval [CI]: 1.014-2.482, p = 0.043) and CA125 (HR: 2.018, 95% CI: 1.163-3.504, p = 0.013) could independently predict prognosis of IPAH. The changes of AFP over time were associated with prognosis of patients, each 1 ng/mL increase in AFP was associated with 5.4% increased risk of clinical worsening (HR: 1.054, 95% CI: 1.001-1.110, p = 0.046), enabling detection of disease progression. Moreover, beyond well-validated PH biomarkers, CA125 was still of prognostic value in the low-risk patients (HR: 1.014, 95% CI: 1.004-1.024, p = 0.004), allowing for more accurate risk stratification and prediction of disease outcomes. AFP and CA125 can serve for prognosis prediction, risk stratification, and dynamic monitor in patients with IPAH.
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Affiliation(s)
- Xin Li
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yi Zhang
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of ICU, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Sicheng Zhang
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Qing Zhao
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Qi Jin
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Cardiology, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Anqi Duan
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhihua Huang
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Luyang Gao
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yijia Wang
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Sicong Li
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhihui Zhao
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Qin Luo
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhihong Liu
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Tan J, Liu C, Yang M, Xiong Y, Huang S, Qi Y, Chen M, Thabane L, Liu X, He L, Sun X. Investigation of statistical methods used in prognostic prediction models for obstetric care: A 10 year-span cross-sectional study. Acta Obstet Gynecol Scand 2024; 103:611-620. [PMID: 38140844 PMCID: PMC10867372 DOI: 10.1111/aogs.14757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/06/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Obstetric care is a highly active area in the development and application of prognostic prediction models. The development and validation of these models often require the utilization of advanced statistical techniques. However, failure to adhere to rigorous methodological standards could greatly undermine the reliability and trustworthiness of the resultant models. Consequently, the aim of our study was to examine the current statistical practices employed in obstetric care and offer recommendations to enhance the utilization of statistical methods in the development of prognostic prediction models. MATERIAL AND METHODS We conducted a cross-sectional survey using a sample of studies developing or validating prognostic prediction models for obstetric care published in a 10-year span (2011-2020). A structured questionnaire was developed to investigate the statistical issues in five domains, including model derivation (predictor selection and algorithm development), model validation (internal and external), model performance, model presentation, and risk threshold setting. On the ground of survey results and existing guidelines, a list of recommendations for statistical methods in prognostic models was developed. RESULTS A total of 112 eligible studies were included, with 107 reporting model development and five exclusively reporting external validation. During model development, 58.9% of the studies did not include any form of validation. Of these, 46.4% used stepwise regression in a crude manner for predictor selection, while two-thirds made decisions on retaining or dropping candidate predictors solely based on p-values. Additionally, 26.2% transformed continuous predictors into categorical variables, and 80.4% did not consider nonlinear relationships between predictors and outcomes. Surprisingly, 94.4% of the studies did not examine the correlation between predictors. Moreover, 47.1% of the studies did not compare population characteristics between the development and external validation datasets, and only one-fifth evaluated both discrimination and calibration. Furthermore, 53.6% of the studies did not clearly present the model, and less than half established a risk threshold to define risk categories. In light of these findings, 10 recommendations were formulated to promote the appropriate use of statistical methods. CONCLUSIONS The use of statistical methods is not yet optimal. Ten recommendations were offered to assist the statistical methods of prognostic prediction models in obstetric care.
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Affiliation(s)
- Jing Tan
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Biostatistics UnitSt Joseph's Healthcare—HamiltonHamiltonOntarioCanada
| | - Chunrong Liu
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
| | - Min Yang
- Department of Epidemiology and Biostatistics, West China School of Public HealthSichuan UniversityChengduChina
- Faculty of Health, Design and ArtSwinburne Technology UniversityMelbourneVictoriaAustralia
| | - Yiquan Xiong
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
| | - Shiyao Huang
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
| | - Yana Qi
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
| | - Meng Chen
- Department of Obstetrics and Gynecology, and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University HospitalSichuan UniversityChengduSichuanChina
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Biostatistics UnitSt Joseph's Healthcare—HamiltonHamiltonOntarioCanada
| | - Xinghui Liu
- Department of Obstetrics and Gynecology, and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University HospitalSichuan UniversityChengduSichuanChina
| | - Lin He
- The Intelligence Library Center, Ministry of Science and Technology, Chinese Evidence‐Based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
| | - Xin Sun
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
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Yi JS, Ki HJ, Jeon YS, Park JJ, Lee TJ, Kwak JT, Lee SB, Lee HJ, Kim IS, Kim JH, Lee JS, Roh HG, Kim HJ. The collateral map: prediction of lesion growth and penumbra after acute anterior circulation ischemic stroke. Eur Radiol 2024; 34:1411-1421. [PMID: 37646808 PMCID: PMC10873223 DOI: 10.1007/s00330-023-10084-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/03/2023] [Accepted: 07/15/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES This study evaluated the collateral map's ability to predict lesion growth and penumbra after acute anterior circulation ischemic strokes. METHODS This was a retrospective analysis of selected data from a prospectively collected database. The lesion growth ratio was the ratio of the follow-up lesion volume to the baseline lesion volume on diffusion-weighted imaging (DWI). The time-to-maximum (Tmax)/DWI ratio was the ratio of the baseline Tmax > 6 s volume to the baseline lesion volume. The collateral ratio was the ratio of the hypoperfused lesion volume of the phase_FU (phase with the hypoperfused lesions most approximate to the follow-up DWI lesion) to the hypoperfused lesion volume of the phase_baseline of the collateral map. Multiple logistic regression analyses were conducted to identify independent predictors of lesion growth. The concordance correlation coefficients of Tmax/DWI ratio and collateral ratio for lesion growth ratio were analyzed. RESULTS Fifty-two patients, including twenty-six males (mean age, 74 years), were included. Intermediate (OR, 1234.5; p < 0.001) and poor collateral perfusion grades (OR, 664.7; p = 0.006) were independently associated with lesion growth. Phase_FUs were immediately preceded phases of the phase_baselines in intermediate or poor collateral perfusion grades. The concordance correlation coefficients of the Tmax/DWI ratio and collateral ratio for the lesion growth ratio were 0.28 (95% CI, 0.17-0.38) and 0.88 (95% CI, 0.82-0.92), respectively. CONCLUSION Precise prediction of lesion growth and penumbra can be possible using collateral maps, allowing for personalized application of recanalization treatments. Further studies are needed to generalize the findings of this study. CLINICAL RELEVANCE STATEMENT Precise prediction of lesion growth and penumbra can be possible using collateral maps, allowing for personalized application of recanalization treatments. KEY POINTS • Cell viability in cerebral ischemia due to proximal arterial steno-occlusion mainly depends on the collateral circulation. • The collateral map shows salvageable brain extent, which can survive by recanalization treatments after acute anterior circulation ischemic stroke. • Precise estimation of salvageable brain makes it possible to make patient-specific treatment decision.
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Affiliation(s)
- Jin Seok Yi
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Hee Jong Ki
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Yoo Sung Jeon
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jeong Jin Park
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Kangwon National University College of Medicine, Chuncheon, Republic of Korea
| | - Taek-Jun Lee
- Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Jin Tae Kwak
- School of Electrical Engineering, Korea University, Seoul, Republic of Korea
| | - Sang Bong Lee
- Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Hyung Jin Lee
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - In Seong Kim
- Siemens Healthineers Ltd., Seoul, Republic of Korea
| | - Joo Hyun Kim
- Philips Healthcare Korea, Seoul, Republic of Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hong Gee Roh
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Kwangjin-Gu, Seoul, 05030, Republic of Korea.
| | - Hyun Jeong Kim
- Department of Radiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon, 34943, Republic of Korea.
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19
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Antonini S, Pedersini R, Birtolo MF, Baruch NL, Carrone F, Jaafar S, Ciafardini A, Cosentini D, Laganà M, Torrisi R, Farina D, Leonardi L, Balzarini L, Vena W, Bossi AC, Zambelli A, Lania AG, Berruti A, Mazziotti G. Denosumab improves trabecular bone score in relationship with decrease in fracture risk of women exposed to aromatase inhibitors. J Endocrinol Invest 2024; 47:433-442. [PMID: 37592052 DOI: 10.1007/s40618-023-02174-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE Trabecular bone score (TBS) is a gray-level textural metric that has shown to correlate with risk of fractures in several forms of osteoporosis. The value of TBS in predicting fractures and the effects of bone-active drugs on TBS in aromatase inhibitors (AIs)-induced osteoporosis are still largely unknown. The primary objective of this retrospective study was to assess the effects of denosumab and bisphosphonates (BPs) on TBS and vertebral fractures (VFs) in women exposed to AIs. METHODS 241 consecutive women (median age 58 years) with early breast cancer undergoing treatment with AIs were evaluated for TBS, bone mineral density (BMD) and morphometric VFs at baseline and after 18-24 months of follow-up. During the study period, 139 women (57.7%) received denosumab 60 mg every 6 months, 53 (22.0%) BPs, whereas 49 women (20.3%) were not treated with bone-active drugs. RESULTS Denosumab significantly increased TBS values (from 1.270 to 1.323; P < 0.001) accompanied by a significant decrease in risk of VFs (odds ratio 0.282; P = 0.021). During treatment with BPs, TBS did not significantly change (P = 0.849) and incidence of VFs was not significantly different from women untreated with bone-active drugs (P = 0.427). In the whole population, women with incident VFs showed higher decrease in TBS vs. non-fractured women (P = 0.003), without significant differences in changes of BMD at any skeletal site. CONCLUSIONS TBS variation predicts fracture risk in AIs treated women. Denosumab is effective to induce early increase of TBS and reduction in risk of VFs.
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Affiliation(s)
- S Antonini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - R Pedersini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - M F Birtolo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - N L Baruch
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - F Carrone
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - S Jaafar
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - A Ciafardini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - D Cosentini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - M Laganà
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - R Torrisi
- Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - D Farina
- Radiology Unit 2, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - L Leonardi
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - L Balzarini
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - W Vena
- Endocrinology, Humanitas Gavazzeni-Castelli, Bergamo, Italy
| | - A C Bossi
- Endocrinology, Humanitas Gavazzeni-Castelli, Bergamo, Italy
| | - A Zambelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - A G Lania
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy.
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.
| | - A Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - G Mazziotti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy.
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.
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20
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Kokkinakis S, Kritsotakis EI, Paterakis K, Karali GA, Malikides V, Kyprianou A, Papalexandraki M, Anastasiadis CS, Zoras O, Drakos N, Kehagias I, Kehagias D, Gouvas N, Kokkinos G, Pozotou I, Papatheodorou P, Frantzeskou K, Schizas D, Syllaios A, Palios IM, Nastos K, Perdikaris M, Michalopoulos NV, Margaris I, Lolis E, Dimopoulou G, Panagiotou D, Nikolaou V, Glantzounis GK, Pappas-Gogos G, Tepelenis K, Zacharioudakis G, Tsaramanidis S, Patsarikas I, Stylianidis G, Giannos G, Karanikas M, Kofina K, Markou M, Chrysos E, Lasithiotakis K. Development and internal validation of a clinical prediction model for serious complications after emergency laparotomy. Eur J Trauma Emerg Surg 2024; 50:283-293. [PMID: 37648805 PMCID: PMC10923974 DOI: 10.1007/s00068-023-02351-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE Emergency laparotomy (EL) is a common operation with high risk for postoperative complications, thereby requiring accurate risk stratification to manage vulnerable patients optimally. We developed and internally validated a predictive model of serious complications after EL. METHODS Data for eleven carefully selected candidate predictors of 30-day postoperative complications (Clavien-Dindo grade > = 3) were extracted from the HELAS cohort of EL patients in 11 centres in Greece and Cyprus. Logistic regression with Least Absolute Shrinkage and Selection Operator (LASSO) was applied for model development. Discrimination and calibration measures were estimated and clinical utility was explored with decision curve analysis (DCA). Reproducibility and heterogeneity were examined with Bootstrap-based internal validation and Internal-External Cross-Validation. The American College of Surgeons National Surgical Quality Improvement Program's (ACS-NSQIP) model was applied to the same cohort to establish a benchmark for the new model. RESULTS From data on 633 eligible patients (175 complication events), the SErious complications After Laparotomy (SEAL) model was developed with 6 predictors (preoperative albumin, blood urea nitrogen, American Society of Anaesthesiology score, sepsis or septic shock, dependent functional status, and ascites). SEAL had good discriminative ability (optimism-corrected c-statistic: 0.80, 95% confidence interval [CI] 0.79-0.81), calibration (optimism-corrected calibration slope: 1.01, 95% CI 0.99-1.03) and overall fit (scaled Brier score: 25.1%, 95% CI 24.1-26.1%). SEAL compared favourably with ACS-NSQIP in all metrics, including DCA across multiple risk thresholds. CONCLUSION SEAL is a simple and promising model for individualized risk predictions of serious complications after EL. Future external validations should appraise SEAL's transportability across diverse settings.
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Affiliation(s)
- Stamatios Kokkinakis
- Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Evangelos I Kritsotakis
- Laboratory of Biostatistics, School of Medicine, University of Crete, 71003, Heraklion, Crete, Greece.
| | - Konstantinos Paterakis
- Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Garyfallia-Apostolia Karali
- Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Vironas Malikides
- Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Anna Kyprianou
- Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Melina Papalexandraki
- Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Charalampos S Anastasiadis
- Department of Surgical Oncology, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Odysseas Zoras
- Department of Surgical Oncology, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Nikolas Drakos
- Department of Surgery, School of Medicine, University General Hospital of Patras, University of Patras, Patras, Greece
| | - Ioannis Kehagias
- Department of Surgery, School of Medicine, University General Hospital of Patras, University of Patras, Patras, Greece
| | - Dimitrios Kehagias
- Department of Surgery, School of Medicine, University General Hospital of Patras, University of Patras, Patras, Greece
| | - Nikolaos Gouvas
- Department of Surgery, School of Medicine, General Hospital of Nicosia, University of Cyprus, Nicosia, Cyprus
| | - Georgios Kokkinos
- Department of Surgery, School of Medicine, General Hospital of Nicosia, University of Cyprus, Nicosia, Cyprus
| | - Ioanna Pozotou
- Department of Surgery, School of Medicine, General Hospital of Nicosia, University of Cyprus, Nicosia, Cyprus
| | - Panayiotis Papatheodorou
- Department of Surgery, School of Medicine, General Hospital of Nicosia, University of Cyprus, Nicosia, Cyprus
| | - Kyriakos Frantzeskou
- Department of Surgery, School of Medicine, General Hospital of Nicosia, University of Cyprus, Nicosia, Cyprus
| | - Dimitrios Schizas
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Syllaios
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ifaistion M Palios
- Second Propaedeutic Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Nastos
- Department of Surgery, School of Medicine, University General Hospital Attikon, University of Athens, Athens, Greece
| | - Markos Perdikaris
- Department of Surgery, School of Medicine, University General Hospital Attikon, University of Athens, Athens, Greece
| | - Nikolaos V Michalopoulos
- Department of Surgery, School of Medicine, University General Hospital Attikon, University of Athens, Athens, Greece
| | - Ioannis Margaris
- Department of Surgery, School of Medicine, University General Hospital Attikon, University of Athens, Athens, Greece
| | - Evangelos Lolis
- Department of Surgery, General Hospital of Volos, Volos, Greece
| | | | | | | | | | | | - Kostas Tepelenis
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Georgios Zacharioudakis
- Department of Surgery, School of Medicine, Ippokrateion General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Savvas Tsaramanidis
- Department of Surgery, School of Medicine, Ippokrateion General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Patsarikas
- Department of Surgery, School of Medicine, Ippokrateion General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Georgios Giannos
- Second Department of Surgery, Evangelismos General Hospital, Athens, Greece
| | - Michail Karanikas
- Department of Surgery, School of Medicine, University General Hospital of Alexandroupolis, University of Thrace, Alexandroupolis, Greece
| | - Konstantinia Kofina
- Department of Surgery, School of Medicine, University General Hospital of Alexandroupolis, University of Thrace, Alexandroupolis, Greece
| | - Markos Markou
- Department of Surgery, School of Medicine, University General Hospital of Alexandroupolis, University of Thrace, Alexandroupolis, Greece
| | - Emmanuel Chrysos
- Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Konstantinos Lasithiotakis
- Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece
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21
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Vitali E, Franceschini B, Milana F, Soldani C, Polidoro MA, Carriero R, Kunderfranco P, Trivellin G, Costa G, Milardi G, Di Tommaso L, Torzilli G, Lleo A, Lania AG, Donadon M. Filamin A is involved in human intrahepatic cholangiocarcinoma aggressiveness and progression. Liver Int 2024; 44:518-531. [PMID: 38010911 DOI: 10.1111/liv.15800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/19/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND & AIMS Intrahepatic cholangiocarcinoma (iCCA) is a primary liver tumour, characterized by poor prognosis and lack of effective therapy. The cytoskeleton protein Filamin A (FLNA) is involved in cancer progression and metastasis, including primary liver cancer. FLNA is cleaved by calpain, producing a 90 kDa fragment (FLNACT ) that can translocate to the nucleus and inhibit gene transcription. We herein aim to define the role of FLNA and its cleavage in iCCA carcinogenesis. METHODS & RESULTS We evaluated the expression and localization of FLNA and FLNACT in liver samples from iCCA patients (n = 82) revealing that FLNA expression was independently correlated with disease-free survival. Primary tumour cells isolated from resected iCCA patients expressed both FLNA and FLNACT , and bulk RNA sequencing revealed a significant enrichment of cell proliferation and cell motility pathways in iCCAs with high FLNA expression. Further, we defined the impact of FLNA and FLNACT on the proliferation and migration of primary iCCA cells (n = 3) and HuCCT1 cell line using silencing and Calpeptin, a calpain inhibitor. We observed that FLNA silencing decreased cell proliferation and migration and Calpeptin was able to reduce FLNACT expression in both the HuCCT1 and iCCA cells (p < .05 vs. control). Moreover, Calpeptin 100 μM decreased HuCCT1 and primary iCCA cell proliferation (p <.00001 vs. control) and migration (p < .05 vs. control). CONCLUSIONS These findings demonstrate that FLNA is involved in human iCCA progression and calpeptin strongly decreased FLNACT expression, reducing cell proliferation and migration.
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Affiliation(s)
- Eleonora Vitali
- Laboratory of Cellular and Molecular Endocrinology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Barbara Franceschini
- Hepatobiliary Immunopathology Laboratory, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Flavio Milana
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Cristiana Soldani
- Hepatobiliary Immunopathology Laboratory, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Michela A Polidoro
- Hepatobiliary Immunopathology Laboratory, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Roberta Carriero
- Bioinformatics Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Giampaolo Trivellin
- Laboratory of Cellular and Molecular Endocrinology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Guido Costa
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giulia Milardi
- Hepatobiliary Immunopathology Laboratory, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Luca Di Tommaso
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Pathology Department, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Guido Torzilli
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ana Lleo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Andrea G Lania
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Matteo Donadon
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
- Department of General Surgery, University Maggiore Hospital, Novara, Italy
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McDonald PL, Foley TJ, Verheij R, Braithwaite J, Rubin J, Harwood K, Phillips J, Gilman S, van der Wees PJ. Data to knowledge to improvement: creating the learning health system. BMJ 2024; 384:e076175. [PMID: 38272498 PMCID: PMC10809034 DOI: 10.1136/bmj-2023-076175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Affiliation(s)
| | - Tom J Foley
- Newcastle University, Newcastle upon Tyne, UK
- University College Dublin, Dublin, Ireland
- Health Service Executive, Donegal, Ireland
| | - Robert Verheij
- Netherlands Institute of Health Services Research (NIVEL), Utrecht, Netherlands
- Tranzo, Department of Social and Behavioural Sciences, Tilburg University, Tilburg, Netherlands
- Dutch National Healthcare Institute, Diemen, Netherlands
| | | | | | | | - Jessica Phillips
- Translational Health Sciences, Department of Clinical Research and Leadership, George Washington University, Washington, DC, USA
| | - Sarah Gilman
- Translational Health Sciences, Department of Clinical Research and Leadership, George Washington University, Washington, DC, USA
| | - Philip J van der Wees
- George Washington University, Washington, DC, USA
- Radboud University Medical Center, Nijmegen, Netherlands
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23
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Guo C, Yang X, Li L. Pyroptosis-Related Gene Signature Predicts Prognosis and Response to Immunotherapy and Medication in Pediatric and Young Adult Osteosarcoma Patients. J Inflamm Res 2024; 17:417-445. [PMID: 38269108 PMCID: PMC10807455 DOI: 10.2147/jir.s440425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024] Open
Abstract
Purpose Pyroptosis, a new form of inflammatory programmed cell death, has recently gained attention. However, the impact of the expression levels of pyroptosis-related genes (PRGs) on the overall survival (OS) of osteosarcoma patients remains unclear. This study aims to investigate the impact of the expression levels of PRGs on the OS of pediatric and young adult patients with osteosarcoma. Patients and Methods Transcriptome matrix datasets of normal muscle or skeletal tissues from the Genotype-Tissue Expression (GTEx) project and osteosarcoma specimen the National Cancer Institute's (NCI) Therapeutically Applicable Research to Generate Effective Treatments (TARGET) database were used to identify pyroptosis-related genes (PRGs) associated with prognosis. The National Center for Biotechnology Information's (NCBI) GSE21257 dataset was employed to validate the predictive value of the pyroptosis-related signature (PRS). Additionally, reverse transcription polymerase chain reaction (RT-qPCR) experiment was performed in normal and osteosarcoma cell lines. Results The study identified 18 differentially expressed PRGs (DEPRGs) between normal muscle or skeletal tissues and tumor samples. Multiple machine learning techniques were used to select PRGs, resulting in the identification of four hub PRGs. A PRS-score was calculated for each sample based on the expression of these four hub PRGs, and samples were categorized into low and high PRS-score level groups. It was confirmed that metastatic status and PRS-score level are independent prognostic predictors. A nomogram model for predicting OS of osteosarcoma patients was constructed. Single-cell RNA-sequencing data display the expression patterns of the hub PRGs. RT-qPCR data results were found to be consistent with the differential expression analysis performed on TARGET and GTEx samples. Conclusion The study developed a novel pyroptosis-related gene signature that can stratify pediatric and young adult osteosarcoma patients into different risk groups, thus predicting their response to immunotherapy and chemotherapy.
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Affiliation(s)
- Chaofan Guo
- Department of Orthopedics, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi Province, People’s Republic of China
- Department of Spine Surgery, Fifth Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, People’s Republic of China
| | - Xin Yang
- Department of Neurosurgery, Chongqing Fourth People’s Hospital, Chongqing, People’s Republic of China
| | - Lijun Li
- Department of Orthopedics, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi Province, People’s Republic of China
- Department of Spine Surgery, Fifth Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, People’s Republic of China
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24
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Mesina RS, Rustøen T, Hagen M, Laake JH, Hofsø K. Long-term functional disabilities in intensive care unit survivors: A prospective cohort study. Aust Crit Care 2024:S1036-7314(23)00197-2. [PMID: 38171986 DOI: 10.1016/j.aucc.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 11/16/2023] [Accepted: 11/26/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Functional disabilities are common in intensive care unit (ICU) survivors and may affect their ability to live independently. Few previous studies have investigated long-term functional outcomes with health status before ICU admission (pre-ICU health), and they are limited to specific patient groups. OBJECTIVES The objective of this study was to investigate the prevalence of functional disabilities and examine pre-ICU health variables as possible predictive factors of functional disabilities 12 months after ICU admission in a mixed population of ICU survivors. METHODS This prospective cohort study was conducted in six ICUs in Norway. Data on pre-ICU health were collected as soon as possible after ICU admission using patients, proxies, and patient electronic health records and at 12 months after ICU admission. Self-reported functional status was assessed using the Katz Index of independence in personal activities of daily living (P-ADL) and the Lawton instrumental activities of daily living scale (I-ADL). RESULTS A total of 220 of 343 (64%) ICU survivors with data on pre-ICU health completed the questionnaires at 12 months and reported the following functional disabilities at 12 months: 31 patients (14.4%) reported P-ADL dependencies (new in 16 and persisting in 15), and 80 patients (36.4%) reported I-ADL dependencies (new in 41 and persisting in 39). In a multivariate analysis, worse baseline P-ADL and I-ADL scores were associated with dependencies in P-ADLs (odds ratio [OR]: 1.87; 95% confidence interval [CI]: 1.14-3.06) and I-ADLs (OR: 1.52; 95% CI: 1.03-2.23), respectively, at 12 months. Patients who were employed were less likely to report I-ADL dependencies at 12 months (OR: 0.34; 95% CI: 0.12-0.95). CONCLUSION In a subsample of ICU survivors, patients reported functional disabilities 12 months after ICU admission, which was significantly associated with their pre-ICU functional status. Early screening of pre-ICU functional status may help identify patients at risk of long-term functional disabilities. ICU survivors with pre-ICU functional disabilities may find it difficult to improve their functional status.
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Affiliation(s)
- Renato S Mesina
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen N-0424, Oslo, Norway; Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1078, Blindern NO-0316, Oslo, Norway.
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen N-0424, Oslo, Norway; Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1078, Blindern NO-0316, Oslo, Norway
| | - Milada Hagen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen N-0424, Oslo, Norway; Department of Public Health, Faculty of Nursing Science, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass N-0130, Oslo, Norway
| | - Jon Henrik Laake
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen N-0424, Oslo, Norway; Department of Anaesthesiology and Intensive Care Medicine, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen N-0424, Oslo, Norway
| | - Kristin Hofsø
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen N-0424, Oslo, Norway; Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, P. O. Box 4950, Nydalen N-0424, Oslo, Norway; Lovisenberg Diaconal University College, Lovisenberggt. 15b, 0456, Oslo, Norway
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25
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Achanta A, Wasfy JH, Moss CT, Cherukara A, Ho D, Boxer R, Schmieding M, Phadke NA, Thompson R, Levine DM, Weiner RB. Home Hospital Outcomes for Acute Decompensated Heart Failure and Factors Associated With Escalation of Care. Circ Cardiovasc Qual Outcomes 2024; 17:e010031. [PMID: 38054286 DOI: 10.1161/circoutcomes.123.010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/24/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Overall outcomes and the escalation rate for home hospital admissions for heart failure (HF) are not known. We report overall outcomes, predict escalation, and describe care provided after escalation among patients admitted to home hospital for HF. METHODS Our retrospective analysis included all patients admitted for HF to 2 home hospital programs in Massachusetts between February 2020 and October 2022. Escalation of care was defined as transfer to an inpatient hospital setting (emergency department, inpatient medical unit) for at least 1 overnight stay. Unexpected mortality was defined as mortality excluding those who desired to pass away at home on admission or transitioned to hospice. We performed the least absolute shrinkage and selection operator logistic regression to predict escalation. RESULTS We included 437 hospitalizations; patients had a median age of 80 (interquartile range, 69-89) years, 58.1% were women, and 64.8% were White. Of the cohort, 29.2% had reduced ejection fraction, 50.9% had chronic kidney disease, and 60.6% had atrial fibrillation. Median admission Get With The Guidelines HF score was 39 (interquartile range, 35-45; 1%-5% predicted inpatient mortality). Escalation occurred in 10.3% of hospitalizations. Thirty-day readmission occurred in 15.1%, 90-day readmission occurred in 33.8%, and 6-month mortality occurred in 11.5%. There was no unexpected mortality during home hospitalization. Patients who experienced escalation had significantly longer median length of stays (19 versus 7.5 days, P<0.001). The most common reason for escalation was progressive renal dysfunction (36.2%). A low mean arterial pressure at the time of admission to home hospital was the most significant predictor of escalation in the least absolute shrinkage and selection operator regression. CONCLUSIONS About 1 in 10 home hospital patients with HF required escalation; none had unexpected mortality. Patients requiring escalation had longer length of stays. A low mean arterial pressure at the time of admission to home hospital was the most important predictor of escalation of care in the least absolute shrinkage and selection operator logistic regression model.
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Affiliation(s)
- Aditya Achanta
- Department of Medicine (A.A., J.H.W., N.P., R.T., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
- Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital and Harvard Medical School, Boston, MA (A.C., D.H., R.B., M.S., D.L.)
| | - Jason H Wasfy
- Department of Medicine (A.A., J.H.W., N.P., R.T., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
- Cardiology Division (J.H.W., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
| | | | | | - David Ho
- Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital and Harvard Medical School, Boston, MA (A.C., D.H., R.B., M.S., D.L.)
| | - Robert Boxer
- Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital and Harvard Medical School, Boston, MA (A.C., D.H., R.B., M.S., D.L.)
| | - Malte Schmieding
- Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital and Harvard Medical School, Boston, MA (A.C., D.H., R.B., M.S., D.L.)
| | - Neelam Ameya Phadke
- Department of Medicine (A.A., J.H.W., N.P., R.T., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
- Allergy and Immunology Division (N.P.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Ryan Thompson
- Department of Medicine (A.A., J.H.W., N.P., R.T., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - David Michael Levine
- Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital and Harvard Medical School, Boston, MA (A.C., D.H., R.B., M.S., D.L.)
| | - Rory B Weiner
- Department of Medicine (A.A., J.H.W., N.P., R.T., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
- Cardiology Division (J.H.W., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
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Ambrožič J, Rauber M, Berlot B, Škofic N, Toplišek J, Bervar M, Cvijić M. Challenges and pitfalls in classification of disproportionate mitral regurgitation. Int J Cardiovasc Imaging 2023:10.1007/s10554-023-03043-1. [PMID: 38159132 DOI: 10.1007/s10554-023-03043-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
The concept of disproportionate mitral regurgitation (dispropMR) has been introduced to identify patients with functional mitral regurgitation (MR) who benefit from percutaneous treatment. We aimed to examine echocardiographic characteristics behind this entity. We retrospectively included 172 consecutive patients with reduced left ventricular ejection fraction (LVEF), and more than mild MR referred to clinically indicated echocardiography. According to the proportionality ratio (effective regurgitant orifice area (EROA)/left ventricular end-diastolic volume (LVEDV)) patients were divided into dispropMR and proportionate MR (propMR) group. Potential factors which might affect proportionality definition were analyzed. 55 patients (32%) had dispropMR. Discrepant grading of MR severity was observed when using regurgitant volume (RegVol) by proximal isovelocity surface area (PISA) method or volumetric method, with significant discordance only in dispropMR (p < 0.001). Patients with dispropMR had more frequently left ventricular foreshortened images for LVEDV calculation than patients with propMR (p = 0.003), resulting in smaller LVEDV in dispropMR group. DispropMR group had more substantial dynamic variation of regurgitant flow compared to propMR. Accordingly, EROA was consistently overestimated by standard single-point PISA method compared to serial PISA method. This was more pronounced in dispropMR (bias:10.5 ± 28.3 mm2) compared to propMR group (bias:6.4 ± 12.8 mm2). DispropMR may be found in roughly one third of clinically indicated echocardiographic studies in patients with reduced LVEF and more than mild MR. EROA overestimation due to dynamic variation of regurgitant flow and LVEDV underestimation due to LV foreshortening were more frequently found in dispropMR. Our results indicate that methodological limitations of echocardiographic MR grading could not be neglected in classifying the proportionality of MR.
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Affiliation(s)
- Jana Ambrožič
- Department of Cardiology, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, 1000, Slovenia
| | - Martin Rauber
- Department of Cardiology, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, 1000, Slovenia
| | - Boštjan Berlot
- Department of Cardiology, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, 1000, Slovenia
| | - Nataša Škofic
- Department of Surgery, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, 1000, Slovenia
| | - Janez Toplišek
- Department of Cardiology, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, 1000, Slovenia
| | - Mojca Bervar
- Department of Cardiology, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, 1000, Slovenia
| | - Marta Cvijić
- Department of Cardiology, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, 1000, Slovenia.
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana, 1000, Slovenia.
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Song H, Zhang H, Zhang D, Liu B, Wang P, Liu Y, Li J, Ye Y. Establishment and Validation of a Risk Prediction Model for Mortality in Patients with Acinetobacter baumannii Infection: A Retrospective Study. Infect Drug Resist 2023; 16:7855-7866. [PMID: 38162321 PMCID: PMC10757776 DOI: 10.2147/idr.s423969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/24/2023] [Indexed: 01/03/2024] Open
Abstract
Purpose This study aims to establish a valuable risk prediction model for mortality in patients with Acinetobacter baumannii (A. baumannii). Patients and Methods The 622 patients with A. baumannii infection from the First Affiliated Hospital of Anhui Medical University were enrolled as the study cohort. Univariate and multivariate logistic regression analysis was used to preliminarily screen the independent risk factors of death caused by A. baumannii infection, followed by LASSO regression analysis to determine the risk factors. According to the calculated regression coefficient, the Nomogram death prediction model is established. The area under the curve (AUC) and decision curve analysis (DCA) of the operating characteristic (ROC) curve of the subjects are used to evaluate the discrimination of the established prediction model. The calibration degree of the prediction model is represented by a calibration chart. A validation cohort that consisted of 477 patients admitted to the 901st Hospital was also included. Results Our results revealed that the source of infection, carbapenem-resistant A. baumannii, mechanical ventilation, serum albumin value, and Charlson comorbidity index were independent risk factors for death caused by A. baumannii infection. The AUC value of ROC curves of study cohort and validation cohort were 0.76 and 0.69, respectively. The probability range (30-80%) indicated a high net income of the modified model and strong capacity of discrimination. The calibration curve obtained by analysis swings up and down around the 45 diagonal line, which shows that the calibration degree of the prediction model is very high. Conclusion In this study, we have reconstructed a risk prediction model for mortality in patients with A. baumannii infections. This model provides useful information to predict the risk of death in patients with A. baumannii infection, but the specificity is not optimistic. If this prediction model is wanted to be applied to clinical practice, more analysis and research are necessary.
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Affiliation(s)
- Haiyan Song
- Department of Infectious Disease, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
- Department of Infectious Disease, the 901st Hospital, Hefei, Anhui, People’s Republic of China
| | - Hui Zhang
- Department of Infectious Disease, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Ding Zhang
- Department of Infectious Disease, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Bo Liu
- Department of Infectious Disease, the 901st Hospital, Hefei, Anhui, People’s Republic of China
| | - Pengcheng Wang
- Department of Clinical Laboratory, the 901st Hospital, Hefei, Anhui, People’s Republic of China
| | - Yanyan Liu
- Department of Infectious Disease, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
- Anhui Center for Surveillance of Bacterial Resistance, Hefei, Anhui, People’s Republic of China
- Institute of Bacterial Resistance, Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Jiabin Li
- Department of Infectious Disease, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
- Anhui Center for Surveillance of Bacterial Resistance, Hefei, Anhui, People’s Republic of China
- Institute of Bacterial Resistance, Anhui Medical University, Hefei, Anhui, People’s Republic of China
- Department of Infectious Diseases, the Chaohu Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Ying Ye
- Department of Infectious Disease, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
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28
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Cappello IA, Pannone L, Della Rocca DG, Sorgente A, Del Monte A, Mouram S, Vetta G, Kronenberger R, Ramak R, Overeinder I, Bala G, Almorad A, Ströker E, Sieira J, La Meir M, Belsack D, Sarkozy A, Brugada P, Tanaka K, Chierchia GB, Gharaviri A, de Asmundis C. Coronary artery disease in atrial fibrillation ablation: impact on arrhythmic outcomes. Europace 2023; 25:euad328. [PMID: 38064697 PMCID: PMC10751806 DOI: 10.1093/europace/euad328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/09/2023] [Indexed: 12/18/2023] Open
Abstract
AIMS Catheter ablation (CA) is an established treatment for atrial fibrillation (AF). A computed tomography (CT) may be performed before ablation to evaluate the anatomy of pulmonary veins. The aim of this study is to investigate the prevalence of patients with coronary artery disease (CAD) detected by cardiac CT scan pre-ablation and to evaluate the impact of CAD and revascularization on outcomes after AF ablation. METHODS AND RESULTS All consecutive patients with AF diagnosis, hospitalized at Universitair Ziekenhuis Brussel, Belgium, between 2015 and 2019, were prospectively screened for enrolment in the study. Inclusion criteria were (i) AF diagnosis, (ii) first procedure of AF ablation with cryoballoon CA, and (iii) contrast CT scan performed pre-ablation. A total of 576 consecutive patients were prospectively included and analysed in this study. At CT scan, 122 patients (21.2%) were diagnosed with CAD, of whom 41 patients (7.1%) with critical CAD. At survival analysis, critical CAD at CT scan was a predictor of atrial tachyarrhythmia (AT) recurrence during the follow-up, only in Cox univariate analysis [hazard ratio (HR) = 1.79] but was not an independent predictor in Cox multivariate analysis. At Cox multivariate analysis, independent predictors of AT recurrence were as follows: persistent AF (HR = 2.93) and left atrium volume index (HR = 1.04). CONCLUSION In patients undergoing CT scan before AF ablation, critical CAD was diagnosed in 7.1% of patients. Coronary artery disease and revascularization were not independent predictors of recurrence; thus, in this patient population, AF ablation should not be denied and can be performed together with CAD treatment.
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Affiliation(s)
- Ida Anna Cappello
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Alvise Del Monte
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Sahar Mouram
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Giampaolo Vetta
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Rani Kronenberger
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Robbert Ramak
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Mark La Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Dries Belsack
- Department of Radiology, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Ali Gharaviri
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
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de Wit K, Mercuri M, Clayton N, Mercier É, Morris J, Jeanmonod R, Eagles D, Varner C, Barbic D, Buchanan IM, Ali M, Kagoma YK, Shoamanesh A, Engels P, Sharma S, Worster A, McLeod S, Émond M, Stiell I, Papaioannou A, Parpia S. Derivation of the Falls Decision Rule to exclude intracranial bleeding without head CT in older adults who have fallen. CMAJ 2023; 195:E1614-E1621. [PMID: 38049159 PMCID: PMC10699318 DOI: 10.1503/cmaj.230634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Ground-level falls are common among older adults and are the most frequent cause of traumatic intracranial bleeding. The aim of this study was to derive a clinical decision rule that safely excludes clinically important intracranial bleeding in older adults who present to the emergency department after a fall, without the need for a computed tomography (CT) scan of the head. METHODS This prospective cohort study in 11 emergency departments in Canada and the United States enrolled patients aged 65 years or older who presented after falling from standing on level ground, off a chair or toilet seat, or out of bed. We collected data on 17 potential predictor variables. The primary outcome was the diagnosis of clinically important intracranial bleeding within 42 days of the index emergency department visit. An independent adjudication committee, blinded to baseline data, determined the primary outcome. We derived a clinical decision rule using logistic regression. RESULTS The cohort included 4308 participants, with a median age of 83 years; 2770 (64%) were female, 1119 (26%) took anticoagulant medication and 1567 (36%) took antiplatelet medication. Of the participants, 139 (3.2%) received a diagnosis of clinically important intracranial bleeding. We developed a decision rule indicating that no head CT is required if there is no history of head injury on falling; no amnesia of the fall; no new abnormality on neurologic examination; and the Clinical Frailty Scale score is less than 5. Rule sensitivity was 98.6% (95% confidence interval [CI] 94.9%-99.6%), specificity was 20.3% (95% CI 19.1%-21.5%) and negative predictive value was 99.8% (95% CI 99.2%-99.9%). INTERPRETATION We derived a Falls Decision Rule, which requires external validation, followed by clinical impact assessment. Trial registration: ClinicalTrials. gov, no. NCT03745755.
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Affiliation(s)
- Kerstin de Wit
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont.
| | - Mathew Mercuri
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Natasha Clayton
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Éric Mercier
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Judy Morris
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Rebecca Jeanmonod
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Debra Eagles
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Catherine Varner
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - David Barbic
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Ian M Buchanan
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Mariyam Ali
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Yoan K Kagoma
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Ashkan Shoamanesh
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Paul Engels
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Sunjay Sharma
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Andrew Worster
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Shelley McLeod
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Marcel Émond
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Ian Stiell
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Alexandra Papaioannou
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Sameer Parpia
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
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30
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Ali H, Shahzad M, Sarfraz S, Sewell KB, Alqalyoobi S, Mohan BP. Application and impact of Lasso regression in gastroenterology: A systematic review. Indian J Gastroenterol 2023; 42:780-790. [PMID: 37594652 DOI: 10.1007/s12664-023-01426-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/05/2023] [Indexed: 08/19/2023]
Abstract
Least absolute shrinkage and selection operator (Lasso) regression is a statistical technique that can be used to study the effects of clinical variables in outcome prediction. In this study, we aimed at systematically reviewing the application of Lasso regression in gastroenterology for developing predictive models and providing a method of performing Lasso regression. A comprehensive search strategy was conducted in PubMed, Embase and Cochrane CENTRAL databases (Keywords: lasso regression; gastrointestinal tract/diseases) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were screened for eligibility based on pre-defined selection criteria and the data was extracted using a standardized form. Total 16 studies were included, comprising a diverse range of gastroenterological disease-related outcomes. Sample sizes ranged from 134 to 8861 subjects. Eleven studies reported liver disease-related prediction models, while five focused on non-hepatic etiology models. Lasso regression was applied for variable selection, risk prediction and model development, with various validation methods and performance metrics used. Model performance metrics included Area Under the Receiver Operating Characteristics (AUROC), C-index and calibration plots. In gastroenterology, Lasso regression has been used in various diseases such as inflammatory bowel disease, liver disease and esophageal cancer. It is valuable for complex scenarios with many predictors. However, its effectiveness depends on high-quality and complete data. While it identifies important variables, it doesn't provide causal interpretations. Therefore, cautious interpretation is necessary considering the study design and data quality.
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Affiliation(s)
- Hassam Ali
- Department of Gastroenterology and Hepatology, East Carolina University, Greenville, NC, USA
| | - Maria Shahzad
- Department of Internal Medicine, University of Health Sciences, Lahore, Punjab, Pakistan
| | - Shiza Sarfraz
- Department of Internal Medicine, University of Health Sciences, Lahore, Punjab, Pakistan
| | - Kerry B Sewell
- Laupus Health Sciences Library, East Carolina University, Greenville, NC, USA
| | - Shehabaldin Alqalyoobi
- Department of Pulmonary and Critical Care Medicine, East Carolina University, Greenville, NC, USA
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
| | - Babu P Mohan
- Gastroenterology and Hepatology, Orlando Gastroenterology PA, 1507 S Hiawassee Road, Ste 105, Orlando, FL, 32835, USA.
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31
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Nguyen Ho PT, van Arendonk J, Steketee RME, van Rooij FJA, Roshchupkin GV, Ikram MA, Vernooij MW, Neitzel J. Predicting amyloid-beta pathology in the general population. Alzheimers Dement 2023; 19:5506-5517. [PMID: 37303116 DOI: 10.1002/alz.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/06/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Reliable models to predict amyloid beta (Aβ) positivity in the general aging population are lacking but could become cost-efficient tools to identify individuals at risk of developing Alzheimer's disease. METHODS We developed Aβ prediction models in the clinical Anti-Amyloid Treatment in Asymptomatic Alzheimer's (A4) Study (n = 4,119) including a broad range of easily ascertainable predictors (demographics, cognition and daily functioning, health and lifestyle factors). Importantly, we determined the generalizability of our models in the population-based Rotterdam Study (n = 500). RESULTS The best performing model in the A4 Study (area under the curve [AUC] = 0.73 [0.69-0.76]), including age, apolipoprotein E (APOE) ε4 genotype, family history of dementia, and subjective and objective measures of cognition, walking duration and sleep behavior, was validated in the independent Rotterdam Study with higher accuracy (AUC = 0.85 [0.81-0.89]). Yet, the improvement relative to a model including only age and APOE ε4 was marginal. DISCUSSION Aβ prediction models including inexpensive and non-invasive measures were successfully applied to a general population-derived sample more representative of typical older non-demented adults.
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Affiliation(s)
- Phuong Thuy Nguyen Ho
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Joyce van Arendonk
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Rebecca M E Steketee
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Frank J A van Rooij
- Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Gennady V Roshchupkin
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Meike W Vernooij
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Julia Neitzel
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
- Department of Epidemiology, Harvard T.H Chan School of Public Health, Boston, Massachusetts, USA
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32
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Ito H. Letter re: McNally AP, et al. Gastrointestinal Bleeding in Mechanical Cardiac Support. Am Surg 2023; 89:6415. [PMID: 34176334 DOI: 10.1177/00031348211029855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hiroshi Ito
- Division of Hospital Medicine, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
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33
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Atay S. A 15-Gene-Based Risk Signature for Predicting Overall Survival in SCLC Patients Who Have Undergone Surgical Resection. Cancers (Basel) 2023; 15:5219. [PMID: 37958393 PMCID: PMC10649828 DOI: 10.3390/cancers15215219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Small cell lung cancer (SCLC) is a malignancy with a poor prognosis whose treatment has not progressed for decades. The survival benefit of surgery and the selection of surgical candidates are still controversial in SCLC. This study is the first report to identify transcriptomic alterations associated with prognosis and propose a gene expression-based risk signature that can be used to predict overall survival (OS) in SCLC patients who have undergone potentially curative surgery. An integrative transcriptome analysis of three gene expression datasets (GSE30219, GSE43346, and GSE149507) revealed 1734 up-regulated and 2907 down-regulated genes. Cox-Mantel test, Cox regression, and Lasso regression analyses were used to identify genes to be included in the risk signature. EGAD00001001244 and GSE60052-cohorts were used for internal and external validation, respectively. Overall survival was significantly poorer in patients with high-risk scores compared to the low-risk group. The discriminatory performance of the risk signature was superior to other parameters. Multivariate analysis showed that the risk signature has the potential to be an independent predictor of prognosis. The prognostic genes were enriched in pathways including regulation of transcription, cell cycle, cell metabolism, and angiogenesis. Determining the roles of the identified prognostic genes in the pathogenesis of SCLC may contribute to the development of new treatment strategies. The risk signature needs to be validated in a larger cohort of patients to test its usefulness in clinical decision-making.
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Affiliation(s)
- Sevcan Atay
- Department of Medical Biochemistry, Faculty of Medicine, Ege University, 35100 Izmir, Turkey
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Sagaro GG, Angeloni U, Battineni G, Chintalapudi N, Dicanio M, Kebede MM, Marotta C, Rezza G, Silenzi A, Amenta F. Risk prediction model of self-reported hypertension for telemedicine based on the sociodemographic, occupational and health-related characteristics of seafarers: a cross-sectional epidemiological study. BMJ Open 2023; 13:e070146. [PMID: 37793918 PMCID: PMC10551994 DOI: 10.1136/bmjopen-2022-070146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 08/22/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVES High blood pressure is a common health concern among seafarers. However, due to the remote nature of their work, it can be difficult for them to access regular monitoring of their blood pressure. Therefore, the development of a risk prediction model for hypertension in seafarers is important for early detection and prevention. This study developed a risk prediction model of self-reported hypertension for telemedicine. DESIGN A cross-sectional epidemiological study was employed. SETTING This study was conducted among seafarers aboard ships. Data on sociodemographic, occupational and health-related characteristics were collected using anonymous, standardised questionnaires. PARTICIPANTS This study involved 8125 seafarers aged 18-70 aboard 400 vessels between November 2020 and December 2020. 4318 study subjects were included in the analysis. Seafarers over 18 years of age, active (on duty) during the study and willing to give informed consent were the inclusion criteria. OUTCOME MEASURES We calculated the adjusted OR (AOR) with 95% CIs using multiple logistic regression models to estimate the associations between sociodemographic, occupational and health-related characteristics and self-reported hypertension. We also developed a risk prediction model for self-reported hypertension for telemedicine based on seafarers' characteristics. RESULTS Among the 4318 participants, 55.3% and 44.7% were non-officers and officers, respectively. 20.8% (900) of the participants reported having hypertension. Multivariable analysis showed that age (AOR: 1.08, 95% CI 1.07 to 1.10), working long hours per week (AOR: 1.02, 95% CI 1.01 to 1.03), work experience at sea (10+ years) (AOR: 1.79, 95% CI 1.33 to 2.42), being a non-officer (AOR: 1.75, 95% CI 1.44 to 2.13), snoring (AOR: 3.58, 95% CI 2.96 to 4.34) and other health-related variables were independent predictors of self-reported hypertension, which were included in the final risk prediction model. The sensitivity, specificity and accuracy of the predictive model were 56.4%, 94.4% and 86.5%, respectively. CONCLUSION A risk prediction model developed in the present study is accurate in predicting self-reported hypertension in seafarers' onboard ships.
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Affiliation(s)
- Getu Gamo Sagaro
- School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Marche, Italy
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Ulrico Angeloni
- General Directorate of Health Prevention, Ministry of Health, Rome, Italy
| | - Gopi Battineni
- School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Marche, Italy
| | - Nalini Chintalapudi
- School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Marche, Italy
| | - Marzio Dicanio
- School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Marche, Italy
| | | | - Claudia Marotta
- General Directorate of Health Prevention, Ministry of Health, Rome, Italy
| | - Giovanni Rezza
- General Directorate of Health Prevention, Ministry of Health, Rome, Italy
| | - Andrea Silenzi
- General Directorate of Health Prevention, Ministry of Health, Rome, Italy
| | - Francesco Amenta
- School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Marche, Italy
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Tsukita K, Sakamaki-Tsukita H, Kaiser S, Zhang L, Messa M, Serrano-Fernandez P, Takahashi R. High-Throughput CSF Proteomics and Machine Learning to Identify Proteomic Signatures for Parkinson Disease Development and Progression. Neurology 2023; 101:e1434-e1447. [PMID: 37586882 PMCID: PMC10573147 DOI: 10.1212/wnl.0000000000207725] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 05/30/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This study aimed to identify CSF proteomic signatures characteristic of Parkinson disease (PD) and evaluate their clinical utility. METHODS This observational study used data from the Parkinson's Progression Markers Initiative (PPMI), which enrolled patients with PD, healthy controls (HCs), and non-PD participants carrying GBA1, LRRK2, and/or SNCA pathogenic variants (genetic prodromals) at international sites. Study participants were chosen from PPMI enrollees based on the availability of aptamer-based CSF proteomic data, quantifying 4,071 proteins, and classified as patients with PD without GBA1, LRRK2, and/or SNCA pathogenic variants (nongenetic PD), HCs, patients with PD carrying the aforementioned pathogenic variants (genetic PD), or genetic prodromals. Differentially expressed protein (DEP) analysis and the least absolute shrinkage and selection operator (LASSO) were applied to the data from nongenetic PD and HCs. Signatures characteristics of nongenetic PD were quantified as a PD proteomic score (PD-ProS), validated internally and then externally using data of 1,556 CSF proteins from the LRRK2 Cohort Consortium (LCC). We further tested the PD-ProS in genetic PD and genetic prodromals and examined associations with clinical progression. RESULTS Data from 279 patients with nongenetic PD (mean ± SD, age 62.0 ± 9.6 years; male 67.7%) and 141 HCs (age 60.5 ± 11.9 years; male 64.5%) were used for PD-ProS derivation. From 23 DEPs, LASSO determined weights of 14 DEPs for the PD-ProS (area under the curve [AUC] 0.83, 95% CI 0.78-0.87), validated in an independent internal validation cohort of 71 patients with nongenetic PD and 35 HCs (AUC 0.81, 95% CI 0.73-0.90). In the LCC, only 5 of the 14 DEPs were also measured. Notably, these 5 DEPs still distinguished 34 patients with nongenetic PD from 31 HCs with the same weights (AUC 0.75, 95% CI 0.63-0.87). Furthermore, the PD-ProS distinguished 258 patients with genetic PD from 365 genetic prodromals. Finally, regardless of genetic status, the PD-ProS independently predicted both cognitive and motor decline in PD (dementia, adjusted hazard ratio in the highest quintile [aHR-Q5] 2.8 [95% CI 1.6-5.0]; Hoehn and Yahr stage IV, aHR-Q5 2.1 [95% CI 1.1-4.0]). DISCUSSION By integrating high-throughput proteomics with machine learning, we identified PD-associated CSF proteomic signatures crucial for PD development and progression. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov (NCT01176565). A link to the trial registry page is clinicaltrials.gov/ct2/show/NCT01141023. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that the CSF proteome contains clinically important information regarding the development and progression of Parkinson disease that can be deciphered by a combination of high-throughput proteomics and machine learning.
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Affiliation(s)
- Kazuto Tsukita
- From the Department of Neurology (K.T., H.S.-T., R.T.), Graduate School of Medicine, Kyoto University; Advanced Comprehensive Research Organization (K.T.), Teikyo University, Itabashi; Division of Sleep Medicine (K.T.), Kansai Electric Power Medical Research Institute, Osaka, Japan; Translational Medicine Department (S.K., P.S.-F.), Novartis Institutes for Biomedical Research, Basel, Switzerland; and Cardiovascular and Metabolism Department (L.Z.), and Neuroscience Department (M.M.), Novartis Institutes for Biomedical Research, Cambridge, MA.
| | - Haruhi Sakamaki-Tsukita
- From the Department of Neurology (K.T., H.S.-T., R.T.), Graduate School of Medicine, Kyoto University; Advanced Comprehensive Research Organization (K.T.), Teikyo University, Itabashi; Division of Sleep Medicine (K.T.), Kansai Electric Power Medical Research Institute, Osaka, Japan; Translational Medicine Department (S.K., P.S.-F.), Novartis Institutes for Biomedical Research, Basel, Switzerland; and Cardiovascular and Metabolism Department (L.Z.), and Neuroscience Department (M.M.), Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Sergio Kaiser
- From the Department of Neurology (K.T., H.S.-T., R.T.), Graduate School of Medicine, Kyoto University; Advanced Comprehensive Research Organization (K.T.), Teikyo University, Itabashi; Division of Sleep Medicine (K.T.), Kansai Electric Power Medical Research Institute, Osaka, Japan; Translational Medicine Department (S.K., P.S.-F.), Novartis Institutes for Biomedical Research, Basel, Switzerland; and Cardiovascular and Metabolism Department (L.Z.), and Neuroscience Department (M.M.), Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Luqing Zhang
- From the Department of Neurology (K.T., H.S.-T., R.T.), Graduate School of Medicine, Kyoto University; Advanced Comprehensive Research Organization (K.T.), Teikyo University, Itabashi; Division of Sleep Medicine (K.T.), Kansai Electric Power Medical Research Institute, Osaka, Japan; Translational Medicine Department (S.K., P.S.-F.), Novartis Institutes for Biomedical Research, Basel, Switzerland; and Cardiovascular and Metabolism Department (L.Z.), and Neuroscience Department (M.M.), Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Mirko Messa
- From the Department of Neurology (K.T., H.S.-T., R.T.), Graduate School of Medicine, Kyoto University; Advanced Comprehensive Research Organization (K.T.), Teikyo University, Itabashi; Division of Sleep Medicine (K.T.), Kansai Electric Power Medical Research Institute, Osaka, Japan; Translational Medicine Department (S.K., P.S.-F.), Novartis Institutes for Biomedical Research, Basel, Switzerland; and Cardiovascular and Metabolism Department (L.Z.), and Neuroscience Department (M.M.), Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Pablo Serrano-Fernandez
- From the Department of Neurology (K.T., H.S.-T., R.T.), Graduate School of Medicine, Kyoto University; Advanced Comprehensive Research Organization (K.T.), Teikyo University, Itabashi; Division of Sleep Medicine (K.T.), Kansai Electric Power Medical Research Institute, Osaka, Japan; Translational Medicine Department (S.K., P.S.-F.), Novartis Institutes for Biomedical Research, Basel, Switzerland; and Cardiovascular and Metabolism Department (L.Z.), and Neuroscience Department (M.M.), Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Ryosuke Takahashi
- From the Department of Neurology (K.T., H.S.-T., R.T.), Graduate School of Medicine, Kyoto University; Advanced Comprehensive Research Organization (K.T.), Teikyo University, Itabashi; Division of Sleep Medicine (K.T.), Kansai Electric Power Medical Research Institute, Osaka, Japan; Translational Medicine Department (S.K., P.S.-F.), Novartis Institutes for Biomedical Research, Basel, Switzerland; and Cardiovascular and Metabolism Department (L.Z.), and Neuroscience Department (M.M.), Novartis Institutes for Biomedical Research, Cambridge, MA
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Bisignani A, Pannone L, Del Monte A, Eltsov I, Cappello IA, Sieira J, Monaco C, Bala G, Mouram S, Della Rocca DG, Ströker E, Overeinder I, Almorad A, Pappaert G, Gauthey A, de Ravel T, Van Dooren S, Sorgente A, La Meir M, Sarkozy A, Brugada P, Chierchia GB, de Asmundis C. Atrial Abnormalities in Brugada Syndrome: Evaluation With ECG Imaging. JACC Clin Electrophysiol 2023; 9:2096-2105. [PMID: 37565952 DOI: 10.1016/j.jacep.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Patients with Brugada syndrome (BrS) have an increased risk of arrhythmias, including atrial tachyarrhythmias (ATas). OBJECTIVES The purpose of this study was to assess underlying atrial cardiomyopathy in BrS and the effect of ajmaline (AJM) test on the atrium of BrS patients using electrocardiogram imaging (ECGI). METHODS All consecutive patients diagnosed with BrS in a monocentric registry were screened and included if they met the following criteria: 1) BrS diagnosed following current recommendations; and 2) ECGI map performed before and after AJM with a standard protocol. Consecutive patients with no structural heart disease or BrS who had undergone ECGI were included as a control group. Genetic analysis for SCN5A was performed in all BrS patients. Total atrial conduction time (TACT) and local atrial conduction time (LACT) were calculated from atrial ECGI. The primary endpoint was ATas during follow-up. RESULTS Forty-three consecutive BrS patients and 40 control patients were included. Both TACT and LACT were significantly prolonged in BrS patients compared with control patients. Furthermore, TACT and LACT were significantly higher after AJM administration and in BrS patients who were carriers of a pathogenic/likely pathogenic SCN5A variant. After a mean follow-up of 40.9 months, 6 patients experienced a first ATa occurrence (all in the BrS group, 13.9%). TACT was the only independent predictor of ATas with a cutoff of >138.5 ms (sensitivity 0.92 [95% CI: 0.83-0.98], specificity 0.70 [95% CI: 0.59-0.81]). CONCLUSIONS ECGI-calculated TACT and LACT are significantly prolonged in BrS patients compared with control patients, and in BrS patients after AJM. This may be consistent with a concealed atrial cardiomyopathy in BrS.
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Affiliation(s)
- Antonio Bisignani
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium; Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy. https://twitter.com/AntBisignani_MD
| | - Luigi Pannone
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium. https://twitter.com/LuigipannoneM
| | - Alvise Del Monte
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ivan Eltsov
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ida Anna Cappello
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Cinzia Monaco
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sahar Mouram
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gudrun Pappaert
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Anaïs Gauthey
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Thomy de Ravel
- Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sonia Van Dooren
- Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium; Clinical Sciences, Research Group Reproduction and Genetics, Brussels Interuniversity Genomics High Throughput Core (BRIGHTcore), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Mark La Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium.
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Caronni A, Picardi M, Scarano S, Malloggi C, Tropea P, Gilardone G, Aristidou E, Pintavalle G, Redaelli V, Antoniotti P, Corbo M. Pay attention: you can fall! The Mini-BESTest scale and the turning duration of the TUG test provide valid balance measures in neurological patients: a prospective study with falls as the balance criterion. Front Neurol 2023; 14:1228302. [PMID: 37745667 PMCID: PMC10516579 DOI: 10.3389/fneur.2023.1228302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/08/2023] [Indexed: 09/26/2023] Open
Abstract
Background Balance, i.e., the ability not to fall, is often poor in neurological patients and this impairment increases their risk of falling. The Mini-Balance Evaluation System Test (Mini-BESTest), a rating scale, the Timed Up and Go (TUG) test, and gait measures are commonly used to quantify balance. This study assesses the criterion validity of these measures as balance measures. Methods The probability of being a faller within nine months was used as the balance criterion. The Mini-BESTest, TUG (instrumented with inertial sensors), and walking test were administered before and after inpatient rehabilitation. Multiple and LASSO logistic regressions were used for the analysis. The diagnostic accuracy of the model was assessed with the area under the curve (AUC) of the receiver operating characteristic curve. Mobility measure validity was compared with the Akaike Information Criterion (AIC). Results Two hundred and fourteen neurological patients (stroke, peripheral neuropathy, or parkinsonism) were recruited. In total, 82 patients fell at least once in the nine-month follow-up. The Mini-BESTest (AUC = 0.69; 95%CI: 0.62-0.76), the duration of the TUG turning phase (AUC = 0.69; 0.62-0.76), and other TUG measures were significant faller predictors in regression models. However, only the turning duration (AIC = 274.0) and Mini-BESTest (AIC = 276.1) substantially improved the prediction of a baseline model, which only included fall risk factors from the medical history (AIC = 281.7). The LASSO procedure selected gender, disease chronicity, urinary incontinence, the Mini-BESTest, and turning duration as optimal faller predictors. Conclusion The TUG turning duration and the Mini-BESTest predict the chance of being a faller. Their criterion validity as balance measures in neurological patients is substantial.
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Affiliation(s)
- Antonio Caronni
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Michela Picardi
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | - Stefano Scarano
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Chiara Malloggi
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milan, Italy
| | - Peppino Tropea
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | - Giulia Gilardone
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | - Evdoxia Aristidou
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | | | - Valentina Redaelli
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | - Paola Antoniotti
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
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Zhang J, Yang K, Wang C, Gu W, Li X, Fu S, Song G, Wang J, Wu C, Zhu H, Shi Z. Risk factors for chronic ankle instability after first episode of lateral ankle sprain: A retrospective analysis of 362 cases. J Sport Health Sci 2023; 12:606-612. [PMID: 36931594 PMCID: PMC10466191 DOI: 10.1016/j.jshs.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/12/2022] [Accepted: 02/18/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Chronic ankle instability (CAI) is a common sequela following an acute lateral ankle sprain (LAS). To treat an acute LAS more effectively and efficiently, it is important to identify patients at substantial risk for developing CAI. This study identifies magnetic resonance imaging (MRI) manifestations for predicting CAI development after a first episode of LAS and explores appropriate clinical indications for ordering MRI scans for these patients. METHODS All patients with a first-episode LAS who received plain radiograph and MRI scanning within the first 2 weeks after LAS from December 1, 2017 to December 1, 2019 were identified. Data were collected using the Cumberland Ankle Instability Tool at final follow-up. Demographic and other related clinical variables, including age, sex, body mass index, and treatment were also recorded. Univariable and multivariable analyses were performed successively to identify risk factors for CAI after first-episode LAS. RESULTS A total 131 out of 362 patients with a mean follow-up of 3.0 ± 0.6 years (mean ± SD; 2.0-4.1 years) developed CAI after first-episode LAS. According to multivariable regression, development of CAI after first-episode LAS was associated with 5 prognostic factors: age (odds ratio (OR) = 0.96, 95% confidence interval (95%CI): 0.93-1.00, p = 0.032); body mass index (OR = 1.09, 95%CI: 1.02-1.17, p = 0.009); posterior talofibular ligament injury (OR = 2.17, 95%CI: 1.05-4.48, p = 0.035); large bone marrow lesion of the talus (OR = 2.69, 95%CI: 1.30-5.58, p = 0.008), and Grade 2 effusion of the tibiotalar joint (OR = 2.61, 95%CI: 1.39-4.89, p = 0.003). When patients had at least 1 positive clinical finding in the 10-m walk test, anterior drawer test, or inversion tilt test, they had a 90.2% sensitivity and 77.4% specificity in terms of detecting at least 1 prognostic factor by MRI. CONCLUSION MRI scanning is valuable in predicting CAI after first-episode LAS for those patients with at least 1 positive clinical finding in the 10-m walk test, anterior drawer test, and inversion tilt test. Further prospective and large-scale studies are necessary for validation.
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Affiliation(s)
- Jieyuan Zhang
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai 200233, China; Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai 200233, China
| | - Kai Yang
- Department of Radiology, Shanghai Sixth People's Hospital, Shanghai 200233, China
| | - Cheng Wang
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai 200233, China; Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai 200233, China
| | - Wenqi Gu
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai 200233, China; Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai 200233, China
| | - Xueqian Li
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai 200233, China; Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai 200233, China
| | - Shaoling Fu
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai 200233, China; Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai 200233, China
| | - Guoxun Song
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai 200233, China; Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai 200233, China
| | - Jiazheng Wang
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai 200233, China; Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai 200233, China
| | - Chenglin Wu
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai 200233, China; Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai 200233, China
| | - Hongyi Zhu
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai 200233, China; Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai 200233, China; Institute of Clinical Research, National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai 200233, China.
| | - Zhongmin Shi
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai 200233, China; Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai 200233, China.
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Wang S, Huang H, Hou M, Xu Q, Qian W, Tang Y, Li X, Qian G, Ma J, Zheng Y, Shen Y, Lv H. Risk-prediction models for intravenous immunoglobulin resistance in Kawasaki disease: Risk-of-Bias Assessment using PROBAST. Pediatr Res 2023; 94:1125-1135. [PMID: 36964445 PMCID: PMC10444619 DOI: 10.1038/s41390-023-02558-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/01/2023] [Accepted: 02/10/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND The prediction model of intravenous immunoglobulin (IVIG) resistance in Kawasaki disease can calculate the probability of IVIG resistance and provide a basis for clinical decision-making. We aim to assess the quality of these models developed in the children with Kawasaki disease. METHODS Studies of prediction models for IVIG-resistant Kawasaki disease were identified through searches in the PubMed, Web of Science, and Embase databases. Two investigators independently performed literature screening, data extraction, quality evaluation, and discrepancies were settled by a statistician. The checklist for critical appraisal and data extraction for systematic reviews of prediction modeling studies (CHARMS) was used for data extraction, and the prediction models were evaluated using the Prediction Model Risk of Bias Assessment Tool (PROBAST). RESULTS Seventeen studies meeting the selection criteria were included in the qualitative analysis. The top three predictors were neutrophil measurements (peripheral neutrophil count and neutrophil %), serum albumin level, and C-reactive protein (CRP) level. The reported area under the curve (AUC) values for the developed models ranged from 0.672 (95% confidence interval [CI]: 0.631-0.712) to 0.891 (95% CI: 0.837-0.945); The studies showed a high risk of bias (ROB) for modeling techniques, yielding a high overall ROB. CONCLUSION IVIG resistance models for Kawasaki disease showed high ROB. An emphasis on improving their quality can provide high-quality evidence for clinical practice. IMPACT STATEMENT This study systematically evaluated the risk of bias (ROB) of existing prediction models for intravenous immunoglobulin (IVIG) resistance in Kawasaki disease to provide guidance for future model development meeting clinical expectations. This is the first study to systematically evaluate the ROB of IVIG resistance in Kawasaki disease by using PROBAST. ROB may reduce model performance in different populations. Future prediction models should account for this problem, and PROBAST can help improve the methodological quality and applicability of prediction model development.
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Affiliation(s)
- Shuhui Wang
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215003, China
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215003, China
| | - Hongbiao Huang
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215003, China
| | - Miao Hou
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215003, China
| | - Qiuqin Xu
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215003, China
| | - Weiguo Qian
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215003, China
| | - Yunjia Tang
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215003, China
| | - Xuan Li
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215003, China
| | - Guanghui Qian
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215003, China
| | - Jin Ma
- Department of Pharmacy, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215003, China
| | - Yiming Zheng
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215003, China
| | - Yueping Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, 215123, China.
| | - Haitao Lv
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215003, China.
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215003, China.
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Lee E, Hines RB, Zhu J, Rovito MJ, Dharmarajan KV, Mazumdar M. Association between adjuvant radiation treatment and breast cancer-specific mortality among older women with comorbidity burden: A comparative effectiveness analysis of SEER-MHOS. Cancer Med 2023; 12:18729-18744. [PMID: 37706222 PMCID: PMC10557861 DOI: 10.1002/cam4.6493] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/04/2023] [Accepted: 08/23/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND The National Comprehensive Cancer Network suggested that older women with low-risk breast cancer (LRBC; i.e., early-stage, node-negative, and estrogen receptor-positive) could omit adjuvant radiation treatment (RT) after breast-conserving surgery (BCS) if they were treated with hormone therapy. However, the association between RT omission and breast cancer-specific mortality among older women with comorbidity is not fully known. METHODS 1105 older women (≥65 years) with LRBC in 1998-2012 were queried from the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey data resource and were followed up through July 2018. Latent class analysis was performed to identify comorbidity burden classes. A propensity score-based inverse probability of treatment weighting (IPTW) was applied to Cox regression models to obtain subdistribution hazard ratios (HRs) and 95% CI for cancer-specific mortality considering other causes of death as competing risks, overall and separately by comorbidity burden class. RESULTS Three comorbidity burden (low, moderate, and high) groups were identified. A total of 318 deaths (47 cancer-related) occurred. The IPTW-adjusted Cox regression analysis showed that RT omission was not associated with short-term, 5- and 10-year cancer-specific death (p = 0.202 and p = 0.536, respectively), regardless of comorbidity burden. However, RT omission could increase the risk of long-term cancer-specific death in women with low comorbidity burden (HR = 1.98, 95% CI = 1.17, 3.33), which warrants further study. CONCLUSIONS Omission of RT after BCS is not associated with an increased risk of cancer-specific death and is deemed a reasonable treatment option for older women with moderate to high comorbidity burden.
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Affiliation(s)
- Eunkyung Lee
- Department of Health SciencesUniversity of Central Florida College of Health Professions and SciencesFloridaOrlandoUSA
| | - Robert B. Hines
- Department of Population Health SciencesUniversity of Central Florida College of MedicineFloridaOrlandoUSA
| | - Jianbin Zhu
- Department of Statistics and Data ScienceUniversity of Central Florida College of SciencesFloridaOrlandoUSA
- Research Institute, Advent HealthFloridaOrlandoUSA
| | - Michael J. Rovito
- Department of Health SciencesUniversity of Central Florida College of Health Professions and SciencesFloridaOrlandoUSA
| | - Kavita V. Dharmarajan
- Department of Radiation Oncology, Department of Geriatrics Palliative MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Madhu Mazumdar
- Institute for Healthcare Delivery ScienceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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Cinque F, Saeed S, Kablawi D, Ramos Ballesteros L, Elgretli W, Moodie EEM, Price C, Monteith K, Cooper C, Walmsley SL, Pick N, Murray MCM, Cox J, Kronfli N, Costiniuk CT, de Pokomandy A, Routy JP, Lebouché B, Klein MB, Sebastiani G. Role of fatty liver in the epidemic of advanced chronic liver disease among people with HIV: protocol for the Canadian LIVEHIV multicentre prospective cohort. BMJ Open 2023; 13:e076547. [PMID: 37607785 PMCID: PMC10445396 DOI: 10.1136/bmjopen-2023-076547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION Advanced chronic liver disease (ACLD) is a major cause of death for people with HIV (PWH). While viral hepatitis coinfections are largely responsible for this trend, metabolic dysfunction-associated steatotic liver disease (MASLD) is an emerging concern for PWH. We aimed to assess the contribution of MASLD to incident ACLD in PWH. METHODS AND ANALYSIS This multicentre prospective observational cohort study will enrol 968 consecutive HIV monoinfected patients from four Canadian sites, excluding subjects with alcohol abuse, liver disease other than MASLD, or ACLD at baseline. Participants will be followed annually for 4 years by clinical evaluation, questionnaires, laboratory testing and Fibroscan to measure liver stiffness measurement (LSM) and controlled attenuation parameter (CAP). The primary outcome will be incidence of ACLD, defined as LSM>10 kPa, by MASLD status, defined as CAP≥285 dB/m with at least one metabolic abnormality, and to develop a score to classify PWH according to their risk of ACLD. Secondary outcomes will include health-related quality of life (HRQoL) and healthcare resource usage. Kaplan-Meier survival method and Cox proportional hazards regression will calculate the incidence and predictors of ACLD, respectively. Propensity score methods and marginal structural models will account for time-varying exposures. We will split the cohort into a training set (to develop the risk score) and a validation set (for validation of the score). HRQoL scores and healthcare resource usage will be compared by MASLD status using generalised linear mixed effects model. ETHICS AND DISSEMINATION This protocol has been approved by the ethics committees of all participating institutions. Written informed consent will be obtained from all study participants. The results of this study will be shared through scientific publications and public presentations to advocate for the inclusion of PWH in clinical trials of MASLD-targeted therapies and case-finding of ACLD in PWH.
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Affiliation(s)
- Felice Cinque
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sahar Saeed
- Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Dana Kablawi
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Luz Ramos Ballesteros
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Wesal Elgretli
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Colleen Price
- Canadian HIV/AIDS and Chronic Pain Society, Ottawa, Ontario, Canada
| | | | - Curtis Cooper
- Department of Medicine, Division of Infectious Diseases, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sharon L Walmsley
- Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Neora Pick
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Melanie C M Murray
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph Cox
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Nadine Kronfli
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jean-Pierre Routy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | - Marina B Klein
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Giada Sebastiani
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Cheng L, Liu J, Lian L, Duan W, Guan J, Wang K, Liu Z, Wang X, Wang Z, Wu H, Chen Z, Wang J, Jian F. Predicting deep surgical site infection in patients receiving open posterior instrumented thoracolumbar surgery: A-DOUBLE-SSI risk score - a large retrospective multicenter cohort study in China. Int J Surg 2023; 109:2276-2285. [PMID: 37204435 PMCID: PMC10442129 DOI: 10.1097/js9.0000000000000461] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/01/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND To develop a practical prediction model to predict the risk of deep surgical site infection (SSI) in patients receiving open posterior instrumented thoracolumbar surgery. METHODS Data of 3419 patients in four hospitals from 1 January 2012 to 30 December 2021 were evaluated. The authors used clinical knowledge-driven, data-driven, and decision tree model to identify predictive variables of deep SSI. Forty-three candidate variables were collected, including 5 demographics, 29 preoperative, 5 intraoperative, and 4 postoperative variables. According to model performance and clinical practicability, the best model was chosen to develop a risk score. Internal validation was performed by using bootstrapping methods. RESULTS After open posterior instrumented thoracolumbar surgery, 158 patients (4.6%) developed deep SSI. The clinical knowledge-driven model yielded 12 predictors of deep SSI, while the data-driven and decision tree model produced 11 and 6 predictors, respectively. A knowledge-driven model, which had the best C-statistics [0.81 (95% CI: 0.78-0.85)] and superior calibration, was chosen due to its favorable model performance and clinical practicality. Moreover, 12 variables were identified in the clinical knowledge-driven model, including age, BMI, diabetes, steroid use, albumin, duration of operation, blood loss, instrumented segments, powdered vancomycin administration, duration of drainage, postoperative cerebrospinal fluid leakage, and early postoperative activities. In bootstrap internal validation, the knowledge-driven model still showed optimal C-statistics (0.79, 95% CI: 0.75-0.83) and calibration. Based on these identified predictors, a risk score for deep SSI incidence was created: the A-DOUBLE-SSI (Age, D [Diabetes, Drainage], O [duration of Operation, vancOmycin], albUmin, B [BMI, Blood loss], cerebrospinal fluid Leakage, Early activities, Steroid use, and Segmental Instrumentation) risk score. Based on the A-DOUBLE-SSI score system, the incidence of deep SSI increased in a graded fashion from 1.06% (A-DOUBLE-SSIs score ≤8) to 40.6% (A-DOUBLE-SSIs score>15). CONCLUSIONS The authors developed a novel and practical model, the A-DOUBLE-SSIs risk score, that integrated easily accessible demographics, preoperative, intraoperative, and postoperative variables and could be used to predict individual risk of deep SSI in patients receiving open posterior instrumented thoracolumbar surgery.
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Affiliation(s)
- Lei Cheng
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute
| | - Jiesheng Liu
- Department of Spine Surgery, Beijing Bo’ai Hospital, Rehabilitation Research Center, School of Rehabilitation, Capital Medical University
| | - Liyi Lian
- Department of Orthopedics, Shenzhen Baoan People’s Hospital, Shenzhen, China
| | - Wanru Duan
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute
| | - Jian Guan
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute
| | - Kai Wang
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute
| | - Zhenlei Liu
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute
| | - Xingwen Wang
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute
| | - Zuowei Wang
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute
| | - Hao Wu
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute
| | - Jianzhen Wang
- Department of Neurosurgery, Chinese PLA General Hospital, The 3rd Medical Center, Beijing
| | - Fengzeng Jian
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute
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Lewis MW, Webb CA, Kuhn M, Akman E, Jobson SA, Rosso IM. Predicting Fear Extinction in Posttraumatic Stress Disorder. Brain Sci 2023; 13:1131. [PMID: 37626488 PMCID: PMC10452660 DOI: 10.3390/brainsci13081131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
Fear extinction is the basis of exposure therapies for posttraumatic stress disorder (PTSD), but half of patients do not improve. Predicting fear extinction in individuals with PTSD may inform personalized exposure therapy development. The participants were 125 trauma-exposed adults (96 female) with a range of PTSD symptoms. Electromyography, electrocardiogram, and skin conductance were recorded at baseline, during dark-enhanced startle, and during fear conditioning and extinction. Using a cross-validated, hold-out sample prediction approach, three penalized regressions and conventional ordinary least squares were trained to predict fear-potentiated startle during extinction using 50 predictor variables (5 clinical, 24 self-reported, and 21 physiological). The predictors, selected by penalized regression algorithms, were included in multivariable regression analyses, while univariate regressions assessed individual predictors. All the penalized regressions outperformed OLS in prediction accuracy and generalizability, as indexed by the lower mean squared error in the training and holdout subsamples. During early extinction, the consistent predictors across all the modeling approaches included dark-enhanced startle, the depersonalization and derealization subscale of the dissociative experiences scale, and the PTSD hyperarousal symptom score. These findings offer novel insights into the modeling approaches and patient characteristics that may reliably predict fear extinction in PTSD. Penalized regression shows promise for identifying symptom-related variables to enhance the predictive modeling accuracy in clinical research.
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Affiliation(s)
- Michael W. Lewis
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Christian A. Webb
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Manuel Kuhn
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Eylül Akman
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA 02478, USA
| | - Sydney A. Jobson
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA 02478, USA
| | - Isabelle M. Rosso
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
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Teshale AB, Wang VQ, Biney GK, Ameyaw EK, Adjei NK, Yaya S. Contraceptive use pattern based on the number and composition of children among married women in sub-Saharan Africa: a multilevel analysis. Contracept Reprod Med 2023; 8:39. [PMID: 37488658 PMCID: PMC10364431 DOI: 10.1186/s40834-023-00240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The relationship between composition of children and contraception use has received limited scholarly attention in sub-Saharan Africa. In this study, we examined the relationship between contraceptive methods, the number and composition of children in SSA. METHODS Data on 21 countries in sub-Saharan Africa (SSA) countries that had a Demographic and Health Survey on or before 2015 were analysed. We applied a multilevel multinomial logistic regression model to assess the influence of family composition on contraceptive use. Adjusted relative risk ratio (aRRR) and 95% CI were estimated. The significant level was set at p < 0.05. All the analyses were conducted using weighted data. RESULTS Women who had one son and two daughters (aRRR = 0.85, CI = 0.75, 0.95), two sons and one daughter (aRRR = 0.81 CI = 0.72, 0.92), one son and three daughters (aRRR = 0.66, CI = 0.54, 0.80), two sons and two daughters (aRRR = 0.59, CI = 0.50, 0.69), and three or more sons (aRRR = 0.75, CI = 0.63, 0.91) were less likely to use temporary modern contraceptive methods. Those with two sons and two daughters were less likely to use traditional methods (aRRR = 0.52, CI = 0.35, 0.78). Women in the older age group (35-49 years) were less likely to use temporary modern methods (aRRR = 0.60; 95%CI; 0.57, 0.63). However, this group of women were more likely to use permanent (sterilization) (aRRR = 1.71; 95%CI; 1.50, 1.91) and traditional methods (aRRR = 1.28; 95%CI; 1.14, 1.43). CONCLUSION These findings suggest that contraception needs of women vary based on the composition of their children, hence a common approach or intervention will not fit. As a result, contraception interventions ought to be streamlined to meet the needs of different categories of women. The findings can inform policymakers and public health professionals in developing effective strategies to improve contraceptive use in SSA.
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Affiliation(s)
- Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Vicky Qi Wang
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Tuen Mun, Hong Kong
| | - Godness Kye Biney
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, USA
| | - Edward Kwabena Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Tuen Mun, Hong Kong
- L & E Research Consult Ltd, Upper West Region, Ghana
| | - Nicholas Kofi Adjei
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada.
- The George Institute for Global Health, Imperial College London, London, UK.
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Bakalakos A, Elliott PM. The never-ending hunt for risk predictors in hypertrophic cardiomyopathy: the role of cardiac magnetic resonance tissue characterization. Eur Heart J Cardiovasc Imaging 2023; 24:885-886. [PMID: 37150871 DOI: 10.1093/ehjci/jead091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Affiliation(s)
- Athanasios Bakalakos
- Institute of Cardiovascular Science, University College London, 5 University St., London WC1E 6JF, UK
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London EC1A 7BE, UK
| | - Perry M Elliott
- Institute of Cardiovascular Science, University College London, 5 University St., London WC1E 6JF, UK
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London EC1A 7BE, UK
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Thunnissen FM, Comes DJ, Geenen RWF, Riviere D, Latenstein CSS, Lantinga MA, Schers HJ, van Laarhoven CJHM, Drenth JPH, Atsma F, de Reuver PR. Patients with Clinically Suspected Gallstone Disease: A More Selective Ultrasound May Improve Treatment Related Outcomes. J Clin Med 2023; 12:4162. [PMID: 37373855 DOI: 10.3390/jcm12124162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
This study aimed to quantify the confirmation of gallstones on ultrasound (US) in patients with suspicion of gallstone disease. To aid general practitioners (GPs) in diagnostic workup, a model to predict gallstones was developed. A prospective cohort study was conducted in two Dutch general hospitals. Patients (≥18 years) were eligible for inclusion when referred by GPs for US with suspicion of gallstones. The primary outcome was the confirmation of gallstones on US. A multivariable regression model was developed to predict the presence of gallstones. In total, 177 patients were referred with a clinical suspicion of gallstones. Gallstones were found in 64 of 177 patients (36.2%). Patients with gallstones reported higher pain scores (VAS 8.0 vs. 6.0, p < 0.001), less frequent pain (21.9% vs. 54.9%, p < 0.001), and more often met criteria for biliary colic (62.5% vs. 44.2%, p = 0.023). Predictors for the presence of gallstones were a higher pain score, frequency of pain less than weekly, biliary colic, and an absence of heartburn. The model showed good discrimination between patients with and without gallstones (C-statistic 0.73, range: 0.68-0.76). Clinical diagnosis of symptomatic gallstone disease is challenging. The model developed in this study may aid in the selection of patients for referral and improve treatment related outcomes.
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Affiliation(s)
- Floris M Thunnissen
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Daan J Comes
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Remy W F Geenen
- Department of Radiology, Northwest Clinics, 1815 JD Alkmaar, The Netherlands
| | - Deniece Riviere
- Department of Radiology, Jeroen Bosch Hospital, 5223 GZ 's-Hertogenbosch, The Netherlands
| | - Carmen S S Latenstein
- Department of Surgery, Amsterdam UMC, Location VUMC, 1081 HV Amsterdam, The Netherlands
| | - Marten A Lantinga
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Henk J Schers
- Department of General Practice, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Cornelis J H M van Laarhoven
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Femke Atsma
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Philip R de Reuver
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
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Halle-Smith JM, Hall L, Hann A, Arshad A, Armstrong MJ, Bangash MN, Murphy N, Cuell J, Isaac JL, Ferguson J, Roberts KJ, Mirza DF, Perera MTPR. Low C-reactive Protein and Urea Distinguish Primary Nonfunction From Early Allograft Dysfunction Within 48 Hours of Liver Transplantation. Transplant Direct 2023; 9:e1484. [PMID: 37250485 PMCID: PMC10212614 DOI: 10.1097/txd.0000000000001484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/03/2023] [Indexed: 05/31/2023] Open
Abstract
Primary nonfunction (PNF) is a life-threatening complication of liver transplantation (LT), but in the early postoperative period, it can be difficult to differentiate from early allograft dysfunction (EAD). The aim of this study was to determine if serum biomarkers can distinguish PNF from EAD in the initial 48 h following LT. Materials and Methods A retrospective study of adult patients that underwent LT between January 2010 and April 2020 was performed. Clinical parameters, absolute values and trends of C-reactive protein (CRP), blood urea, creatinine, liver function tests, platelets, and international normalized ratio in the initial 48 h after LT were compared between the EAD and PNF groups. Results There were 1937 eligible LTs, with PNF and EAD occurring in 38 (2%) and 503 (26%) patients, respectively. A low serum CRP and urea were associated with PNF. CRP was able to differentiate between the PNF and EAD on postoperative day (POD)1 (20 versus 43 mg/L; P < 0.001) and POD2 (24 versus 77; P < 0.001). The area under the receiver operating characteristic curve (AUROC) of POD2 CRP was 0.770 (95% confidence interval [CI] 0.645-0.895). The urea value on POD2 (5.05 versus 9.0 mmol/L; P = 0.002) and trend of POD2:1 ratio (0.71 versus 1.32 mmol/L; P < 0.001) were significantly different between the groups. The AUROC of the change in urea from POD1 to 2 was 0.765 (95% CI 0.645-0.885). Aspartate transaminase was significantly different between the groups, with an AUROC of 0.884 (95% CI 0.753-1.00) on POD2. Discussion The biochemical profile immediately following LT can distinguish PNF from EAD; CRP, urea, and aspartate transaminase are more effective than ALT and bilirubin in distinguishing PNF from EAD in the initial postoperative 48 h. Clinicians should consider the values of these markers when making treatment decisions.
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Affiliation(s)
- James M. Halle-Smith
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, United Kingdom
| | - Lewis Hall
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, United Kingdom
| | - Angus Hann
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, United Kingdom
| | - Asif Arshad
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Matthew J. Armstrong
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, United Kingdom
| | - Mansoor N. Bangash
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, United Kingdom
| | - Nick Murphy
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, United Kingdom
| | - James Cuell
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - John L. Isaac
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - James Ferguson
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, United Kingdom
| | - Keith J. Roberts
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, United Kingdom
| | - Darius F. Mirza
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, United Kingdom
| | - M. Thamara P. R. Perera
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, United Kingdom
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Gould DJ, Bailey JA, Spelman T, Bunzli S, Dowsey MM, Choong PFM. Predicting 30-day readmission following total knee arthroplasty using machine learning and clinical expertise applied to clinical administrative and research registry data in an Australian cohort. Arthroplasty 2023; 5:30. [PMID: 37259173 DOI: 10.1186/s42836-023-00186-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/10/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Thirty-day readmission is an increasingly important problem for total knee arthroplasty (TKA) patients. The aim of this study was to develop a risk prediction model using machine learning and clinical insight for 30-day readmission in primary TKA patients. METHOD Data used to train and internally validate a multivariable predictive model were obtained from a single tertiary referral centre for TKA located in Victoria, Australia. Hospital administrative data and clinical registry data were utilised, and predictors were selected through systematic review and subsequent consultation with clinicians caring for TKA patients. Logistic regression and random forest models were compared to one another. Calibration was evaluated by visual inspection of calibration curves and calculation of the integrated calibration index (ICI). Discriminative performance was evaluated using the area under the receiver operating characteristic curve (AUC-ROC). RESULTS The models developed in this study demonstrated adequate calibration for use in the clinical setting, despite having poor discriminative performance. The best-calibrated readmission prediction model was a logistic regression model trained on administrative data using risk factors identified from systematic review and meta-analysis, which are available at the initial consultation (ICI = 0.012, AUC-ROC = 0.589). Models developed to predict complications associated with readmission also had reasonable calibration (ICI = 0.012, AUC-ROC = 0.658). CONCLUSION Discriminative performance of the prediction models was poor, although machine learning provided a slight improvement. The models were reasonably well calibrated, meaning they provide accurate patient-specific probabilities of these outcomes. This information can be used in shared clinical decision-making for discharge planning and post-discharge follow up.
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Affiliation(s)
- Daniel J Gould
- Department of Surgery, St Vincent's Hospital Melbourne, University of Melbourne, Level 2 Clinical Sciences Building, 29 Regent Street, Fitzroy, VIC, 3065, Australia.
| | - James A Bailey
- School of Computing and Information Systems, University of Melbourne, Doug McDonell Building, Parkville, VIC, 3052, Australia
| | - Tim Spelman
- Department of Surgery, St Vincent's Hospital Melbourne, University of Melbourne, Level 2 Clinical Sciences Building, 29 Regent Street, Fitzroy, VIC, 3065, Australia
| | - Samantha Bunzli
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Nathan, QLD, 4111, Australia
| | - Michelle M Dowsey
- Department of Surgery, St Vincent's Hospital Melbourne, University of Melbourne, Level 2 Clinical Sciences Building, 29 Regent Street, Fitzroy, VIC, 3065, Australia
- Department of Orthopaedics, St. Vincent's Hospital Melbourne, Level 3/35 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Peter F M Choong
- Department of Surgery, St Vincent's Hospital Melbourne, University of Melbourne, Level 2 Clinical Sciences Building, 29 Regent Street, Fitzroy, VIC, 3065, Australia
- Department of Orthopaedics, St. Vincent's Hospital Melbourne, Level 3/35 Victoria Parade, Fitzroy, VIC, 3065, Australia
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Yu C, Ren X, Cui Z, Pan L, Zhao H, Sun J, Wang Y, Chang L, Cao Y, He H, Xi J, Zhang L, Shan G. A diagnostic prediction model for hypertension in Han and Yugur population from the China National Health Survey (CNHS). Chin Med J (Engl) 2023; 136:1057-1066. [PMID: 35276703 PMCID: PMC10228485 DOI: 10.1097/cm9.0000000000001989] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The prevalence of hypertension is high among Chinese adults, thus, identifying non-hypertensive individuals at high risk for intervention will help to improve the efficiency of primary prevention strategies. METHODS The cross-sectional data on 9699 participants aged 20 to 80 years were collected from the China National Health Survey in Gansu and Hebei provinces in 2016 to 2017, and they were nonrandomly split into the training set and validation set based on location. Multivariable logistic regression analysis was performed to develop the diagnostic prediction model, which was presented as a nomogram and a website with risk classification. Predictive performances of the model were evaluated using discrimination and calibration, and were further compared with a previously published model. Decision curve analysis was used to calculate the standardized net benefit for assessing the clinical usefulness of the model. RESULTS The Lasso regression analysis identified the significant predictors of hypertension in the training set, and a diagnostic model was developed using logistic regression. A nomogram with risk classification was constructed to visualize the model, and a website ( https://chris-yu.shinyapps.io/hypertension_risk_prediction/ ) was developed to calculate the exact probabilities of hypertension. The model showed good discrimination and calibration, with the C-index of 0.789 (95% confidence interval [CI]: 0.768, 0.810) through internal validation and 0.829 (95% CI: 0.816, 0.842) through external validation. Decision curve analysis demonstrated that the model was clinically useful. The model had a higher area under receiver operating characteristic curves in training and validation sets compared with a previously published diagnostic model based on Northern China population. CONCLUSION This study developed and validated a diagnostic model for hypertension prediction in Gansu Province. A nomogram and a website were developed to make the model conveniently used to facilitate the individualized prediction of hypertension in the general population of Han and Yugur.
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Affiliation(s)
- Chengdong Yu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing 100005, China
| | - Xiaolan Ren
- Institute of Chronic and Noncommunicable Disease Control and Prevention, Gansu Provincial Centre for Disease Control and Prevention, Lanzhou, Gansu 730000, China
| | - Ze Cui
- Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, Hebei 050000, China
| | - Li Pan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing 100005, China
| | - Hongjun Zhao
- Institute of Chronic and Noncommunicable Disease Control and Prevention, Gansu Provincial Centre for Disease Control and Prevention, Lanzhou, Gansu 730000, China
- The State Key Lab of Respiratory Disease, The First Affiliated Hospital, The School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong 510182, China
| | - Jixin Sun
- Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, Hebei 050000, China
| | - Ye Wang
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing 100005, China
| | - Lijun Chang
- Institute of Chronic and Noncommunicable Disease Control and Prevention, Gansu Provincial Centre for Disease Control and Prevention, Lanzhou, Gansu 730000, China
| | - Yajing Cao
- Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, Hebei 050000, China
| | - Huijing He
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing 100005, China
| | - Jin’en Xi
- Institute of Chronic and Noncommunicable Disease Control and Prevention, Gansu Provincial Centre for Disease Control and Prevention, Lanzhou, Gansu 730000, China
| | - Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing 100005, China
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Mittman BG, Sheehan M, Kojima L, Cassachia N, Lisheba O, Hu B, Pappas M, Rothberg MB. A Novel Risk Assessment Model Predicts Major Bleeding Risk at Admission in Medical Inpatients. medRxiv 2023:2023.04.29.23289304. [PMID: 37205327 PMCID: PMC10187332 DOI: 10.1101/2023.04.29.23289304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background Venous thromboembolism (VTE) is the leading cause of preventable hospital death in the US. Guidelines from the American College of Chest Physicians and American Society for Hematology recommend providing pharmacological VTE prophylaxis to acutely or critically ill medical patients at acceptable bleeding risk, but there is currently only one validated risk assessment model (RAM) for estimating bleeding risk. We developed a RAM using risk factors at admission and compared it with the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) model. Methods A total of 46,314 medical patients admitted to a Cleveland Clinic Health System hospital from 2017-2020 were included. Data were split into training (70%) and validation (30%) sets with equivalent bleeding event rates in each set. Potential risk factors for major bleeding were identified from the IMPROVE model and literature review. Penalized logistic regression using LASSO was performed on the training set to select and regularize important risk factors for the final model. The validation set was used to assess model calibration and discrimination and compare performance with IMPROVE. Bleeding events and risk factors were confirmed through chart review. Results The incidence of major in-hospital bleeding was 0.58%. Active peptic ulcer (OR = 5.90), prior bleeding (OR = 4.24), and history of sepsis (OR = 3.29) were the strongest independent risk factors. Other risk factors included age, male sex, decreased platelet count, increased INR, increased PTT, decreased GFR, ICU admission, CVC or PICC placement, active cancer, coagulopathy, and in-hospital antiplatelet drug, steroid, or SSRI use. In the validation set, the Cleveland Clinic Bleeding Model (CCBM) had better discrimination than IMPROVE (0.86 vs. 0.72, p < .001) and, at equivalent sensitivity (54%), categorized fewer patients as high-risk (6.8% vs. 12.1%, p < .001). Conclusions From a large population of medical inpatients, we developed and validated a RAM to accurately predict bleeding risk at admission. The CCBM may be used in conjunction with VTE risk calculators to decide between mechanical and pharmacological prophylaxis for at-risk patients.
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Affiliation(s)
- Benjamin G Mittman
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Megan Sheehan
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH
| | - Lisa Kojima
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH
| | | | - Oleg Lisheba
- Enterprise Analytics eResearch Department, Cleveland Clinic, Cleveland, OH
| | - Bo Hu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Matthew Pappas
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH
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