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1.
Sensors (Basel) ; 24(11)2024 May 26.
Article in English | MEDLINE | ID: mdl-38894211

ABSTRACT

This study introduces a novel wearable Inertial Measurement Unit (IMU)-based system for an objective and comprehensive assessment of Work-Related Musculoskeletal Disorders (WMSDs), thus enhancing workplace safety. The system integrates wearable technology with a user-friendly interface, providing magnetometer-free orientation estimation, joint angle measurements, and WMSDs risk evaluation. Tested in a cable manufacturing facility, the system was evaluated with ten female employees. The evaluation involved work cycle identification, inter-subject comparisons, and benchmarking against standard WMSD risk assessments like RULA, REBA, Strain Index, and Rodgers Muscle Fatigue Analysis. The evaluation demonstrated uniform joint patterns across participants (ICC=0.72±0.23) and revealed a higher occurrence of postures warranting further investigation, which is not easily detected by traditional methods such as RULA. The experimental results showed that the proposed system's risk assessments closely aligned with the established methods and enabled detailed and targeted risk assessments, pinpointing specific bodily areas for immediate ergonomic interventions. This approach not only enhances the detection of ergonomic risks but also supports the development of personalized intervention strategies, addressing common workplace issues such as tendinitis, low back pain, and carpal tunnel syndrome. The outcomes highlight the system's sensitivity and specificity in identifying ergonomic hazards. Future efforts should focus on broader validation and exploring the relative influence of various WMSDs risk factors to refine risk assessment and intervention strategies for improved applicability in occupational health.


Subject(s)
Musculoskeletal Diseases , Occupational Diseases , Wearable Electronic Devices , Humans , Musculoskeletal Diseases/physiopathology , Female , Risk Assessment/methods , Adult , Occupational Diseases/diagnosis , Occupational Diseases/prevention & control , Occupational Diseases/physiopathology , Ergonomics/methods , Posture/physiology , Workplace
2.
Front Endocrinol (Lausanne) ; 15: 1387537, 2024.
Article in English | MEDLINE | ID: mdl-38894740

ABSTRACT

There has been continuous progress in diabetes management over the last few decades, not least due to the widespread dissemination of continuous glucose monitoring (CGM) and automated insulin delivery systems. These technological advances have radically changed the daily lives of people living with diabetes, improving the quality of life of both children and their families. Despite this, hypoglycemia remains the primary side-effect of insulin therapy. Based on a systematic review of the available scientific evidence, this paper aims to provide evidence-based recommendations for recognizing, risk stratifying, treating, and managing patients with hypoglycemia. The objective of these recommendations is to unify the behavior of pediatric diabetologists with respect to the timely recognition and prevention of hypoglycemic episodes and the correct treatment of hypoglycemia, especially in patients using CGM or advanced hybrid closed-loop systems. All authors have long experience in the specialty and are members of the Italian Society of Pediatric Endocrinology and Diabetology. The goal of treating hypoglycemia is to raise blood glucose above 70 mg/dL (3.9 mmol/L) and to prevent further decreases. Oral glucose at a dose of 0.3 g/kg (0.1 g/kg for children using "smart pumps" or hybrid closed loop systems in automated mode) is the preferred treatment for the conscious individual with blood glucose <70 mg/dL (3.9 mmol/L), although any form of carbohydrate (e.g., sucrose, which consists of glucose and fructose, or honey, sugary soft drinks, or fruit juice) containing glucose may be used. Using automatic insulin delivery systems, the oral glucose dose can be decreased to 0.1 g/kg. Practical flow charts are included to aid clinical decision-making. Although representing the official position of the Italian Society of Pediatric Endocrinology and Diabetology (ISPED), these guidelines are applicable to the global audience and are especially pertinent in the era of CGM and other advanced technologies.


Subject(s)
Blood Glucose Self-Monitoring , Hypoglycemia , Hypoglycemic Agents , Insulin , Humans , Hypoglycemia/prevention & control , Child , Adolescent , Blood Glucose Self-Monitoring/methods , Insulin/administration & dosage , Insulin/therapeutic use , Hypoglycemic Agents/therapeutic use , Hypoglycemic Agents/administration & dosage , Blood Glucose/analysis , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 1/complications , Insulin Infusion Systems , Risk Assessment , Practice Guidelines as Topic/standards , Disease Management
3.
Front Public Health ; 12: 1381879, 2024.
Article in English | MEDLINE | ID: mdl-38894995

ABSTRACT

Introduction: Risk assessment and management in companies plays a significant role in the prevention section of any field. In the field of Occupational Health and Safety (OHS), its inconsistent or incorrect application has a direct impact on the life and health of employees. In some companies, even today, it is not properly implemented and adequate procedures and methods are not used. The article discusses the development of a step-by-step procedure for risk assessment in industrial environments in the area of OHS. Methods: Main parts of the model and its steps present the partial results of a survey conducted on a sample of 500 small and micro enterprises in the field of risk assessment and the systematic procedure developed following the main survey results. The survey covered only enterprises located in the construction, manufacturing, transport and storage and agriculture, forestry and fishing sectors, which is also a significant statistical feature. Within the structure of respondents, statistical features such as: size of enterprise, sector, region by work are identified. Only enterprises with size by number of employees - micro enterprises from 1 to 9 employees and small enterprises from 10 to 49 employees - were included for the survey. Results: New elements of the methods were integrated into the developed systematic procedure, which was subsequently validated in 7 plants of the one company on the same position. The application of the developed model was verified by an expert group consisting of 7 members, an odd number, and the developed checklists and risk register were applied. On the basis of the verification, the model, checklist and risk register were corrected. In addition, the scoring method and the risk matrix were also used, but they did not contain new elements. Discusion: The procedure is still in use today and employees have been trained to use it. On the basis of the developed methodology and the Checklist, the procedure has been transposed into the European OiRA tool and can be used by companies throughout the European Union.


Subject(s)
Industry , Occupational Health , Humans , Risk Assessment/methods , Surveys and Questionnaires
5.
Hepatol Commun ; 8(7)2024 Jul 01.
Article in English | MEDLINE | ID: mdl-38896083

ABSTRACT

BACKGROUND: The risk of HCC recurrence at particular landmarks since the initial treatment is unknown. With this registry-based study, we aimed to provide a nuanced description of the prognosis following resection or ablation for HCC, including landmark analyses. METHODS: Using the Danish nationwide health care registries, we identified all patients who received resection or ablation in 2000-2018 as the first HCC treatment. HCC recurrence was defined as a new HCC treatment > 90 days after the first treatment. We conducted competing risk landmark analyses of the cumulative risk of recurrence and death. RESULTS: Among 4801 patients with HCC, we identified 426 patients who received resection and 544 who received ablation. The 2 treatment cohorts differed in cirrhosis prevalence and tumor stage. The 5-year recurrence risk was 40.7% (95% CI 35.5%-45.8%) following resection and 60.7% (95% CI: 55.9%-65.1%) following ablation. The 1-year recurrence risk decreased over the landmarks from 20.4% (95% CI: 16.6%-24.6%) at the time of resection to 4.7% (95% CI: 0.9%-13.9%) at the 5-year landmark. For ablation, the risk decreased from 36.1% (95% CI: 31.9%-40.4%) at the time of treatment to 5.3% (95% CI: 0.4%-21.4%) at the 5-year landmark. The risk of death without recurrence was stable over the landmarks following both resection and ablation. CONCLUSIONS: In conclusion, the risk of recurrence or death following resection or ablation for HCC is high from the treatment date, but the risk of recurrence decreases greatly over the survival landmarks. This information is valuable for clinicians and their patients.


Subject(s)
Carcinoma, Hepatocellular , Hepatectomy , Liver Neoplasms , Neoplasm Recurrence, Local , Registries , Humans , Liver Neoplasms/surgery , Liver Neoplasms/mortality , Carcinoma, Hepatocellular/surgery , Carcinoma, Hepatocellular/mortality , Male , Female , Denmark/epidemiology , Middle Aged , Aged , Hepatectomy/statistics & numerical data , Catheter Ablation/mortality , Risk Assessment , Prognosis , Risk Factors
6.
Anesth Analg ; 139(1): 211-219, 2024 Jul 01.
Article in English | MEDLINE | ID: mdl-38885478

ABSTRACT

BACKGROUND: Postoperative acute kidney injury (PO-AKI) is a frequent complication after surgery. Various tools have been proposed to identify patients at high risk for AKI, including preoperative serum creatinine or estimated glomerular filtration rate (eGFR), urinary cell cycle arrest, and tubular damage biomarkers; however, none of these can appropriately assess AKI risk before surgery. Renal functional reserve (RFR) screened by the Doppler-derived intraparenchymal renal resistive index variation (IRRIV) test has been proposed to identify patients at risk for AKI before a kidney insult. IRRIV test has been developed in healthy individuals and previously investigated in cardiac surgery patients. This study aims to evaluate the value of the IRRIV test in identifying PO-AKI among patients undergoing robotic abdominal surgery in the Trendelenburg position for pelvic oncological disease. METHODS: We performed a prospective, double-blinded, observational study. Preoperative baseline renal function and RFR were assessed in 53 patients with baseline eGFR >60 mL/min/1.73 m2, undergoing robotic surgery in the Trendelenburg position for pelvic oncological disease. The capability of Doppler-derived RFR in predicting PO-AKI was investigated with the area under the receiver operating characteristic curve (ROC-AUC). RESULTS: Approximately 15.1% of patients developed AKI within the first 3 postoperative days. Thirty-one (58.5%) patients had a physiologic delta-RRI (ie, ≥0.05), while 22 (41.5%) patients did not. The ROC-AUC for PO-AKI was 0.85 (95% confidence interval [CI], 0.74-0.97; P = .007) for serum creatinine, 0.84 (95% CI, 0.71-0.96; P = .006) for eGFR, and 0.84 (95% CI, 0.78-0.91; P = .017) for delta-RRI. When combined with eGFR, the ROC-AUC for delta-RRI was 0.95 (95% CI, 0.9-1). CONCLUSIONS: Our findings show that the preoperative assessment of Doppler-derived RFR combined with baseline renal function improves the capability of identifying patients at high risk for PO-AKI with eGFR >60 mL/min/1.73 m2 after robotic abdominal surgery in Trendelenburg position for pelvic oncological disease.


Subject(s)
Acute Kidney Injury , Glomerular Filtration Rate , Kidney , Predictive Value of Tests , Robotic Surgical Procedures , Ultrasonography, Doppler , Humans , Acute Kidney Injury/etiology , Acute Kidney Injury/diagnosis , Acute Kidney Injury/physiopathology , Male , Female , Middle Aged , Prospective Studies , Robotic Surgical Procedures/adverse effects , Aged , Kidney/physiopathology , Kidney/diagnostic imaging , Double-Blind Method , Postoperative Complications/etiology , Postoperative Complications/diagnosis , Postoperative Complications/diagnostic imaging , Risk Factors , Head-Down Tilt/adverse effects , Risk Assessment , ROC Curve , Treatment Outcome
7.
Environ Geochem Health ; 46(7): 258, 2024 Jun 17.
Article in English | MEDLINE | ID: mdl-38886307

ABSTRACT

Road deposited sediments (RDS) are important sinks of potentially toxic elements (PTEs), which may have a significant impact on human health. A systematic review of published papers on the PTEs occurrence in RDS was carried out. The main goal was to assess the global RDS contamination by PTEs and human health risks linked with anthropogenic activities. A systematic search was made to collect information about the most cited PTEs in the published literature and perform a statistical analysis. Subsequently, health risks were assessed for 35 different areas worldwide. PTE concentrations showed high variability, and means were multiple times higher than the corresponding consensus-based threshold effect concentrations (5.2-, 10.3-, 5.3-, 3-, 7.3-, and 3.6-fold higher for Zn, Pb, Ni, Cr, Cu, and Cd, respectively). PTEs concentrations were ranked as Zn > Pb > Cu > Mn > Cr > Ni > Cd. Non carcinogenic risks followed the trend Pb > Cu > Zn > Cd. Lead is responsible for the highest significant non carcinogenic risk to human health. Unacceptable exposition to carcinogenic risks is present in most areas. The top carcinogenic risk areas were Singapore > Beijing > Yixing > Shanghai > Zhuzhou for adult male, Dresden > Singapore > Ulsan > Huludao for adult females, and Dresden > Singapore > Ulsan > Huludao for children. Highest chromium and nickel carcinogenic risks occurred in Singapore, Cd in Dresden, and Cu in Huludao. Highest RDS contamination was seen in industrial areas due to pollutants deposition. Highest Zn, Cu, Cd, and Pb concentrations occur in densely urbanized areas due to heavy-duty vehicular exhausts.


Subject(s)
Geologic Sediments , Humans , Geologic Sediments/chemistry , Risk Assessment , Metals, Heavy/analysis , Environmental Monitoring/methods , Female , Male , Environmental Exposure , Spatio-Temporal Analysis
8.
Ying Yong Sheng Tai Xue Bao ; 35(5): 1347-1358, 2024 May.
Article in Chinese | MEDLINE | ID: mdl-38886434

ABSTRACT

In the context of rapid urbanization, metropolitan areas are facing the risk of supply-demand mismatches among ecosystem services. Investigating the patterns, relationships, and driving factors of multiple supply-demand risks is of great significance to support the efficient management of regional ecological risks. We quantified the single/comprehensive supply-demand risk rates of six ecosystem services in Wuhan Metropolitan Area at the township scale in 2000, 2010, and 2020. By applying the self-organizing feature map network and optimal parameter geo-detector, we identified supply-demand risks bundles of ecosystem services and influencing factors of comprehensive risks. The results showed significant spatial variations in the supply-demand risks of typical ecosystem services from 2000 to 2020. The supply-demand risk associated with grain production, water yield, carbon sequestration, and green space recreation increased, while soil conservation and water purification risks decreased. The comprehensive ecosystem services supply-demand risk increased from 0.41 to 0.45, indicating a 'core area increase and periphery decrease' trend. Throughout the study period, the area exhibited bundles of comprehensive extremely high-risk bundles (B1), comprehensive high-risk bundles (B2), water purification high-risk bundles (B3), and grain production-soil conservation risk bundles (B4). The transition of risk types from B3 to B2 and from B2 to B1 suggested an increase in the combination and intensity of supply-demand risk. Vegetation cover, nighttime light index, and population density were the main driving factors for spatial variations in comprehensive supply-demand risk. Ecologi-cal risk assessment based on ecosystem services supply-demand bundles could provide an effective and reliable way to regulate multiple regional risk issues.


Subject(s)
Cities , Conservation of Natural Resources , Ecosystem , China , Risk Assessment , Ecology , Environmental Monitoring , Urbanization
9.
Ying Yong Sheng Tai Xue Bao ; 35(5): 1419-1425, 2024 May.
Article in Chinese | MEDLINE | ID: mdl-38886441

ABSTRACT

The strong coupling between society and ecosystem makes socio-ecological risks become the main object of risk management. As the link between ecological and social processes, ecosystem services (ESs) are the core variable in deconstructing the social-ecological risks and the crucial point in resolving the risks. We explored the concept and the internal formation mechanisms of socio-ecological risk combining ESs, and further put the cascade logic and evolution process of "real risk-risk perception-risk behavior". Based on driver-pressure-state-impact-response framework (DPSIR), we proposed a framework for analyzing socio-ecological risk, and expanded the content and methodology system of research and management practices related to socio-ecological risks. We proposed that socio-ecological risk research coupled with ESs should focus on: 1) exploring the transmission mechanism between ecosystem processes, ecosystem services, and human well-being; 2) exploring the response mechanism of social subject behavior and its impacts on ecosystem services and human well-being; 3) construction of a multi-scale assessment model for social ecological risks coupled with ESs. The socio-ecological risk analysis framework for coupled ecosystem services was based on the mutual feedback between human and nature to explore the logic of risk formation, evolution, and governance, which could provide ideas for clarifying the deep meaning of ecological problems and selecting pathways to resolve socio-ecological risks.


Subject(s)
Conservation of Natural Resources , Ecosystem , Risk Assessment , Ecology , Humans , China
10.
Sci Rep ; 14(1): 13938, 2024 06 17.
Article in English | MEDLINE | ID: mdl-38886455

ABSTRACT

Patients diagnosed with hepatocellular carcinoma (HCC) often present with multimorbidity, significantly contributing to adverse outcomes, particularly in-hospital mortality. This study aimed to develop a predictive nomogram to assess the impact of comorbidities on in-hospital mortality risk in HCC patients undergoing palliative locoregional therapy. We retrospectively analyzed data from 345 hospitalized HCC patients who underwent palliative locoregional therapy between January 2015 and December 2022. The nomogram was constructed using independent risk factors such as length of stay (LOS), hepatitis B virus (HBV) infection, hypertension, chronic obstructive pulmonary disease (COPD), anemia, thrombocytopenia, liver cirrhosis, hepatic encephalopathy (HE), N stage, and microvascular invasion. The model demonstrated high predictive accuracy with an AUC of 0.908 (95% CI: 0.859-0.956) for the overall dataset, 0.926 (95% CI: 0.883-0.968) for the training set, and 0.862 (95% CI: 0.728-0.994) for the validation set. Calibration curves indicated a strong correlation between predicted and observed outcomes, validated by statistical tests. Decision curve analysis (DCA) and clinical impact curves (CIC) confirmed the model's clinical utility in predicting in-hospital mortality. This nomogram offers a practical tool for personalized risk assessment in HCC patients undergoing palliative locoregional therapy, facilitating informed clinical decision-making and improving patient management.


Subject(s)
Carcinoma, Hepatocellular , Hospital Mortality , Liver Neoplasms , Nomograms , Palliative Care , Humans , Carcinoma, Hepatocellular/therapy , Carcinoma, Hepatocellular/mortality , Liver Neoplasms/therapy , Liver Neoplasms/mortality , Male , Female , Middle Aged , Aged , Palliative Care/methods , Retrospective Studies , Risk Factors , Comorbidity , Risk Assessment , Aged, 80 and over
11.
BMC Cardiovasc Disord ; 24(1): 308, 2024 Jun 17.
Article in English | MEDLINE | ID: mdl-38886631

ABSTRACT

AIM: The purpose of this study was to investigate the diagnostic and prognostic value of miR-320a-3p in chronic heart failure (CHF). METHODS: A total of 103 patients with CHF and 95 healthy controls were included in the study population. The expression level of serum miR-320a-3p was detected by qRT-PCR. The diagnostic effect of miR-320a-3p on CHF was evaluated by receiver operating characteristic curve. Kaplan-Meier curve and Cox regression were used to analyze the risk factors for 4-year prognosis of CHF patients. Bioinformatics analysis was used to analyze the possible target genes of miR-320a-3p and related signaling pathways. RESULTS: Serum miR-320a-3p expression was increased in CHF patients, and the levels of BNP and LVEF were positively and negatively correlated with miR-320a-3p, respectively. The AUC value of ROC curve was 0.866, indicating that miR-320a-3p had high diagnostic accuracy for CHF. Survival curve and Cox analysis showed that high expression of miR-320a-3p was associated with poor prognosis in CHF patients, and age and miR-320a-3p were independent risk factors for prognosis in CHF patients. GO and KEGG analysis showed that the downstream target genes of miR-320a-3p were involved in biological processes such as cell adhesion, stem cell differentiation and neural development, and were enriched in mTOR, TNF, AMPK and other signaling pathways. CONCLUSIONS: miR-320a-3p increased abnormally in CHF and was related to the severity of CHF. miR-320a-3p has the potential to be a diagnostic and prognostic marker for CHF.


Subject(s)
Heart Failure , MicroRNAs , Predictive Value of Tests , Stroke Volume , Ventricular Function, Left , Humans , MicroRNAs/genetics , MicroRNAs/blood , Heart Failure/genetics , Heart Failure/diagnosis , Male , Female , Middle Aged , Prognosis , Aged , Chronic Disease , Case-Control Studies , Risk Factors , Risk Assessment , Time Factors , Signal Transduction , Natriuretic Peptide, Brain/blood , Natriuretic Peptide, Brain/genetics , Genetic Markers
12.
BMC Cardiovasc Disord ; 24(1): 306, 2024 Jun 17.
Article in English | MEDLINE | ID: mdl-38886675

ABSTRACT

BACKGROUND: Inflammation is a key driver of atherosclerotic diseases and is often accompanied by disease-related malnutrition. However, the long-term burden of dysregulated inflammation with superimposed undernutrition in patients with acute coronary syndrome (ACS) remains unclear. This study sought to investigate the double burden and interplay of inflammation and malnutrition in patients with ACS undergoing percutaneous Coronary Intervention (PCI). METHODS: We retrospectively included 1,743 ACS patients undergoing PCI from June 2016 through November 2017 and grouped them according to their baseline nutritional and inflammatory status. Malnutrition was determined using the nutritional risk index (NRI) with a score lower than 100 and a high-inflamed condition defined as hs-CRP over 2 mg/L. The primary outcome was major adverse cardiovascular events (MACEs), compositing of cardiac mortality, non-fatal myocardial infarction, non-fatal stroke, and unplanned revascularization. Long-term outcomes were examined using the Kaplan-Meier method and compared with the log-rank test. Multivariable Cox proportional hazards regression analysis was applied to adjust for confounding. The reclassification index (NRI)/integrated discrimination index (IDI) statistics estimated the incremental prognostic impact of NRI and hs-CRP in addition to the Global Registry of Acute Coronary Events (GRACE) risk score. RESULTS: During a median follow-up of 30 months (ranges 30-36 months), 351 (20.1%) MACEs occurred. Compared with the nourished and uninflamed group, the malnourished and high-inflamed group displayed a significantly increased risk of MACEs with an adjusted hazard ratio of 2.446 (95% CI: 1.464-4.089; P < 0.001). The prognostic implications of NRI were influenced by patients' baseline inflammatory status, as it was only associated with MACEs among those high-inflamed (P for interaction = 0.005). Incorporating NRI and hs-CRP into the GRACE risk score significantly improved its predictive ability for MACEs (NRI: 0.210, P < 0.001; integrated discrimination index; IDI: 0.010, P < 0.001) and cardiac death (NRI: 0.666, P < 0.001; IDI: 0.023, P = 0.002). CONCLUSIONS: Among patients with ACS undergoing PCI, the double burden of inflammation and malnutrition signifies poorer outcomes. Their prognostic implications may be amplified by each other and jointly improve the GRACE risk score's risk prediction performance.


Subject(s)
Acute Coronary Syndrome , Inflammation , Malnutrition , Nutritional Status , Percutaneous Coronary Intervention , Humans , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/mortality , Acute Coronary Syndrome/mortality , Acute Coronary Syndrome/therapy , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/complications , Male , Malnutrition/diagnosis , Malnutrition/mortality , Malnutrition/physiopathology , Female , Retrospective Studies , Middle Aged , Aged , Time Factors , Risk Assessment , Inflammation/diagnosis , Inflammation/mortality , Inflammation/blood , Risk Factors , Treatment Outcome , Nutrition Assessment , Inflammation Mediators/blood , Biomarkers/blood
13.
BMC Med Imaging ; 24(1): 149, 2024 Jun 17.
Article in English | MEDLINE | ID: mdl-38886695

ABSTRACT

BACKGROUND: Assessing the aggressiveness of pure ground glass nodules early on significantly aids in making informed clinical decisions. OBJECTIVE: Developing a predictive model to assess the aggressiveness of pure ground glass nodules in lung adenocarcinoma is the study's goal. METHODS: A comprehensive search for studies on the relationship between computed tomography(CT) characteristics and the aggressiveness of pure ground glass nodules was conducted using databases such as PubMed, Embase, Web of Science, Cochrane Library, Scopus, Wanfang, CNKI, VIP, and CBM, up to December 20, 2023. Two independent researchers were responsible for screening literature, extracting data, and assessing the quality of the studies. Meta-analysis was performed using Stata 16.0, with the training data derived from this analysis. To identify publication bias, Funnel plots and Egger tests and Begg test were employed. This meta-analysis facilitated the creation of a risk prediction model for invasive adenocarcinoma in pure ground glass nodules. Data on clinical presentation and CT imaging features of patients treated surgically for these nodules at the Third Affiliated Hospital of Kunming Medical University, from September 2020 to September 2023, were compiled and scrutinized using specific inclusion and exclusion criteria. The model's effectiveness for predicting invasive adenocarcinoma risk in pure ground glass nodules was validated using ROC curves, calibration curves, and decision analysis curves. RESULTS: In this analysis, 17 studies were incorporated. Key variables included in the model were the largest diameter of the lesion, average CT value, presence of pleural traction, and spiculation. The derived formula from the meta-analysis was: 1.16×the largest lesion diameter + 0.01 × the average CT value + 0.66 × pleural traction + 0.44 × spiculation. This model underwent validation using an external set of 512 pure ground glass nodules, demonstrating good diagnostic performance with an ROC curve area of 0.880 (95% CI: 0.852-0.909). The calibration curve indicated accurate predictions, and the decision analysis curve suggested high clinical applicability of the model. CONCLUSION: We established a predictive model for determining the invasiveness of pure ground-glass nodules, incorporating four key radiological indicators. This model is both straightforward and effective for identifying patients with a high likelihood of invasive adenocarcinoma.


Subject(s)
Lung Neoplasms , Neoplasm Invasiveness , Tomography, X-Ray Computed , Humans , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/pathology , Tomography, X-Ray Computed/methods , Risk Assessment , Adenocarcinoma of Lung/diagnostic imaging , Adenocarcinoma of Lung/pathology , Multiple Pulmonary Nodules/diagnostic imaging , Multiple Pulmonary Nodules/pathology
14.
Popul Health Metr ; 22(1): 13, 2024 Jun 17.
Article in English | MEDLINE | ID: mdl-38886744

ABSTRACT

OBJECTIVE: To compare how different imputation methods affect the estimates and performance of a prediction model for premature mortality. STUDY DESIGN AND SETTING: Sex-specific Weibull accelerated failure time survival models were run on four separate datasets using complete case, mode, single and multiple imputation to impute missing values. Six performance measures were compared to access predictive accuracy (Nagelkerke R2, integrated brier score), discrimination (Harrell's c-index, discrimination slope) and calibration (calibration in the large, calibration slope). RESULTS: The highest proportion of missingness for a single variable was 10.86% for the female model and 8.24% for the male model. Comparing the performance measures for complete case, mode, single and multiple imputation: the Nagelkerke R2 values for the female model was 0.1084, 0.1116, 0.1120 and 0.111-0.1120 with the male model exhibited similar variation of 0.1050, 0.1078, 0.1078 and 0.1078-0.1081. Harrell's c-index also demonstrated small variation with values of 0.8666, 0.8719, 0.8719 and 0.8711-0.8719 for the female model and 0.8549, 0.8548, 0.8550 and 0.8550-0.8553 for the male model. CONCLUSION: In the scenarios examined in this study, mode imputation performed well when using a population health survey compared to single and multiple imputation when predictive performance measures is the main model goal. To generate unbiased hazard ratios, multiple imputation methods were superior. This study shows the need to consider the best imputation approach for a predictive model development given the conditions of missing data and the goals of the analysis.


Subject(s)
Mortality, Premature , Humans , Male , Female , Models, Statistical , Risk Assessment/methods , Middle Aged , Data Interpretation, Statistical , Adult
16.
Clin Appl Thromb Hemost ; 30: 10760296241263856, 2024.
Article in English | MEDLINE | ID: mdl-38887044

ABSTRACT

Venous thromboembolism (VTE) is associated with high morbidity and mortality. Risk scores associated with VTE have been widely used in clinical practice. Among numerous scores published, those included in guidelines are usually typical risk scores which have been extensively validated and globally recognized. This review provides an updated overview of the risk scores associated with VTE endorsed by 3 guidelines which are highly recognized in the field of VTE including the European Society of Cardiology, American College of Chest Physicians, and American Society of Hematology, focusing on the development, modification, validation, and comparison of these scores, to provide a comprehensive and updated understanding of all the classic risk scores associated with VTE to medical readers including but not limited to cardiologists, pulmonologists, hematologists, intensivists, physicians, surgeons, and researchers. Although each score recommended by these guidelines was more or less validated, there may still be room for further improvement. It may still be necessary to seek simpler, more practical, and more universally applicable VTE-related risk scores in the future.


Subject(s)
Practice Guidelines as Topic , Venous Thromboembolism , Humans , Risk Factors , Societies, Medical , Risk Assessment/methods , Female
17.
Front Public Health ; 12: 1399470, 2024.
Article in English | MEDLINE | ID: mdl-38887257

ABSTRACT

Objective: Pneumonia is a common and serious infectious disease that affects the older adult population. Severe pneumonia can lead to high mortality and morbidity in this group. Therefore, it is important to identify the risk factors and develop a prediction model for severe pneumonia in older adult patients. Method: In this study, we collected data from 1,000 older adult patients who were diagnosed with pneumonia and admitted to the intensive care unit (ICU) in a tertiary hospital. We used logistic regression and machine learning methods to analyze the risk factors and construct a prediction model for severe pneumonia in older adult patients. We evaluated the performance of the model using accuracy, sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and calibration plot. Result: We found that age, comorbidities, vital signs, laboratory tests, and radiological findings were associated with severe pneumonia in older adult patients. The prediction model had an accuracy of 0.85, a sensitivity of 0.80, a specificity of 0.88, and an AUC of 0.90. The calibration plot showed good agreement between the predicted and observed probabilities of severe pneumonia. Conclusion: The prediction model can help clinicians to stratify the risk of severe pneumonia in older adult patients and provide timely and appropriate interventions.


Subject(s)
Intensive Care Units , Pneumonia , Humans , Aged , Female , Risk Factors , Male , Aged, 80 and over , Logistic Models , ROC Curve , Severity of Illness Index , Machine Learning , Risk Assessment/methods , Comorbidity , Age Factors , Tertiary Care Centers
18.
Clin Oral Investig ; 28(7): 382, 2024 Jun 18.
Article in English | MEDLINE | ID: mdl-38888700

ABSTRACT

OBJECTIVES: The study compared clinical characteristics and caries risk assessments between tobacco heating system (THS) smokers, cigarette smokers and non-smokers. MATERIALS AND METHODS: General data, data regarding fluoridation, smoking and dietary habits was obtained through a questionnaire. Caries experience was assessed by the DMFT index; the amount of biofilm by the Full mouth plaque score index; the amount of salivation by the quantum of stimulated salivation test; salivary pH with pH indicator strips and salivary number of S.mutans and Lactobacilli by cultivation on agar plates. The Cariogram method was used to assess caries risk. RESULTS: No differences between the groups was detected regarding education level, average daily number of meals, fluoridation programs, systemic diseases, and caries experience. The groups significantly differed in the amount of salivary S.mutans and Lactobacilli (p < 0.001), accumulated biofilm (p = 0.034), salivation quantum (p < 0.001), and saliva pH (p = 0.009). Exposure to tobacco smoke and heated tobacco aerosol increased the accumulation of biofilm and decreased salivary pH. Smoking increased S. mutans, while THS consumption decreased salivation and Lactobacilli the most. The Cariogram analysis found no differences in chances of avoiding new caries lesions between the groups, but a significant difference in developing caries lesions due to dietary habits was detected (p < 0.001) with non-smokers having higher risk than smokers, but not than THS consumers. CONCLUSIONS: THS and cigarette smoking were related to clinical characteristics that affect caries activity even though the caries risk assessment revealed no significant difference in the chances of avoiding new caries lesions between the groups. CLINICAL RELEVANCE: THS and cigarette smokers could have higher caries activity than non-smokers. The clinical study protocol has been registered on ClinicalTrials.gov under the ID number: NCT06314100.


Subject(s)
Dental Caries , Humans , Dental Caries/microbiology , Cross-Sectional Studies , Male , Female , Adult , Risk Assessment , Biofilms , Saliva/microbiology , Saliva/chemistry , Surveys and Questionnaires , DMF Index , Middle Aged , Smoking , Dental Plaque Index
19.
PLoS One ; 19(6): e0304423, 2024.
Article in English | MEDLINE | ID: mdl-38889124

ABSTRACT

INTRODUCTION: Ischemic heart disease is a leading cause of death worldwide, and its importance is increasing with the aging population. The aim of this study was to evaluate the accuracy of SurvTrace, a survival analysis model using the Transformer-a state-of-the-art deep learning method-for predicting recurrent cardiovascular events and stratifying high-risk patients. The model's performance was compared to that of a conventional scoring system utilizing real-world data from cardiovascular patients. METHODS: This study consecutively enrolled patients who underwent percutaneous coronary intervention (PCI) at the Department of Cardiovascular Medicine, University of Tokyo Hospital, between 2005 and 2019. Each patient's initial PCI at our hospital was designated as the index procedure, and a composite of major adverse cardiovascular events (MACE) was monitored for up to two years post-index event. Data regarding patient background, clinical presentation, medical history, medications, and perioperative complications were collected to predict MACE. The performance of two models-a conventional scoring system proposed by Wilson et al. and the Transformer-based model SurvTrace-was evaluated using Harrell's c-index, Kaplan-Meier curves, and log-rank tests. RESULTS: A total of 3938 cases were included in the study, with 394 used as the test dataset and the remaining 3544 used for model training. SurvTrace exhibited a mean c-index of 0.72 (95% confidence intervals (CI): 0.69-0.76), which indicated higher prognostic accuracy compared with the conventional scoring system's 0.64 (95% CI: 0.64-0.64). Moreover, SurvTrace demonstrated superior risk stratification ability, effectively distinguishing between the high-risk group and other risk categories in terms of event occurrence. In contrast, the conventional system only showed a significant difference between the low-risk and high-risk groups. CONCLUSION: This study based on real-world cardiovascular patient data underscores the potential of the Transformer-based survival analysis model, SurvTrace, for predicting recurrent cardiovascular events and stratifying high-risk patients.


Subject(s)
Myocardial Ischemia , Humans , Male , Female , Aged , Myocardial Ischemia/mortality , Middle Aged , Survival Analysis , Risk Assessment/methods , Percutaneous Coronary Intervention , Risk Factors , Recurrence , Deep Learning , Kaplan-Meier Estimate , Prognosis
20.
Circ Cardiovasc Imaging ; 17(6): e016372, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38889215

ABSTRACT

BACKGROUND: Aortic valve calcification (AVC), Lp(a) [lipoprotein(a)], and low-density lipoprotein cholesterol (LDL-C) are associated with severe aortic stenosis (AS). We aimed to determine which of these risk factors were most strongly associated with the risk of incident severe AS. METHODS: A total of 6792 participants from the MESA study (Multi-Ethnic Study of Atherosclerosis) had computed tomography-quantified AVC, Lp(a), and LDL-C values at MESA visit 1 (2000-2002). We calculated the absolute event rate of incident adjudicated severe AS per 1000 person-years and performed multivariable adjusted Cox proportional hazards regression. RESULTS: The mean age was 62 years old, and 47% were women. Over a median 16.7-year follow-up, the rate of incident severe AS increased exponentially with higher AVC, regardless of Lp(a) or LDL-C values. Participants with AVC=0 had a very low rate of severe AS even with elevated Lp(a) ≥50 mg/dL (<0.1/1000 person-years) or LDL-C ≥130 mg/dL (0.1/1000 person-years). AVC >0 was strongly associated with severe AS when Lp(a) <50 mg/dL hazard ratio (HR) of 33.8 (95% CI, 16.4-70.0) or ≥50 mg/dL HR of 61.5 (95% CI, 7.7-494.2) and when LDL-C <130 mg/dL HR of 31.1 (95% CI, 14.4-67.1) or ≥130 mg/dL HR of 50.2 (95% CI, 13.2-191.9). CONCLUSIONS: AVC better identifies people at high risk for severe AS compared with Lp(a) or LDL-C, and people with AVC=0 have a very low long-term rate of severe AS regardless of Lp(a) or LDL-C level. These results suggest AVC should be the preferred prognostic risk marker to identify patients at high risk for severe AS, which may help inform participant selection for future trials testing novel strategies to prevent severe AS.


Subject(s)
Aortic Valve Stenosis , Aortic Valve , Biomarkers , Calcinosis , Cholesterol, LDL , Lipoprotein(a) , Severity of Illness Index , Humans , Aortic Valve Stenosis/blood , Aortic Valve Stenosis/diagnosis , Aortic Valve Stenosis/epidemiology , Aortic Valve Stenosis/diagnostic imaging , Female , Lipoprotein(a)/blood , Male , Middle Aged , Cholesterol, LDL/blood , Aortic Valve/diagnostic imaging , Aortic Valve/pathology , Calcinosis/blood , Calcinosis/diagnostic imaging , Calcinosis/diagnosis , Calcinosis/epidemiology , Calcinosis/ethnology , Aged , Biomarkers/blood , Risk Factors , Risk Assessment , Incidence , United States/epidemiology , Aged, 80 and over , Predictive Value of Tests , Time Factors , Prospective Studies , Proportional Hazards Models , Tomography, X-Ray Computed , Prognosis
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