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Medicine Sep 2022We focused on "returning to the horizontal position," one of the measures for preventing well leg compartment syndrome implemented at our hospital, and aimed to clarify... (Observational Study)
Observational Study
We focused on "returning to the horizontal position," one of the measures for preventing well leg compartment syndrome implemented at our hospital, and aimed to clarify the effect of intraoperative positional changes by operating table rotation on blood perfusion in the lower extremities during lithotomy in patients under general anesthesia. This prospective observational study examined 64 patients scheduled to undergo general anesthesia in the lithotomy position from March 2021 to May 2022. The primary endpoint was the perfusion index (PI) of the lower limb before and after operating table rotation. The baseline lower limb PI before the operating table rotation was 2.376 (1.591), and the lower limb PI after the change from Trendelenburg to the horizontal position was as follows: immediately after, 2.123 (1.405); 5 minutes, 1.894 (1.138); 10 minutes, 1.915 (1.167); and 15 minutes, 1.993 (1.218). Compared with the baseline, no significant difference was noted in the change in the lower limb PI due to the Trendelenburg to horizontal positional change. The baseline lower leg pressure before the operating table rotation was 51.4 (13.4) mm Hg, and the lower leg pressure after the change from the Trendelenburg to the horizontal position was as follows: immediately after, 36.6 (10.3) mm Hg; 5 minutes, 36.5 (10.2) mm Hg; 10 minutes, 36.4 (10.0) mm Hg; and 15 minutes, 36.5 (10.2) mm Hg. Compared with the baseline, the change in lower leg pressure due to the Trendelenburg to horizontal positional change showed a significant decrease immediately afterward (P < .001). After operating table rotation from the Trendelenburg to the horizontal position, the lower limb PI did not change significantly after 15 min. However, lower leg pressure showed a significant decrease immediately after returning to the horizontal position. This result provides evidence for operating table rotation as a preventive measure for well leg compartment syndrome.
Topics: Humans; Lower Extremity; Operating Tables; Perfusion Index; Postoperative Complications; Rotation
PubMed: 36197219
DOI: 10.1097/MD.0000000000030677 -
Online Journal of Public Health... 2021Research data may have substantial impact beyond the original study objectives. The Collaborating Consortium of Cohorts Producing NIDA Opportunities (C3PNO) facilitates...
Research data may have substantial impact beyond the original study objectives. The Collaborating Consortium of Cohorts Producing NIDA Opportunities (C3PNO) facilitates the combination of data and access to specimens from nine NIDA-funded cohorts in a virtual data repository (VDR). Unique challenges were addressed to create the VDR. An initial set of common data elements was agreed upon, selected based on their importance for a wide range of research proposals. Data were mapped to a common set of values. Bioethics consultations resulted in the development of various controls and procedures to protect against inadvertent disclosure of personally identifiable information. Standard operating procedures govern the evaluation of proposed concepts, and specimen and data use agreements ensure proper data handling and storage. Data from eight cohorts have been loaded into a relational database with tables capturing substance use, available specimens, and other participant data. A total of 6,177 participants were seen at a study visit within the past six months and are considered under active follow-up for C3PNO cohort participation as of the third data transfer, which occurred in January 2020. A total of 70,391 biospecimens of various types are available for these participants to test approved scientific hypotheses. Sociodemographic and clinical data accompany these samples. The VDR is a web-based interactive, searchable database available in the public domain, accessed at www.c3pno.org. The VDR are available to inform both consortium and external investigators interested in submitting concept sheets to address novel scientific questions to address high priority research on HIV/AIDS in the context of substance use.
PubMed: 35079324
DOI: 10.5210/ojphi.v13i3.10878 -
Frontiers in Medicine 2022Artificial Intelligence (AI) holds considerable promise for diagnostics in the field of gastroenterology. This systematic review and meta-analysis aims to assess the...
BACKGROUND
Artificial Intelligence (AI) holds considerable promise for diagnostics in the field of gastroenterology. This systematic review and meta-analysis aims to assess the diagnostic accuracy of AI models compared with the gold standard of experts and histopathology for the diagnosis of various gastrointestinal (GI) luminal pathologies including polyps, neoplasms, and inflammatory bowel disease.
METHODS
We searched PubMed, CINAHL, Wiley Cochrane Library, and Web of Science electronic databases to identify studies assessing the diagnostic performance of AI models for GI luminal pathologies. We extracted binary diagnostic accuracy data and constructed contingency tables to derive the outcomes of interest: sensitivity and specificity. We performed a meta-analysis and hierarchical summary receiver operating characteristic curves (HSROC). The risk of bias was assessed using Quality Assessment for Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Subgroup analyses were conducted based on the type of GI luminal disease, AI model, reference standard, and type of data used for analysis. This study is registered with PROSPERO (CRD42021288360).
FINDINGS
We included 73 studies, of which 31 were externally validated and provided sufficient information for inclusion in the meta-analysis. The overall sensitivity of AI for detecting GI luminal pathologies was 91.9% (95% CI: 89.0-94.1) and specificity was 91.7% (95% CI: 87.4-94.7). Deep learning models (sensitivity: 89.8%, specificity: 91.9%) and ensemble methods (sensitivity: 95.4%, specificity: 90.9%) were the most commonly used models in the included studies. Majority of studies ( = 56, 76.7%) had a high risk of selection bias while 74% ( = 54) studies were low risk on reference standard and 67% ( = 49) were low risk for flow and timing bias.
INTERPRETATION
The review suggests high sensitivity and specificity of AI models for the detection of GI luminal pathologies. There is a need for large, multi-center trials in both high income countries and low- and middle- income countries to assess the performance of these AI models in real clinical settings and its impact on diagnosis and prognosis.
SYSTEMATIC REVIEW REGISTRATION
[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=288360], identifier [CRD42021288360].
PubMed: 36405592
DOI: 10.3389/fmed.2022.1018937 -
Kidney International Reports Mar 2021Classification of acute kidney injury (AKI) requires a premorbid baseline creatinine, often unavailable in studies in acute infection.
INTRODUCTION
Classification of acute kidney injury (AKI) requires a premorbid baseline creatinine, often unavailable in studies in acute infection.
METHODS
We evaluated commonly used surrogate and imputed baseline creatinine values against a "reference" creatinine measured during follow-up in an adult clinical trial cohort. Known AKI incidence (Kidney Disease: Improving Global Outcomes [KDIGO] criteria) was compared with AKI incidence classified by (1) back-calculation using the Modification of Diet in Renal Disease (MDRD) equation with and without a Chinese ethnicity correction coefficient; (2) back-calculation using the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation; (3) assigning glomerular filtration rate (GFR) from age and sex-standardized reference tables; and (4) lowest measured creatinine during admission. Back-calculated distributions were performed using GFRs of 75 and 100 ml/min.
RESULTS
All equations using an assumed GFR of 75 ml/min underestimated AKI incidence by more than 50%. Back-calculation with CKD-EPI and GFR of 100 ml/min most accurately predicted AKI but misclassified all AKI stages and had low levels of agreement with true AKI diagnoses. Back-calculation using MDRD and assumed GFR of 100 ml/min, age and sex-reference GFR values adjusted for good health, and lowest creatinine during admission performed similarly, best predicting AKI incidence (area under the receiver operating characteristic curves [AUC ROCs] of 0.85, 0.87, and 0.85, respectively). MDRD back-calculation using a cohort mean GFR showed low total error (22%) and an AUC ROC of 0.85.
CONCLUSION
Current methods for estimating baseline creatinine are large sources of potential error in acute infection studies. Preferred alternatives include MDRD equation back-calculation with a population mean GFR, age- and sex-specific GFR values corrected for "good health," or lowest measured creatinine. Studies using surrogate baseline creatinine values should report specific methodology.
PubMed: 33732979
DOI: 10.1016/j.ekir.2020.12.020 -
Frontiers in Medicine 2022The aim of this study was to assess the accuracy of prenatal imaging for the diagnosis of congenital Zika syndrome.
OBJECTIVE
The aim of this study was to assess the accuracy of prenatal imaging for the diagnosis of congenital Zika syndrome.
DATA SOURCES
Medline (via Pubmed), PubMed, Scopus, Web of Science, and Google Scholar from inception to March 2022. Two researchers independently screened study titles and abstracts for eligibility.
STUDY ELIGIBILITY CRITERIA
Observational studies with Zika virus-infected pregnant women were included. The index tests included ultrasound and/or magnetic resonance imaging. The reference standard included (1) Zika infection-related perinatal death, stillbirth, and neonatal death within the first 48 h of birth, (2) neonatal intensive care unit admission, and (3) clinically defined adverse perinatal outcomes.
SYNTHESIS METHODS
We extracted 2 × 2 contingency tables. Pooled sensitivity and specificity were estimated using the random-effects bivariate model and assessed the summary receiver operating characteristic (ROC) curve. Risk of bias was assessed using QUADAS 2 tool. The certainty of the evidence was evaluated with grading of recommendations.
RESULTS
We screened 1,459 references and included 18 studies (2359 pregnant women, 347 fetuses with confirmed Zika virus infection). Twelve studies (67%) were prospective cohorts/case series, and six (37%) were retrospective cohort/case series investigations. Fourteen studies (78%) were performed in endemic regions. Ten studies (56%) used prenatal ultrasound only, six (33%) employed ultrasound and fetal MRI, and two studies (11%) used prenatal ultrasound and postnatal fetal MRI. A total of six studies (ultrasound only) encompassing 780 pregnant women (122 fetuses with confirmed Zika virus infection) reported relevant data for meta-analysis (gestation age at which ultrasound imagining was captured ranged from 16 to 34 weeks). There was large heterogeneity across studies regarding sensitivity (range: 12 to 100%) and specificity (range: 50 to 100%). Under a random-effects model, the summary sensitivity of ultrasound was 82% (95% CI, 19 to 99%), and the summary specificity was 97% (71 to 100%). The area under the ROC curve was 97% (95% CI, 72 to 100%), and the summary diagnostic odds ratio was 140 (95% CI, 3 to 7564, < 0.001). The overall certainty of the evidence was "very low".
CONCLUSION
Ultrasound may be useful in improving the diagnostic accuracy of Zika virus infection in pregnancy. However, the evidence is still substantially uncertain due to the methodological limitations of the available studies. Larger, properly conducted diagnostic accuracy studies of prenatal imaging for the diagnosis of congenital Zika syndrome are warranted.
SYSTEMATIC REVIEW REGISTRATION
Identifier [CRD42020162914].
PubMed: 36250095
DOI: 10.3389/fmed.2022.962765 -
Patient Safety in Surgery Jun 2022Covering the prepared sterile back tables (PSBTs) during periods of nonuse and during active surgeries may decrease contamination of sterile surgical instruments that...
BACKGROUND
Covering the prepared sterile back tables (PSBTs) during periods of nonuse and during active surgeries may decrease contamination of sterile surgical instruments that have direct contact to surgical wound. The Association of periOperative Registered Nurses (AORN) declared that an easy method for covering and removing the drape will ultimately be most effective (e.g. standard two-drape method). Hence, this study was designed to test the hypothesis that using a novel single-drape cover had more efficiency and safety in decreasing airborne bacteria-carrying particles (ABCPs) settling on the PSBTs during static and dynamic periods than the standard two-drape method.
METHODS
This experimental study was conducted with using 918 agar plates to detect contamination of the PSBTs with ABCPs on two conditions (static and dynamic) at an academic medical center in Kashan, Iran, from September 25, 2021, to January 20, 2022. The contamination of PSBTs was evaluated by 6 agar settle plates (n = 918 in total) on each PSBT in static and dynamic operating room (OR) conditions. At each time-point, this set-up was repeated on two occasions else during data collection, establishing 81 PSBTs in total. Tested groups included the PSBTs covered with the standard two-drape method, the novel single-drape cover, or no cover. The plates were collected after 15, 30, 45, 60, 120, 180, 240 min and 24 h. The primary outcome measured was comparison of mean bioburden of ABCPs settling on covered PSBTs on two conditions by using agar settle plates. The secondary outcomes measured were to determine the role of covering in decreasing contamination of PSBTs and the estimation of time-dependent surgical instrument contamination in the uncovered PSBTs on two conditions by using agar settle plates.
RESULTS
Covering the PSBTs during static and dynamic OR conditions lead to a significantly decreased bioburden of ABCPs on them (P < 0.05). No differences were seen between the standard two-drape method and the novel single-drape cover (P > 0.05).
CONCLUSIONS
We found that there is no preference for using the novel single-drape cover than the standard two-drape method. Our results showed a significant decrease in bioburden of ABCPs on the PSBTs when those were covered during static and dynamic OR conditions, indicating the efficiency for covering the PSBTs during periods of nonuse and during active surgery.
PubMed: 35655219
DOI: 10.1186/s13037-022-00330-z -
Frontiers in Surgery 2022For peripheral pulmonary nodules, the regularity of lymph node (LN) metastasis has not been studied. This study aimed to evaluate the metastasis pattern of...
BACKGROUND
For peripheral pulmonary nodules, the regularity of lymph node (LN) metastasis has not been studied. This study aimed to evaluate the metastasis pattern of intrapulmonary and relevant mediastinal lymph nodes in early-stage lung cancer, and further selected patients who were of low risk of LN metastasis as potential population to receive sub-lobectomy.
METHODS
This study prospectively included consecutive patients with peripheral clinical T1N0M0 disease who underwent complete resection with LN dissection or sampling from August 2014 to July 2015. The patients were followed up to 15, May 2021. Univariable or multivariable Logistic analysis was used to identify the risk factors. Models predicting LN metastasis risk were conducted. The area under the curve for the receiver operating characteristic curves was used to evaluate the diagnostic value. Disease-free survival and overall survival were compared between groups.
RESULTS
Finally, 201 patients were included in this study. For patients with negative tumor-bearing (TB) 13 and 14 station LNs, the positive rate of other lymph node stations was extremely low. Maximum CT value, pleural indentation and CEA level were risk factors for N1 station LNs metastasis. Besides, the factors above and lobulation sign were risk factors for skip metastasis beyond TB 13 and 14 station LNs. We constructed two scoring tables to predict N1 station metastasis and skip metastasis beyond TB 13 and 14 station. The AUC were 0·837 and 0·823, respectively. Based on the first table, 40·9% of patients suffered N1 station LNs metastasis and 27·3% had N2 disease in "high risk group" while the proportion was only 5·7% and 4·5% in "low risk group". For patients with negative TB13 and TB14 station LNs, based on the latter table, 11·1% of patients had N1 stations LNs metastasis and 16·7% had pN2 disease in "high risk group" while only 2·3% patients in "low risk group" suffered this kind of metastasis.
CONCLUSION
For peripheral pulmonary nodules patients, stations 13 and 14 LNs may be the sentinel nodes. For patients with low risk of N1 metastasis and skip metastasis, sub-lobar resection might be sufficient for those who were of negative TB 13 and 14 station LNs.
PubMed: 36017514
DOI: 10.3389/fsurg.2022.981313 -
Journal of Oral and Maxillofacial... Dec 2020In an effort to protect health care workers at the beginning and end of oral and maxillofacial surgeries, we describe a negative-pressure intubation hood (NPIH) designed...
PURPOSE
In an effort to protect health care workers at the beginning and end of oral and maxillofacial surgeries, we describe a negative-pressure intubation hood (NPIH) designed to reduce the risk aerosol exposure from fiberoptic intubation (FOI) and extubation. This design is especially important during the Coronavirus disease 2019 era, as it provides greater protection from Severe Acute Respiratory Syndrome-Coronavirus-2 during FOI and extubation, which are some of the most high-risk, aerosol generating procedures of oral and maxillofacial surgery cases.
MATERIALS AND METHODS
This article describes the step-by-step process of assembling a NPIH for FOI using various supplies found commonly in hospitals and surrounding community retail stores, which include transparent medical dressings, equipment covers, intravenous pole clips, polyvinylchloride pipes and adaptors, copper pipe, and a Buffalo smoke evacuator. We then discuss how to create access ports for the anesthesiologist to insert their arms and FOI instrumentation and provide a demonstration of us using the hood with a manikin on an operating room table.
RESULTS
This study successfully demonstrates a novel technique for performing FOI in a NIPH assembled from basic supplies found commonly among hospital and community retail stores.
CONCLUSIONS
This NIPH for FOI is easily made and adaptable to operating room tables, and provides protection against aerosols generated from FOI and subsequent extubation during oral and maxillofacial surgeries.
Topics: COVID-19; Humans; Intubation, Intratracheal; Pandemics; SARS-CoV-2
PubMed: 32822615
DOI: 10.1016/j.joms.2020.07.027 -
The Cochrane Database of Systematic... Mar 2022Systematic screening in high-burden settings is recommended as a strategy for early detection of pulmonary tuberculosis disease, reducing mortality, morbidity and... (Review)
Review
BACKGROUND
Systematic screening in high-burden settings is recommended as a strategy for early detection of pulmonary tuberculosis disease, reducing mortality, morbidity and transmission, and improving equity in access to care. Questioning for symptoms and chest radiography (CXR) have historically been the most widely available tools to screen for tuberculosis disease. Their accuracy is important for the design of tuberculosis screening programmes and determines, in combination with the accuracy of confirmatory diagnostic tests, the yield of a screening programme and the burden on individuals and the health service.
OBJECTIVES
To assess the sensitivity and specificity of questioning for the presence of one or more tuberculosis symptoms or symptom combinations, CXR, and combinations of these as screening tools for detecting bacteriologically confirmed pulmonary tuberculosis disease in HIV-negative adults and adults with unknown HIV status who are considered eligible for systematic screening for tuberculosis disease. Second, to investigate sources of heterogeneity, especially in relation to regional, epidemiological, and demographic characteristics of the study populations.
SEARCH METHODS
We searched the MEDLINE, Embase, LILACS, and HTA (Health Technology Assessment) databases using pre-specified search terms and consulted experts for unpublished reports, for the period 1992 to 2018. The search date was 10 December 2018. This search was repeated on 2 July 2021.
SELECTION CRITERIA
Studies were eligible if participants were screened for tuberculosis disease using symptom questions, or abnormalities on CXR, or both, and were offered confirmatory testing with a reference standard. We included studies if diagnostic two-by-two tables could be generated for one or more index tests, even if not all participants were subjected to a microbacteriological reference standard. We excluded studies evaluating self-reporting of symptoms.
DATA COLLECTION AND ANALYSIS
We categorized symptom and CXR index tests according to commonly used definitions. We assessed the methodological quality of included studies using the QUADAS-2 instrument. We examined the forest plots and receiver operating characteristic plots visually for heterogeneity. We estimated summary sensitivities and specificities (and 95% confidence intervals (CI)) for each index test using bivariate random-effects methods. We analyzed potential sources of heterogeneity in a hierarchical mixed-model.
MAIN RESULTS
The electronic database search identified 9473 titles and abstracts. Through expert consultation, we identified 31 reports on national tuberculosis prevalence surveys as eligible (of which eight were already captured in the search of the electronic databases), and we identified 957 potentially relevant articles through reference checking. After removal of duplicates, we assessed 10,415 titles and abstracts, of which we identified 430 (4%) for full text review, whereafter we excluded 364 articles. In total, 66 articles provided data on 59 studies. We assessed the 2 July 2021 search results; seven studies were potentially eligible but would make no material difference to the review findings or grading of the evidence, and were not added in this edition of the review. We judged most studies at high risk of bias in one or more domains, most commonly because of incorporation bias and verification bias. We judged applicability concerns low in more than 80% of studies in all three domains. The three most common symptom index tests, cough for two or more weeks (41 studies), any cough (21 studies), and any tuberculosis symptom (29 studies), showed a summary sensitivity of 42.1% (95% CI 36.6% to 47.7%), 51.3% (95% CI 42.8% to 59.7%), and 70.6% (95% CI 61.7% to 78.2%, all very low-certainty evidence), and a specificity of 94.4% (95% CI 92.6% to 95.8%, high-certainty evidence), 87.6% (95% CI 81.6% to 91.8%, low-certainty evidence), and 65.1% (95% CI 53.3% to 75.4%, low-certainty evidence), respectively. The data on symptom index tests were more heterogenous than those for CXR. The studies on any tuberculosis symptom were the most heterogeneous, but had the lowest number of variables explaining this variation. Symptom index tests also showed regional variation. The summary sensitivity of any CXR abnormality (23 studies) was 94.7% (95% CI 92.2% to 96.4%, very low-certainty evidence) and 84.8% (95% CI 76.7% to 90.4%, low-certainty evidence) for CXR abnormalities suggestive of tuberculosis (19 studies), and specificity was 89.1% (95% CI 85.6% to 91.8%, low-certainty evidence) and 95.6% (95% CI 92.6% to 97.4%, high-certainty evidence), respectively. Sensitivity was more heterogenous than specificity, and could be explained by regional variation. The addition of cough for two or more weeks, whether to any (pulmonary) CXR abnormality or to CXR abnormalities suggestive of tuberculosis, resulted in a summary sensitivity and specificity of 99.2% (95% CI 96.8% to 99.8%) and 84.9% (95% CI 81.2% to 88.1%) (15 studies; certainty of evidence not assessed).
AUTHORS' CONCLUSIONS
The summary estimates of the symptom and CXR index tests may inform the choice of screening and diagnostic algorithms in any given setting or country where screening for tuberculosis is being implemented. The high sensitivity of CXR index tests, with or without symptom questions in parallel, suggests a high yield of persons with tuberculosis disease. However, additional considerations will determine the design of screening and diagnostic algorithms, such as the availability and accessibility of CXR facilities or the resources to fund them, and the need for more or fewer diagnostic tests to confirm the diagnosis (depending on screening test specificity), which also has resource implications. These review findings should be interpreted with caution due to methodological limitations in the included studies and regional variation in sensitivity and specificity. The sensitivity and specificity of an index test in a specific setting cannot be predicted with great precision due to heterogeneity. This should be borne in mind when planning for and implementing tuberculosis screening programmes.
Topics: Adult; Cough; HIV Infections; Humans; Mass Screening; Radiography; Sensitivity and Specificity; Tuberculosis, Pulmonary
PubMed: 35320584
DOI: 10.1002/14651858.CD010890.pub2 -
Sensors (Basel, Switzerland) Aug 2022A radar is an important part of an air defense and combat system. It is of great significance to military defense to improve the effectiveness of radar state monitoring...
A radar is an important part of an air defense and combat system. It is of great significance to military defense to improve the effectiveness of radar state monitoring and the accuracy of fault diagnosis during operation. However, the complexity of radar equipment's structure and the uncertainty of the operating environment greatly increase the difficulty of fault diagnosis in real life situations. Therefore, a Bayesian network diagnosis method based on multi-source information fusion technology is proposed to solve the fault diagnosis problems caused by uncertain factors such as the high integration and complexity of the system during the process of fault diagnosis. Taking a fault of a radar receiver as an example, we study 2 typical fault phenomena and 21 fault points. After acquiring and processing multi-source information, establishing a Bayesian network model, determining conditional probability tables (CPTs), and finally outputting the diagnosis results. The results are convincing and consistent with reality, which verifies the effectiveness of this method for fault diagnosis in radar receivers. It realizes device-level fault diagnosis, which shortens the maintenance time for radars and improves the reliability and maintainability of radars. Our results have significance as a guide for judging the fault location of radars and predicting the vulnerable components of radars.
PubMed: 36080860
DOI: 10.3390/s22176396