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Methods (San Diego, Calif.) Dec 2023This study explores the possibility of using routinely taken blood tests in the diagnosis and triage of patients with suspected musculoskeletal malignancy.
AIMS
This study explores the possibility of using routinely taken blood tests in the diagnosis and triage of patients with suspected musculoskeletal malignancy.
METHODS
A retrospective study was performed on results of patients who had presented for assessment to a regional musculoskeletal tumour unit. Blood results of patients with a histologically confirmed diagnosis between 2010 and 2020 were retrieved. 33 distinct blood tests were available for model forming. Results were standardised by calculating z-scores. Data were split into a training set (70%) and a test set (30%). The training set was balanced by resampling underrepresented classes. The random forest algorithm performed best and was selected for model forming. Receiver operating characteristic curves were used to find the optimum threshold. Models were calibrated and performance metrics evaluated with confusion tables.
RESULTS
2371 patients formed the study population. 1080 had a malignant diagnosis in one of three categories: sarcoma, metastasis, or haematological malignancy. 1291 had a benign condition. Metastasis could be predicted with an accuracy of 79% (AUC 87%, sensitivity 79%, specificity 80% NPV 91%). Haematological malignancy accuracy 79% (AUC 81%, sensitivity 77%, specificity 79%, NPV 97%). Sarcoma accuracy 64% (AUC 73%, sensitivity 76%, specificity 61%, NPV 88%) and all malignancy accuracy 74% (AUC 80%, sensitivity 72%, specificity 75%, NPV 76%).
CONCLUSION
Routinely performed blood tests can be useful in triage of musculoskeletal tumours and can be used to predict presence of musculoskeletal malignancy.
Topics: Humans; Retrospective Studies; Sarcoma; Hematologic Tests; Machine Learning; Hematologic Neoplasms
PubMed: 37951558
DOI: 10.1016/j.ymeth.2023.10.012 -
Journal of Personalized Medicine Aug 2023To systematically review and meta-analyze the predictive value of the Fournier gangrene severity index (FGSI), the simplified FGSI (SFGSI), and the Uludag FGSI (UFGSI)... (Review)
Review
OBJECTIVE
To systematically review and meta-analyze the predictive value of the Fournier gangrene severity index (FGSI), the simplified FGSI (SFGSI), and the Uludag FGSI (UFGSI) on mortality in patients affected by Fournier's Gangrene (FG).
METHODS
A search was performed in PubMed, Web of Science, Embase, and the Cochrane Library, from January 2000 to May 2023, to identify original cohorts comparing data between surviving and non-surviving FG patients. The statistical analysis consisted of two parts. First, the mean and standard deviation (SD) of the FGSI, SFGSI, and UFGSI at admission were extrapolated from each study, and the pooled mean difference (MD) with 95% confidence interval (95% CI) was obtained using the Der Simonian-Laird random-effect model. Second, to evaluate the accuracy of the FGSI, SFGSI, and UFSGI in predicting mortality, true positive (TP), false positive (FP), true negative (TN), and false negative (FN) values were extracted where possible and reported in 2 × 2 contingency tables. The sensitivity, specificity, and AUC values were pooled, and summary receiver operating characteristic (SROC) curves were constructed.
RESULTS
Overall, forty studies comprising 2257 patients were included. The pooled analysis revealed that the FGSI, SFGSI, and UFGSI values at admission were higher in non-survivors than survivors (MD: 5.53 (95% CI: 4.68-6.37); MD: 2.41 (95% CI: 1.06-3.77); and MD: 5.47 (95% CI: 3.68-7.26), respectively). Moreover, the AUC values of the FGSI, SFGSI, and UFGSI were 0.90 (95% CI: 0.87-0.92), 0.84 (95% CI: 0.80-0.87), and 0.94 (95% CI: 0.92-0.96), respectively.
CONCLUSIONS
The higher scores of the FGSI, SFGSI, and UFGSI on admission were associated with mortality. Moreover, when comparing accuracy rates, the UFGSI exhibited the highest AUC value.
PubMed: 37763051
DOI: 10.3390/jpm13091283 -
HardwareX Sep 2023Traditionally, surgical head immobilization for neurobiological research with large animals is achieved using stereotaxic frames. Despite their widespread use, these...
Traditionally, surgical head immobilization for neurobiological research with large animals is achieved using stereotaxic frames. Despite their widespread use, these frames are bulky, expensive, and inflexible, ultimately limiting surgical access and preventing research groups from practicing surgical approaches used to treat humans. Here, we designed a mobile, low-cost, three-pin skull clamp for performing a variety of neurosurgical procedures on non-human primates. Modeled after skull clamps used to operate on humans, our system was designed with added adjustability to secure heads with small or irregular geometries for innovative surgical approaches. The system has six degrees of freedom with skull pins attached to setscrews for independent, fine-tuned depth adjustment. Unlike other conventional skull clamps which require additional mounting fixtures, our system has an integrated tray with mounting bracket for easy use on most operating room tables. Our system has successfully secured primate heads in the supine and lateral position, allowing surgeons to match surgical approaches currently practiced when operating on humans. The system also expands the opportunity for researchers to utilize imaged-guided robotic surgery techniques. Overall, we hope that our system can serve as an adaptable, affordable, and robust surgery platform for any laboratory performing neurobiological research with large animal models.
PubMed: 37680492
DOI: 10.1016/j.ohx.2023.e00472 -
BMC Medical Research Methodology Aug 2023A multiple dependent state sampling plan (MDSSP) is designed when the lifetimes of the variables follow New Lomax Rayleigh Distribution (NLRD). The decision to accept or...
A multiple dependent state sampling plan (MDSSP) is designed when the lifetimes of the variables follow New Lomax Rayleigh Distribution (NLRD). The decision to accept or reject a lot in the proposed methodology is based on the quality of the given present or previous lots. A binomial model-based operating characteristic curve (OC curve) for continuous lots of variables under similar settings in healthcare is used in finding the probability of acceptance, acceptance number, rejection number, and the number of preceding (succeeding) lots to consider. Time truncated life test based on the specified median of the NLRD is used in designing the current acceptance sampling plan. For specified values of the parameters of NLRD, quantile ratios, consumer's risk and producer's risk, average sampling number (ASN) and probability of acceptance of a lot are reported in tables. Real data on worldwide suicide rates of 15-19 years in the year 2019 from the World Health Organization (WHO) website is considered to illustrate this methodology. The minimum sample size required from the selected data to comment on worldwide suicide rates in late adolescents is explained with MDSSP. The results of the proposed acceptance sampling method are compared with the single-stage sampling plan.
Topics: Humans; Adolescent; Models, Statistical; Probability; Sample Size; Suicide; World Health Organization
PubMed: 37608353
DOI: 10.1186/s12874-023-02007-2 -
Journal of Education and Health... 2023The most important part of learning happens in the clinic. To determine the differences between the real educational environment and the desirable environment, the...
BACKGROUND
The most important part of learning happens in the clinic. To determine the differences between the real educational environment and the desirable environment, the DREEM1 model is used. The present study was conducted to evaluate the clinical educational environment based on the DREEM model from the viewpoint of the OR2 students of the Lorestan University of Medical Sciences.
MATERIALS AND METHODS
The present descriptive-analytical cross-sectional study evaluated the viewpoint of 118 students of operation room (OR) technology using the DREEM (Dundee Ready Educational Environment Measure) questionnaire in the hospitals affiliated with the Lorestan University of Medical Sciences during the second semester of 2020. The DREEM questionnaire has 50 statements and is divided into five sections, which are rated on a five-point Likert scale (0-4). The data were analyzed using frequency distribution tables, mean and standard deviation indices, Mann-Whitney and Kruskal-Wallis tests. Data analysis was conducted using IBM SPSS Statistics 22.0. IBM Corp.; 2013. and the level of significance was set at 0.05.
RESULTS
The total perception of the students of the clinical educational environment was good and excellent in 73.8% of the cases and of the subscales was also good (50.8%-63.2%). There was a significant relation between the total score of students' perception of the clinical educational environment and age ( = 5.618, < 0.001), semester (χ= 43.929, df = 3, < 0.001), internship hospital (χ= 12.948, df = 6, = 0.044) and also the mean score of the subscales ( < 0.001). As the GPA3 and interest in the major increased, the mean score of total perception and its subscales also increased except for perception from the educators ( < 0.05).
CONCLUSION
According to the results, the studied students had a positive perception of the clinical educational environment. It is recommended that the scientific foundation of the educators, the physical facilities of the operating rooms, and social communication should be strengthened to improve the care, treatment, and educational services. It will be useful to use the results to improve the accreditation level of medical centers.
PubMed: 37546016
DOI: 10.4103/jehp.jehp_1861_22 -
Brazilian Journal of Otorhinolaryngology 2023To evaluate the performance of the Berlin Questionnaire, the STOP-Bang Questionnaire, and the Epworth Sleepiness Scale in screening for the disease in adults of...
OBJECTIVE
To evaluate the performance of the Berlin Questionnaire, the STOP-Bang Questionnaire, and the Epworth Sleepiness Scale in screening for the disease in adults of different age groups by comparing them with polysomnography.
METHODS
Cross-sectional study with prospective patient allocation, in which individuals underwent a medical interview, completion of the three screening instruments, and polysomnography. Individuals were categorized into three age groups: 18-39, 40-59, and ≥60 years. The results of the screening instruments were compared to the diagnostic criteria of the International Classification of Sleep Disorders-third edition. Performance was assessed using 2×2 contingency tables, estimating sensitivity, specificity, predictive value, likelihood ratio, and accuracy. Receiver Operating Characteristic curves were also constructed and the area under the curve was estimated for each instrument by age group.
RESULTS
We obtained a sample with 321 individuals suitable for analysis. The mean age was 50 years, with a predominance of females (56%). The prevalence of the disease in the overall sample was 79%, more prevalent in males in any age group and more frequent in the middle age group. The analyzes revealed that STOP-Bang performed better, both for the overall sample and for all age groups, followed by Berlin Questionnaire and Epworth Sleepiness Scale.
CONCLUSION
In an outpatient setting with individuals with characteristics similar to those in this study, it seems sensible to choose the STOP-Bang as a screening tool for the disease, regardless of age group. LEVEL OF EVIDENCE ACCORDING THE GUIDE FOR AUTHORS: level 2.
Topics: Male; Middle Aged; Adult; Female; Humans; Adolescent; Prospective Studies; Cross-Sectional Studies; Sleepiness; Sleep Apnea, Obstructive; Surveys and Questionnaires; Mass Screening
PubMed: 37418853
DOI: 10.1016/j.bjorl.2023.101283 -
Safety and Health At Work Jun 2023This study evaluated occupational exposure levels of doxorubicin in healthcare workers performing rotational intraperitoneal pressurized aerosol chemotherapy (PIPAC)...
BACKGROUND
This study evaluated occupational exposure levels of doxorubicin in healthcare workers performing rotational intraperitoneal pressurized aerosol chemotherapy (PIPAC) procedures.
METHODS
All samples were collected during PIPAC procedures applying doxorubicin to an experimental animal model (pigs). All procedures were applied to seven pigs, each for approximately 44 min. Surface samples ( = 51) were obtained from substances contaminating the PIPAC devices, surrounding objects, and protective equipment. Airborne samples were also collected around the operating table ( = 39). All samples were analyzed using ultra-high performance liquid chromatography-mass spectrometry.
RESULTS
Among the surface samples, doxorubicin was detected in only five samples (9.8%) that were directly exposed to antineoplastic drug aerosols in the abdominal cavity originating from PIPAC devices. The telescopes showed concentrations of 0.48-5.44 ng/cm and the trocar showed 0.98 ng/cm in the region where the spraying nozzles were inserted. The syringe line connector showed a maximum concentration of 181.07 ng/cm, following a leakage. Contamination was not detected on the surgeons' gloves or shoes. Objects surrounding the operating table, including tables, operating lights, entrance doors, and trocar holders, were found to be uncontaminated. All air samples collected at locations where healthcare workers performed procedures were found to be uncontaminated.
CONCLUSIONS
Most air and surface samples were uncontaminated or showed very low doxorubicin concentrations during PIPAC procedures. However, there remains a potential for leakage, in which case dermal exposure may occur. Safety protocols related to leakage accidents, selection of appropriate protective equipment, and the use of disposable devices are necessary to prevent occupational exposure.
PubMed: 37389318
DOI: 10.1016/j.shaw.2023.04.002 -
Data in Brief Jun 2023This paper provides experimental data on the temperature rise during granular flows in a small-scale rotating drum due to heat generation. All heat is believed to be...
This paper provides experimental data on the temperature rise during granular flows in a small-scale rotating drum due to heat generation. All heat is believed to be generated by conversion of some mechanical energy, through mechanisms such as friction and collisions between particles and between particles and walls. Particles of different material types were used, while multiple rotation speeds were considered, and the drum was filled with different amounts of particles. The temperature of the granular materials inside the rotating drum was monitored using a thermal camera. The temperature increases at specific times of each experiment are presented in form of tables, along with the average and standard deviation of the repetitions of each setup configuration. The data can be used as a reference to set the operating conditions of rotating drums, in addition to calibrating numerical models and validating computer simulations.
PubMed: 37383737
DOI: 10.1016/j.dib.2023.109282 -
Frontiers in Neuroscience 2023To outline the complex biological rhythms underlying the time-to-action of goal-oriented behavior in the adult brain, we employed a Boolean Algebra model based on...
To outline the complex biological rhythms underlying the time-to-action of goal-oriented behavior in the adult brain, we employed a Boolean Algebra model based on Control Systems Theory. This suggested that "timers" of the brain reflect a metabolic excitation-inhibition balance and that healthy clocks underlying goal-oriented behavior (optimal range of signal variability) are maintained by XOR logic gates in parallel sequences between cerebral levels. Using truth tables, we found that XOR logic gates reflect healthy, regulated time-to-action events between levels. We argue that the brain clocks of time-to-action are active within multileveled, parallel-sequence complexes shaped by experience. We show the metabolic components of time-to-action in levels ranging from the atom level through molecular, cellular, network and inter-regional levels, operating as parallel sequences. We employ a thermodynamic perspective, suggest that clock genes calculate free energy versus entropy and derived time-to-action level-wise as a master controller, and show that they are receivers, as well as transmitters of information. We argue that regulated multileveled time-to-action processes correspond to Boltzmann's thermodynamic theorem of micro- and macro-states, and that the available metabolic free-energy-entropy matrix determines the brain's reversible states for its age-appropriate chrono-properties at given moments. Thus, healthy timescales are not a precise number of nano- or milliseconds of activity nor a simple phenotypic distinction between slow vs. quick time-to-action, but rather encompass a range of variability, which depends on the molecules' size and dynamics with the composition of receptors, protein and RNA isoforms.
PubMed: 37378011
DOI: 10.3389/fnins.2023.1171765 -
Advanced Biomedical Research 2023Ocular trauma is one of the most common causes of hospitalization in patients with ocular injuries. It imposes many direct and indirect physical and psychological costs...
BACKGROUND
Ocular trauma is one of the most common causes of hospitalization in patients with ocular injuries. It imposes many direct and indirect physical and psychological costs on the patient and the community.
MATERIALS AND METHODS
The present descriptive cross-sectional and retrospective study includes all patients with ocular trauma who underwent surgery in the referral center's ophthalmic operating room for 10 years. A checklist was completed for each patient, including demographic information and the variables required for the study. A total of 927 patients who underwent eye surgery due to ocular trauma were eligible for the study. All descriptive data were reported as the mean plus standard deviation for quantitative variables and distribution tables and frequency percentage for qualitative variables. Inferential tests such as independent t-test and Chi-square test were used to evaluate the research questions.
RESULTS
This study showed that most ocular traumas occur at a young age and mostly in males. The types of trauma in the studied eyes were divided into penetrating and non-penetrating in different age groups. The results showed that the most common type of surgery was corneal laceration repair, and in all patients, visual acuity improved significantly after surgery. In this study, a total of 81% of patients underwent only one operation.
CONCLUSIONS
Training and caring for children and adolescents about high-risk behaviors and educating industry professionals to wear goggles, and increase workplace safety can reduce these types of trauma.
PubMed: 37200739
DOI: 10.4103/abr.abr_108_21