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The Journal of Prevention of... 2022Preclinical Alzheimer's disease (AD) provides an opportunity for the study and implementation of interventions and strategies aimed at delaying, mitigating, and...
BACKGROUND
Preclinical Alzheimer's disease (AD) provides an opportunity for the study and implementation of interventions and strategies aimed at delaying, mitigating, and preventing AD. While this preclinical state is an ideal target, it is difficult to identify efficiently and cost-effectively. Recent findings have suggested that cognitive-motor dual task paradigms may provide additional inference.
OBJECTIVES
Investigate the relationship between dual task performance and amyloidosis, suggestive of preclinical Alzheimer's disease and whether dual task performance provides additional information beyond a cognitive composite, to help in the identification of amyloidosis.
DESIGN
Cross-sectional.
SETTING
Outpatient specialty brain health clinical research institution in the United States.
PARTICIPANTS
52 cognitively healthy adults.
MEASUREMENTS
The data included demographics, amyloid standardized uptake value ratio obtained via florbetapir-PET, neuropsychological testing, apolipoprotien E genotype, and dual task performance measures. Data were analyzed via hierarchal multiple linear regression or logistic regression, controlling for age, education, and apolipoprotien E genotype. Receiver operating characteristic curves were plotted, and sensitivity and specificity calculated via 2x2 contingency tables.
RESULTS
There was a moderate relationship (rs>.30) between motor and cognitive dual task effects and amyloid standardized uptake value ratio (ps<.042). A strong relationship (r=.58) was found between combined dual task effect, a measure of automaticity derived from dual task performance, and amyloid standardized uptake value ratio (p<.001). Additionally, combined dual task effect showed promise in its unique contributions to amyloid standardized uptake value ratio, accounting for 7.8% of amyloid standardized uptake value ratio variance beyond cognitive composite scores (p=.018). Additionally, when incorporated into the cognitive composite, combined dual task effect resulted in improved diagnostic accuracy for determining elevated amyloid standardized uptake value ratio, and increased the sensitivity and specificity of the cognitive composite.
CONCLUSSION
Dual task performance using the combined dual task effect, a measure of automaticity, was a moderate predictor of cerebral amyloidosis, which suggests that it has utility in the screening and diagnosis of individuals for preclinical AD. Additionally, when combined with the cognitive composite, the combined dual task effect improves diagnostic accuracy. Further research is warranted.
Topics: Adult; Alzheimer Disease; Amyloid; Amyloid beta-Peptides; Amyloidosis; Cross-Sectional Studies; Humans; Positron-Emission Tomography; Task Performance and Analysis
PubMed: 35543003
DOI: 10.14283/jpad.2022.1 -
Methods of Information in Medicine Jun 2022Receiver operating characteristic (ROC) analysis is commonly used for comparing models and humans; however, the exact analytical techniques vary and some are flawed. (Review)
Review
BACKGROUND
Receiver operating characteristic (ROC) analysis is commonly used for comparing models and humans; however, the exact analytical techniques vary and some are flawed.
OBJECTIVES
The aim of the study is to identify common flaws in ROC analysis for human versus model performance, and address them.
METHODS
We review current use and identify common errors. We also review the ROC analysis literature for more appropriate techniques.
RESULTS
We identify concerns in three techniques: (1) using mean human sensitivity and specificity; (2) assuming humans can be approximated by ROCs; and (3) matching sensitivity and specificity. We identify a technique from Provost et al using dominance tables and cost-prevalence gradients that can be adapted to address these concerns.
CONCLUSION
Dominance tables and cost-prevalence gradients provide far greater detail when comparing performances of models and humans, and address common failings in other approaches. This should be the standard method for such analyses moving forward.
Topics: Humans; Prevalence; ROC Curve; Research Design; Sensitivity and Specificity
PubMed: 34972233
DOI: 10.1055/s-0041-1740565 -
Surgical Endoscopy Jun 2010Perforated peptic ulcer (PPU), despite antiulcer medication and Helicobacter eradication, is still the most common indication for emergency gastric surgery associated... (Review)
Review
BACKGROUND
Perforated peptic ulcer (PPU), despite antiulcer medication and Helicobacter eradication, is still the most common indication for emergency gastric surgery associated with high morbidity and mortality. Outcome might be improved by performing this procedure laparoscopically, but there is no consensus on whether the benefits of laparoscopic closure of perforated peptic ulcer outweigh the disadvantages such as prolonged surgery time and greater expense.
METHODS
An electronic literature search was done by using PubMed and EMBASE databases. Relevant papers written between January 1989 and May 2009 were selected and scored according to Effective Public Health Practice Project guidelines.
RESULTS
Data were extracted from 56 papers, as summarized in Tables 1-7. The overall conversion rate for laparoscopic correction of perforated peptic ulcer was 12.4%, with main reason for conversion being the diameter of perforation. Patients presenting with PPU were predominantly men (79%), with an average age of 48 years. One-third had a history of peptic ulcer disease, and one-fifth took nonsteroidal anti-inflammatory drugs (NSAIDs). Only 7% presented with shock at admission. There seems to be no consensus on the perfect setup for surgery and/or operating technique. In the laparoscopic groups, operating time was significant longer and incidence of recurrent leakage at the repair site was higher. Nonetheless there was significant less postoperative pain, lower morbidity, less mortality, and shorter hospital stay.
CONCLUSION
There are good arguments that laparoscopic correction of PPU should be first treatment of choice. A Boey score of 3, age over 70 years, and symptoms persisting longer than 24 h are associated with higher morbidity and mortality and should be considered contraindications for laparoscopic intervention.
Topics: Duodenal Ulcer; Humans; Laparoscopy; Omentum; Peptic Ulcer Perforation; Stomach Ulcer; Treatment Outcome
PubMed: 20033725
DOI: 10.1007/s00464-009-0765-z -
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 -
Journal of the American Heart... Dec 2023The Diamond-Forrester model was used extensively to predict obstructive coronary artery disease (CAD) but overestimates probability in current populations. Coronary...
BACKGROUND
The Diamond-Forrester model was used extensively to predict obstructive coronary artery disease (CAD) but overestimates probability in current populations. Coronary artery calcium (CAC) is a useful marker of CAD, which is not routinely integrated with other features. We derived simple likelihood tables, integrating CAC with age, sex, and cardiac chest pain to predict obstructive CAD.
METHODS AND RESULTS
The training population included patients from 3 multinational sites (n=2055), with 2 sites for external testing (n=3321). We determined associations between age, sex, cardiac chest pain, and CAC with the presence of obstructive CAD, defined as any stenosis ≥50% on coronary computed tomography angiography. Prediction performance was assessed using area under the receiver-operating characteristic curves (AUCs) and compared with the CAD Consortium models with and without CAC, which require detailed calculations, and the updated Diamond-Forrester model. In external testing, the proposed likelihood tables had higher AUC (0.875 [95% CI, 0.862-0.889]) than the CAD Consortium clinical+CAC score (AUC, 0.868 [95% CI, 0.855-0.881]; =0.030) and the updated Diamond-Forrester model (AUC, 0.679 [95% CI, 0.658-0.699]; <0.001). The calibration for the likelihood tables was better than the CAD Consortium model (Brier score, 0.116 versus 0.121; =0.005).
CONCLUSIONS
We have developed and externally validated simple likelihood tables to integrate CAC with age, sex, and cardiac chest pain, demonstrating improved prediction performance compared with other risk models. Our tool affords physicians with the opportunity to rapidly and easily integrate a small number of important features to estimate a patient's likelihood of obstructive CAD as an aid to clinical management.
Topics: Humans; Coronary Artery Disease; Calcium; Coronary Angiography; Risk Assessment; Calcium, Dietary; Chest Pain; Predictive Value of Tests; Risk Factors
PubMed: 38108259
DOI: 10.1161/JAHA.123.031601 -
World Journal of Surgical Oncology Feb 2021Xpert Bladder Cancer is a detection method developed in recent years, designed with the functions of integrating sample automatically, nucleic acid amplification, and... (Review)
Review
BACKGROUND
Xpert Bladder Cancer is a detection method developed in recent years, designed with the functions of integrating sample automatically, nucleic acid amplification, and target sequence detection. It is a urine assay targeting five mRNAs (CRH, IGF2, UPK1B, ANXA10, and ABL1). The purpose of this article is to review the accuracy of Xpert Bladder Cancer in the follow-up diagnosis of bladder cancer and evaluate the role of Xpert Bladder Cancer in detecting the recurrence of non-muscle-invasive bladder cancer in the round.
METHODS
In the database of Embase, PubMed, Web of Science, and Cochrane Library, the articles published up to October 13, 2020, were searched and screened based on the exclusion and inclusion criteria, and data were extracted from the included studies. The sensitivity, specificity, negative likelihood ratio, positive likelihood ratio summary of receiver operating characteristic curves, and diagnostic odds ratio were combined by the Meta-DiSc 1.4 software. The Stata 12.0 software was used to obtain the assessment of publication bias.
RESULTS
A total of 8 articles involving eight fourfold tables were finally identified. The pooled sensitivity and specificity of Xpert Bladder Cancer in the diagnosis of bladder cancer were 0.71 and 0.81, respectively. The positive likelihood ratio and negative likelihood ratio were 3.74 and 0.34, respectively. The area under the curve was 0.8407. The diagnostic odds ratio was 11.99. Deeks' funnel plot asymmetry test manifested no publication bias.
CONCLUSIONS
In summary, Xpert Bladder Cancer presents high accuracy and specificity in monitoring bladder cancer compared with cystoscopy. More researches are still required to further confirm this conclusion.
Topics: Carcinoma; Humans; Neoplasm Recurrence, Local; Prognosis; RNA, Messenger; Sensitivity and Specificity; Urinary Bladder Neoplasms
PubMed: 33563292
DOI: 10.1186/s12957-021-02154-0 -
International Journal of Cancer Mar 2023Gestational trophoblastic neoplasia (GTN) patients are treated according to the eight-variable International Federation of Gynaecology and Obstetrics (FIGO) scoring...
Gestational trophoblastic neoplasia (GTN) patients are treated according to the eight-variable International Federation of Gynaecology and Obstetrics (FIGO) scoring system, that aims to predict first-line single-agent chemotherapy resistance. FIGO is imperfect with one-third of low-risk patients developing disease resistance to first-line single-agent chemotherapy. We aimed to generate simplified models that improve upon FIGO. Logistic regression (LR) and multilayer perceptron (MLP) modelling (n = 4191) generated six models (M1-6). M1, all eight FIGO variables (scored data); M2, all eight FIGO variables (scored and raw data); M3, nonimaging variables (scored data); M4, nonimaging variables (scored and raw data); M5, imaging variables (scored data); and M6, pretreatment hCG (raw data) + imaging variables (scored data). Performance was compared to FIGO using true and false positive rates, positive and negative predictive values, diagnostic odds ratio, receiver operating characteristic (ROC) curves, Bland-Altman calibration plots, decision curve analysis and contingency tables. M1-6 were calibrated and outperformed FIGO on true positive rate and positive predictive value. Using LR and MLP, M1, M2 and M4 generated small improvements to the ROC curve and decision curve analysis. M3, M5 and M6 matched FIGO or performed less well. Compared to FIGO, most (excluding LR M4 and MLP M5) had significant discordance in patient classification (McNemar's test P < .05); 55-112 undertreated, 46-206 overtreated. Statistical modelling yielded only small gains over FIGO performance, arising through recategorisation of treatment-resistant patients, with a significant proportion of under/overtreatment as the available data have been used a priori to allocate primary chemotherapy. Streamlining FIGO should now be the focus.
Topics: Pregnancy; Female; Humans; Gestational Trophoblastic Disease; Retrospective Studies; Models, Statistical
PubMed: 36346113
DOI: 10.1002/ijc.34352 -
Journal of Vascular Surgery Aug 2019Iliac conduits (ICs) are used for challenging iliac access during endovascular aortic aneurysm repair (EVAR) with contradictory reports of safety and increased surgical...
OBJECTIVE
Iliac conduits (ICs) are used for challenging iliac access during endovascular aortic aneurysm repair (EVAR) with contradictory reports of safety and increased surgical complications, morbidity, and mortality in national database reviews. The objective of this study was to examine outcomes related to IC placement before or concomitant with EVAR at a high-volume single center.
METHODS
A retrospective analysis of patients who underwent IC placement for endovascular aortic repair from 2006 to 2016 was conducted. Planned and unplanned, as well as staged and concomitant IC for EVAR, thoracic EVAR, and fenestrated/branched EVAR were included. Categorical factors were described using frequencies and percentages. Continuous measures were summarized in comparative tables. Comparisons between the planned and unplanned groups, concomitant and staged groups, and between those with and without a postoperative event were performed using Pearson χ tests, two-sample t-tests, and Wilcoxon rank-sum tests.
RESULTS
A total of 137 patients underwent IC placement, of which 9 were bilateral procedures, for a total of 144 IC placements. IC placement was necessary in 14 EVARs (9.7%), 38 thoracic EVARs (26.4%), and 92 fenestrated/branched EVARs (63.9%). The 30-day related mortality was 2.1% (n = 3). Perioperative morbidities included return to the operating room in five patients (5.6%) for bleeding (n = 4) and graft thrombosis (n = 1), 4 myocardial infarctions (2.8%), 5 episodes of respiratory failure (3.5%), 12 wound complications (8.3%), and 7 renal injuries (4.9%), of which 3 had progression to dialysis (2.1%). Other complications included return to the operating room for endoleak reintervention (n = 3) and late graft infection (n = 1 [0.7%]). There were 112 ICs (77.8%) planned and 65 (45.1%) were staged. Staged ICs were less likely to have postoperative complications (P < .001), respiratory failure (P < .05), infectious complications (P < .05), and postoperative cerebrovascular accidents (P < .05). ICs were done to accommodate 20F to 24F sheath sizes in 131 instances (91.0%). Factors associated with unplanned IC placement were iliac rupture and an inability to advance the endograft in arteries deemed size-appropriate preoperatively (P < .001). Unplanned ICs were associated with higher estimated blood loss (P < .001), operating room transfusion volume (P < .001), and overall complication rates (P < .05). Women (P < .05), preoperative chronic kidney disease (P < .05), and concomitant IC placement (P < .001) were associated with higher overall complication rates. Operative time, estimated blood loss, and operating room transfusion volume were associated with increased rate of complications in comparison between all subgroups (P < .05).
CONCLUSIONS
ICs are a safe and viable option for high-risk patients with challenging iliac artery access for EVVAR. ICs are best performed in a planned fashion or in a staged manner, when feasible.
Topics: Aged; Aged, 80 and over; Aortic Aneurysm; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Databases, Factual; Endovascular Procedures; Female; Hospitals, High-Volume; Humans; Iliac Artery; Male; Postoperative Complications; Prosthesis Design; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 30598354
DOI: 10.1016/j.jvs.2018.10.099 -
Discovery Medicine Sep 2012In many areas of medicine risk prediction models are used to identify high-risk persons to receive treatment, with the goal of maximizing the ratio of benefits to harms.... (Review)
Review
In many areas of medicine risk prediction models are used to identify high-risk persons to receive treatment, with the goal of maximizing the ratio of benefits to harms. Thus there is considerable interest in evaluating markers to improve risk prediction. Many measures to evaluate a new marker for risk prediction are based solely on predictive accuracy including the odds ratio, change in the area under the receiver operating characteristic curve, and net reclassification improvement. However, predictive accuracy measures do not capture important clinical implications. Decision analysis comes to the rescue by including the ratio of the anticipated harm ("cost") of a false positive to the anticipated benefit of a true positive, which is transformed into a risk threshold (T) of indifference between treatment and no treatment. A decision-analytic measure of the "value" of a new marker is the number needed to test at a particular risk threshold, denoted NNTest(T), the minimum number of marker tests per true positive needed for risk prediction to be worthwhile. If NNTest(T) is acceptable given the invasiveness and adverse consequences of the test for the new marker, the new marker is recommended for inclusion in risk prediction. We provide a simple review of the derivation and computation of NNTest(T) from risk stratification tables and compare the minimum of NNTest(T), over risk thresholds, with measures of predictive accuracy in six studies. The results illustrate the advantages of this decision-analytic approach for evaluating a new marker for risk prediction.
Topics: Biomarkers; Biomarkers, Tumor; Blood Pressure; Breast Neoplasms; C-Reactive Protein; Decision Support Techniques; Female; Genotype; Humans; Lipoproteins, HDL; Models, Genetic; Models, Statistical; Odds Ratio; Predictive Value of Tests; ROC Curve; Recurrence; Risk
PubMed: 23021372
DOI: No ID Found