scholarly journals Using random forests to understand unrecognized progression to late-stage CKD, a case-control study

2021 ◽  
Author(s):  
Christopher Hane ◽  
Stephan Dunning ◽  
Jeffrey McPheeters ◽  
David Mosely ◽  
Jennifer St. Clair Russell ◽  
...  
Keyword(s):  
Random Forests ◽  
Late Stage ◽  
Early Stage ◽  
Case Control ◽  
Care Utilization ◽  
Control Group ◽  
Control Analysis ◽  
Fee For Service ◽  
Home Dialysis ◽  
Increased Risk

Abstract Background and objectives Patients with undiagnosed CKD are at increased risk of suboptimal dialysis initiation and therefore reduced access to home dialysis and transplantation as well as poor outcomes. Improved understanding of how patients remain undiagnosed is important to determine better intervention strategies. Design, setting, participants, and measurements A retrospective, matched, case-control analysis of 1,535,053 patients was performed to identify factors differentiating 4 patient types: unrecognized late-stage CKD, recognized late-stage CKD, early-stage CKD and a control group without CKD. The sample included patients with commercial insurance, Medicare Advantage, and Medicare fee-for service coverage. Patient demographics, comorbidities, health care utilization, and prescription use were analyzed using random forests to determine the most salient features discriminating the types. Models were built using all four types, as well as pairwise for each type versus the unrecognized late-stage type. Results Area under the curve for the three pairwise models (unrecognized late-stage vs recognized late-stage; unrecognized late-stage vs early-stage; unrecognized late-stage vs no CKD) were 82%, 68% and 82%. Conclusions The lower performance of the unrecognized late-stage vs early-stage model indicates a greater similarity of these two patient groups. The unrecognized late-stage CKD group is not simply avoiding or unable to get care in a manner distinguishable from the early-stage group. New outreach for CKD to undiagnosed or undetected, insured patients should look more closely at patient sets that are like diagnosed early-stage CKD patients.

scholarly journals A prospective case control study of the effects of oligohydramnios on fetomaternal outcome in mothers with term pregnancy in a rural medical college

2018 ◽  
Vol 7 (11) ◽  
pp. 4706
Author(s):  
Dipak Mandi ◽  
Sayantan Sen ◽  
Vasundhara Goswami
Keyword(s):  
Demographic Data ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
Case Control ◽  
Control Group ◽  
Case Group ◽  
Perinatal Complications ◽  
Medical College ◽  
Increased Risk ◽  
Nicu Admission

Background: The aim of the current study was to assess the fetomaternal effects of oligohydramnios on term pregnancies in a rural tertiary care setup.Methods: A perspective case control hospital-based trial was conducted at Burdwan Medical College and Hospital for a period of one year. Pregnancies at term (37-42 weeks) were included in the study. 103 patients with sonographically diagnosed oligohydramnios were included in the case group. The control group comprised of 103 mothers at term with normal liquor volume. Demographic data and fetomaternal outcome parameters were assessed and compared.Results: There was increased incidence of fetal and perinatal complications including low birth weight, birth asphyxia and NICU admission. There were more perinatal deaths in the case group compared to the control group. Induction of labour, operative delivery, meconium stained liquor and incidence of preeclampsia were also increased in mothers with low AFI.Conclusions: Oligohydramnios is associated with an increased risk of labour and perinatal complications. Adequate antenatal surveillance and intranatal monitoring coupled with correction of underly-ing factors is the mainstay of management.

scholarly journals Oral Contraceptive Use and Breast Cancer Risk Assessment: A Systematic Review and Meta-Analysis of Case-Control Studies, 2009–2020

Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5654
Author(s):  
Agnieszka Barańska ◽  
Agata Błaszczuk ◽  
Wiesław Kanadys ◽  
Maria Malm ◽  
Katarzyna Drop ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Oral Contraceptive ◽  
Cancer Risk ◽  
Meta Analysis ◽  
Case Control ◽  
Cochrane Library ◽  
Control Group ◽  
Case Control Studies ◽  
Increased Risk ◽  
Breast Cancer Risk Assessment

To perform a meta-analysis of case-control studies that addressed the association between oral contraceptive pills (OC) use and breast cancer (BrCa), PubMED (MEDLINE), Embase, and the Cochrane Library were searched to identify case-control studies of OC and BrCa published between 2009 and 2020. We used the DerSimonian–Laird method to compute pooled odds ratios (ORs) and confidence intervals (CIs), and the Mantel–Haenszel test to assess the association between OC use and cancer. Forty-two studies were identified that met the inclusion criteria and we included a total of 110,580 women (30,778 into the BrCa group and 79,802 into the control group, of which 15,722 and 38,334 were using OC, respectively). The conducted meta-analysis showed that the use of OC was associated with a significantly increased risk of BrCa in general, OR = 1.15, 95% CI: 1.01 to 1.31, p = 0.0358. Regarding other risk factors for BrCa, we found that increased risk was associated significantly with early menarche, nulliparous, non-breastfeeding, older age at first parity, postmenopause, obesity, smoking, and family history of BrCa. Despite our conclusion that birth control pills increase the cancer risk being supported by extensive previous studies and meta-analyzes, further confirmation is required.

613 The Floating Hip: A Distinct Injury Pattern? A Descriptive Study and Case-Control Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Wong ◽  
M Ghobrial ◽  
W M Han ◽  
J Alsousou ◽  
D Chou ◽  
...  
Keyword(s):  
Case Series ◽  
Femoral Fractures ◽  
Descriptive Study ◽  
Case Control ◽  
Injury Pattern ◽  
Pelvic Fractures ◽  
Control Group ◽  
Control Analysis ◽  
Hip Injury ◽  
Case Control Analysis

Abstract Aim A “Floating Hip” injury describes a simultaneous ipsilateral fracture of the femur and pelvis. We performed a descriptive study of the injury patterns, management, and outcomes of floating hip patients, and compared these patients to those with similar pelvic fractures without femoral involvement. Method This was a retrospective case-series review with secondary case-control analysis. Medical records of patients presenting with a floating hip injury to our tertiary orthopaedics department between 2015 and 2020 were reviewed. The control group comprised of patients with pelvic fractures but without associated femoral fractures, matched by age, sex, pelvic fracture classification, and mechanism of injury. Results 46 Floating Hip cases were identified (34 males), of average age 39 (15-86) years. 20 had acetabular fractures, 21 had pelvic ring fractures and 5 had both fractures, concomitant with ipsilateral femoral fractures. The most common site of femoral fracture was mid-shaft (21.7%), followed by distal (19.6%). 69.6% of P/A fractures were managed surgically, with ORIF (43%) the most common option. 4 (12.50%) patients suffered complications, including 2 infections and 1 DVT. Compared to controls, Floating Hip patients were more likely to require surgical management (67.6% vs 47.8%, p = 0.03), and had higher rates of surgical complications (12.5% vs 4.6%), though not statistically significant (p = 0.3). Conclusions Our study describes the patterns, management, and outcomes of Floating Hip injuries, and observes differences in the management and complications compared to similar pelvic fractures without femoral involvement. These findings suggest Floating Hip cases may warrant consideration as a distinct injury pattern.

The Pediatric Experience of an Experimental Prepaid Group Practice in a Medical School Setting

PEDIATRICS ◽  
1974 ◽  
Vol 53 (3) ◽  
pp. 319-325
Author(s):  
Lawrence Kahn ◽  
Gerald T. Perkoff
Keyword(s):  
Medical School ◽  
Medical Care ◽  
Hospital Admissions ◽  
School Setting ◽  
Controlled Study ◽  
Care Group ◽  
Care Utilization ◽  
Control Group ◽  
Group Practice ◽  
Fee For Service

The Medical Care Group (MCG) of Washington University is an experimental prepaid group practice which operates as an integral part of a medical school. When the practice was begun, study (MCG) and control group (CG) families were enrolled and selected prospectively by random drawing. Medical care utilization by families in the prepaid group practice (MCG) then was compared with that of families cared for in the traditional fee-for-service system (CG). The data presented here represent pediatric utilization for the first 25 months' experience. There were 592 pediatric person years of experience (PY) in MCG and 697 PY in CG. MCG enrollees made almost twice as many ambulatory visits as did CG, 3.45 versus 1.79 visits/PY. There were fewer hospital admissions and the average duration of stay was shorter for MCG than for CG. Thus, MCG used 53.4% fewer hospital days 10.8 per 100 PY compared to 23.2 for CG (p = < 0.01). This reduction resulted more from reduced nonsurgical than surgical utilization. These data substantiate, in a prospectively controlled study of pediatric enrollees, the reduced hospital and increased ambulatory care utilization expected in a prepaid group practice and support the feasibility of conducting such a practice as an integral part of a medical school setting.

Identifying Potential Markers for Monitoring Progression to Ovarian Cancer Using Plasma Label-free Proteomics

2019 ◽  
Author(s):  
Wenjie Wang ◽  
Hongyu Xie ◽  
Bairong Xia ◽  
LiuChao Zhang ◽  
Ce Wang ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Patients ◽  
Plasma Protein ◽  
Late Stage ◽  
Early Stage ◽  
Label Free ◽  
Absolute Quantitation ◽  
Keywords Ovarian Cancer ◽  
Benign Ovarian Tumor ◽  
Increased Risk

Abstract PurposeCancer antigen 125 (CA125) is considered to have high sensitivity but poor specificity for ovarian cancer. New biomarkers utilized to early detect and monitor the progression of ovarian cancer patients are critically needed. Methods A total of 80 patients including 16 early stage, and matched with 17 late stage, 23 benign ovarian tumor (BOT) and 24 uterine fibroid (UF) patients were utilized to perform plasma proteomics analysis using isobaric tag for relative and absolute quantitation (iTRAQ) method to identify differential diagnostic proteins of ovarian cancer patients. A validation set of 9 early stage, 11 late stage, 17 BOT and 16 UF collected by an independent cohort of samples with the same matching principles was examined to confirm the expressed levels of differential expression proteins by ELISA analysis. Results CRP and ARHGEF 11 were identified as potential diagnostic biomarkers of ovarian cancer. Results of area under the curve (AUC) analysis suggested that combination of diagnostic proteins and CA125 achieved a much higher diagnostic accuracy compared with CA125 alone (AUC values: 0.98 versus 0.80), especially improved the specificity (0.97 versus 0.77). In addition, elevated plasma CRP levels were associated with increased risk of ovarian cancer. Conclusions Current study found that plasma protein CRP was an indicator for monitoring the progression of ovarian cancer. Combination of plasma protein biomarkers with CA125 could be utilized to early diagnose of ovarian cancer patients. Keywords ovarian cancer, proteomics, diagnosis, progression, CRP

Distinct Pattern of Inflammation of Articular Cartilage and the Synovium in Early and Late Hip Femoroacetabular Impingement

2020 ◽  
Vol 48 (10) ◽  
pp. 2481-2488
Author(s):  
Masahiko Haneda ◽  
Muhammad Farooq Rai ◽  
Lei Cai ◽  
Robert H. Brophy ◽  
Regis J. O’Keefe ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Late Stage ◽  
Early Stage ◽  
Hip Osteoarthritis ◽  
Cartilage Degeneration ◽  
Control Group ◽  
Acetabular Cartilage ◽  
Similar Expression ◽  
Related Proteins ◽  
Head Neck

Background: The molecular mechanism of how femoroacetabular impingement (FAI) morphology leads to hip osteoarthritis (OA) is yet to be determined. The expression and location of inflammation-related molecules during early- and late-stage FAI have not been previously described. Moreover, the characterization of intra-articular inflammation away from the cam deformity as well as the nature of adjacent synovial tissue have also not been extensively reported. Hypothesis: Early-stage FAI has a similar expression of inflammation-related markers in the head-neck and acetabular cartilage but less synovitis than late-stage FAI. Study Design: Controlled laboratory study. Methods: Head-neck cartilage, acetabular cartilage, and synovial samples were obtained from patients undergoing hip preservation surgery for the treatment of symptomatic cam FAI (early FAI group; n = 15) and advanced OA secondary to cam FAI (late FAI group; n = 15). Samples procured from healthy young adult donors served as the control group (n = 7). Cartilage degeneration was assessed by histology, and the expression of inflammation-related proteins (interleukin–1 beta [IL-1β], matrix metalloproteinase–13 [MMP-13], a disintegrin and metalloproteinase with thrombospondin motifs–4 [ADAMTS-4], type II collagen [COL2], and aggrecan neoepitope [NITEGE]) was measured by immunostaining. Synovial samples in the early and late FAI groups were examined for synovitis and the expression of IL-1β. Results: Head-neck cartilage in the early FAI group showed significantly more degeneration than the control group and an increased expression of inflammation-related proteins (IL-1β: 69.7% ± 18.1% vs 20.2% ± 4.9%, respectively; MMP-13: 79.6% ± 12.6% vs 25.3% ± 9.5%; ADAMTS-4: 83.9% ± 12.2% vs 24.3% ± 11.1%; NITEGE: 89.7% ± 7.7% vs 39.8% ± 20.5%) ( P < .001). Head-neck and acetabular cartilage in the early and late FAI groups showed a similar degree of degeneration. Moreover, a similar expression of inflammation-related proteins was observed between the early and late FAI groups for head-neck cartilage (IL-1β: 69.7% ± 18.1% vs 72.5% ± 13.2%; MMP-13: 79.6% ± 12.6% vs 71.4% ± 18.8%; ADAMTS-4: 83.9% ± 12.2% vs 82.6% ± 12.5%; COL2: 93.6% ± 3.9% vs 92.5% ± 5.8%; NITEGE: 89.7% ± 7.7% vs 95.7% ± 4.7%) and acetabular cartilage (IL-1β: 83.3% ± 24.8% vs 80.7% ± 15.6%; MMP-13: 94.3% ± 9.7% vs 85.2% ± 12.3%; ADAMTS-4: 98.5% ± 2.3% vs 98.4% ± 3.4%; COL2: 99.8% ± 0.7% vs 99.7% ± 1.1%; NITEGE: 96.7% ± 6.7% vs 99.2% ± 2.2%). In contrast, synovitis was minimal with a low expression of IL-1β in the early FAI group compared with the late FAI group. Conclusion: Hip cartilage exhibited an OA phenotype in patients with early-stage FAI, similar to what was observed in hip OA secondary to FAI. Severe synovitis was only evident with late-stage FAI. Clinical Relevance: This study supports the concept that early hip impingement is associated with cartilage degeneration and catabolism.

ACE inhibitor use and risk of cataract: a case–control analysis

2019 ◽  
Vol 103 (11) ◽  
pp. 1561-1565 ◽  
Author(s):  
Claudia Becker ◽  
Susan S Jick ◽  
Christoph R Meier
Keyword(s):  
Observational Study ◽  
Index Date ◽  
Antihypertensive Drugs ◽  
Conditional Logistic Regression ◽  
Case Control ◽  
Sensitivity Analyses ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Control Analysis ◽  
Increased Risk

Background/AimUse of ACE inhibitors (ACEIs) has been associated with an increased risk of cataract in a previous observational study in humans. In contrast, ACEIs were associated with beneficial effects on cataract development in experimental studies. We assessed the risk of cataract in relation to exposure to ACEI and other antihypertensive drugs.MethodsThis is a case-control study based on data from the UK-based Clinical Practice Research Datalink (CPRD). We included first-time cataract patients aged ≥40 years between 1995 and 2015 and an equal number of cataract-free controls. We matched the controls to cases on age, sex, general practice, date of first cataract (ie, index date) and years of history in the CPRD prior to the index date. We assessed the number of prescriptions for ACEI and other antihypertensive drugs in detail and explored the use of single ACEI substances. We performed conditional logistic regression and conducted various sensitivity analyses to test the robustness of our findings. We calculated the risk of cataract associated with previous exposure to ACEI, measured as OR with 95% CIs, and adjusted the multivariable model for body mass index, smoking, diabetes, hypertension, prescriptions of systemic corticosteroids and other antihypertensive drugs.ResultsWe identified 206 931 cataract cases and the same number of matched controls. Use of ACEI was not associated with a materially altered risk of cataract compared with non-use of ACEI, neither in the main analysis (OR 1.06, 95% CI 1.04 to 1.08) nor in any of the sensitivity or stratified analyses.ConclusionIn our large observational study, use of ACEI was not associated with an altered risk of cataract.

Recurrence rates in patients with uterine papillary serous cancer with and without breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16529-e16529
Author(s):  
Jessica E. Stine ◽  
Stuart Pierce ◽  
Paola A. Gehrig ◽  
John Nakayama ◽  
Laura Jean Havrilesky ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Recurrence Rate ◽  
Late Stage ◽  
Early Stage ◽  
Disease Stage ◽  
Serous Carcinoma ◽  
Recurrence Rates ◽  
Increased Risk ◽  
Risk Patients ◽  
Papillary Serous Carcinoma

e16529 Background: Women with uterine papillary serous carcinoma (UPSC) are at increased risk for breast cancer and the converse is true. A genetic association between breast cancer and UPSC was recently described and counseling women faced with more than one cancer diagnosis can be difficult. Our objective was to evaluate recurrence rates of women with UPSC to those with UPSC and a personal history of breast cancer (UPSCBR). Methods: Data was collected for UPSCBR patients at two academic institutions between 7/1990 and 7/2012. Patient demographics, pathology, disease stage, and treatments were recorded. A UPSC literature review was performed focusing on recurrences per number of at-risk patients by stage. We used the fixed effect Mantel-Haenszel method to estimate the common pooled effect (recurrence rate) for the UPSC studies and compared these to UPSCBR patients. Results: Forty-three UPSCBR patients were identified. Median age at diagnosis was 72 (49-93). Twenty-six patients were Caucasian, 14 African-American and 3 other. Twenty-four (56%) had early stage at diagnosis (IA-IC) and 19 (44%) had late stage (III-IV). All but one underwent surgical staging/debulking; 36 (90%) were optimally debulked. Twelve (50%) early stage and 17 (89.5%) late stage patients underwent adjuvant therapy with radiation and/or chemotherapy. Nine studies were identified with available recurrence data for early stage UPSC; 8 for late stage. The recurrence rate for stage IA UPSCBR patients was 2/11 (18%) [95% CI: 2 to 52%] compared to 11% [95% CI: 9.8 to 13%] in the UPSC literature. In IB/IC UPSCBR patients we had 3/13 (23%) [95% CI: 5 to 54%] recur versus 21% [95% CI: 19 to 23%]. In later stages III/IV, 7/19 (37%) [95% CI:16 to 62%] UPSCBR patients had recurrences compared to 58% [95% CI: 56 to 60%] of UPSC patients. Conclusions: There is an association between breast cancer and UPSC with regard to incidence. We failed to find evidence of an appreciable difference in recurrence rates between our UPSCBR patients and UPSC patient groups from other reported studies. While diagnosis with two primary malignancies can be challenging for patients, this does not appear to impact their risk of recurrence.

scholarly journals Lymphoma in patients treated with anti-TNF: results of the 3-year prospective French RATIO registry

2009 ◽  
Vol 69 (2) ◽  
pp. 400-408 ◽  
Author(s):  
X Mariette ◽  
F Tubach ◽  
H Bagheri ◽  
M Bardet ◽  
J M Berthelot ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Inflammatory Diseases ◽  
Antibody Therapy ◽  
Case Control ◽  
Hodgkin's Lymphoma ◽  
Control Analysis ◽  
Barr Virus ◽  
Increased Risk ◽  
Epstein Barr ◽  
Case Control Analysis

Objective:To describe cases of lymphoma associated with anti-TNF therapy, identify risk factors, estimate the incidence and compare the risks for different anti-TNF agents.Methods:A national prospective registry was designed (Research Axed on Tolerance of bIOtherapies; RATIO) to collect all cases of lymphoma in French patients receiving anti-TNF therapy from 2004 to 2006, whatever the indication. A case–control analysis was conducted including two controls treated with anti-TNF per case and an incidence study of lymphoma with the French population was used as the reference.Results:38 cases of lymphoma, 31 non-Hodgkin’s lymphoma (NHL) (26 B cell and five T cell), five Hodgkin’s lymphoma (HL) and two Hodgkin’s-like lymphoma were collected. Epstein–Barr virus was detected in both of two Hodgkin’s-like lymphoma, three of five HL and one NHL. Patients receiving adalimumab or infliximab had a higher risk than those treated with etanercept: standardised incidence ratio (SIR) 4.1 (2.3–7.1) and 3.6 (2.3–5.6) versus 0.9 (0.4–1.8). The exposure to adalimumab or infliximab versus etanercept was an independent risk factor for lymphoma in the case–control study: odds ratio 4.7 (1.3–17.7) and 4.1 (1.4–12.5), respectively. The sex and age-adjusted incidence rate of lymphoma was 42.1 per 100 000 patient-years. The SIR was 2.4 (95% CI 1.7 to 3.2).Conclusion:The two to threefold increased risk of lymphoma in patients receiving anti-TNF therapy is similar to that expected for such patients with severe inflammatory diseases. Some lymphomas associated with immunosuppression may occur, and the risk of lymphoma is higher with monoclonal-antibody therapy than with soluble-receptor therapy.

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