Difference In Predictive Value Research Articles

Reconciling Algorithmic Fairness Criteria

Reconciling Algorithmic Fairness Criteria

Racial differences in predictive value of the 21-gene recurrence score assay: a population-based study using the SEER database

PurposeThe 21-gene recurrence score (RS) assay is currently used for predicting chemotherapeutic benefits for hormone receptor-positive (HR +) early-stage breast cancer patients without consideration regarding racial differences in that predictive value. This study aimed at demonstrating racial differences in the predictive values of the 21-gene RS assay.MethodsThe study cohort was selected from the Surveillance, Epidemiology, and End Results (SEER) database. Breast cancer-specific mortality (BCSM) was compared between patients who received chemotherapy (the “CTx group”) and those who did not (the “no CTx group”) to estimate the predictive value of the assay. This comparison was repeated for each racial group.ResultsAmong 88,498 T1 − 2N0 HR + breast cancer patients who had results of 21-gene RS, 13,123 patients had RS > 25, which included 10,697 Whites, 1282 Blacks, and 1,144 Asian Americans/Pacific Islanders (AAPIs). Chemotherapy was administered to 8364 patients (63.4%). The adjusted hazard ratio for BCSM in the CTx group (vs. no CTx group) was 0.734 (95% confidence interval [CI] 0.588–0.917) in Whites, 0.748 (95% CI 0.428–1.307) in Blacks, and 1.343 (95% CI 0.558–3.233) in AAPIs. No subgroup within patients with RS > 25 among non-White women showed a significant predictive value of the 21-gene RS assay, except for Black women with grade 3 tumors.ConclusionThe predictive value of the 21-gene RS assay for assessing chemotherapy benefit was validated in White women based on the SEER database, although the predictive value was not warranted in non-White women.

Prediction of cardiovascular events from systolic or diastolic blood pressure.

Over time, a focus on blood pressure has transferred from diastolic pressure to systolic pressure. Formal analyses of differences in predictive value are scarce. Our goal of the study was whether office SBP adds prognostic information to office DBP and whether both 24‐h ambulatory SBP and 24‐h ambulatory DBP is specifically important. The authors examined 2097 participants from a population cohort recruited in Copenhagen, Denmark. Cause‐specific Cox regression was performed to predict 10‐year person‐specific absolute risks of fatal and non‐fatal cardiovascular (CV) events. Also, the time‐dependent area under the receiver operator curve (AUC) was utilized to evaluate discriminative ability. The calibration plots of the models (Hosmer‐May test) were calculated as well as the Brier score which combines (discrimination and calibration). Adding both 24‐h ambulatory SBP and 24‐h ambulatory diastolic blood pressure did not significantly increase AUC for CV mortality and CV events. Moreover, adding both office SBP and office DBP did not significantly improve AUC for both CV mortality and CV events. The difference in AUC (95% confidence interval; p‐value) was .26% (‐.2% to .73%; .27) for 10‐year CV mortality and .69% (‐.09% to 1.46%; .082) for 10‐year risk of CV events. The difference in AUC was .12% (‐.2% to .44%; .46) for 10‐year CV mortality and .04% (‐.35 to .42%; .85) for 10‐year risk of CV events. Moreover, for both CV mortality and CV events, office SBP did not improve prognostic information to office DBP. In addition, the Brier scores of office BP in both CV mortality and CV events were .078 and .077, respectively. Furthermore, the Brier scores were .077 and .078 in CV mortality and CV events of 24‐h ambulatory. For the average population as those participating in a population survey, the 10‐year discriminative ability for long‐term predictions of CV death and CV events is not improved by adding systolic to diastolic blood pressure. This finding is found for ambulatory as well as office blood pressure.

Sex-Dependent Differences in Predictive Value of the C2HEST Score in Subjects with COVID-19-A Secondary Analysis of the COLOS Study.

Background: Since the outbreak of the COVID-19 pandemic, a growing number of evidence suggests that COVID-19 presents sex-dependent differences in clinical course and outcomes. Nevertheless, there is still an unmet need to stratify the risk for poor outcome at the beginning of hospitalization. Since individual C2HEST components are similar COVID-19 mortality risk factors, we evaluated sex-related predictive value of the score. Material and Methods: A total of 2183 medical records of consecutive patients hospitalized due to confirmed SARS-CoV-2 infections were analyzed. Subjects were assigned to one of two of the study arms (male vs. female) and afterward allocated to different stratum based on the C2HEST score result. The measured outcomes included: in-hospital-mortality, three-month- and six-month-all-cause-mortality and in-hospital non-fatal adverse clinical events. Results: The C2HEST score predicted the mortality with better sensitivity in female population regarding the short- and mid-term. Among secondary outcomes, C2HEST-score revealed predictive value in both genders for pneumonia, myocardial injury, myocardial infarction, acute heart failure, cardiogenic shock, and acute kidney injury. Additionally in the male cohort, the C2HEST value predicted acute liver dysfunction and all-cause bleeding, whereas in the female arm-stroke/TIA and SIRS. Conclusion: In the present study, we demonstrated the better C2HEST-score predictive value for mortality in women and illustrated sex-dependent differences predicting non-fatal secondary outcomes.

Consistent Major Differences in Sex- and Age-Specific Diagnostic Performance among Nine Faecal Immunochemical Tests Used for Colorectal Cancer Screening.

Simple SummaryWe evaluated the performance of nine faecal immunochemical tests among participants of screening colonoscopy. A total of 216 cases of advanced neoplasia (AN, colorectal cancer or advanced adenoma) and 300 randomly selected participants without AN were included. Diagnostic performance for detection of AN was assessed by sex and age (50–64 vs. 65–79 years), for each of the nine faecal immunochemical tests (FITs) individually and for all FITs combined. Major differences in diagnostic performance by sex and age were consistently seen across nine different FIT brands. Sensitivities were consistently lower, and specificities were consistently higher, for females as compared with males. Positive predictive values were similar between both sexes, but negative predictive values were higher for females. A negative FIT is less reliable in ruling out AN among men than among women and among older than among younger participants.Evidence on diagnostic performance of faecal immunochemical tests (FITs) by sex and age is scarce. We aimed to evaluate FIT performance for detection of advanced colorectal neoplasia (AN) by sex and age across nine different FIT brands in a colonoscopy-controlled setting. The faecal samples were obtained from 2042 participants of colonoscopy screening. All eligible cases with AN (n = 216) and 300 randomly selected participants without AN were included. Diagnostic performance for detection of AN was assessed by sex and age (50–64 vs. 65–79 years for each of the nine FITs individually and for all FITs combined. Sensitivity was consistently lower, and specificity was consistently higher for females as compared with males (pooled values at original FIT cutoffs, 25.7% vs. 34.6%, p = 0.12 and 96.2% vs. 90.8%, p < 0.01, respectively). Positive predictive values (PPVs) were similar between both sexes, but negative predictive values (NPVs) were consistently higher for females (pooled values, 91.8% vs. 86.6%, p < 0.01). Sex-specific cutoffs attenuated differences in sensitivities but increased differences in predictive values. According to age, sensitivities and specificities were similar, whereas PPVs were consistently lower and NPVs were consistently higher for the younger participants. A negative FIT is less reliable in ruling out AN among men than among women and among older than among younger participants. Comparisons of measures of diagnostic performance among studies with different sex or age distributions should be interpreted with caution.

Limited predictive value of illness perceptions for short-term poor recovery in musculoskeletal pain. A multi-center longitudinal study

BackgroundMusculoskeletal pain (MSP) is recognized worldwide as a major cause of increased years lived with disability. In addition to known generic prognostic factors, illness perceptions (IPs) may have predictive value for poor recovery in MSP. We were interested in the added predictive value of baseline IPs, over and above the known generic prognostic factors, on clinical recovery from MSP. Also, it is hypothesized there may be overlap between IPs and domains covered by the Four-Dimensional Symptom Questionnaire (4DSQ), measuring distress, depression, anxiety and somatization. The aim of this study is twofold; 1) to assess the added predictive value of IPs for poor recovery and 2) to assess differences in predictive value for poor recovery between the Brief Illness Perception Questionnaire - Dutch Language Version (Brief IPQ-DLV) and the 4DSQ.MethodsAn eligible sample of 251 patients with musculoskeletal pain attending outpatient physical therapy were included in a multi-center longitudinal cohort study. Pain intensity, physical functioning and Global Perceived Effect were the primary outcomes. Hierarchical logistic regression models were used to assess the added value of baseline IPs for predicting poor recovery. To investigate the performance of the models, the levels of calibration (Hosmer-Lemeshov test) and discrimination (Area under the Curve (AUC)) were assessed.ResultsBaseline ‘Treatment Control’ added little predictive value for poor recovery in pain intensity [Odds Ratio (OR) 0.80 (Confidence Interval (CI) 0.66–0.97), increase in AUC 2%] and global perceived effect [OR 0.78 (CI 0.65–0.93), increase in AUC 3%]. Baseline ‘Timeline’ added little predictive value for poor recovery in physical functioning [OR 1.16 (CI 1.03–1.30), increase in AUC 2%]. There was a non-significant difference between AUCs in predictive value for poor recovery between the Brief IPQ-DLV and the 4DSQ.ConclusionsBased on the findings of this explorative study, assessing baseline IPs, over and above the known generic prognostic factors, does not result in a substantial improvement in the prediction of poor recovery.Also, no recommendations can be given for preferring either the 4DSQ or the Brief IPQ-DLV to assess psychological factors.

Indeterminate Thyroid Nodules With RAS Mutations Have Higher Rates of Malignancy When Multiple Non-Cystic Nodules or Irregular Borders Are Present

Background: There is heterogeneity in positive predictive value for cancer in RAS-mutated cytologically indeterminate nodules and paucity of data with regards to specific ultrasound features that are associated with malignancy in these nodules. The goal of this study is to assess the ultrasonographic characteristics, in relation to clinical and histopathologic outcomes of thyroid nodules known to have a RAS mutation. Design and Methods: Cases were identified using our institutional Afirma® Genetic Sequence Classifier (GSC) database, and a retrospective review of electronic medical records for thyroid nodules biopsied between January 2018 and August 2020. Nodules categorized as Bethesda III or IV and harboring a RAS mutation by Xpression Atlas® were included. Thyroid ultrasound images were reviewed by the authors and were risk stratified according to the 2015 American Thyroid Association Thyroid Nodule and Differentiated Thyroid Cancer Guidelines (ATA Guidelines) and the 2017 ACR TIRADS system (ACR Guidelines). The nodules were divided into benign or malignant categories based on surgical pathology. Noninvasive follicular thyroid neoplasms with papillary like nuclear features (NIFTP) were categorized as benign. Results: A total of 22 nodules were identified to have a RAS mutation. NRAS mutated nodules, all with the same point mutation (pQ61R c.182A>G), were most common 14/22 (63.6%). There was no significant difference in clinical features, ultrasonographic appearance or histopathologic outcomes between NRAS- and HRAS-mutated nodules. 12/22 (54.4%) were low risk by ATA Guidelines and 11/22 (50%) were TIRADS 4 (moderately suspicious) by ACR Guidelines. There was no significant difference in predictive value of ATA Guidelines vs ACR Guidelines. The prevalence of malignancy was 45.4% (only slightly lower than the general risk for a suspicious GSC). Invasive follicular variant papillary thyroid cancer (FVPTC), was the most common malignancy, 4/10 (40%). 6/10 (60%) were classified as low risk of recurrence post-operatively. All malignant RAS-mutated nodules (10/10) had at least one other non-cystic nodule present on ultrasonography whereas only 4/9 (44%) of RAS-mutated benign nodules did [P=.006]. RAS-mutated malignant nodules had significantly more nodules with irregular borders compared to RAS-mutated benign nodules (4/10 and 0/10, 40% and 0% respectively) [P=.03]. Conclusions: This is the first study to observe higher rates of malignancy in RAS-mutated indeterminate nodules when other non-cystic nodules are present. A lobectomy is the preferred surgical approach for RAS-mutated nodules, however a total thyroidectomy may be considered in patients with other non-cystic nodules or irregular nodules borders. Overall, RAS-mutated nodules have a low risk of recurrence post-operatively.

Acute necrotising pancreatitis: measurements of necrosis volume and mean CT attenuation help early prediction of organ failure and need for intervention.

This study explored the early predictive value of volume and mean CT density of necrosis for adverse outcomes in patients with acute necrotising pancreatitis (ANP). A total of 155 patients with ANP who underwent CECT within 7 days of symptom onset were included. The necrosis volume, mean CT density, and modified CT severity index (mCTSI) were calculated. C-reactive protein (CRP) and blood urea nitrogen (BUN) levels both 48 h after symptom onset were reviewed. Adverse outcomes were recorded. The predictive value of each indicator was assessed using ROC curve analysis. There were significant associations between necrosis volume and mean CT density and organ failure (OF), persistent OF (POF), and need for intervention (p < 0.001 for all). For predicting OF, the area under the curve (AUC) was significantly higher for necrosis volume than for mCTSI and BUN (AUC: 0.84 vs 0.67, p = 0.0011; 0.84 vs 0.71, p = 0.0193, respectively). For predicting POF and need for intervention, the AUCs for necrosis volume were significantly higher than those for mCTSI (AUC: 0.79 vs 0.66, p = 0.0045; 0.77 vs 0.61, p = 0.0019, respectively), but did not significantly differ from those for CRP and BUN. For predicting OF, a significantly better predictive value was achieved with mean CT density than with mCTSI (AUC: 0.79 vs 0.67, p = 0.0163). There were no significant differences in predictive value between mean CT density, CRP, and BUN. The volume and mean CT density of necrosis based on CECT can provide early prediction of OF, POF, and need for intervention. • Compared to mCTSI, necrosis volume might be used to more accurately diagnose organ failure and persistent organ failure and might be better associated with the need for intervention. • Necrosis volume and mean CT density based on CECT are reliable quantitative predictors for organ failure, persistent organ failure, and intervention in acute pancreatitis.

Predicting metacarpal length using paired ratios with bilateral X-ray films.

Introduction:When the metacarpal bones sustain severe osseous injury requiring reconstruction, functional recovery relies on the precise distribution of tension throughout full range of motion. While the small scale of hand structures compounds the effects of altering normal anatomy, literature lacks consensus recommendations for the acceptable degree of length alteration and/or appropriate methods of length estimation in reconstructive procedures. Length asymmetry has been reported in human metacarpal bones; however, studies assessing this phenomenon in living subjects with attention to functional implications or length prediction are lacking.Methods:Hand X-rays were obtained for 34 patients aged 25–80 without history of metacarpal trauma, joint degeneration, or pathologic bone metabolism. A scaled bivariate model predicted metacarpal length using an ipsilateral paired metacarpal and matching contralateral ratio: Estimate_Dx_R = Median_Dy_R * (Median_Dx_L/Median_Dy_L). A second set of predictions used the contralateral metacarpal as a control. Pearson correlation coefficients, paired t-tests, and chi-square tests evaluated the symmetry between bilateral metacarpal lengths and paired metacarpal ratios as well as the accuracy of each predictive method.Results:The contralateral control and target metacarpal differed significantly in digits 1, 2, 3, and 5. No significant difference in matched metacarpal ratios of the right and left hands was found. For all digits except 5D, bivariate model predictions generated were more strongly correlated with actual target length. Chi-square tests did not detect a significant difference in predictive value of the two models.Conclusion:The scaled bivariate model we describe may be useful and economic in generating accurate length estimates of metacarpals for reconstructive procedures.

Accurate prediction of severe postoperative complications after pancreatic surgery: POSSUM vs E-PASS.

Few reports have evaluated the differences in the predictive accuracy between the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and estimation of physiologic ability and surgical stress (E-PASS) in pancreatic surgery. Thus, we evaluated the accuracy and similarity of POSSUM and E-PASS for the prediction of severe postoperative complications (PCs) after pancreatic surgery. We enrolled 343 consecutive patients who underwent pancreatic surgery in our department between April 2006 and September 2017.The difference in predictive values of POSSUM and E-PASS for the occurrence of PCs≥Clavien-Dindo grade IIIa (PCs-CD≥IIIa) was nonparametrically compared. The predictive accuracy and similarity of each tool was examined using the receiver operating characteristic (ROC) curve and linear regression analyses. Forty-five patients developed PCs-CD≥IIIa. E-PASS had a significantly higher predictive value for estimating PCs-CD≥IIIa occurrence (P=.002) than did POSSUM. The area under the curve value in ROC analysis was significantly higher in E-PASS than in POSSUM (0.643 vs 0.543, P=.014), with a weak positive correlation in the predictive value between E-PASS and POSSUM (R2 =.333, P<.001). Estimation of physiologic ability and surgical stress was useful for predicting severe PCs after pancreatic surgery and had a higher accuracy than POSSUM.

Differences in the Predictive value of Elixhauser Comorbidity Index and the Charlson Comorbidity indices in patients with hand infections

PurposeHand infections are a common source of potentially debilitating morbidity, particularly in patients with comorbid disease. We hypothesize that there is a difference in predictive value between two commonly used comorbidity indices for the prognosis of hand infections, which may have clinical implications in the management of these conditions. MethodsThe Nationwide Inpatient Sample 2001–2013 database was queried for hand infections using International Classification of Diseases, Ninth Revision codes. The Elixhauser (ECI) and Charlson (CCI) comorbidity scores were calculated based on validated sets of ICD-9 codes. Primary outcomes included mortality, prolonged length of stay (LOS, defined as >95 percentile), discharge destination, and postoperative complications. Indices were compared using receiver operating characteristic (ROC) curves and the areas under the curve (AUC). If confidence intervals overlapped, significance was determined using the DeLong method for correlated ROC curves. This is a validated, non-parametric comparison used for the calculation of the difference between two AUCs. ResultsA weighted total of 1,511,057 patients were included in this study. The majority were Caucasian (57.1%) males (61.4%). Complication rates included 0.9% mortality, 5.3% prolonged length of stay, 25.3% discharges to non-home destinations, and 5.3% post-operative complications. The ECI and CCI each demonstrated good predictive value for mortality, but poor predictive value for non-routine discharge, prolonged LOS, and post-operative complications. There was a significantly increased likelihood of each complication with increasing comorbidity score for both indices, with the greatest odds ratio in the ECI ≥4 cohort. ConclusionsThe CCI was superior in predicting mortality while the ECI was superior in predicting non-routine discharge, prolonged length of stay, and postoperative complications, but these indices may not be clinically relevant. While both represent good predictive models, a score specifically designed for patients with hand infections may have superior prognostic value. Level of evidenceLevel IV.

Are Body Composition Parameters Better than Conventional Anthropometric Measures in Predicting Pediatric Hypertension?

Body composition (BC) parameters are associated with cardiometabolic diseases in children; however, the importance of BC parameters for predicting pediatric hypertension is inconclusive. This cross-sectional study aimed to compare the difference in predictive values of BC parameters and conventional anthropometric measures for pediatric hypertension in school-aged children. A total of 340 children (177 girls and 163 boys) with a mean age of 8.8 ± 1.7 years and mean body mass index (BMI) z-score of 0.50 ± 1.24 were enrolled (102 hypertensive children and 238 normotensive children). Significantly higher values of anthropometric measures (BMI, BMI z-score, BMI percentile, waist-to-height ratio) and BC parameters (body-fat percentage, muscle weight, fat mass, fat-free mass) were observed among the hypertensive subgroup compared to their normotensive counterparts. A prediction model combining fat mass ≥ 3.65 kg and fat-free mass ≥ 34.65 kg (area under the receiver operating characteristic curve = 0.688; sensitivity = 66.7%; specificity = 89.9%) performed better than BMI alone (area under the receiver operating characteristic curve = 0.649; sensitivity = 55.9%; specificity = 73.9%) in predicting hypertension. In conclusion, BC parameters are better than anthropometric measures in predicting pediatric hypertension. BC measuring is a reasonable approach for risk stratification in pediatric hypertension.

Association between genetic polymorphism and antidepressants in major depression: a network meta-analysis.

This network meta-analysis was conducted to compare the predictive value of eight SNPs on the efficacy of antidepressants in major depressive disorder (MDD), including 5-HTTLPR, 5HTR2A(rs6311, rs6314, rs7997012 andrs6313), 5HTR2A(rs6295), BDNF(rs6265)and 5HTTSTin2.Databases were searched for related studies published up to December 2019. A total of 16 studieswere included in thisstudy.The predictive value were evaluated by the use of the odd ratios (OR) and drawing surface under the cumulative ranking curves (SUCRA). The pairwise meta-analysis indicated that in terms of overall response ratio, the SNPs were not associated with the efficacy of antidepressants in MDD. The result of this network meta-analysis suggested that there was no significant difference in predictive value of eightSNPs on the efficacy of antidepressants in MDD. More research is needed to explore the relationship between SNPs and antidepressant response.

AUTHOR REPLY

We wish to expand on some of the excellent points made by Dr. Nyame in his editorial on our paper. While we also view race itself as largely a social construct, we recognize that important biological and environmental risk factors cluster by race and thereby affect prostate cancer risk and mortality. Such factors include vitamin D deficiency, genetic background and tumor gene expression along with factors which are intertwined with socioeconomic deprivation, including access to care, screening and smoking behaviors, body composition and diet. 1 Smith ZL Eggener SE Murphy AB African-American prostate cancer disparities. Curr Urol Rep. 2017; 18: 81 Crossref PubMed Scopus (31) Google Scholar Translational research on biomarkers tends to move ahead rapidly, and early studies often do not include enough Black men to permit analyses to detect differences in predictive value that could lead to race-specific test thresholds or alternate testing strategies. Thus, initial estimates of the balance between risk and harm related to a biomarker could be inapplicable for Black men, and opportunities to reduce the racial disparity could be lost.

85P Racial differences in predictive value of 21-gene recurrence score assay: A population-based study using the SEER database

The 21-gene recurrence score (RS) assay is included in treatment guidelines for predicting adjuvant chemotherapy benefit for early-stage breast cancer patients with hormone-receptor (HR) positive disease. However, there has been no consideration regarding racial difference of that predictive value, although the assay had developed based on mainly Western women. This study aimed to demonstrate the racial differences in the predictive values of 21-gene RS assay.

Abstract 210: Effects of Indication for Veno-Arterial Extracorporeal Membrane Oxygenation on Predictive Value of Save Score

Introduction: Veno-Arterial Extracorporeal Membrane Oxygenation (VA ECMO) has emerged as a prominent tool for management of patients with Inability to Wean Off Cardiopulmonary Bypass (IWOCB), extracorporeal cardiopulmonary resuscitation (eCPR) or refractory cardiogenic shock (RCS). The high mortality that is still associated with these diseases urges for the development of reliable prediction models for mortality after cannulation. Survival After VA ECMO (SAVE) Score consists one of the most widely used prediction tools and the only model with external validation. However, its predictive value is still under debate. Hypothesis: Whether VA ECMO indication affects the predictive value of SAVE Score. Methods: 317 patients treated with VA ECMO in a quaternary center (n= 52 for IWOCB, n=179 for eCPR and n=86 for RCS) were retrospectively assessed for differences in SAVE Score and their primary outcomes. The Receiver Operating Characteristic (ROC) curve for SAVE Score and mortality was calculated separately for each VA ECMO indication. Results: The three groups had significant differences in SAVE Score (p&lt;0.01) without significant differences in mortality (p=0.176). ROC Curve calculation indicated significant differences in predictive value of SAVE Score for survival among its different indications. (Area Under the Curve= 81.69% for IWOCB, 53.79% for eCPR and 69.46% for RCS). Conclusion: VA ECMO indication markedly affects the predictive value of SAVE Score. Prediction of primary outcome in IWOCB patients was reliable. On the contrary, routine application for survival estimation in eCPR patients is not supported from our results.

Study of the hippocampal internal architecture in temporal lobe epilepsy using 7 T and 3 T MRI

PurposeTo compare the hippocampal internal architecture (HIA) between 3 and 7 Tesla (T) magnetic resonance imaging (MRI) in patients with temporal lobe epilepsy (TLE), and to investigate the relationship between HIA and hippocampal volume, and postoperative outcomes. Materials and methodsThirty-nine TLE patients were recruited with 3 and 7 T MRI scans and a semi-quantitative assessment of the HIA was performed. Differences in HIA scores between 3 and 7 T MRI were evaluated. HIA and hippocampal volume asymmetry were also calculated and compared. The utility of HIA and hippocampal volume asymmetry in epilepsy lateralization, and the predictive value between these two indicators were compared. The relationship between HIA and postoperative outcomes was investigated in 25 patients with amygdalohippocampectomy. ResultsHIA scores of epileptogenic hippocampi were lower than those of non-epileptogenic hippocampi at 3 and 7 T MRI. Higher HIA scores were observed at 7 T MRI. The HIA asymmetry and hippocampal volume asymmetry were both strong predictors for epilepsy lateralization and did not show difference in predictive value. No statistical differences in HIA asymmetry were observed between seizure-free patients (ILAE 1) compared to patients with seizures (ILAE 2–5). ConclusionsVisualization of hippocampal internal architecture (HIA) may be improved at 7 T MRI. HIA asymmetry is a significant predictor of laterality of seizure onset in TLE patients and has similar predictive value as hippocampal volume asymmetry, however, HIA asymmetry at 7 T does not have extra value in determining epilepsy lateralization and neither does predict surgical outcomes.

Can we rely on the combination of serological tests and frozen sections at the time of reimplantation for two-stage exchange hip arthroplasty in patients with a \u201cdry tap\u201d?

PurposeThe optimal timing of reimplantation of two-stage exchange arthroplasty for periprosthetic joint infection remains unknown. The purpose of the study was to (1) evaluate performance of combination of serum erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and frozen section in predicting persistent infection at the time of second-stage hip reimplantation and (2) compare accuracies of 5 and 10 polymorphonuclear neutrophils (PMNs) per high power field (HPF) as the threshold of frozen section.MethodsWe retrospectively reviewed 97 two-stage exchange hip arthroplasties from 2012–2016. Persistent infection at time of reimplantation was diagnosed using the Musculoskeletal Infection Society (MSIS) criteria. Two diagnostic models were developed. Model 1 utilized ESR, CRP, and > 5 PMNs/HPF on frozen section. Model 2 utilized ESR, CRP, and > 10 PMNs/HPF. Receiver operating characteristic (ROC) curves of the two models were generated, and areas under the curves (AUCs) were compared. A set of sensitivity analysis, using the Delphi-based consensus criteria for treatment success, was conducted to verify the accuracy of our models.ResultsThe overall rate of infection at reimplantation was 14.4%. AUCs for models 1 and 2 were 0.709 (95% confidence interval [CI], 0.557–0.852) and 0.697 (95% CI, 0.529–0.847), respectively. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 57.1%, 88.0%, 44.4%, and 92.4%, respectively, in model 1 and 42.9%, 96.4%, 66.7%, and 90.9%, respectively, in model 2. Models 1 and 2 had no significant difference in predictive values (p = 0.821). Results remained robust in the sensitivity analysis.ConclusionsThis study reveals that the combination of serum ESR, CRP, and frozen section has limited diagnostic value in predicting persistent infection at reimplantation. Additionally, no significant difference in accuracies between 5 and 10 PMNs/HPF as the threshold of frozen section were found. There is a need for timely biomarkers with higher accuracy in diagnosing infection before reimplantation.

Validating registry data on statins prescriptions by blood measurements.

To validate prescription registry data as a measurement of adherence to statins through a direct method using assays for selected statins in serial blood samples collected from two prospective cohorts of Danish colorectal cancer patients. We linked information on statin prescriptions from the Aarhus University Prescription Database with the cancer cohorts from Aalborg University Hospital. For statin-prescribed patients, we calculated a prescription window covering the anticipated duration of the prescription. For each statin-prescribed patient with at least one blood sample in a prescription window, we selected without replacement a never-statin-prescribed patient matched on sex, age, and calendar year of surgery. Each of the selected blood samples were analyzed using assays to detect statins. We calculated the positive and negative predictive value of the prescription registry reporting using the assay result as the gold standard. We identified 73 ever-statin-prescribed patients with a total of 253 blood samples and 74 blood samples among never-statin-prescribed patients. The positive predictive value for prescribed patients, with presence of statins in at least one blood sample as the gold standard, was 93% (95% CI, 86%-97%) and the negative predictive value was 93% (95% CI, 86%-97%). Stratified results did not reveal substantial differences in predictive values. Fifty-two (71%) of the statin-prescribed patients had statins in every blood sample, suggesting continuous adherence. This study showed a high adherence with treatment with statins among colorectal cancer patients.

Patients' pre-operative general and specific outcome expectations predict postoperative pain and function after total knee and total hip arthroplasties.

Background and aims Previous studies have suggested there is an association between preoperative expectations about the outcome and outcomes of total knee and total hip arthroplasty (TKA/THA). However, expectations have been rarely examined on their clinical relevance relative to other well-known predictive factors. Furthermore expectations can be measured on a more generic level (e.g. does one expect their symptoms to improve after surgery) or on a more specific level (e.g. does one expect to be able to squat again after surgery). Aim of this study was to examine whether patients' general and specific preoperative outcome expectations predict function and pain 12-months after TKA/THA, when assessed as one of the candidate predictive variables alongside other relevant clinical and sociodemographic variables. Moreover, we explored whether a more generic or a more specific assessment of expectations would better predict outcome. Methods A prospective cohort study on consecutive TKA/THA patients, with assessments done preoperatively and 12-months postoperative. Primary outcomes were the knee injury and osteoarthritis outcome score (KOOS) and hip injury and osteoarthritis outcome score (HOOS) activities of daily living (ADL) and pain subscale scores at 12-months. The pain subscales consist of nine-(KOOS) and 10-(HOOS) items and the ADL of 17 items. Patients' preoperative outcome expectations were measured with the credibility expectancy questionnaire (CEQ), which contains three items scored on a 0-9 scale and sum score 0-27 and the Hospital for Special Surgery expectations surveys (HSS expectation surveys) for 17(TKA) or 18(THA) outcomes on 0-4 scale. Other candidate predictors: preoperative pain and function as measured with HOOS/KOOS, sex, age, education level, body mass index, Kellgren/Lawrence score, preoperative mental health and treatment credibility as measured with CEQ. Eight prediction models were constructed using multivariate linear regression analysis with a backward selection procedure. Results The 146 TKA patients included in this study had a mean age of 66.9 years (SD 9.2) and 69% was female. The 148 THA patients had a mean age 67.2 (SD 9.5) and 57% was female. Mean outcomes: postoperative HOOS-ADL 84.3 (SD 16.6), pain 88.2 (SD 15.4), KOOS-ADL 83.9 (SD 15.8) and pain 83.6 (SD 17.1). CEQ-expectancy median was in THA 23 (IQR 21;24) and TKA 23 (IQR 20;24). HSS-expectation surveys function was for THA 21.0 (18.0;24.0) and 19.0 (14.0;22.0) in TKA. Patients' outcome expectations were consistently part of the combination of variables that best predicted outcomes for both TKA/THA 1-year post-operatively. Expectations alone explained between 17.0 and 30.3% of the variance in outcomes. The CEQ expectancy subscale explained more variance of postoperative function in TKA and of function and pain in THA as compared to the HSS expectation surveys. Conclusions In planning of surgical treatment, orthopedic surgeons should take a range of variables into account of which the patient's expectations about outcome of surgery is one. The CEQ expectancy subscale predicted outcomes slightly better as the HSS expectation surveys, but differences in predictive value of the two measurements were too small to prefer between the two. Future studies are advised to replicate these findings and externally validate the models presented.