Category: Statistics

Gastrointest Endosc. 2024 Oct 25:S0016-5107(24)03635-6. doi: 10.1016/j.gie.2024.10.036. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Refractory benign esophageal strictures (RBES) are defined by inadequate response to dilation. Early recognition of RBES allows for earlier initiation of aggressive therapy potentially leading to less morbidity and cost. We sought to establish a predictive model for RBES.

METHODS: Patients who underwent esophagogastroduodenoscopy (EGD) with esophageal dilation at Mayo Clinic Rochester were identified. In addition, a cohort of patients from a clinical database of patients with RBES managed with self-dilation was identified. Malignant strictures, Schatzki rings, and previously treated strictures were excluded. RBES was defined by inability to maintain a diameter ≥14mm over 5 dilation sessions. Multivariable logistic regression models were built to predict RBES.

RESULTS: 128 patients with index EGD and esophageal dilation were identified, with 25 meeting RBES criteria. An additional 63 RBES patients were identified from the self-dilation cohort for a total of 88 RBES and 103 non-RBES patients. Multivariable analysis yielded a strong predictive model, with a c-statistic of 0.85, identifying stricture length ≥ 2cm, diameter ≤ 7mm and proximal/diffuse stricture location as associated with a higher risk for RBES. Patients without any of these risk factors had a 2% risk of RBES while those with all 3 risk factors had a risk of 73% for RBES.

CONCLUSIONS: Risk of RBES can be predicted at index EGD based on stricture features. A predictive model for RBES was created based on readily available risk factors, which may guide an individualized therapeutic approach to patients with benign esophageal stricture, potentially reducing morbidity and cost.

PMID:39490691 | DOI:10.1016/j.gie.2024.10.036

Acad Pediatr. 2024 Oct 26:S1876-2859(24)00540-0. doi: 10.1016/j.acap.2024.10.010. Online ahead of print.

ABSTRACT

OBJECTIVE: To understand the association between food insecurity (FI) and housing insecurity (HI) risk, the effects of the COVID-19 pandemic on health-related activities among children with overweight or obesity, and caregivers’ and clinicians’ challenges and priorities related to pediatric weight management.

METHODS: We conducted surveys with caregivers of children with overweight and obesity and pediatric clinicians at two academic medical centers in the Greater Boston area. We used multivariable logistic regression models to examine associations between FI and HI risk and the effects of the COVID-19 pandemic on health-related activities and descriptive statistics to summarize caregivers’ and clinicians’ challenges and priorities related to pediatric weight management.

RESULTS: We analyzed data from surveys with 344 caregivers and 100 pediatric clinicians. Overall, 37% of caregivers endorsed both FI+HI, 18% FI alone, 10% HI alone, and 35% neither FI/HI. In the adjusted logistic regression models, combined FI+HI (reference: neither FI/HI) was significantly associated with higher odds of sleeping less (aOR 2.96 [95% confidence interval (CI): 1.46, 6.01]) and higher odds of spending less time outside (aOR 2.10 [95% CI: 1.06, 4.16]). Top priorities for pediatric weight management identified by both caregivers and clinicians were related to physical activity and availability of outdoor spaces.

CONCLUSIONS: Endorsement of both FI+HI was associated with children getting less sleep and spending less time outside during the COVID-19 pandemic. Future innovations in care plans for children with overweight and obesity should be adapted to a family’s social context and should incorporate caregivers’ and clinicians’ challenges and priorities.

PMID:39490687 | DOI:10.1016/j.acap.2024.10.010

J Mol Biol. 2024 Oct 26:168841. doi: 10.1016/j.jmb.2024.168841. Online ahead of print.

ABSTRACT

Microbiome research has increasingly underscored the profound link between microbial compositions and human health, with numerous studies establishing a strong correlation between microbiome characteristics and various diseases. However, the analysis of microbiome data is frequently compromised by inherent sparsity issues, characterized by a substantial presence of observed zeros. These zeros not only skew the abundance distribution of microbial species but also undermine the reliability of scientific conclusions drawn from such data. Addressing this challenge, we introduce GEMimp, an innovative imputation method designed to infuse robustness into microbiome data analysis. GEMimp leverages the node2vec algorithm, which incorporates both Breadth-First Search (BFS) and Depth-First Search (DFS) strategies in its random walks sampling process. This approach enables GEMimp to learn nuanced, low-dimensional representations of each taxonomic unit, facilitating the reconstruction of their similarity networks with unprecedented accuracy. Our comparative analysis pits GEMimp against state-of-the-art imputation methods including SAVER, MAGIC and mbImpute. The results unequivocally demonstrate that GEMimp outperforms its counterparts by achieving the highest Pearson correlation coefficient when compared to the original raw dataset. Furthermore, GEMimp shows notable proficiency in identifying significant taxa, enhancing the detection of disease-related taxa and effectively mitigating the impact of sparsity on both simulated and real-world datasets, such as those pertaining to Type 2 Diabetes (T2D) and Colorectal Cancer (CRC). These findings collectively highlight the strong effectiveness of GEMimp, allowing for better analysis on microbial data. With alleviation of sparsity issues, it could be greatly facilitated in downstream analyses and even in the field of microbiology.

PMID:39490678 | DOI:10.1016/j.jmb.2024.168841

J Affect Disord. 2024 Oct 25:S0165-0327(24)01808-1. doi: 10.1016/j.jad.2024.10.114. Online ahead of print.

ABSTRACT

INTRODUCTION: Osteoporosis, a significant public health concern, affects millions of adult women globally, leading to increased morbidity and fracture risk. Antidepressant use, prevalent in this demographic, is suggested to influence bone mineral density (BMD), yet evidence remains limited across antidepressant classes.

OBJECTIVE/AIM: We investigated the association between antidepressant use and osteoporosis in a representative sample of adult women in the United States, focusing on different classes of antidepressants and their potential associations with BMD and fracture risk.

METHODS: We conducted a cross-sectional analysis using data from ten cohorts of the National Health and Nutrition Examination Survey (NHANES) spanning 1999-2000 to 2017-2020. The sample included adult women, with data collected on antidepressant use, BMD scores, and reported fractures. Statistical models adjusted for potential confounders such as Major Depressive Disorder (MDD), age, physical activity, and comorbidities.

RESULTS: Antidepressant use was associated with a 44 % increase in the odds of osteoporosis. Phenylpiperazines showed the highest association, followed by miscellaneous antidepressants and tricyclic antidepressants (TCAs). Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) also demonstrated significant, though comparatively lower associations. The odds of fractures were elevated by 62 % among antidepressant users, particularly with phenylpiperazines and miscellaneous antidepressants. Increased antidepressant use duration significantly correlated with higher osteoporosis and fracture risks, regardless of the antidepressant class.

CONCLUSION: Our findings underscore the need for heightened awareness of the adverse effects of antidepressants on bone health, particularly in adult women. Careful consideration is necessary when prescribing these medications, especially in populations at risk for osteoporosis and MDD.

PMID:39490674 | DOI:10.1016/j.jad.2024.10.114

Bone. 2024 Oct 26:117309. doi: 10.1016/j.bone.2024.117309. Online ahead of print.

ABSTRACT

Despite its invasive character, bone biopsy followed by histomorphometry remains the gold standard for diagnosing and classifying many metabolic bone diseases. However, the interpretation of histomorphometric parameters requires comparison with average values obtained from a proper control group, which are only available for some populations, and reference standards still need to be published. Therefore, our objective was to estimate average values for bone histomorphometric parameters overall, by age, gender, and race (White and Black) categories of healthy adult individuals, based on a systematic review and meta-analysis of clinical studies. Relevant studies published in English with available results until December 2020 were identified by PubMed (Medline) search and consulting experts in the field. Out of 447 potentially relevant studies, 37 met the inclusion criteria. Meta-analysis using fixed-effects models was used to pool mean estimates and 95 % confidence intervals (CI) for 16 bone histomorphometry parameters. An age-by-gender trend was observed in most histomorphometry parameters. The mean estimates of bone volume/tissue volume (BV/TV), trabecular thickness (Tb.Th), and trabecular number (Tb.N) decreased. In contrast, trabecular separation (Tb.Sp) increased from the youngest to the oldest age categories in both genders. Osteoblast surface (Ob.S/BS) and osteoclast surface (Oc.S/BS) decreased across all age categories in males. Mineralizing surface (MS/BS) increased from the youngest to the oldest age categories in females, while mineralization lag time (Mlt) increased in both genders. Furthermore, gender and race had a significant effect on several histomorphometry parameters. In conclusion, this meta-analysis provided mean estimates for normal values of histomorphometric parameters that clinicians may use when evaluating bone biopsies in patients. This enables the direct comparison of patients’ histomorphometric values with the suitable reference group regarding age, gender, and race.

PMID:39490656 | DOI:10.1016/j.bone.2024.117309

Eur J Vasc Endovasc Surg. 2024 Oct 25:S1078-5884(24)00906-7. doi: 10.1016/j.ejvs.2024.10.031. Online ahead of print.

ABSTRACT

OBJECTIVE: This retrospective, nationwide cohort study aimed compare periprocedural stroke or death within 30 days of the procedure (PPSD30) in patients who underwent carotid endarterectomy (CEA) or carotid stenting (CAS).

METHODS: This retrospective cohort study used data from the French hospital database PMSI. All patients who underwent CEA or CAS between 2010 and 2019 in France were included. Information on individual patients and hospital characteristics was retrieved. A random effects logistic regression model compared the occurrence of PPSD30 after CEA or CAS. High surgical risk was accounted for by using propensity score matching and adjusted for patient and hospital characteristics. Analyses were also stratified to consider symptomatic and asymptomatic patients separately.

RESULTS: Between 2010 and 2019, 164 248 patients underwent a carotid artery procedure in France: 156 561 CEA and 7 687 CAS (including about 25.0% asymptomatic women and 40.0% high risk patients). The PPSD30 rate was 1.5% overall (n = 2 514 patients) (1.5% after CEA vs. 2.4% after CAS), 1.3% in asymptomatic patients (1.2% after CEA vs. 1.8% after CAS), and 3.3% in symptomatic patients (3.1% after CEA vs. 6.5% after CAS). After matching and adjustment, the risk of PPSD30 was statistically significantly greater in patients who underwent CAS than in patients who underwent CEA (adjusted OR [aOR] 1.4, 95% CI 1.1 – 1.8 in overall patients; aOR 1.4, 95% CI 1.1 – 1.8 in asymptomatic patients; and aOR 2.7, 95% CI 1.8 – 4.0 in symptomatic patients).

CONCLUSION: This nationwide real life study showed that CEA performed better than CAS, more markedly in symptomatic patients, but also in asymptomatic patients. Moreover, many patients received procedures that were more likely to be harmful than beneficial according to conclusions from past randomised trials (i.e., all asymptomatic women, all high surgical risk patients, and all who had undergone CAS).

PMID:39490630 | DOI:10.1016/j.ejvs.2024.10.031

J Dent. 2024 Oct 25:105431. doi: 10.1016/j.jdent.2024.105431. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective was to investigate the dimensional stability of different types of 3D printed dental models, and to measure the dimensional changes over time.

METHODS: Four dental casts with different constructions were printed. The four types of models were as follows: hollow casts with 2.5 mm wall thickness (2,5mm.H), hollow casts with 2 mm wall thickness (2mm.H), hollow casts with 2 mm wall thickness with stabilization bars (2mm.B) and hollow casts with 2 mm wall thickness with gypsum base (2mm.G). The casts were digitized with a laboratory scanner (3Shape E3 Red E Scanner) to obtain the reference Standard Tessellation Language (STL) files. All models were stored at room temperature and scanned again after 1 day and after 1, 2 and 10 weeks. This data was compared to the reference STL file and was analysed by comparing the deformation using surface fitting software (Geomagic Control X, 3D Systems). The results were statistically evaluated using paired Student’s t-tests, with the significance level set at p<0.05.

RESULTS: There were significant differences in dimensional stability after 10 weeks between the four different dental casts. According to our results, the 2mm.B casts showed the least deformation which was followed by the 2mm.H casts. However, both the 2,5mm.H and the 2mm.G casts showed significant deformation compared to the 2mm.B casts.

CONCLUSIONS: Within the limitations of this study – using only one printer and one type of resin – we found that the deformation of all investigated casts remained within the clinically acceptable range. However, there were significant differences between the various construction types printed with the Bego Varseo Printer and Bego Varseo Wax Model Gray material.

CLINICAL SIGNIFICANCE: It is crucial to determine how long 3D printed models can maintain their accuracy to prevent potential adverse effects, especially given the extended storage periods required for the time-consuming procedures in prosthodontic and orthodontic treatments.

PMID:39490627 | DOI:10.1016/j.jdent.2024.105431

J Dent. 2024 Oct 26:105433. doi: 10.1016/j.jdent.2024.105433. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the effects of three different scanning strategies on the trueness and precision of optical impressions obtained with four intraoral scanners (IOSs).

METHODS: The reference maxillary dental arch model was fabricated using Telio CAD, and the relative reference digital reference cast was obtained using a computer numerical control machine and an optical scanner (E4, 3Shape, Copenhagen, Denmark). Test scans were performed with four different IOSs (TRIOS3, MEDIT i700, CS 3600, and iTero Element 5D) by an experienced operator and three different scanning strategies (S1: manufacturer-recommended, S2: optimal per previous literature, and S3: experimental). The scan duration was recorded for each scan. All scans were converted to standard tessellation language format and imported into Geomagic Control X. The accuracy was measured by absolute deviation/distance between aligned surfaces. for comparison with the reference cast using Initial Alignment and Best Fit Alignment functions. Data of trueness and precision of each IOS and scan duration were statistically compared using analysis of variance for repeated measures and Bonferroni post-hoc test (p<.05).

RESULTS: Scans obtained with MEDIT i700 and CS 3600 showed higher trueness with S3 (p<.05). Scans obtained with TRIOS 3, MEDIT i700, and CS 3600 were more precise with S3, whereas those with iTero Element 5D were more precise with S2 (p<.05). Statistically significant differences were found in scan duration between different scan strategies for all IOSs.

RESULTS: No significant differences in trueness were found among strategies (S1: 9.98 µm, S2: 11.93 µm, S3: 8.84 µm; p=0.388) in Trios 3 and iTero Element 5D (S1: 12.24µm, S2: 11.53µm, S3: 10.71µm; p= p=0.279). Scanning strategy S3 with MEDIT i700 achieved greater trueness (7.33 µm) than S2 (16.33 µm, p<.05), while no significant difference was noted between S1 (10.44 µm) and S3 (p=0.291). S3 showed the highest trueness (16.28 µm) compared to S2 (24.05 µm) and S1 (24.78 µm, p<.001) for CS 3600, with no difference between S1 and S2 (p=0.457). Trios 3 had higher precision with S2 (22.46 µm) than S3 (31.69 µm, p<.05), and no significant differences between S1 (25.67 µm) and S2/S3 (p>.05). MEDIT i700 with S3 (29.52 µm) was more precise than both S1 (39.52 µm) and S2 (46.24 µm) (p<.001) with no difference between the last two (p=0.302). S2 yielded the highest precision (44.93 µm) compared to S3 (61.81 µm) and S1 (76.53 µm) (p<.001) for CS 3600, with S3 more precise than S1 (p<.001). Similarly, iTero Element 5D showed S2 as the most precise (30.19 µm) compared to S3 (42.80 µm) and S1 (44.45 µm) (p<.05), with no difference between S1 and S3 (p=0.472). Scan durations were shorter for S3 and S1 compared to S2 in Trios 3 (p<.001), and S3 was faster than S1 and S2 for MEDIT i700 (p<.001). CS 3600 scans with S1 were quicker than S2 and S3 (p<.001). For iTero Element 5D, no significant differences were found between S1 and S3 (p=0.511), but S2 was slower than both (p<.001).

CONCLUSIONS: Scanning strategies significantly affect the accuracy and scan duration of optical impressions. Overall, scans obtained with S3 showed the best combination of trueness, precision, and scan duration with MEDIT i700. Specifically, S3 provided the best trueness with both the MEDIT i700 and the CS 3600 while the S2 strategy demonstrated the highest precision for most scanners. Overall, the S1 and S3 strategies resulted faster than S2 among the devices evaluated.

CLINICAL SIGNIFICANCE: The study’s results suggest that the experimental scan strategy may optimize the use of intraoral scanners in clinical practice, potentially leading to more accurate and time-efficient dental impressions.

PMID:39490607 | DOI:10.1016/j.jdent.2024.105433

Reprod Toxicol. 2024 Oct 26:108737. doi: 10.1016/j.reprotox.2024.108737. Online ahead of print.

ABSTRACT

Studies provide notable evidence that oxidative stress (OS) mediated reactive oxygen species (ROS) disturb reproductive health. We have shown in our previous publication that exposure of Di-(2-ethylhexyl) phthalate (DEHP), induces OS mediated ROS generation which inhibits steroid synthesis. In the present study, we demonstrated the ameliorative/protective effects of one of the steroidal saponins, i.e., Shatavarin-IV, isolated from the roots of Asparagus racemosus against DEHP induced OS in rat granulosa cells. Granulosa cells were exposed with DEHP alone (400μM), Shatavarin-IV alone (8μg/ml), and a combination of DEHP + Shatavarin-IV (400μM + 8μg/ml) in vitro for 24 hrs. Intracellular ROS, OS/hypoxia, mitochondrial membrane potential, steroid-responsive genes expression were analyzed. The results revealed that the effective dose of DEHP (400µg) significantly increased OS compared to the control by increasing ROS levels, mitochondrial membrane potential, and β-galactosidase activity with a higher level of apoptotic genes (Bax, Caspase-3) expression at mRNA level. Further, DEHP significantly (p<0.05) reduced mRNA expression of steroidogenic responsive genes (StAR, CYP17A1 and CYP19A1) in granulosa cells treated with above combination compared to control. Interestingly, co-treatment of DEHP + Shatavarin-IV significantly suppressed the DEHP induced OS, ROS, β-galactosidase levels and enhanced steroidogeneic and apoptotic gene expression activities, which suggests that Shatavarin-IV rescued DEHP-induced changes that may useful for the prevention of DEHP- induced reproductive toxicity.

PMID:39490591 | DOI:10.1016/j.reprotox.2024.108737

J Hosp Infect. 2024 Oct 25:S0195-6701(24)00356-6. doi: 10.1016/j.jhin.2024.10.008. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to evaluate whether subcutaneous tunneling in peripherally inserted central catheters (PICC) placement could reduce the occurrence of central-line associated blood stream infection (CLABSI).

METHODS: We conducted an open-label, multicentre, randomized, controlled trial in five tertiary hospitals. Adult hospitalized patients requiring a PICC were randomized in a one-to-one ratio to conventional (cPICC) or tunneled PICC (tPICC) arms using a centralized web-based computer-generated stratified randomization. CLABSI rates between groups were compared in a modified intention-to-treat population. Safety including the incidence of exit-site infection or hemorrhage-associated catheter removal were also compared. This trial was registered with Clinical Research Information Service of Republic of Korea (KCT0005521).

RESULTS: From November 2020 to March 2023, 1,324 participants were enrolled and randomly assigned to tPICC (n=662) and cPICC (n=662). This study was terminated early due to the cohort CLABSI rate being lower than estimated, therefore, the original sample size of 1,694 would render the study underpowered to detect a difference in CLABSI rates. In the tPICC, CLABSI occurred in 13 of 651 participants over 11,071 catheter-days (1.2/1,000 catheter-days), compared with 20 among 650 patients with cPICC over 11,141 catheter-days (1.8/1,000 catheter-days, rate ratio 0.65, 95% CI 0.30-1.38, p=0.30). The incidence of exit-site infection (29 tPICC, 36 cPICC, p=0.5) and hemorrhage-associated catheter removal (11 tPICC, 11 cPICC, p=0.99) was not different between both groups.

CONCLUSION: Due to insufficient sample size, this study could not demonstrate a statistically significant CLABSI risk reduction in the tPICC group compared to the cPICC group. Both groups had similar rates of exit site infection and bleeding.

PMID:39490586 | DOI:10.1016/j.jhin.2024.10.008