Category: Statistics

BMC Cancer. 2024 Nov 18;24(1):1423. doi: 10.1186/s12885-024-13188-4.

ABSTRACT

INTRODUCTION: This study aimed to evaluate the consistency of lung cancer case assessments across multidisciplinary team (MDT) sites in Denmark. The goal was to appraise the comparability of outcomes between hospitals in a real-world context.

METHODS: We prepared sixty comprehensive, fictitious lung cancer case stories, complete with images, and distributed them to the four primary lung cancer MDT conferences in Denmark. These cases were subsequently evaluated as had they been ordinary patients during regular MDT meetings. We compared the conclusions on assigned TNM stage and proposed treatment intent using Kappa statistics.

RESULTS: The consensus on assigned stage (Stages IA-B, IIA-B, IIIA-B, IV, and undetermined) corresponded to a Fleiss’ Kappa-value of 0.62 (95% CI: 0.52-0.71). The overall assessment of curability, categorized as Curable, Incurable, and Undetermined, corresponded to a Kappa-value of 0.72 (CI: 0.61-0.84). However, for cases unanimously judged by all MDT sites to be Stage III, the concordance on treatment intent was poor, with an agreement coefficient of only 0.32 (95% CI: -0.27-0.97).

CONCLUSION: In detail, the level of agreement on assigned stages was less than desired. In consequence, comparative analyses of treatment results from different hospitals or centres may be prone to bias caused by systematic differences in stage assessment or intent of treatment. The least consensus was observed for cases in Stage III, indicating a need for quality improvement efforts to ensure a higher degree of consistency in MDT decisions.

PMID:39558297 | DOI:10.1186/s12885-024-13188-4

BMC Med Inform Decis Mak. 2024 Nov 18;24(1):344. doi: 10.1186/s12911-024-02753-3.

ABSTRACT

BACKGROUND: Lung cancer is characterized by high morbidity and mortality due to the lack of practical early diagnostic and prognostic tools. The present study uses machine learning algorithms to construct a clinical predictive model for non-small cell lung cancer (NSCLC) patients.

METHODS: Laboratory indices of the NSCLC patients at their initial visit were collected for quality control and exploratory analysis. By comparing the levels of the above indices between the survival and death groups, the statistically significant indices were selected for subsequent machine learning modeling. Ten machine learning algorithms were then employed to develop the predictive models with survival and recurrence as outcomes, respectively. Moreover, regression models were constructed using the random survival forest algorithm by incorporating the survival time dimension. Finally, critical variables in the optimal model were screened based on the interpretable algorithms to build a decision tree to facilitate clinical application.

RESULTS: 682 patients were enrolled according to the inclusion and exclusion criteria. The preliminary comparison results revealed that except for fast blood glucose, CD₃⁺T cell proportion, NK cell proportion, and CA72-4, there were significant statistical differences in other tumor markers, inflammation, metabolism, and immune-related indices between the survival and death groups (p < 0.01). Subsequently, indices with statistical differences were incorporated into machine learning modeling and evaluation. The results showed that among the ten prognostic models constructed using survival status as the outcome, the neural network model obtained the best predictive performance, with accuracy, sensitivity, specificity, AUC, and precision values of 0.993, 0.987, 1.000, 0.994, and 1.000, respectively. The corresponding SHAP16 algorithm revealed that the top five variables in terms of importance were interleukin6 (IL-6), soluble interleukin2 receptor (sIL-2R), cholesterol, CEA, and Cy211, respectively. The random survival forest model also confirmed the critical role of CEA, sIL-2R, and IL-6 in predicting the prognosis of NSCLC patients. A decision tree model with seven cut-off points based on the above three indices was eventually built for clinical application.

CONCLUSION: The neural network model exhibited ideal predictive performance in the survival status of NSCLC patients, and the decision tree model constructed based on selected important variables was conducive to rapid bedside prognosis assessment and decision-making.

PMID:39558294 | DOI:10.1186/s12911-024-02753-3

BMC Musculoskelet Disord. 2024 Nov 18;25(1):920. doi: 10.1186/s12891-024-08061-1.

ABSTRACT

OBJECTIVE: To assess the mechanism of supraspinatus tendinopathy induced by type 2 diabetes mellitus (T2DM) in rats using untargeted metabolomics analysis.

METHODS: The liquid chromatography-mass spectrometry (LC-MS)-based untargeted metabolomics approach was used to screen tendon biomarkers of supraspinatus tendinopathy in rats with T2DM. Seventy-eight Sprague-Dawley rats were divided into normal group (NG) and T2DM groups. Rats in T2DM groups were divided into 12-week (T2DM-12w), and 24-week (T2DM-24w) subgroups according to the time point of the establishment of the T2DM rat model. Histological evaluation (modified Bonar score) and biomechanical testing were used to analyze the adverse effects of type 2 diabetes on the tendon of the supraspinatus muscle in rats.Three comparable groups were set up, including T2DM-12w group vs. NG, T2DM-24w group vs. NG, and T2DM-24w group vs. T2DM-12w group. Differentially expressed metabolites (DEMs) in the supraspinatus tendons in the three groups of rats were analyzed using LC-MS, and data were analyzed using multivariate statistical methods to screen potential biomarkers. The DEMs included in the intersection of the three groups were identified as those associated with the development of diabetic supraspinatus tendinopathy, and trend analysis and pathway topology analysis were performed.

RESULTS: With the progression of diabetes, the tendinopathy of the supracinatus muscle of diabetic rats gradually intensified, mainly manifested as inflammatory reactions, disordered collagen fibers, fat infiltration, and increased modified Bonar score. The intersection of DEMs among the three comparable groups was resulted in the identification of 10 key DEMs, in which melezitose and raffinose showed a continuous increasing trend with the prolongation of disease course. By pathway topology analysis, 10 DEMs (P < 0.01) were mainly associated with the pathways of galactose metabolism, which could be involved in the development of diabetes-induced supraspinatus tendinopathy.

CONCLUSION: T2DM causes tendinopathy of the supraspinatus muscle in rats. 10 key DEMs obtained by untargeted metabolomics assay suggested that the development of diabetes-induced supraspinatus tendinopathy was associated with changes in metabolic pathways, such as galactose metabolism. melezitose and raffinose hold promise as a biomarker for disease discrimination and/or disease indication in diabetic supraspinatus tendinopathy.

PMID:39558291 | DOI:10.1186/s12891-024-08061-1

BMC Med Educ. 2024 Nov 18;24(1):1323. doi: 10.1186/s12909-024-06288-z.

ABSTRACT

BACKGROUND: Individuals with diabetes and co-existing psychiatric disorders have more diabetes complications and lower life expectancy than those with diabetes but no co-existing psychiatric disorders. Psychiatric health professionals may have a role in improving these outcomes but often lack diabetes knowledge and skills. This study aims to examine the effectiveness of a diabetes training course for psychiatric health professionals on their diabetes knowledge and skills and clinical outcomes, diabetes support and diabetes distress among individuals with diabetes and psychiatric disorders treated in psychiatric outpatient clinics.

METHODS: A pragmatic non-randomized controlled cluster trial was conducted in eight psychiatric outpatient clinics in Denmark. All psychiatric health professionals from four clinics participated in the diabetes training course (the intervention) and completed a questionnaire on experience of the training course and a 20-item pre- and post-test to measure diabetes knowledge and skills. Difference in pre- and post-tests were analyzed using t-tests. From August 2018 – June 2019, individuals with diabetes were recruited from the intervention clinics (n = 49) and from four control clinics continuing usual clinical practice (n = 57). Differences in clinical outcomes, diabetes support and diabetes distress between the intervention and control groups at six and 12 months after the training course, were analyzed using logistic and linear regression models adjusted for baseline levels.

RESULTS: Psychiatric health professionals (n = 64) had more correct answers after completing the course, with a mean increase of 6.3 [95% CI 5.6 to 7.0] correct answers. A total of 49 and 57 individuals were recruited for the intervention and control group, respectively. At follow-up, individuals treated in the intervention group had lower levels (clinical improvement) of systolic blood pressure, but had lower receipt of annual assessment of blood pressure, and body mass index (BMI) (worsening of process measures). While there were observed differences in odds and means for several other outcomes, none of these received statistical significance (see Table 2 and Fig. 2).

CONCLUSIONS: Training psychiatric health professionals in diabetes care improved their diabetes knowledge and skills and improved clinical levels of systolic blood pressure in individuals treated in the intervention group. However, this training intervention was associated with a lower likelihood of receiving annual assessment of blood pressure and BMI.

TRIAL REGISTRATION: ISRCTN registry registration number ISRCTN15523920, registration date: 02/10/2019.

PMID:39558289 | DOI:10.1186/s12909-024-06288-z

BMC Endocr Disord. 2024 Nov 18;24(1):250. doi: 10.1186/s12902-024-01760-9.

ABSTRACT

OBJECTIVE: Vitamin D plays a critical role in the prevention and management of osteoporosis. However, there is an ongoing debate regarding the most effective vitamin D supplementation strategies for maintaining optimal bone mineral density (BMD) levels in adults. This study sought to establish the correlation between serum 25-hydroxyvitamin D [25(OH)D] levels and total BMD in a substantial population sample.

METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) for the 2011-2018 cycles, encompassing 11,375 adult participants, were analyzed. The primary variables of interest were serum 25(OH)D levels and BMD. A multivariable logistic regression model was utilized to account for relevant variables associated with these correlations.

RESULTS: A U-shaped relationship between serum 25(OH)D levels and BMD was observed. In males, a significant positive association was identified for 25(OH)D levels below 84.8 nmol/L (p < 0.0001), while levels above this threshold showed no significant correlation (p = 0.3377). In females, those with 25(OH)D levels below 31.4 nmol/L exhibited a significant positive association with BMD (p = 0.0010), but this association weakened and became marginally significant above this threshold (p = 0.0650).

CONCLUSIONS: For adult males, the optimal serum 25(OH)D level is 84.8 nmol/L, beyond which higher levels do not lead to increased BMD. A deficiency threshold for adult females should be above 31.4 nmol/L, as lower 25(OH)D levels are not conducive to BMD. These findings underscore the importance of maintaining appropriate vitamin D levels for bone health in both genders.

PMID:39558288 | DOI:10.1186/s12902-024-01760-9

BMC Ophthalmol. 2024 Nov 18;24(1):503. doi: 10.1186/s12886-024-03765-3.

ABSTRACT

BACKGROUND: Blepharitis is a chronic inflammatory condition of the eyelids that affects a large proportion of patients in eye care settings. First-line treatments provide only partial relief for many patients. The BlephEx™ device provides automated eyelid debridement and aims to remove pathogenic biofilms from the eyelid margin to treat blepharitis long-term. However, evidence supporting the efficacy of BlephEx™ is limited.

METHODS: In this double-masked randomized controlled trial, 42 patients with symptomatic blepharitis refractory to treatment were assigned to the BlephEx™ treatment or sham treatment group. Outcome measures including Ocular surface disease index (OSDI), tear break-up time (TBUT), Schirmer test, and Efron grading scale scores were assessed at baseline and after 4 weeks. A crossover design in which the treatment groups were swapped after 4 weeks was used as a recruitment tool. After receiving treatment, two patients (one per group) were lost to follow-up.

RESULTS: The sham group exhibited a significant decrease in the Efron Grading Scale score. No significant differences were observed in the other outcomes between the two groups. The BlephEx™ group showed slightly greater decreases in the OSDI and Efron grading scale scores and an increase in the TBUT than did the sham group, but these differences were not statistically significant. Mild discomfort was the most common side effect and occurred equally in both groups.

CONCLUSIONS: No significant difference in outcomes was observed between patients who underwent BlephEx™ therapy and those who received sham treatment. BlephEx™ treatment cannot be recommended for treating blepharitis.

TRIAL REGISTRATION: Retrospectively registered on February 16, 2024 in the DRKS (German Clinical Trials Register under https://drks.de/search/de/trial/DRKS00033492 ) under the trial registration number DRKS00033492.

PMID:39558272 | DOI:10.1186/s12886-024-03765-3

BMC Public Health. 2024 Nov 18;24(1):3190. doi: 10.1186/s12889-024-20587-6.

ABSTRACT

BACKGROUND: It has been documented that regular physical activity is considered one of the most effective strategies for preventing diabetes; however, it is not the sole contributing factor. Therefore, we decided to evaluate the meditation effect of liver function and anthropometric indices on the relationship between incidence of diabetes and physical activity (PA) in the Azar cohort population.

MATERIALS AND METHODS: Subjects who were diabetic in the baseline phase from 15,006 participants in study of azar cohort population were excluded and to follow up, a total of 13,253 people was included in the analysis. Demographic characteristics, physical activity, 10 anthropometric indices (AI) and seven liver indices (LI) were measured. Evaluated and displayed using Pearson correlation heatmap and canonical correlation of liver and anthropometric indices. The Generalized Structural Equation Modeling (GSEM) with the Maximum Likelihood method employed to estimate the model.

RESULTS: During the follow-up years, a total of 685 participants developed diabetes. The measurements of the AI were significantly higher in subjects with diabetes (P < .001). Patients with diabetes were older, had a higher proportion of women, and had lower values of PA (P < .05). Body Roundness Index (BRI) and Waist height ratio (WHtR) exhibited the largest AUCs for predicting diabetes onset risk (both AUC = 0.6989) among these anthropometric measures. The increase in AI (RR [95%CI] = 1.25 [1.22,1.29], P < .001) and liver enzyme (LE) (RR [95%CI] = 1.14 [1.08.1.19], P < .001) increase the risk of diabetes by 25% and 14%, respectively. Despite the mediation effects of AI and Liver Enzymes for an increase of one MET of PA, the risk of developing diabetes decreases by 5% (RR [95% CI] = .95 [.92,.99], P = .013). Around VAF = 53% of the association between PA and diabetes onset (Total effect: RR [95% CI] = .90 [.87,.94], P < .001) was mediated by AI and LE.

CONCLUSIONS: A low level of PA was found to be significantly correlated with high levels of AI and LI, all of which are associated with an increased risk of developing diabetes. These analyses provide evidence that when the relationship between PA and diabetes is mediated by AI and LI this association becomes stronger, with AI playing a more significant role than LI.

PMID:39558270 | DOI:10.1186/s12889-024-20587-6

BMC Genomics. 2024 Nov 18;25(1):1097. doi: 10.1186/s12864-024-11006-6.

ABSTRACT

Quantifying the features of mitochondrial genome structural variation is crucial for understanding its contribution to complexity. Accurate quantification and interpretation of organizational diversity can help uncover biological evolutionary laws and patterns. The current qMGR approach accumulates the changes in two adjacent genes to calculate the rearrangement frequency RF of each single gene and the rearrangement score RS for specific taxa in the mitogenomes of a given taxonomic group. However, it may introduce bias, as it assigns scores to adjacent genes rather than to rearranged genes. To overcome this limitation, we propose a novel statistical method called qGO to quantify the diversity of gene organization. The qGO method, which is based on the homology of gene order, provides a more accurate representation of genome organizational diversity by partitioning gene strings and individually assigning weights to genes spanning different regions. Additionally, a comprehensive approach is employed for distance computation, generating an extensive matrix of rearrangement distances. Through experiments on more than 5500 vertebrate mitochondrial genomes, we demonstrated that the qGO method outperforms existing methods in terms of accuracy and interpretability. This method improves the comparability of genomes and allows a more accurate comparison of the diversity of mitochondrial genome organization across taxa. These findings have significant implications for unraveling genome evolution, exploring genome function, and investigating the process of molecular evolution.

PMID:39558268 | DOI:10.1186/s12864-024-11006-6

BMC Geriatr. 2024 Nov 18;24(1):960. doi: 10.1186/s12877-024-05500-5.

ABSTRACT

BACKGROUND: The lesions observed in very old populations exhibit a wide spectrum of characteristics. Histopathological evaluation may be necessary for accurate diagnosis in this demographic. There is limited amount of data on the histopathological evaluation of lesions in very old patients. Therefore, the aim of this study was to assess the histopathological features in this population.

METHODS: A total of 5376 pathological samples from very old patients (≥ 80 years old) were analyzed. Clinical and pathological data were retrospectively reviewed. Histopathological diagnoses were categorized into three groups: malignant (invasive) lesions (MLs), benign/inflammatory lesions (BLs), and dysplastic-dysmorphic/non-invasive malignant lesions (DLs). Statistical analyses were conducted on the histopathological data. Pearson’s chi-square test and the Fisher exact test were used to analyze the data, and statistical significance was considered at a p-value of < 0.05.

RESULTS: The mean age of the patients was 83.6 ± 3.4 years (range: 80-107), with 53% being female. The upper gastrointestinal (GI) tract was the most common site among all materials (28%, n = 1524). Benign/inflammatory lesions (BLs) accounted for the highest proportion of cases (62%, n = 3322) compared to MLs and DLs. BLs were significantly more prevalent in female patients (p < 0.001). MLs were notably more common in biopsies from breast locations (p < 0.001). No patients were diagnosed with DLs in the cytological materials.

CONCLUSIONS: Despite the broad spectrum of lesions observed in very old patients, the majority tend to be benign. While the Coronavirus disease 2019 (COVID-19) pandemic has altered healthcare dynamics, the increased frequency of benign lesions among the very old population, as a result of more frequent healthcare facility visits, is noteworthy. However, dysplastic and malignant lesions remain significant in this population and can profoundly impact patients’ quality of life. This study contributes to our understanding of histopathological diagnoses in the very old population, shedding light on the current approach to managing their pathological specimens.

PMID:39558257 | DOI:10.1186/s12877-024-05500-5

BMC Gastroenterol. 2024 Nov 18;24(1):414. doi: 10.1186/s12876-024-03506-2.

ABSTRACT

BACKGROUND: Colonoscopy as a common screening practice to prevent colorectal cancer lacks strong evidence. NordICC, the first randomized trial of colonoscopy screening, reported no clear clinical benefit for colonoscopy in the intention-to-screen population with suggested benefit in the risk of colorectal incidence and cancer-specific mortality in the per-protocol analyses. However, although the study was designed to perform survival analysis, no survival outcomes were reported since the underlying assumption for hazard ratio was not valid. We aimed to assess whether colonoscopy screening is associated with improved survival outcomes compared with usual care.

METHODS: We reconstructed patient-level data from the Kaplan-Meier estimator of the primary endpoints reported in NordICC for the intention-to-screen and adjusted per-protocol populations. The restricted-mean survival time difference (RMST-D) and restricted-mean time loss ratio (RMTL-R), which are robust alternatives to the hazard ratio without specific model assumptions, were calculated for colorectal cancer incidence and death.

RESULTS: In this study, no significant difference in colorectal cancer incidence over 10 years was found in the intention-to-screen population (RMST-D: -0.68 days, 95% CI -3.9-2.6; RMTL-R: 1.04, 95% CI 0.88-1.22) or in the per-protocol analysis population (RMST-D: -2.9 days, 95% CI -6.5-0.67; RMTL-R: 1.15, 95% CI 0.97-1.35). In the intention-to-screen population, inviting individuals to colonoscopy did not improve colorectal-cancer death (RMST-D: -0.29 days, 95% CI -1.6-1.0; RMTL-R: 1.07, 95% CI 0.78-1.48). Over 10 years, in the per-protocol analysis, individuals who underwent colonoscopy survived an average of 1.1 more days free of colorectal cancer, but this difference was not statistically significant (RMST-D: 95% CI -0.13-2.3; RMTL-R: 0.72, 95% CI 0.49-1.07).

CONCLUSIONS: In this reanalysis of the NordICC data, no evidence of improvement in survival outcomes for participants invited to undergo colonoscopy compared to usual care was identified, even when assuming that all invited participants did undergo colonoscopy. Thus, our results do not support the use of colonoscopy as a population-wide screening test as a mean to decrease colorectal cancer incidence or death.

REGISTRY: Not applicable.

PMID:39558249 | DOI:10.1186/s12876-024-03506-2