Category: Statistics

Int Urol Nephrol. 2024 Jul 15. doi: 10.1007/s11255-024-04155-w. Online ahead of print.

ABSTRACT

BACKGROUND: Acute kidney disease (AKD) is a recently described syndrome consisting of kidney function abnormalities lasting less than 3 months. Little is known regarding AKD following ureteroscopy (URS) and laser lithotripsy.

OBJECTIVE: To evaluate the occurrence and evolution of AKD in stone patients treated with URS.

MATERIALS AND METHODS: Data from 284 patients treated with URS for urinary stones were retrospectively analyzed. According to the KDIGO 2020 criteria, AKD was defined as postoperative acute kidney injury (AKI) occurrence, estimated glomerular filtration rate (eGFR) decrease ≥ 35%, or serum creatinine (SCr) increase ≥ 50%. AKI was defined as SCr increase ≥ 0.3 mg/dL or ≥ 50%. AKD evolution was evaluated 60 days post-URS. Data were analyzed using descriptive statistics. Univariable (UVA) and multivariable (MVA) logistic regression analyses tested the association of patients’ characteristics and perioperative data with the occurrence of AKD.

RESULTS: Overall, postoperative AKD occurred in 32 (11.3%) patients. Recovery from AKD was found in 26 (82%) patients and persistent AKD occurred in 6 (18%) patients. At UVA, age at surgery (p = 0.05), baseline SCr (p = 0.02), baseline CKD category (p = 0.006), Charlson comorbidity index (p = 0.01), operative time (p = 0.04) and postoperative complications (< 0.001) were associated with AKD. At MVA, CKD category (OR 2.99, 95% CI = 1.4-6.3; p = 0.004), operative time (OR 1.01, 95% CI = 1.001-1.018; p = 0.023) and postoperative complications (OR 3.5, 95% CI = 1.46-8.49; p = 0.005) were independent predictors of AKD.

CONCLUSIONS: AKD is a frequent complication in patients treated with URS. Moreover, AKD persists in a non-neglectable percentage of patients at medium-term follow-up. Therefore, nephrological assessment should be considered, especially in high-risk patients. Current findings should be considered for the peri-operative management of stone patients.

PMID:39008224 | DOI:10.1007/s11255-024-04155-w

Int Urol Nephrol. 2024 Jul 15. doi: 10.1007/s11255-024-04140-3. Online ahead of print.

ABSTRACT

BACKGROUND: This study examines the association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and urinary stones in American adults.

METHODS: We conducted a cross-sectional study utilizing the 2007-2018 National Health and Nutrition Examination Survey (NHANES) data set. The prevalence of urinary stones was determined based on patient-reported experiences of renal colic. We converted NHHR to natural logarithm (ln-NHHR) to align it better with our statistical analyses. Our analysis methods included weighted multivariate logistic regression, generalized additive model (GAM), and application of smoothed curves to better elucidate the association between ln-NHHR and the prevalence of urinary stones. In addition, we conducted subgroup analyses and employed multiple imputation for sensitivity analyses.

RESULTS: This study involved a total of 30,903 participants, with a 9.97% prevalence of urinary stones and reported colic experience. Elevated ln-NHHR levels were linked with a higher likelihood of urinary stones (OR = 1.20, 95% CI 1.07-1.35). Smooth curve fitting revealed an inverted U-shaped relationship, pinpointing a significant increase in urinary stone risk at ln-NHHR levels below 1.43 (OR = 1.40, 95% CI 1.19-1.64, p < 0.001). Notably, this correlation was stronger among Non-Hispanic Whites and those married or living with a partner. Multiple imputation analyses strengthened the confidence in our results.

CONCLUSIONS: Our findings suggest a reverse U-shaped association between urinary stone occurrence and NHHR level, with a positive association at ln-NHHR < 1.43. This correlation was more pronounced in the Non-Hispanic White population and among those married or living with a partner.

PMID:39008223 | DOI:10.1007/s11255-024-04140-3

Clin Rheumatol. 2024 Jul 15. doi: 10.1007/s10067-024-07050-y. Online ahead of print.

ABSTRACT

This study aimed to examine psychometric properties of the Adherence to Refills and Medications Scale (ARMS) in people with gout. We conducted exploratory factor analysis (EFA) and tested internal consistency (ordinal and Cronbach’s alpha coefficients) and agreement (intraclass correlation coefficient (2,1)) in ARMS scores across three timepoints (baseline, 6, and 12 months) in 487 people with gout. The Kruskal-Wallis test, Spearman’s rank, Kendall’s tau-b correlations, and logistic regression were used to examine the criterion-related validity of the ARMS and factors associated with the ARMS. EFA suggested a one-factor structure, explaining 43.2% of total variance. High internal consistency (ordinal alpha = 0.902 at baseline) and moderate agreement in ARMS scores over time (ICCs > 0.5; p < 0.001) were observed. Lower ARMS scores (indicating better adherence) predicted achieving target serum urate (OR, 0.89; 95% CI, 0.83-0.95; p < 0.001), but not urate-lowering therapy (ULT) adherence (Proportion of Days Covered (PDC) ≥ 80%) (OR, 0.93; 95% CI, 0.81-1.05; p = 0.261). Negative correlations between ARMS and PDC were not statistically significant (Kendall’s tau-b, r = – 0.126, p = 0.078; Spearman’s rho = – 0.173, p < 0.073). Differences in median ARMS scores (IQR) of 16 (14-20), 13 (12-15), and 17.5 (15-21) in three groups of participants who reported (1) not taking ULT, (2) taking ULT and adherent, and (3) taking ULT but not adherent, respectively, were statistically significant (p < 0.001). Age was the only patient factor independently associated with optimal adherence (ARMS score = 12) (OR, 1.91; 95% CI, 1.50-2.43; p < 0.001). The ARMS is a reliable and valid measure of medication adherence behaviours in people with gout, justifying its use in gout medication adherence research.

PMID:39008222 | DOI:10.1007/s10067-024-07050-y

Mol Biol Rep. 2024 Jul 15;51(1):813. doi: 10.1007/s11033-024-09729-6.

ABSTRACT

BACKGROUND: We aimed to investigate the serum Nuclear Factor Kappa B (NF-κB) p105, NF-κB p65 and Inhibitor Kappa B Alpha (IκBα) levels in patients with mild/moderate Coronavirus Disease 2019 (COVID-19) and their association with the course of the disease.

MATERIALS AND METHODS: Blood was drawn from 35 COVID-19 patients who applied to the Department of Emergency Medicine of Istanbul University-Cerrahpasa at the time of diagnosis and from 35 healthy individuals. The patients were evaluated to have mild/moderate degree of disease according to National Early Warning Score 2 (NEWS2) scoring and computed tomography (CT) findings. The markers were studied in the obtained serum samples, using enzyme-linked immunoassay (ELISA). Receiver Operating Characteristic (ROC) analysis was performed. Statistical significance was evaluated to be p < 0.05.

RESULTS: NF-κB p105 levels were significantly higher in the COVID-19 group compared to the control group. C-reactive protein (CRP), D-dimer, ferritin levels of the patients were significantly higher (p < 0.001) compared to the control group, while the lymphocyte count was found lower (p = 0.001). IκBα and NF-κB p65 levels are similar in both groups. Threshold value for NF-κB p105 was above 0.78 ng/mL, sensitivity was 71.4% and specificity was 97.1% (p < 0.05). NF-κB p105 levels at the time of diagnosis of the patients who required supplemental oxygen (O₂), were significantly higher (p < 0.01).

CONCLUSIONS: The rise in serum NF-κB p105 levels during the early stages of infection holds diagnostic value. Besides its relation with severity might have a prognostic feature to foresee the requirement for supplemental O₂ that occurs during hospitalization.

PMID:39008220 | DOI:10.1007/s11033-024-09729-6

Ann Surg Oncol. 2024 Jul 15. doi: 10.1245/s10434-024-15670-6. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative adverse events (AEs) in patients with borderline resectable pancreatic ductal adenocarcinoma (BR-PC) treated with neoadjuvant therapy and pancreatectomy in the national cooperative group setting have not been previously characterized. We conducted a preplanned secondary analysis of patients enrolled on the Alliance A021501 clinical trial to quantify perioperative AE rates.

METHODS: The A021501 phase 2 trial randomized patients with BR-PC to receive 8 doses of mFOLFIRINOX (Arm 1) or 7 doses of mFOLFIRINOX and hypofractionated radiotherapy (Arm 2), followed by pancreatectomy (December 31, 2016 to May 31, 2019). Adverse events were assessed 90 days after pancreatectomy.

RESULTS: Of 126 enrolled patients, 51 (40%) underwent pancreatectomy (n = 32, Arm 1; n = 19, Arm 2) at 28 institutions. Five (10%) patients required reoperation within 90 days; 56% of patients (n = 27/48) experienced at least one grade 3 or higher AE (50% vs. 67%, p = 0.37). Ninety-day mortality was 2.0%. Readmission was less frequent in Arm 1 (16% vs. 42%, p = 0.05), but there were no differences between study arms in rates of reoperation (13% vs. 5%), pancreatic fistula or intra-abdominal abscess requiring drainage (9% vs. 16%), or wound infection (6% vs. 16%). Pancreatic fistula or intra-abdominal abscess requiring drainage was associated with receipt of adjuvant therapy (p = 0.012). No difference in overall survival was observed based on occurrence of postoperative AEs (hazard ratio = 1.1; 95% confidence interval 0.5-2.6).

CONCLUSIONS: In this multicenter study, rates of postoperative AEs were consistent with those previously reported. Multimodality trials of preoperative therapy for BR-PC may be performed in the cooperative group setting with careful quality assurance and safety monitoring.

TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT02839343.

PMID:39008208 | DOI:10.1245/s10434-024-15670-6

Ann Surg Oncol. 2024 Jul 15. doi: 10.1245/s10434-024-15821-9. Online ahead of print.

NO ABSTRACT

PMID:39008203 | DOI:10.1245/s10434-024-15821-9

Endocrine. 2024 Jul 15. doi: 10.1007/s12020-024-03960-8. Online ahead of print.

ABSTRACT

PURPOSE: One of the key functions of brown adipose tissue is its positive impact on metabolism. This study aimed to examine the potential involvement of brown fat-related hormones in the development of metabolically healthy obesity. Specifically, we sought to compare the levels of NRG4, FGF21, and irisin between metabolically healthy and unhealthy individuals with obesity.

METHODS: Patients with BMI ≥ 30 kg/m² and aged between 20 and 50 years were included in the study. Among these patients, those who did not have any metabolic syndrome criteria except for increased waist circumference were defined as metabolically healthy obese. Age, gender, BMI, body fat, and muscle mass, matched metabolically healthy and unhealthy obese groups were compared in terms of FGF21, irisin, and NRG4 levels.

RESULTS: Metabolically healthy and unhealthy obese groups were similar in terms of age and gender. There was no difference between the two groups in terms of BMI, weight, total body fat, muscle, fat-free mass, distribution of body fat and muscle mass. No statistically significant difference was found between irisin, NRG4, and FGF21 levels between metabolically healthy and unhealthy individuals with obesity. It was found that irisin had a significant inverse correlation with BMI and body fat percentage.

CONCLUSION: The present study showed no difference between metabolically healthy and unhealthy obese individuals in terms of irisin, FGF21, and NRG4 levels. The weak association between irisin and BMI and body fat percentage may suggest a potential link between irisin with metabolic health.

PMID:39008201 | DOI:10.1007/s12020-024-03960-8

Eur Geriatr Med. 2024 Jul 15. doi: 10.1007/s41999-024-01016-8. Online ahead of print.

ABSTRACT

PURPOSE: Feeding assistance should be safe and improve the assisted individual’s ability to feed, yet objective tools for evaluating these skills are lacking. This study focuses on developing a tool for assessing feeding assistance skills.

METHODS: A group consisting of 25 experts employed the Delphi method to achieve a consensus on the essential items necessary for assessing feeding assistance skills. Subsequently, a draft score using a three-point scale was developed. To test the reliability of the draft scores, a group of 20 patients and 20 nurses was matched to record a meal assistance scene, which were independently evaluated by three raters. We computed the AC₁ statistic to assess both intra- and inter-rater reliability, and further examined correlations between the Feeding Assistance Skill Score (FASS) scores and outcome items to verify validity.

RESULTS: Initially, an 18-item draft score was generated using the Delphi method. Subsequently, seven items were omitted from the intra- or inter-rater reliability analysis. Furthermore, after discussion, researchers removed one item that assessed food cognition, because the agreement score between the two items was 91%. Finally, the 10-item FASS was developed, showing a correlation with dietary intake upon validation.

CONCLUSIONS: We successfully developed a scoring system for peer evaluation of feeding assistance skills. Future studies should aim to validate the FASS. The implementation of the FASS aims to assess the effectiveness of feeding assistance training and care quality, potentially improving safety and satisfaction for those receiving feeding assistance.

PMID:39008198 | DOI:10.1007/s41999-024-01016-8

Equine Vet J. 2024 Jul 15. doi: 10.1111/evj.14137. Online ahead of print.

ABSTRACT

BACKGROUND: Equine suspensory ligament branch (branch) ultrasonography is becoming increasingly commonplace presale. No ultrasonographical branch reference data exists for Thoroughbred sales horses.

OBJECTIVES: To define the prevalence of ultrasonographical findings in the forelimb suspensory branches of yearling and 2-year-old sales Thoroughbreds and to analyse associations with racing performance. To track changes in branch findings between 1 and 2 years of age in horses that present for sale at both ages.

STUDY DESIGN: Prospective cohort study using an enrolled sample.

METHODS: Horses were enrolled from a 2016 yearling sale and five 2017 2-year-old sales with consignor permission. Ultrasonography was performed immediately prior to the sales. Ultrasonographical findings relating to branch size, fibrillar pattern, the presence of hyperechoic foci, periligamentar tissue thickness and the adjacent proximal sesamoid bone surface were examined. Associations with racing performance from 2 to 4 years of age were investigated using multivariate regression analyses. Clinical follow-up was sought to ascertain why horses that did not race never started.

RESULTS: A total of 593 sales yearlings and 367 2-year-olds had forelimb branch ultrasonography performed. Grade ≥2 fibrillar branch change was present in 8.9% of yearlings and 14.4% of 2-year-olds. A 0.25 cm increase in branch width was associated with a 49-day delayed start to racing careers (P < 0.001, 95% confidence interval (95% CI): 21-77 days). The presence of grade 2 hyperechoic foci was associated with significantly lower total earnings (P = 0.01, 95% CI: $2000-$16 022) and lower earnings per start (P = 0.003, 95% CI: $349-$1718) in United States Dollars. Grade 3 fibrillar branch change had clinically important reductions in the probability of racing, the calibre of racing performance and earnings. Grade 1 fibrillar pattern was associated with significantly higher earnings per start (P = 0.004, 95% CI: $2641-$5759).

MAIN LIMITATIONS: The findings are applicable to horses prepared for public auction and deemed fit to be entered for sale. The results may underestimate the proportion of severe lesions in horses not entered for sale.

CONCLUSIONS: Reference values specific to young Thoroughbreds have been established. Grade 1 fibrillar branch change should be regarded as an acceptable appearance in sales yearlings and 2-year-olds. Approximately one-third of grade 2 yearling branches progressed to a grade 3 lesion. Evidence of enlarged branch width and grade 2 hyperechoic foci at 2-year-old sales constitute a risk to racing performance.

PMID:39007207 | DOI:10.1111/evj.14137

J Clin Nurs. 2024 Jul 15. doi: 10.1111/jocn.17359. Online ahead of print.

ABSTRACT

AIMS: To investigate the incidence of fear of cancer recurrence in patients with digestive tract cancers analyse its influencing factors, and further establish a visual risk prediction model.

DESIGN: A cross-sectional study.

METHODS: A cross-sectional survey was conducted among 570 patients with digestive tract tumours admitted to a local hospital, from May 2023 to December 2023 by convenient sampling method. Univariate analysis and logistic analysis were performed on the influencing factors, and the risk prediction nomogram model of fear of cancer recurrence in patients with digestive tract cancer was constructed by using R 4.1.3 software. ROC curve was used to evaluate the differentiation of the nomogram model. The calibration curve and Hosmer-Lemeshow goodness of fit test were used to evaluate the consistency of the model. This study was reported using the TRIPOD checklist.

RESULTS: In this study, 272 (47.7%) patients developed fear of recurrence. The risk prediction model of recurrence fear column chart for digestive tract cancer patients incorporated six variables of gender, therapy, alimentary tract haemorrhage, pain, depression and social support. The C-statistic was (.976), and the calibration curve showed that the predicted probability was more in line with the actual probability of occurrence, and the decision curve showed that the predictive model had better practicality.

CONCLUSION: The column-line diagram prediction model constructed in this study is effective and facilitates timely intervention and management by healthcare professionals based on their risk factors.

IMPACT: Nomogram is helpful to calculate the risk probability of FCR in patients with digestive tract cancer, identify FCR patients in time, and formulate comprehensive and personalized countermeasures, to provide a good quality of life and prolong the survival cycle of patients with digestive tract cancer.

PATIENT OR PUBLIC CONTRIBUTION: Participants were hospitalized patients or patients with digestive tract cancer undergoing follow-up. First of all, before the investigation and research, a team is formed to discuss the concept, research purpose, method, significance, etc., and determine the research tools. Second, by reasonably explaining the study to patients to seek informed consent from the patient and sign it, patients filled in the questionnaire independently. For patients with low education levels who could not fill in the questionnaire, the team members made objective explanations to help them choose reasonable options.

PMID:39007189 | DOI:10.1111/jocn.17359