Category: Statistics

Int J Clin Oncol. 2024 Jun 21. doi: 10.1007/s10147-024-02572-6. Online ahead of print.

ABSTRACT

BACKGROUND: Multidrug chemotherapy for Ewing sarcoma can lead to severe myelosuppression. We proposed two clinical questions (CQ): CQ #1, “Does primary prophylaxis with G-CSF benefit chemotherapy for Ewing sarcoma?” and CQ #2, “Does G-CSF-based intensified chemotherapy improve Ewing sarcoma treatment outcomes?”.

METHODS: A comprehensive literature search was conducted in PubMed, Cochrane Library, and Ichushi web databases, including English and Japanese articles published from 1990 to 2019. Two reviewers assessed the extracted papers and analyzed overall survival (OS), febrile neutropenia (FN) incidence, infection-related mortality, quality of life (QOL), and pain.

RESULTS: Twenty-five English and five Japanese articles were identified for CQ #1. After screening, a cohort study of vincristine, ifosfamide, doxorubicin, and etoposide chemotherapy with 851 patients was selected. Incidence of FN was 60.8% with G-CSF and 65.8% without; statistical tests were not conducted. Data on OS, infection-related mortality, QOL, or pain was unavailable. Consequently, CQ #1 was redefined as a future research question. As for CQ #2, we found two English and five Japanese papers, of which one high-quality randomized controlled trial on G-CSF use in intensified chemotherapy was included. This trial showed trends toward lower mortality and a significant increase in event-free survival for 2-week interval regimen with the G-CSF primary prophylactic use compared with 3-week interval.

CONCLUSION: This review indicated that G-CSF’s efficacy as primary prophylaxis in Ewing sarcoma, except in children, is uncertain despite its common use. This review tentatively endorses intensified chemotherapy with G-CSF primary prophylaxis for Ewing sarcoma.

PMID:38904887 | DOI:10.1007/s10147-024-02572-6

Environ Monit Assess. 2024 Jun 21;196(7):643. doi: 10.1007/s10661-024-12815-8.

ABSTRACT

Urban water systems are potential sources of secondary microplastics (MPs) as well as a distributor of MPs in the environment. In the present study, the presence of MPs in the urban water systems of the Tehran Metropolitan (Capital of Iran) was investigated. In addition, the probable relationship of MPs with different land uses (i.e., residential-commercial, forest, military, and highway) was assessed. The results showed that all parts of Tehran’s urban water system in the study area were contaminated with MPs (107.1 ± 39, 37.8 ± 10.5, 48.3 ± 3.1, 46.9 ± 5.6, 59.4 ± 26.5, 1.7, 2.0 ± 0.6, 7.9 ± 1, 1.8 ± 0.2 particles/liter at the residential, integrated, military, forest, highway runoffs, drinking water, groundwater, seasonal river, and the effluent of the wastewater treatment plants; respectively). However, significant differences were found between different land uses. As expected, the residential runoff had the highest rate of MPs pollution, with 107.1 ± 39 particles/liter. According to the obtained results and our estimation, more than five million MPs/day can enter into the water bodies and soil of the study area through the wastewater treatment plants. While there are significant differences in MPs in the different land uses, our findings suggest that residential areas and highways need further attention in controlling the spread of MPs in urban areas.

PMID:38904869 | DOI:10.1007/s10661-024-12815-8

Support Care Cancer. 2024 Jun 21;32(7):449. doi: 10.1007/s00520-024-08672-3.

ABSTRACT

PURPOSE: Patients on oral anticancer agent (OAA) therapies have the autonomy to manage their cancer treatments in home settings. However, patients may not have adequate knowledge, confidence, or ability to effectively manage OAA-related consequences, which can significantly impact their treatment and health outcomes. This study aims to identify the associations between medication beliefs, patient activation, and self-rated health (SRH) among oncology patients taking OAAs and explore the potential mediation effects of patient activation on the relationship between medication beliefs and SRH.

METHODS: A secondary data analysis was conducted on cross-sectional data from 114 patients who were diagnosed with breast, colorectal, lung, or prostate cancer. Patients completed a self-reported survey including items of SRH, Beliefs about Medicines Questionnaire (BMQ), and Patient Activation Measure (PAM-13). Descriptive statistics, bivariate correlation, hierarchical multiple linear regression, and mediation analysis were conducted.

RESULTS: The results indicate that patients taking OAAs have ambivalent attitudes toward medication. Both medication necessity (r = – 0.27) and concerns (r = – 0.21) were negatively associated with SRH, while patient activation was positively associated with SRH (r = 0.38). Patient activation had a negative association with medication concerns (r = – 0.36) and fully mediated the relationship between medication concerns and SRH in patients taking OAAs (indirect effect = – 0.154, 95% confidence interval, – 0.276 to – 0.060).

CONCLUSION: The findings highlight the significance of activating patients to better understand and manage their OAAs. It is crucial for oncology professionals to provide multifaceted interventions to promote patient activation with an effort to mitigate the negative impact of medication beliefs on patient-perceived health outcomes.

PMID:38904864 | DOI:10.1007/s00520-024-08672-3

Am J Physiol Heart Circ Physiol. 2024 Jun 21. doi: 10.1152/ajpheart.00766.2023. Online ahead of print.

ABSTRACT

Computational, or in-silico, models are an effective, non-invasive tool for investigating cardiovascular function. These models can be used in the analysis of experimental and clinical data to identify possible mechanisms of (ab)normal cardiovascular physiology. Recent advances in computing power and data management have led to innovative and complex modeling frameworks that simulate cardiovascular function across multiple scales. While commonly used in multiple disciplines, there is a lack of concise guidelines for the implementation of computer models in cardiovascular research. In line with recent calls for more reproducible research, it is imperative that scientists adhere to credible practices when developing and applying computational models to their research. The goal of this manuscript is to provide a consensus document that identifies best practices for in-silico computational modeling in cardiovascular research. These guidelines provide the necessary methods for mechanistic model development, model analysis, and formal model calibration using fundamentals from statistics. We outline rigorous practices for computational modeling in cardiovascular research and discuss its synergistic value to experimental and clinical data.

PMID:38904851 | DOI:10.1152/ajpheart.00766.2023

Int J Biometeorol. 2024 Jun 21. doi: 10.1007/s00484-024-02728-z. Online ahead of print.

ABSTRACT

BACKGROUND: PM_2.5 has been associated with various adverse health effects, particularly affecting lung function and chronic respiratory diseases. However, the genetic causality relationship between PM_2.5 exposure and lung function as well as chronic respiratory diseases remains poorly understood.

METHOD: We conducted a two-sample Mendelian randomization analysis to investigate the causal impact of PM_2.5 on lung function and chronic respiratory diseases. Instrumental variables were carefully selected, with significance thresholds (P < 5 × 10^{– 8}), and linkage disequilibrium with an r² value below 0.001. Additionally, SNPs with an F-statistic exceeding 10 were included to mitigate potential bias stemming from weak instrumental variables. The primary analytical approach employed the Inverse Variance Weighted method, supplemented by the Weighted Median, MR-Egger, Simple Model, and Weighted Model. Furthermore, pleiotropy and heterogeneity were evaluated through the MR-Egger intercept test and Cochrane’s Q test, with a sensitivity analysis conducted using the leave-one-out method.

RESULTS: Eight SNPs significantly associated with PM_2.5 exposure were identified as Instrumental variables. Mendelian randomization analysis revealed a significant causal association between PM_2.5 exposure and lung function (FEV), with an OR of 0.7284 (95% CI: 0.5799-0.9150). Similarly, PM_2.5 exposure demonstrated a substantial causal effect on asthma, with an OR of 1.5280 (95% CI: 1.0470-2.2299). However, no causal association was observed between PM_2.5 exposure and chronic obstructive pulmonary disease, with an OR of 1.5176 (95% CI: 0.8294-2.7768).

CONCLUSION: These findings emphasize the necessity for continued research efforts in environmental health to develop effective strategies for the prevention and management of chronic respiratory diseases.

PMID:38904841 | DOI:10.1007/s00484-024-02728-z

J Chemother. 2024 Jun 21:1-7. doi: 10.1080/1120009X.2024.2366683. Online ahead of print.

ABSTRACT

We aimed to evaluate the efficacy and safety of trastuzumab emtansine in patients with metastatic breast cancer previously treated with pertuzumab plus trastuzumab and taxane. We reviewed the medical records of patients who were diagnosed with Human Epidermal Growth Factor Receptor 2 (HER-2) positive metastatic breast cancer and received pertuzumab and then TDM-1 between January 2014 and January 2021 from twenty- five cancer centers. The Kaplan- Meier method estimated progression-free survival (PFS) and overall survival (OS). Additionally, objective response rate (ORR), clinical benefit rate (CBR), and safety were evaluated. One hundred fifty-three patients were included,79.1% of the patients received TDM-1 in the second line, 90.8% had visceral metastasis, and 30.7% had central nervous system involvement. The PFS and OS of TDM-1 were evaluated according to the number of previous lines (on the 2nd line or more than two lines) metastatic sites (visceral and non-visceral) and the presence of central nervous metastasis. In TDM-1 therapy, PFS in second line therapy was ten months (95% CI: 7.7 – 12.2); this was statistically higher than later-line PFS, which was six months (95% CI: 3.3 to 8.6) (p = 0.004). The median OS time was 25 months (95% CI: 21.0 to 28.9) in patients treated with TDM-1 in the second line and 19 months (95% CI: 12.3 to 25.6) in patients who received later than the second line(p = 0.175). There were no significant differences in PFS time of patients with and without visceral and central nervous metastases. Our study showed that TDM-1 was also effective in patients using pertuzumab, contributes significantly to PFS when used in the second line compared to its use in the later line, and does not make any difference in OS.

PMID:38904164 | DOI:10.1080/1120009X.2024.2366683

Curr Aging Sci. 2024;17(2):127-134. doi: 10.2174/0118746098273724231107092608.

ABSTRACT

OBJECTIVE: The increasing prevalence of age-related cognitive decline highlights the importance of physical activity for cognitive health. Regular exercise has been associated with improved mental health and reduced risk of cognitive decline. This study investigated the connection between self-reported physical activity and cognitive function in middle-aged adults.

METHODS: This cross-sectional study included 56 Indian adults aged 30-55, selected based on a health screening questionnaire. Participants reported their physical activity using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), which categorized them into low, moderate, and high activity levels. Cognitive functions, including visual memory, executive function, and attention, were assessed using the Cambridge Neuropsychological Automated Testing Battery (CANTAB). Results were statistically analyzed for relationships between cognitive domains and physical activity parameters using Pearson’s correlation and linear regression analysis.

RESULTS: The study showed a significant positive correlation of attention with moderate and vigorous physical activity, while sedentary behavior negatively impacted attention. Linear regression showed that attention is affected by moderate-intensity activity whereas executive function and visual memory are affected by age.

CONCLUSION: This study supports the view that moderate and vigorous intensity activities may positively affect attention in middle-aged adults highlighting the benefits of physical activity.

PMID:38904155 | DOI:10.2174/0118746098273724231107092608

BMJ Open. 2024 Jun 19;14(6):e077742. doi: 10.1136/bmjopen-2023-077742.

ABSTRACT

PURPOSE: COVID-19 continues to affect millions of individuals worldwide, both in the short and long term. The post-acute complications of SARS-CoV-2 infection, referred to as long COVID, result in diverse symptoms affecting multiple organ systems. Little is known regarding how the symptoms associated with long COVID progress and resolve over time. The Johns Hopkins COVID Long Study aims to prospectively examine the short-term and long-term consequences of COVID-19 in individuals both with and without a history of SARS-CoV-2 infection using self-reported data collected in an online survey.

PARTICIPANTS: 16 764 adults with a history of SARS-CoV-2 infection and 799 adults without a history of SARS-CoV-2 infection who completed an online baseline survey.

FINDINGS TO DATE: This cohort profile describes the baseline characteristics of the Johns Hopkins COVID Long Study. Among 16 764 participants with a history of SARS-CoV-2 infection and defined long COVID status, 75% reported a very good or excellent health status prior to infection, 99% reported experiencing at least one COVID-19 symptom during the acute phase of infection, 9.9% reported hospitalisation and 63% were defined as having long COVID using the WHO definition.

FUTURE PLANS: Analysis of longitudinal data will be used to investigate the progression and resolution of long COVID symptoms over time.

PMID:38904142 | DOI:10.1136/bmjopen-2023-077742

BMJ Open. 2024 Jun 19;14(6):e084285. doi: 10.1136/bmjopen-2024-084285.

ABSTRACT

OBJECTIVE: This study aimed at investigating the relationship between occupational exposure to external ionising radiation and central nervous system (CNS) tumours mortality in healthcare workers working in France.

DESIGN AND SETTING: The Occupational Radiation-Induced Cancer in Medical staff (ORICAMs) nested case-control study was conducted based on the dosimetric records of the national register of occupational dosimetry (Système d’information de la surveillance de l’exposition aux rayonnements ionisants).

PARTICIPANTS AND METHODS: 33 CNS tumour deaths occurred between 2002 and 2012 among the ORICAMs cohort composed of 164 015 healthcare workers. Each case was matched to five controls alive at the time of the corresponding case’s death, based on sex, year of birth, date of enrolment in the cohort and duration of follow-up. All participants were badge monitored for external radiation exposure, expressed in H_p(10). Conditional logistic regression was used to analyse the dose-response relationship between radiation dose and CNS mortality.

RESULTS: Cases were exposed to a mean cumulative career radiation dose of 5.8±13.7 (max: 54.3) millisievert (mSv) compared with 4.1±15.2 (142.2) mSv for controls. No statistically significant association was found between CNS tumour mortality and cumulative whole-body career dose (OR=1.00, 95% CI 0.98 to 1.03), duration of exposure (OR=1.03; 95% CI 0.95 to 1.12) or age at first exposure (OR=0.98; 95% CI 0.91 to 1.06).

CONCLUSION: We found no evidence of an association between external radiation exposure and CNS tumour risk in healthcare workers. Limitations of the study include low statistical power and short duration of follow-up.

PMID:38904132 | DOI:10.1136/bmjopen-2024-084285

BMJ Open. 2024 Jun 19;14(6):e083456. doi: 10.1136/bmjopen-2023-083456.

ABSTRACT

OBJECTIVES: This study aimed to assess whether the national centralised volume-based procurement policy and the Shanghai government’s supportive measures (coronary stent policies) implemented in Shanghai, China, on 20 January 2021 affected the cost-effectiveness of percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) in the year after surgery.

DESIGN: A retrospective cohort study based on real-world data and propensity score (PS)-matched data was conducted to compare the cost-effectiveness of PCI before and after policy implementation.

PATIENTS AND SETTING: Patients with ACS who had undergone first-time PCI over 1 year previously in hospitals in Shanghai and were discharged between 1 March 2019 and 30 April 2022 were included in the study.

OUTCOME MEASURES: In the present study, cost was defined as total direct medical expenses, and effectiveness was defined as the prevention of major adverse cardiac events (MACEs). Incremental cost-effectiveness ratios (ICERs) were used to measure the cost-effectiveness of PCI in patients with ACS 1 year after surgery.

RESULTS: The study included 31 760 patients. According to real-world and PS-matched data, the implementation of coronary stent policies in Shanghai reduced the total medical cost of patients with ACS 1 year after PCI by 24.39% (p<0.0001) and 22.26% (p<0.0001), respectively. The ICERs were ¥-1131.72 and ¥-842.00 thousand per MACE avoided, respectively. The ICERs were robust to parameter uncertainty, and there was a substantial chance for policy implementation to improve the cost-effectiveness of PCI among patients with ACS in the short term.

CONCLUSIONS: The implementation of coronary stent policies has improved the cost-effectiveness of PCI for patients with ACS in the short term. The long-term impact of coronary stent policies on the cost-effectiveness of PCI in patients with ACS or other coronary heart diseases should be assessed in the future.

PMID:38904127 | DOI:10.1136/bmjopen-2023-083456