Category: Statistics

Microbiome. 2022 Dec 26;10(1):240. doi: 10.1186/s40168-022-01442-5.

ABSTRACT

BACKGROUND: Early childhood caries (ECC)-dental caries (cavities) occurring in primary teeth up to age 6 years-is a prevalent childhood oral disease with a microbial etiology. Streptococcus mutans was previously considered a primary cause, but recent research promotes the ecologic hypothesis, in which a dysbiosis in the oral microbial community leads to caries. In this incident, density sampled case-control study of 189 children followed from 2 months to 5 years, we use the salivary bacteriome to (1) prospectively test the ecological hypothesis of ECC in salivary bacteriome communities and (2) identify co-occurring salivary bacterial communities predicting future ECC.

RESULTS: Supervised classification of future ECC case status using salivary samples from age 12 months using bacteriome-wide data (AUC-ROC 0.78 95% CI (0.71-0.85)) predicts future ECC status before S. mutans can be detected. Dirichlet multinomial community state typing and co-occurrence network analysis identified similar robust and replicable groups of co-occurring taxa. Mean relative abundance of a Haemophilus parainfluenzae/Neisseria/Fusobacterium periodonticum group was lower in future ECC cases (0.14) than controls (0.23, P value < 0.001) in pre-incident visits, positively correlated with saliva pH (Pearson rho = 0.33, P value < 0.001) and reduced in individuals who had acquired S. mutans by the next study visit (0.13) versus those who did not (0.20, P value < 0.01). In a subset of whole genome shotgun sequenced samples (n = 30), case plaque had higher abundances of antibiotic production and resistance gene orthologs, including a major facilitator superfamily multidrug resistance transporter (MFS DHA2 family P_BH value = 1.9 × 10^-28), lantibiotic transport system permease protein (P_BH value = 6.0 × 10^-6) and bacitracin synthase I (P_BH value = 5.6 × 10^-6). The oxidative phosphorylation KEGG pathway was enriched in case plaque (P_BH value = 1.2 × 10^-8), while the ABC transporter pathway was depleted (P_BH value = 3.6 × 10^-3).

CONCLUSIONS: Early-life bacterial interactions predisposed children to ECC, supporting a time-dependent interpretation of the ecological hypothesis. Bacterial communities which assemble before 12 months of age can promote or inhibit an ecological succession to S. mutans dominance and cariogenesis. Intragenera competitions and intergenera cooperation between oral taxa may shape the emergence of these communities, providing points for preventive interventions. Video Abstract.

PMID:36567334 | DOI:10.1186/s40168-022-01442-5

BMC Musculoskelet Disord. 2022 Dec 26;23(1):1129. doi: 10.1186/s12891-022-06095-x.

ABSTRACT

BACKGROUND: The epidemiology and payer costs for ankle fractures are not well documented. This study evaluated: (1) the incidence of ankle fracture and ankle surgery following fracture in the US population; and (2) the clinical presentation of patients presenting with ankle fractures requiring surgery, their complication rates, and payer costs.

METHODS: Patients in the IBM® MarketScan® Commercial and Medicare Supplemental databases with an inpatient/outpatient diagnosis of ankle fracture from 2016 to 2019 were stratified by age group and gender, and rates of fracture per 10,000 enrollees were estimated. Surgically-treated patients between January 2016 – October 2021 were further analyzed. One-year post-surgical outcomes evaluated complication rates (e.g., infection, residual pain), reoperations, and 1-year payments. Standard descriptive statistics were calculated for all variables and outcomes. Generalized linear models were designed to estimate payments for surgical care and incremental payments associated with postoperative complications.

RESULTS: Fracture cases affected 0.14% of the population; 23.4% of fractures required surgery. Pediatric and elderly patients were at increased risk. From 3 weeks to 12 months following index ankle surgery, 5.5% (5.3% – 5.7%) of commercially insured and 5.9% (5.1% – 6.8%) of Medicare patients required a new surgery. Infection was observed in 4.4% (4.2% – 4.6%) commercially insured and 9.8% (8.8% – 10.9%) Medicare patients, and residual pain 3 months post-surgery was observed in 29.5% (28.7% – 30.3%) commercially-insured and 39.3% (36.0% – 42.6%) Medicare patients. Commercial payments for index surgery ranged from $9,821 (95% CI: $9,697 – $9,945) in the ambulatory surgical center to $28,169 (95% CI: $27,780 – $28,559) in the hospital inpatient setting, and from $16,775 (95% CI: $16,668 – $16,882) in patients with closed fractures, to $41,206 (95% CI: $38,795 – $43,617) in patients with Gustilo III fractures. Incremental commercial payments for pain and infection averaged $5,200 (95% CI: $4,261 – $6,139) and $27,510 (95% CI: $21,759 – $33,261), respectively.

CONCLUSION: Ankle fracture has a high incidence and complication rate. Residual pain affects more than one-third of all patients. Ankle fracture thus presents a significant societal impact in terms of patient outcomes and payer burden.

PMID:36567314 | DOI:10.1186/s12891-022-06095-x

Curr Med Imaging. 2022 Dec 23. doi: 10.2174/1573405619666221223090050. Online ahead of print.

ABSTRACT

BACKGROUND: It is still uncertain to determine the exact diagnostic accuracy of MRI for medial meniscus (MM) tear, lateral meniscus (LM) tear and MM posterior root tear (MMPRT) at different magnetic field intensities (MFIs), different sequences and different publication dates. This study aimed to identify the diagnostic performance of MRI for different meniscus lesions at different MFIs, different sequences and different publication dates, and also to compare it with physical examination.

METHODS: PubMed, Embase, Ovid database, Biosis Previews, Cochrane library, Web of Sciences and manual searching were performed from 1 January 2000 to 31 December 2021. Prospective studies of meniscus injuries examined by physical examination, MRI and arthroscopy were included.

RESULTS: Thirteen studies with 1583 meniscal tears were included. The pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), diagnostic odds ratio (DOR) and area under curve (AUC) were 87% [95% confidence interval (CI), 86-89%], 82% (80-83%), 7.44 (5.11-10.75), 0.18 (0.14-0.23), 45.95 (26,68-79.15) and 0.93, respectively. The pooled specificity between MM and LM (p=0.015), the pooled sensitivity and LR- between MM and MMPR (p=0.031), different MRI sequences (p=0.035, p=0.027), and the accuracy of less than 1.5T and 3.0T (p=0.04), 1.5T and 3.0T (p=0.035) were statistically different. There was no publication bias (p=0.54).

CONCLUSION: MRI performed well in the diagnosis of MM tear, LM tear and MMPRT, and the diagnostic performance of physical examination is similar to MRI. The diagnostic accuracy of 3.0T is the highest, and the -weighted imaging (SWI) sequence may be beneficial for diagnosing meniscus tear. However, there are not enough evidence to prove that recent studies are significantly better than previous ones.

PMID:36567283 | DOI:10.2174/1573405619666221223090050

Curr Mol Med. 2022 Dec 22. doi: 10.2174/1566524023666221222111934. Online ahead of print.

ABSTRACT

BACKGROUND: Brain injury after intracerebral hemorrhage is extremely complicated, and the exact mechanism remains puzzling. Piezo1, a novel mammalian mechanosensitive ion channel, has been identified to play important roles in several pathologic and physiologic procedures that involve cellular mechanotransduction. However, the role of Piezo1 in hematoma compression after intracerebral hemorrhage is still unclear.

MATERIALS AND METHODS: In the present study, we established a balloon-inflated brain model based on an adult male rat mimicking the pure mechanical compression of a hematoma. Then the behavioral assessment (Garcia Scale) was taken to observe the syndrome after “hematoma”. Western blotting and immunofluorescence were applied to detect Piezo1 expression around lesions in rat brains. ELISA was used for quantitative analysis of inflammation factors. A statistical significance was confirmed as P value<0.05.

RESULTS: Balloon compression lesions were detected in the basal ganglia region of the brain, resulting in abnormal behaviors and a significant increase in the expression of Piezo1 and proinflammatory cytokines. GsMTx4, an antagonist of Piezo1, reversed these effects. Additionally, the balloon deflation time affected behavioral function and the levels of Piezo1 and proinflammatory cytokines.

CONCLUSION: These results establish the first in vivo evidence for the role of Piezo1 in blood-brain neuroinflammation after hematoma compression. Piezo1 showed “bidirectional mechanosensitivity” and therefore is a potential therapeutic target for the treatment of intracerebral hemorrhage.

PMID:36567276 | DOI:10.2174/1566524023666221222111934

J Voice. 2022 Dec 23:S0892-1997(22)00376-9. doi: 10.1016/j.jvoice.2022.11.023. Online ahead of print.

ABSTRACT

OBJECTIVE: This study analyzes the effects of the vocal exercises called semi-occluded nasal tract exercises (SONTEs), which were carried out with a new appliance that extends the nasal cavity as a part of the vocal tract. The acoustic, aerodynamic and electroglottographic (EGG) measurements were compared with those of the traditional semi-occluded vocal tract exercises (SOVTEs) of phonation in water.

METHODS: In this study, 34 women were randomly asked to perform phonation in water for 5 min through the nasal and oral routes with the sounds /m/ and /ɔ/, respectively, using a tube with a submersion depth of 5 cm. The acoustic, aerodynamic and EGG measurements before and after the exercises were analyzed using the appropriate statistical methods.

RESULTS: No significant difference was found in the time and frequency domain parameters before and after the exercises, except for the amplitude perturbation quotient (APQ) values, which decreased after both exercises. In addition, there was no significant difference in any aerodynamic parameters before and after the exercises, but the mean SPL values significantly increased after both exercises. The oral and nasal peak inspiratory flow rates increased after both exercises, but the increase peaked after the SONTEs implementation. As expected, the EGG-jitter and EGG-periodicity values had a reciprocal interaction with each other, while differences were observed between the values of the vocal fold movements measured in both exercises.

CONCLUSIONS: SONTEs may be as effective as the conventional SOVTEs because it made tube phonation into water possible through artificial extension of the nasal cavity and increased the resonant effect by using the positive effects based on the principles of SOVTEs.

PMID:36567236 | DOI:10.1016/j.jvoice.2022.11.023

J Voice. 2022 Dec 23:S0892-1997(22)00387-3. doi: 10.1016/j.jvoice.2022.11.035. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate the differences in laryngopharyngeal reflux (LPR) characteristics between gender and age groups based on the Reflux Symptom Index (RSI), Reflux Finding Score (RFS) scale and 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH (HEMII-pH) monitoring.

METHODS: The enrolled were patients with LPR symptoms completed the 24h-HEMII-pH monitoring and divided into two gender groups (male and female) and elderly group (>60 years), middle-aged group (41-60 years) and young group (18-40 years). The total RSI and RFS scores of individuals were counted. Various potential differences as well as incidence of each type of LPR events between gender and age groups were analyzed.

RESULTS: A total of 420 patients were included, with 333 (79.3%) diagnosed with LPR confirmed by 24h-HEMII-pH monitoring. Females (n=49) had a statistically higher LPR positivity (91.0% vs. 76.6%, P < 0.01) than males (n=342). Female patients with LPR had significantly higher RSI scores (14.08 ± 6.72 vs. 11.08 ± 4.82, P < 0.001) than male patients. The positive rate of LPR were 82.6%, 80.7% and 63.3% in the elderly, middle-aged and young groups. The Elderly group had significantly lower RSI scores (10.20 ± 4.06 vs. 12.80 ± 6.58, 12.24 ± 5.57, P < 0.001) but higher RFS scores (9.37 ± 3.25 vs. 8.16 ± 3.34, 8.57 ± 2.58, P < 0.05) than the other two groups. The number of acid hypopharyngeal-proximal reflux episodes (HREs) and distal esophageal acid reflux were significantly higher in elderly than in young patients. Except for non-acid gas HREs, the positive rates of other types of HREs were increasing from young to middle-aged to the elderly group (P < 0.05).

CONCLUSIONS: Female patients with suspected LPR symptoms had a higher positive rate of LPR and RSI score than males. The prevalence of LPR and the number of acid reflux were progressively increasing with age, but the perception of reflux symptoms may diminish.

PMID:36567235 | DOI:10.1016/j.jvoice.2022.11.035

J Am Pharm Assoc (2003). 2022 Dec 7:S1544-3191(22)00397-1. doi: 10.1016/j.japh.2022.12.001. Online ahead of print.

ABSTRACT

BACKGROUND: Respond to Prevent (R2P) is a randomized clinical trial which sought to accelerate distribution of naloxone and other harm reduction materials from community pharmacies. R2P combined an online continuing education course with in-store materials, specifically designed for use in community pharmacies, and then supported implementation through the one-on-one educational technique of academic detailing.

OBJECTIVE: The objective of this paper is to describe and synthesize our experiences providing academic detailing as part of the R2P randomized trial.

METHODS: Closed-ended items from standardized post detailing questionnaires were analyzed with descriptive statistics. Open-ended items were content analyzed for key themes using immersion-crystallization qualitative methods.

RESULTS: A total of 176 pharmacies participated in R2P with 175 receiving their initial academic detailing visit between August 2019 and May 2021. Initial visits were in-person and lasted a median of 35 minutes (interquartile range, 20-45 minutes). The R2P naloxone guide was the most common topic covered (n = 162, 92.6%). Following a fidelity check to assess adequacy of the R2P program implementation, 80 pharmacies (45.7%) required secondary academic detailing. Secondary detailing was more targeted and most frequently focused on the sale of nonprescription syringes (n = 28; 35.2%) or disposal container distribution (n = 30; 37.5%). Analysis of the open-ended items identified factors that the detailers perceived to affect the quality of academic detailing sessions, including the pharmacy environment, participant knowledge of and attitudes toward the subject matter, and ability of the detailer to remain flexible yet consistent.

CONCLUSION: R2P provided a standardized process to foster naloxone distribution and engagement in harm reduction with demonstrated implementation in 175 community pharmacies across 4 states. Academic detailing was perceived to be well-received and effective at providing education and promoting distribution of naloxone and nonprescription syringes in community pharmacies. Additional research is needed to confirm these perceptions through evaluation post-intervention behavioral and attitude changes.

PMID:36567216 | DOI:10.1016/j.japh.2022.12.001

Clin Lymphoma Myeloma Leuk. 2022 Dec 7:S2152-2650(22)01751-7. doi: 10.1016/j.clml.2022.12.006. Online ahead of print.

ABSTRACT

BACKGROUND: Bone marrow (BM) fibrosis is a condition characterized by deposition of reticulin and collagen fibers in BM. It may confer a poor prognosis in some of hematological malignancies. However, the relationship between fibrosis and the disease pathology is not fully understood and no biomarkers for BM fibrosis are available in clinical practice. Autotaxin (ATX) is a secreted enzyme that is associated with various pathophysiological responses, including fibrosis. We conducted a pilot study to investigate the serum ATX levels in various hematological disorders in patients with or without BM fibrosis.

PATIENTS AND METHODS: The serum levels of ATX in a total of 198 patients with hematological disorders and 160 healthy subjects were analyzed. Because of sexual difference in ATX level, the ATX ratio-determined by dividing the ATX level by the mean value of ATX of control subjects of the same sex-was calculated for further comparative analysis. A trephine biopsy samples from 53 patients were also evaluated to determine the Reticulin Fibrosis Index and Collagen Fibrosis Index of each sample.

RESULTS: In comparison to the control group, the ATX ratio was significantly higher in patients, especially those with malignant lymphoma. The ATX ratio in lymphoma patients with BM fibrosis was significantly higher than that in patients without BM fibrosis. The Collagen Fibrosis Index showed statistically significant negative correlation with the ATX ratio.

CONCLUSION: Our results suggest that the ATX ratio may be a candidate diagnostic biomarker for BM fibrosis in selected patients, including those with malignant lymphoma.

PMID:36567212 | DOI:10.1016/j.clml.2022.12.006

Clin Lymphoma Myeloma Leuk. 2022 Nov 23:S2152-2650(22)01741-4. doi: 10.1016/j.clml.2022.11.008. Online ahead of print.

ABSTRACT

BACKGROUND: Adults with triple-class refractory (TCR) multiple myeloma (MM) have limited treatment options and poor prognosis, but the burden of TCR MM has not been well characterized. This study evaluated treatment patterns, overall survival (OS), health-related quality of life (HRQoL), and healthcare resource use (HCRU) among patients with TCR MM in US clinical practice.

PATIENTS AND METHODS: Patients with TCR MM in the Connect MM Registry (NCT01081028; a large, US, multicenter, prospective observational cohort study of patients with newly diagnosed MM) were included. Patient characteristics, treatment patterns, HRQoL, and HCRU were analyzed using descriptive statistics. OS was calculated using Kaplan-Meier methodology for the overall cohort and for patients with/without ≥1 post-TCR line of therapy (LOT).

RESULTS: A total of 232 patients with TCR MM were included; 155 (67%) had ≥1 post-TCR LOT (post-TCR-Treated subgroup; median 9.9 months of follow-up). Most common post-TCR treatments were carfilzomib (47%), pomalidomide (40%), and daratumumab (26%); median treatment duration was 3.3 months. Median OS was 9.9 months in the overall population, 10.8 months in post-TCR-Treated patients, and 2.6 months for those with no new post-TCR LOT. HRQoL deteriorated and pain increased over 1 year of follow-up, with clinically meaningfully changes in EQ-5D (mean, -0.06 points) and FACT-G (mean, -9.9 points). 124 (53%) patients had ≥1 all-cause hospitalization and 58 (25%) had ≥1 MM-related hospitalization; median annualized length of stay was 35.3 and 42.9 days, respectively.

CONCLUSION: The burden of TCR MM is substantial, emphasizing the need for more effective treatment options in the TCR setting.

PMID:36567211 | DOI:10.1016/j.clml.2022.11.008

Fertil Steril. 2022 Dec 23:S0015-0282(22)01971-9. doi: 10.1016/j.fertnstert.2022.10.021. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the benefit of frozen vs. fresh elective single embryo transfer using traditional and novel methods of controlling for confounding.

DESIGN: Retrospective cohort study using data from the National Assisted Reproductive Technology Surveillance System.

SETTING: Not applicable.

PATIENT(S): A total of 44,750 women aged 20-35 years undergoing their first lifetime oocyte retrieval and embryo transfer in 2016-2017, who had ≥4 embryos cryopreserved.

INTERVENTION(S): Fresh elective single embryo transfer and frozen elective single embryo transfer.

MAIN OUTCOME MEASURE(S): The primary outcome was a singleton live birth. Secondary outcomes included rates of total live birth (singleton plus multiple gestations), twin live birth, clinical intrauterine gestation, total pregnancy loss, biochemical pregnancy, and ectopic pregnancy. Outcomes for infants included gestational age at delivery, birth weight, and being small for gestational age.

RESULT(S): The eligibility criteria were met by 6,324 fresh and 2,318 frozen cycles. Patients undergoing fresh and frozen transfer had comparable mean age (30.69 [standard deviation {SD} 0.08] years vs. 31.06 [SD 0.08] years) and body mass index (24.76 [SD 0.20] vs. 25.65 [SD 0.15]); however, women in the frozen cohort created more embryos (8.1 [SD 0.12] vs. 6.8 [SD 0.08]). Singleton live birth rates in the fresh vs. frozen groups were 51.4% vs. 48.8% (risk ratio 1.05; 95% confidence interval [CI], 1.00-1.10). After adjustment with a log-linear regression model and propensity score analysis, the difference in singleton live birth rates remained nonsignificant (adjusted risk ratio, 1.05; 95% CI, 0.97-1.14 and 1.02; 95% CI, 0.96-1.08, respectively). A novel dynamical model confirmed inherent fertility (probability of ever achieving a pregnancy) was balanced between groups (odds ratio, 1.23; 95% CI 0.78-1.95]). The per-cycle probability of singleton live birth was not different between groups (odds ratio 1.11 [95% CI 0.94-1.3]).

CONCLUSION(S): In this retrospective cohort study of fresh vs. frozen elective single embryo transfer, there was no statistically significant difference in singleton live birth rate after adjustment using log-linear models and propensity score analysis. The successful application of a novel dynamical model, which incorporates multiple assisted reproductive technology cycles from the same woman as a surrogate for inherent fertility, offers a novel and complementary perspective for assessing interventions using national surveillance data.

PMID:36567206 | DOI:10.1016/j.fertnstert.2022.10.021