Category: Statistics

Int J Stroke. 2023 Dec 26:17474930231225568. doi: 10.1177/17474930231225568. Online ahead of print.

ABSTRACT

BACKGROUND.: In stroke patients with insulin resistance (IR), post-stroke cognitive impairment (PSCI) is associated with higher risk of recurrent stroke, but the effect of pioglitazone on that risk has not been explored. The goal of this study was to compare the secondary stroke prevention effect of pioglitazone against placebo in patients with versus without PSCI.

METHODS.: We studied patients enrolled in the Insulin Resistance Intervention after Stroke (IRIS) trial with a post-stroke Modified Mini-Mental State Examination (3MS) cognitive assessment (mean time of assessment: 79 days post-stroke). We considered a baseline score of ≤ 88 on the 3MS to indicate global PSCI, and domain-specific summary scores in the lowest quartile to indicate attention, language, memory, orientation, and visuospatial impairments.

RESULTS.: In n=3338 patients with IR, the effect of pioglitazone vs. placebo on secondary stroke significantly differed by initial post-stroke global (interaction p = 0.0127) and memory impairment status (interaction p = 0.0003). Hazard ratios (HRs) were time-dependent such that, among those with either global or memory impairment, pioglitazone has an increasingly stronger protective effect at later timepoints. There was no statistically significant effect of pioglitazone among those without either global or memory impairment. The effect of pioglitazone vs. placebo on myocardial infarction (MI) also significantly differed by global impairment status (interaction p = 0.030). Pioglitazone was protective among those with global impairment (HR = 0.23; 95% CI: 0.08, 0.71)) but not among those without (HR = 0.88; 95% CI: 0.59, 1.31).

CONCLUSIONS.: These data indicate that pioglitazone treatment may be more effective at reducing risk of recurrent stroke and MI in stroke patients with PSCI. Simple cognitive testing 2 to 3 months post-stroke may identify patients for whom treatment would be most beneficial.

PMID:38148372 | DOI:10.1177/17474930231225568

J Expo Sci Environ Epidemiol. 2023 Dec 26. doi: 10.1038/s41370-023-00636-9. Online ahead of print.

ABSTRACT

BACKGROUND: Residential mobility can introduce exposure misclassification in pediatric epidemiology studies using birth address only.

OBJECTIVE: We examined whether residential mobility varies by sociodemographic factors and urbanicity/rurality among children with cancer.

METHODS: Our study included 400 children born in Pennsylvania during 2002-2015 and diagnosed with leukemia at ages 2-7 years. Addresses were obtained from state registries at birth and diagnosis. We considered three aspects of mobility between birth and diagnosis: whether a child moved, whether a mover changed census tract, and distance moved. We evaluated predictors of these aspects in urban- and rural-born children using chi-square, t-tests, and regression analyses.

RESULTS: Overall, 58% of children moved between birth and diagnosis; suburban/rural-born children were more likely to move than urban-born children (67% versus 57%). The mean distance moved was 16.7 km in suburban/rural-born and 14.8 km in urban-born movers. In urban-born children, moving between birth and diagnosis was associated with race, education, participation in the Nutrition Program for Women, Infants and Children (WIC), and census tract-level income (all χ² p < 0.01). Urban-born movers tended to be born in a census tract with a higher Social Vulnerability Index than non-movers (t-test p < 0.01). No factors were statistically significantly associated with any of the residential mobility metrics in suburban/rural-born children, although the sample size was small.

IMPACT STATEMENT: In this study of a vulnerable population of children with cancer, we found that rural-born children were more likely to move than urban-born children, however, the frequency of movers changing census tracts was equivalent. Mobility in urban-born children, but not rural-born, was associated with several social factors, although the sample size for rural-born children was small. Mobility could be an important source of misclassification depending on the spatial heterogeneity and resolution of the exposure data and whether the social factors are related to exposures or health outcomes. Our results highlight the importance of considering differences in mobility between urban and rural populations in spatial research.

PMID:38148338 | DOI:10.1038/s41370-023-00636-9

Nat Commun. 2023 Dec 26;14(1):8504. doi: 10.1038/s41467-023-43967-9.

ABSTRACT

Forward genetic screens of mutated variants are a versatile strategy for protein engineering and investigation, which has been successfully applied to various studies like directed evolution (DE) and deep mutational scanning (DMS). While next-generation sequencing can track millions of variants during the screening rounds, the vast and noisy nature of the sequencing data impedes the estimation of the performance of individual variants. Here, we propose ACIDES that combines statistical inference and in-silico simulations to improve performance estimation in the library selection process by attributing accurate statistical scores to individual variants. We tested ACIDES first on a random-peptide-insertion experiment and then on multiple public datasets from DE and DMS studies. ACIDES allows experimentalists to reliably estimate variant performance on the fly and can aid protein engineering and research pipelines in a range of applications, including gene therapy.

PMID:38148337 | DOI:10.1038/s41467-023-43967-9

J Obstet Gynaecol Res. 2023 Dec 26. doi: 10.1111/jog.15869. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to determine the effect of progressive relaxation exercises (PRE) and transcutaneous electrical nerve stimulation administered to women delivering via cesarean delivery on acute pain, breastfeeding success, and comfort levels.

METHODS: This is a single-blind, randomized controlled study. This study was carried out in the obstetrics and gynecology clinic of a university hospital affiliated with the Ministry of Health in Turkey between August 20, 2018 and April 15, 2019. A total of 120 participants were randomly assigned to one of four groups, which included a transcutaneous electrical neural stimulation (TENS) group, a PRE group, a combined intervention group, and a control group. Data were collected with a Data Collection Form, The Visual Analogue Scale, The LATCH Breastfeeding Diagnostic Tool, and The Postpartum Comfort Scale.

RESULTS: According to the findings of the study, it was determined that pain significantly decreased and comfort increased after having a cesarean delivery in all three intervention groups compared to the control group (p < 0.05). Regarding the breastfeeding success, while there was no statistically significant change in this behavior in the TENS group, it was significantly better in the PRE group and the combined intervention group, where TENS and PRE were administered together (p < 0.05).

CONCLUSIONS: According to our study results, we recommend that TENS and PRE should be employed together after a cesarean delivery as safe non-pharmacological methods in pain management, eliminating breastfeeding problems, and increasing comfort.

PMID:38148300 | DOI:10.1111/jog.15869

Neuroradiol J. 2023 Dec 26:19714009231224447. doi: 10.1177/19714009231224447. Online ahead of print.

ABSTRACT

BACKGROUND: For patients with oral cavity squamous cell carcinoma (OCSCC) without evidence of nodal metastasis (cN0) on pre-operative evaluation, there are no clear guidelines who should undergo elective neck dissection (END) versus clinical surveillance.

OBJECTIVE: To identify CT imaging characteristics of sub-centimeter lymph nodes that would help predict the likelihood of nodal metastases on pathology.

METHODS: Retrospective review of cN0 OCSCC patients at a tertiary academic medical center was performed. Inclusion criteria included elective neck dissection, pre-operative CT imaging and presence of metastatic disease within lymph nodes. Control group consisted of patients without nodal metastases on pathology. CT features that were evaluated included asymmetric size, disrupted fatty hilum, asymmetric number, presence of cortical nodule, cortical nodule size, and round/oval shape. We evaluated the associations between CT LN features and the presence of metastases using multi-level mixed-effects logistic regression models. Model evaluation was performed using 5-fold cross-validation. The positive predictive value (PPV) and negative predictive value (NPV) were calculated.

RESULTS: 26 patients in each study and control groups were included. Three-level mixed-effects logistic regression models indicated round/oval shape (OR = 1.39, p = .01), asymmetric number (OR = 7.20, p = .005), and disrupted fatty hilum (OR = 3.31, p = .04) to be independently predictive in a 3-variable model with sensitivity = 38.0%, specificity = 92.0%, and PPV = 93.8%.

CONCLUSIONS: In cN0 OCSCC patients undergoing END, round/oval shape, asymmetric number, and disrupted fatty hilum of lymph nodes on pre-operative CT imaging are novel and highly predictive of occult nodal disease.

PMID:38148295 | DOI:10.1177/19714009231224447

PM R. 2023 Dec 26. doi: 10.1002/pmrj.13118. Online ahead of print.

ABSTRACT

INTRODUCTION: Musculoskeletal (MSK) pathologies significantly impact the rehabilitation course for patients admitted to an inpatient rehabilitation facility (IRF). The impact of a specialized inpatient MSK consult service has not been previously evaluated.

OBJECTIVE: To assess the demographics, pathologies, and impact on pain scores of patients who were evaluated by a specialized MSK consult service.

DESIGN: Retrospective descriptive analysis of patients at an IRF who were evaluated by the MSK consult service.

SETTING: Academic IRF.

PATIENTS (OR PARTICIPANTS): 230 patients evaluated by the MSK consult service over 4.5 years.

INTERVENTIONS: MSK consult service composed of sports medicine fellowship-trained physiatrists who utilize history, physical examination, point-of-care ultrasound and specialized MSK knowledge to assess and address MSK barriers to functional improvement.

MAIN OUTCOME MEASURE(S): Primary rehabilitation diagnosis, length of stay, discharge destination, reason for consult, MSK diagnosis, need for injection, change in numerical pain rating scale (NPRS) pain scores, change in Functional Independence Measures (FIM).

RESULTS: 230 consults met inclusion criteria for analysis. The most common complaints were shoulder pain (47%), knee pain (30%), and hip/groin pain (10.4%). The MSK consult service made 82 different musculoskeletal and neuromuscular diagnoses. The most common primary rehabilitation diagnosis was stroke (28.3%). Injections were performed in 44.3% of consults, with an average reduction in NPRS pain score of 2.3 (SD 1.9) and a statistically significant reduction in average NPRS pain scores in patients who underwent injections compared to those who did not (p < 0.0001).

CONCLUSIONS: This study is the first to examine the use of an innovative inpatient MSK physiatry consult service in an IRF. This promising consult service can play a pivotal role in patient care by reducing functionally limiting musculoskeletal pain to allow for better toleration of therapies and to optimize functional gains.

PMID:38148275 | DOI:10.1002/pmrj.13118

Physiol Plant. 2023 Nov-Dec;175(6):e14069. doi: 10.1111/ppl.14069.

ABSTRACT

Wheat is one of the most important cereal crops in the world. Cold stress is a major constraint in production of wheat grown in cold climate regions. In this study, we conducted a comprehensive assessment of cold stress tolerance in wheat genotypes through field screening, cell membrane stability through electrolyte leakage assay and biochemical profiling. A core set comprising 4560 genotypes was evaluated for two years (2021-2022), revealing substantial genetic variation for cold stress tolerance. Most genotypes exhibited moderate tolerance, while a smaller proportion showed susceptibility to cold stress. Based on the cold screening data in the field, a mini-core set of 350 genotypes was selected for membrane stability analysis using electrical conductivity assays. Significant differences were observed in membrane stability among the genotypes, indicating the presence of genetic variation for this trait. Furthermore, a mini-core set was narrowed down to 50 diverse candidate genotypes that were subsequently profiled for various biochemicals, including reactive oxygen species (ROS) like lipid peroxidation (MDA) and hydrogen peroxide (H₂ 0₂ ), osmoprotectant (proline) and enzymatic antioxidants including ascorbate peroxidase (APX), superoxide dismutase (SOD), guaiacol peroxidase (GPX), and catalase (CAT). Correlation analysis of the biochemicals revealed negative associations between antioxidants and reactive oxygen species (ROS), highlighting their role in mitigating oxidative damage under cold stress. This study enhances our understanding of the physiological and biochemical mechanisms underlying cold stress tolerance in wheat. The identified genotypes with superior cold stress tolerance can serve as valuable genetic resources for wheat breeding.

PMID:38148247 | DOI:10.1111/ppl.14069

Physiol Plant. 2023 Nov-Dec;175(6):e14085. doi: 10.1111/ppl.14085.

ABSTRACT

Foliar N-fertilization (FNf) has emerged as a promising approach to synchronize plant nitrogen (N) demands and application timing, reducing the N losses to the environment associated with traditional soil-based fertilization methods. However, limited information exists regarding the effectiveness of FNf in sugarcane. This study aimed to optimize FNf in sugarcane by evaluating N-fertilizer recovery by the plant (NRP) and assessing potential toxicity effects. Four sugarcane genotypes were subjected to FNf using ¹⁵ N-urea at five nitrogen concentrations. NRP was assessed at five time points for roots, stalk, old leaves, ¹⁵ N-urea-fertilized leaves (¹⁵ NL), and unexpanded leaves (UEL). Leaf scorching, indicating FNf toxicity, was analyzed using morpho-anatomical and histochemical techniques. The results showed that FNf promoted high NRP, with an average recovery of 62.3%. Surprisingly, the redistribution of ¹⁵ N-urea did not follow the nitrogen uptake rate by sugarcane leaves, with an average of 41.3% of the total-NRP. The stalk emerged as the primary sink for ¹⁵ N-urea, followed by the UEL. Genotypes differed in the leaf scorching intensity, which increased with higher concentration of ¹⁵ N-urea. Genotypes also differed in the ¹⁵ N-urea uptake rate, down-regulated by the N content in the ¹⁵ NL. These findings emphasize that by carefully choosing the appropriate genotype and nitrogen concentration, FNf can significantly enhance N-fertilizer uptake, resulting in potential environmental and economic benefits.

PMID:38148209 | DOI:10.1111/ppl.14085

NMR Biomed. 2023 Dec 26:e5090. doi: 10.1002/nbm.5090. Online ahead of print.

ABSTRACT

This study demonstrates the feasibility and performance of the point-resolved spectroscopy (PRESS)-based, single-shot diffusion trace-weighted sequence in quantifying the trace apparent diffusion coefficient (ADC) in phantom and in vivo using a 3-T MRI/MRS scanner. The single-shot diffusion trace-weighted PRESS sequence was implemented and compared with conventional diffusion-weighted (DW)-PRESS variants using bipolar and unipolar diffusion-sensitizing gradients. Nine phantom datasets were acquired using each sequence, and seven volunteers were scanned in three different brain regions to determine the range and variability of trace ADC values, and to allow a comparison of trace ADCs among the sequences. This sequence results in a comparatively stable range of trace ADC values that are statistically significantly higher than those produced from unipolar and bipolar DW-PRESS sequences. Only total n-acetylaspartate, total creatine, and total choline were reliably estimated in all sequences with Cramér-Rao lower bounds of, at most, 20%. The larger trace ADCs from the single-shot sequences are probably attributable to the shorter diffusion time relative to the other sequences. Overall, this study presents the first demonstration of the single-shot diffusion trace-weighted sequence in a clinical scanner at 3 T. The results show excellent agreement of phantom trace ADCs computed with all sequences, and in vivo ADCs agree well with the expected differences between gray and white matter. The diffusion trace-weighted sequence could provide an estimate of the trace ADC in a shorter scan time (by nearly a factor of 3) compared with conventional DW-PRESS approaches that require three separate orthogonal directions.

PMID:38148181 | DOI:10.1002/nbm.5090

Dig Endosc. 2023 Dec 26. doi: 10.1111/den.14752. Online ahead of print.

ABSTRACT

BACKGROUND: We previously demonstrated that a favorable long-term prognosis indicated that endoscopic submucosal dissection (ESD) could be the standard treatment for large colorectal epithelial neoplasms, but the usefulness of ESD for local residual or recurrent tumors with submucosal fibrosis has not been fully demonstrated. The aim of the present study was to assess the usefulness of ESD for local residual or recurrent colorectal tumors.

METHODS: We conducted a nationwide multicenter prospective study to evaluate the outcomes of ESD for colorectal tumors. In this post-hoc analysis, a total of 54 local residual or recurrent colorectal tumors in 54 patients were included, and we analyzed the short-term and long-term outcomes of ESD for these lesions.

RESULTS: The median size of the lesions was 16.0 (IQR;11-25) mm. ESD was completed in 53 cases (98.1%) with a median procedure time of 65.0 min, but it was discontinued in one case due to submucosal cancer invasion. En-bloc resection was achieved in 52 cases (96.3%), while R0 resection was achieved in 45 cases (83.3%). Intraoperative perforation was observed in 4 cases (7.4%) and delayed perforation in 1 case (1.9%), but all cases could be managed conservatively. Delayed bleeding was not observed. There were no significant differences in short-term outcomes between the rectal and colonic lesions. There was no recurrence of the tumor during the median follow-up period of 60 months (IQR 50-64).

CONCLUSION: An analysis of our multicenter prospective study suggests that ESD is an effective salvage management for local residual or recurrent colorectal lesions.

PMID:38148178 | DOI:10.1111/den.14752