Category: Statistics

Minerva Cardiol Angiol. 2023 Dec 12. doi: 10.23736/S2724-5683.23.06368-8. Online ahead of print.

ABSTRACT

BACKGROUND: Paravalvular leakage (PVL) is a common finding after transcatheter aortic valve replacement (TAVR) and affects late clinical outcome. It is more frequent with self-expandable (SE) transcatheter-heart-valve (THV). Few is known about SE-THV expansion after implantation. The purpose is to assess SE-THV frame expansion and its possible influence on PVL.

METHODS: We designed a prospective pilot study to assess the time-course of SE-THV frame dimensions and PVL after TAVR. Consecutive patients undergoing TAVR with SE-THV were enrolled. Prosthesis fluoroscopy and echocardiography were prospectively performed immediately after TAVR (T0) and before discharge (T1) to grade PVL. Prosthesis diameters were assessed in 2 fluoroscopic orthogonal views. PVL reduction ≥1+ from T0 to T1 at echocardiography was the primary study endpoint.

RESULTS: Twenty-five patients were enrolled. Mean interval between T0 and T1 evaluations was 5 days. Grade 1 or 2 was present in 76% of patients at T0 and in 68% at T1 (P=0.034). A total of 7 patients (28%) improved PVL ≥1 grade from T0 to T1. Differences between T0 and T1 fluoroscopic diameters were not statistically significant. When comparing the diameter changes according to PVL evolution, patients with PVL improvement (as compared with those without) had significantly larger minimum diameter increase at both annulus/inflow (P=0.016) and outflow/distal edge (P=0.027).

CONCLUSIONS: PVL may improve in the early days after SE-THV and those patients with PVL improvement may have THV frame expansion. Further studies are needed to confirm such preliminary observations and to establish the clinical relevance of this phenomenon.

PMID:38088090 | DOI:10.23736/S2724-5683.23.06368-8

Urol J. 2023 Dec 13. doi: 10.22037/uj.v20i.7758. Online ahead of print.

ABSTRACT

PURPOSE: To analyze the risk factors for the relapse of prostate cancer (PC) after radical prostatectomy (RP) and build a nomogram as a predictive model. Materials andMethods: The patients who underwent PR from March 2019 to February 2022 were retrospectively enrolled in our hospital’s case system. During the follow-up process, two consecutive prostate-specific antigens (PSA) ≥0.2 μg/L were performed. And needle biopsy was performed to further determine whether the patient had prostate cancer recurrence. According to the follow-up results, the patients were divided into non-relapsed and relapsed groups.The related parameters of the two groups were collected. Independent risk factors for postoperative recurrence were determined using a Cox proportional hazards regression model. Statistical software, R, was used to build nomograms. R software was used to construct a nomogram, and the prediction effect of the nomogram was evaluated by the calibration curve and the area under the ROC curve (AUC).

RESULTS: Among the 367 patients who underwent RP, 112 (30.52%) had, and 255 (69.48%) did not have relapses after surgery. Cox multivariableregression analysis revealed that preoperative Gleason score, preoperative PSA, pathological staging, positive margin, and seminal vesicle invasion, were the risk factors for postoperative recurrence after RP (all P < 0.05). Verification of the predictive model by ROC curve demonstrated that the AUC of the ROC curves for patients’ relapses 3 and 5 years after RP was 0.986 (95%CI0.975-0.998) and 0.974 (95%CI0.961-0.987), respectively. This model validation showed that the results of the predictive model were basically consistent with the actual results, suggesting that the nomogram was able to accurately predict a patient’s relapse.

CONCLUSION: The nomogram of this study was a good predictor of postoperative recurrence of PC after RP, which will help doctors provide personalized treatment and follow-up strategies for patients.

PMID:38088088 | DOI:10.22037/uj.v20i.7758

Eur Psychiatry. 2023 Dec 13:1-36. doi: 10.1192/j.eurpsy.2023.2473. Online ahead of print.

NO ABSTRACT

PMID:38088068 | DOI:10.1192/j.eurpsy.2023.2473

Psychiatr Serv. 2023 Dec 13:appips20230134. doi: 10.1176/appi.ps.20230134. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine potential health disparities due to a broad reliance on telehealth during the COVID-19 pandemic, the authors studied the impact of video-enabled tablets provided by the U.S. Department of Veterans Affairs (VA) on psychotherapy usage among rural versus urban, Black versus White, and female versus male veterans.

METHODS: Psychotherapy usage trends before and after onset of the COVID-19 pandemic were examined among veterans with at least one mental health visit in 2019 (63,764 tablet recipients and 1,414,636 nonrecipients). Adjusted difference-in-differences and event study analyses were conducted to compare psychotherapy usage among tablet recipients and nonrecipients (March 15, 2020-December 31, 2021) 10 months before and after tablet issuance. Analyses were stratified by rurality, sex, and race.

RESULTS: Adjusted analyses demonstrated that tablet receipt was associated with increases in psychotherapy visit frequency in every patient group studied (rural, 27.4%; urban, 24.6%; women, 30.5%; men, 24.4%; Black, 20.8%; White, 28.1%), compared with visits before tablet receipt. Compared with men, women had statistically significant tablet-associated psychotherapy visit increases (video visits, 1.2 per year; all modalities, 1.0 per year).

CONCLUSIONS: VA-issued tablets led to increased psychotherapy usage for all groups examined, with similar increases found for rural versus urban and Black versus White veterans and higher increases for women versus men. Eliminating barriers to Internet access or device ownership may improve mental health care access among underserved or historically disadvantaged populations. VA’s tablet program offers insights to inform policy makers’ and health systems’ efforts to bridge the digital divide.

PMID:38088041 | DOI:10.1176/appi.ps.20230134

Pharmacotherapy. 2023 Dec 13. doi: 10.1002/phar.2900. Online ahead of print.

ABSTRACT

BACKGROUND: Most patients receiving Low-molecular-weight heparin therapy do not require routine coagulation monitoring, but due to uncertainty in certain populations, clinicians may feel compelled to perform anti-Xa monitoring.

METHODS: This retrospective cohort study compared clinical outcomes in propensity-score matched adult inpatients from an academic health care system who did and did not receive anti-Xa monitoring of enoxaparin for venous thromboembolism prophylaxis. The primary outcome was the composite of any venous thromboembolism, any bleeding, and mortality in the 30 days following enoxaparin initiation. Secondary outcomes were the individual components of the composite outcome and major bleeding.

RESULTS: During the 13-month study period, a total of 6,611 patients received enoxaparin for venous thromboembolism prophylaxis, 301 in the anti-Xa monitored group and 6,310 in the unmonitored group (4.6% received monitoring). The mean age was 52.9 years and 52% of patients were male. The mean body mass index was 31 kg/m² and the mean creatinine clearance was 109 mL/min. Twenty percent of patients had active cancer. The most common indication for enoxaparin prophylaxis was hospitalization for medical illness (52%) followed by non-orthopedic surgery (37%). The adjusted odds ratio for the primary outcome comparing monitored to unmonitored patients was 1.26 (95% confidence interval, 0.75-2.11). None of the between group differences in the individual components of the composite outcome were statistically significant.

CONCLUSIONS: Thirty-day clinical outcomes in patients receiving enoxaparin for venous thromboembolism prophylaxis were not improved by anti-Xa monitoring. Our results support current evidence-based guideline recommendations against anti-Xa monitoring for patients receiving enoxaparin for venous thromboembolism prophylaxis.

PMID:38088033 | DOI:10.1002/phar.2900

BMC Surg. 2023 Dec 12;23(1):377. doi: 10.1186/s12893-023-02283-1.

ABSTRACT

BACKGROUND: To systematically assess the safety and effectiveness of titanium mesh grafting compared with bone grafting in the treatment of spinal tuberculosis.

METHODS: Electronic databases, including PubMed, Embase, Web of Science, and Cochrane Library, were searched from their inception until April 2023. The outcome indicators for patients treated with titanium mesh grafting or bone grafting for spinal tuberculosis include surgical duration, intraoperative blood loss, graft fusion time, American Spinal Injury Association (ASIA) Spinal Cord Injury Grade E assessment, VAS score, lumbar pain score, post-graft kyphotic angle, and postoperative complications. The Newcastle-Ottawa Scale (NOS) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach were used for quality assessment and evidence grading of clinical studies. Funnel plots and Begg’s test were employed for bias assessment.

RESULTS: A total of 8 studies were finally included, comprising 523 patients, with 267 cases of titanium mesh fixation and 256 cases of bone grafting. The meta-analysis showed no significant statistical differences in surgical duration (Weighted Mean Difference (WMD) = -7.20, 95% Confidence Interval (CI): -28.06 to 13.67, P = 0.499), intraoperative blood loss (WMD = 16.22, 95% CI: -40.62 to 73.06, P = 0.576), graft fusion time (WMD = 0.97, 95% CI: -0.88 to 2.81, P = 0.304), ASIA Spinal Cord Injury Grade E assessment (Relative Risk (RR) = 1.03, 95% CI: 0.97 to 1.09, P = 0.346), and overall complications (RR = 0.87, 95% CI: 0.49 to 1.55, P = 0.643). Differences in VAS score, ODI lumbar pain score, and post-graft kyphotic angle between the titanium mesh grafting group and the bone grafting group were not significant within the 95% CI range. The rate of postoperative implant subsidence was slightly lower in bone grafting than in titanium mesh grafting (RR = 9.30, 95% CI: 1.05 to 82.22, P = 0.045).

CONCLUSIONS: Both bone grafting and titanium mesh grafting are effective and safe for the surgery, with no significant statistical differences in the results. Considering the limitations of the present study, large-scale randomized controlled trials are warranted to further verify the reliability of this finding.

PMID:38087216 | DOI:10.1186/s12893-023-02283-1

BMC Genomics. 2023 Dec 12;24(1):768. doi: 10.1186/s12864-023-09861-w.

ABSTRACT

Early detection of human disease is associated with improved clinical outcomes. However, many diseases are often detected at an advanced, symptomatic stage where patients are past efficacious treatment periods and can result in less favorable outcomes. Therefore, methods that can accurately detect human disease at a presymptomatic stage are urgently needed. Here, we introduce “frequentmers”; short sequences that are specific and recurrently observed in either patient or healthy control samples, but not in both. We showcase the utility of frequentmers for the detection of liver cirrhosis using metagenomic Next Generation Sequencing data from stool samples of patients and controls. We develop classification models for the detection of liver cirrhosis and achieve an AUC score of 0.91 using ten-fold cross-validation. A small subset of 200 frequentmers can achieve comparable results in detecting liver cirrhosis. Finally, we identify the microbial organisms in liver cirrhosis samples, which are associated with the most predictive frequentmer biomarkers.

PMID:38087204 | DOI:10.1186/s12864-023-09861-w

BMC Microbiol. 2023 Dec 12;23(1):396. doi: 10.1186/s12866-023-03094-3.

ABSTRACT

Malaria is a persistent illness that is still a public health issue. On the other hand, marine organisms are considered a rich source of anti‑infective drugs and other medically significant compounds. Herein, we reported the isolation of the actinomycete associated with the Red Sea sponge Callyspongia siphonella. Using “one strain many compounds” (OSMAC) approach, a suitable strain was identified and then sub-cultured in three different media (M1, ISP2 and OLIGO). The extracts were evaluated for their in-vitro antimalarial activity against Plasmodium falciparum strain and subsequently analyzed by Liquid chromatography coupled with high-resolution mass spectrometry (LC-HR-MS). In addition, MetaboAnalyst 5.0 was used to statistically analyze the LC-MS data. Finally, Molecular docking was carried out for the dereplicated metabolites against lysyl-tRNA synthetase (PfKRS1). The phylogenetic study of the 16S rRNA sequence of the actinomycete isolate revealed its affiliation to Streptomyces genus. Antimalarial screening revealed that ISP2 media is the most active against Plasmodium falciparum strain. Based on LC-HR-MS based metabolomics and multivariate analyses, the static cultures of the media, ISP2 (ISP2-S) and M1 (M1-S), are the optimal media for metabolites production. OPLS-DA suggested that quinone derivatives are abundant in the extracts with the highest antimalarial activity. Fifteen compounds were identified where eight of these metabolites were correlated to the observed antimalarial activity of the active extracts. According to molecular docking experiments, saframycin Y3 and juglomycin E showed the greatest binding energy scores (-6.2 and -5.13) to lysyl-tRNA synthetase (PfKRS1), respectively. Using metabolomics and molecular docking investigation, the quinones, saframycin Y3 (5) and juglomycin E (1) were identified as promising antimalarial therapeutic candidates. Our approach can be used as a first evaluation stage in natural product drug development, facilitating the separation of chosen metabolites, particularly biologically active ones.

PMID:38087203 | DOI:10.1186/s12866-023-03094-3

BMC Palliat Care. 2023 Dec 12;22(1):198. doi: 10.1186/s12904-023-01317-y.

ABSTRACT

OBJECTIVE: The aims of the study were first to explore the adaptive leisure activities of classified nursing model from the perspective of nurse-patient interactive care, and to explore its impact on the physical and mental health of patients with colon cancer.

METHODS: From September 2017 to March 2022 as the observation time node, 82 patients with colon cancer who met the established inclusion and exclusion criteria were regarded as the research objects through the random number table as the grouping tool. The two groups of patients were named as the research group and the control group, with 41 patients in each group. The control group implemented routine nursing measures, and the research group implemented classified nursing mode and adaptive leisure activity mode. The two groups of patients received 4 weeks of nursing intervention. With the help of self-rating anxiety scale, self-rating depression scale, self-care ability evaluation scale and health status survey brief form, the two groups of patients were compared before intervention and at the end of the 4th week after intervention.

RESULTS: After the intervention, the anxiety score (t = 6.656, p < 0.001) and depression score (t = 4.851, p < 0.001) of the research group were lower than those of the control group, and the difference was statistically significant. After the intervention, the self-concept (t = 4.845, p < 0.001), self-responsibility (t = 6.071, p < 0.001), self-care skills (t = 3.341, p < 0.001), health knowledge (t = 3.698, p < 0.001) and total score (t = 9.246, p < 0.001) of the research group were higher than those of the control group, and the difference was statistically significant. After the intervention, physical functioning (t = 8.141, p < 0.001), bodily pain (t = 6.083, p < 0.001), general health (t = 9.424, p < 0.001), role-physical (t = 8.057, p < 0.001), role-emotional (t = 13.252, p < 0.001), mental health (t = 12.565, p < 0.001), social functioning (t = 10.813, p < 0.001) and vitality score (t = 12.890, p < 0.001) of the research group were higher than those of the control group, with significant differences.

CONCLUSION: Interactive care through adaptive leisure nursing improves mental well-being, self-management, and psychosocial functioning in elderly colon cancer patients, promoting overall health.

PMID:38087201 | DOI:10.1186/s12904-023-01317-y

J Gen Intern Med. 2023 Dec 12. doi: 10.1007/s11606-023-08415-w. Online ahead of print.

ABSTRACT

BACKGROUND: We define a “flagship hospital” as the largest academic hospital within a hospital referral region and a “flagship system” as a system that contains a flagship hospital and its affiliates. It is not known if patients admitted to an affiliate hospital, and not to its main flagship hospital, have better outcomes than those admitted to a hospital outside the flagship system but within the same hospital referral region.

OBJECTIVE: To compare mortality at flagship hospitals and their affiliates to matched control patients not in the flagship system but within the same hospital referral region.

DESIGN: A matched cohort study PARTICIPANTS: The study used hospitalizations for common medical conditions between 2018-2019 among older patients age ≥ 66 years. We analyzed 118,321 matched pairs of Medicare patients admitted with pneumonia (N=57,775), heart failure (N=42,531), or acute myocardial infarction (N=18,015) in 35 flagship hospitals, 124 affiliates, and 793 control hospitals.

MAIN MEASURES: 30-day (primary) and 90-day (secondary) all-cause mortality.

KEY RESULTS: 30-day mortality was lower among patients in flagship systems versus control hospitals that are not part of the flagship system but within the same hospital referral region (difference= -0.62%, 95% CI [-0.88%, -0.37%], P<0.001). This difference was smaller in affiliates versus controls (-0.43%, [-0.75%, -0.11%], P=0.008) than in flagship hospitals versus controls (-1.02%, [-1.46%, -0.58%], P<0.001; difference-in-difference -0.59%, [-1.13%, -0.05%], P=0.033). Similar results were found for 90-day mortality.

LIMITATIONS: The study used claims-based data.

CONCLUSIONS: In aggregate, within a hospital referral region, patients treated at the flagship hospital, at affiliates of the flagship hospital, and in the flagship system as a whole, all had lower mortality rates than matched controls outside the flagship system. However, the mortality advantage was larger for flagship hospitals than for their affiliates.

PMID:38087179 | DOI:10.1007/s11606-023-08415-w