Category: Statistics

Eur J Vasc Endovasc Surg. 2023 Aug 1:S1078-5884(23)00614-7. doi: 10.1016/j.ejvs.2023.07.048. Online ahead of print.

ABSTRACT

OBJECTIVE: Fenestrated and branched thoracic endovascular aortic repair (f/b-TEVAR) of the aortic arch is a viable approach in patients unsuitable for open repair. The aim is to summarise the published results of manufactured f/b-TEVAR devices for partial and total repair of the aortic arch, and to compare fenestrated vs. branched configurations.

DATA SOURCES: PubMed, Scopus and The Cochrane Library were searched for articles (2018 – 2021) about patients with elective/urgent/emergent aortic requiring a proximal landing zone in the aortic arch (zone 0 – 1 – 2) and treated by f/b-TEVAR.

REVIEW METHODS: Systematic review and meta-analysis were performed according to the PRISMA guidelines. Open repair, supra-aortic trunk (SAT) debranching + standard TEVAR, and in situ/physician modified/parallel grafts were excluded. Primary outcomes were technical success and 30 day mortality. Secondary outcomes were 30 day major adverse events, and overall survival and procedure related endpoints during follow up.

RESULTS: Out of 458 articles screened, 18 articles involving 571 patients were selected. Indications for intervention were chronic dissections (50.1%), degenerative aneurysms (39.6%), penetrating aortic ulcers (7.4%), and pseudoaneurysms (2%). f-TEVAR, b-TEVAR, and f + b-TEVAR were used in 38.4%, 54.1%, and 7.5% of patients, respectively. Overall, technical success was 95.9% (95% confidence interval [CI] 0.93 – 0.97; I² = 0%; p for heterogeneity (Het) = .77) and 30 day mortality was 6.7% (95% CI 0.05 – 0.09; I² = 0%; p Het = .66). No statistical differences were found comparing fenestrated vs. branched endografts, except for a higher rate of type I – III endoleaks in f-TEVAR (9.8% vs 2.6%; p = .034). Overall survival rate and freedom from aortic related death at the one year follow up ranged between 82 – 96.4% and 94 – 94.7%, respectively. Thirteen and five studies were considered at moderate and high risk of bias, respectively.

CONCLUSION: f/b-TEVAR for the treatment of the aortic arch, nowadays show, according to experience in dedicated centres, a satisfactory level of technical success together with progressive lowered load in terms of early mortality. There are of several limitations, and further studies are needed to reach clearer conclusions.

PMID:37536517 | DOI:10.1016/j.ejvs.2023.07.048

Drug Alcohol Depend. 2023 Jul 28;250:110910. doi: 10.1016/j.drugalcdep.2023.110910. Online ahead of print.

ABSTRACT

BACKGROUND: Although homelessness is a well-documented risk factor for drug overdose at the individual level, less is known about state-level homelessness and overdose mortality in the United States (US).

METHODS: This study used 2007-2020 panel data for all US states and the District of Columbia, from the following sources: US Department of Housing and Urban Development (homelessness data); Centers for Disease Control and Prevention (drug overdose death counts, population estimates, and opioid prescribing rates); Bureau of Labor Statistics (unemployment rates); and the National Forensic Laboratory Information System (drug seizure data). Two-way (state and year) fixed effects models regressed log-transformed drug overdose mortality rates on homelessness prevalence, in nested models adding demographic composition and unemployment measures, as well as drug supply measures. Models were weighted by state population size, and standard errors (SEs) were clustered at the state level.

RESULTS: Homelessness prevalence was significantly and positively associated with rates of drug overdose mortality after adjusting for nationwide trends, time-invariant differences between states, demographic composition, and unemployment rates (b[SE]=0.98[0.36], p=0.009). The positive association between homelessness prevalence and overdose mortality was attenuated at higher levels of fentanyl availability (fentanyl involvement in drug seizures; interaction term b[SE]=-0.02[0.01], p=0.001).

CONCLUSION: The positive association between state-level homelessness and drug overdose mortality suggests that policies and programs to prevent and reduce homelessness represent fundamental elements of a comprehensive response to the US overdose crisis.

PMID:37535991 | DOI:10.1016/j.drugalcdep.2023.110910

Rev Med Inst Mex Seguro Soc. 2023 Jul 31;61(4):420-426. doi: 10.5281/zenodo.8200105.

ABSTRACT

BACKGROUND: Currently, epithelial ovarian cancer is diagnosed in advanced stages (EC IIIC) in 75-80% of cases worldwide. In this group of patients treatment with neoadjuvant chemotherapy is started, followed by interval cytoreduction of residual disease and even require peritonectomy with application of hyperthermic intraperitoneal chemotherapy (HIPEC).

OBJECTIVE: To identify the overall survival and progression-free survival associated with peritonectomy, in patients with peritoneal carcinomatosis secondary to ovarian cancer treated in the oncology gynecology service from January 2009 to January 2019 at the UMAE Hospital de Oncología Centro Médico Nacional Siglo XXI.

MATERIAL AND METHODS: Observational, descriptive, cross-sectional, retrospective study, information was obtained from the clinical file of patients treated with peritonectomy with the use of hyperthermic intraperitoneal chemotherapy in the gynecological oncology service from January 2009 to January 2019 at the UMAE Hospital de Oncología Centro Médico Nacional Siglo XXI.

RESULTS: Information was obtained from a total of 36 patients (n=100%), 36.1% received intraperitoneal chemotherapy and 63.8% underwent cytoreduction without the application of intraoperative chemotherapy. The most frequently used drug was cisplatin followed by mitomycin. There was no statistical significance when comparing both groups, however there was a trend in favor of the use of intraoperative chemotherapy by obtaining a greater number of months in terms of overall survival.

CONCLUSION: Peritonectomy with hyperthermic intraperitoneal chemotherapy is an option in selected patients with advanced stage ovarian cancer in primary and recurrent surgery, as well as in patients with platinum-resistant ovarian cancer.

PMID:37535978 | DOI:10.5281/zenodo.8200105

Med Phys. 2023 Aug 3. doi: 10.1002/mp.16645. Online ahead of print.

ABSTRACT

PURPOSE: The recently proposed sparsifying transform (ST) models incur low computational cost and have been applied to medical imaging. Meanwhile, deep models with nested network structure reveal great potential for learning features in different layers. In this study, we propose a network-structured ST learning approach for X-ray computed tomography (CT), which we refer to as multi-layer clustering-based residual sparsifying transform (MCST) learning. The proposed MCST scheme learns multiple different unitary transforms in each layer by dividing each layer’s input into several classes. We apply the MCST model to low-dose CT (LDCT) reconstruction by deploying the learned MCST model into the regularizer in penalized weighted least squares (PWLS) reconstruction.

METHODS: The proposed MCST model combines a multi-layer sparse representation structure with multiple clusters for the features in each layer that are modeled by a rich collection of transforms. We train the MCST model in an unsupervised manner via a block coordinate descent (BCD) algorithm. Since our method is patch-based, the training can be performed with a limited set of images. For CT image reconstruction, we devise a novel algorithm called PWLS-MCST by integrating the pre-learned MCST signal model with PWLS optimization.

RESULTS: We conducted LDCT reconstruction experiments on XCAT phantom data, Numerical Mayo Clinical CT dataset and “LDCT image and projection dataset” (Clinical LDCT dataset). We trained the MCST model with two (or three) layers and with five clusters in each layer. The learned transforms in the same layer showed rich features while additional information is extracted from representation residuals. Our simulation results and clinical results demonstrate that PWLS-MCST achieves better image reconstruction quality than the conventional filtered back-projection (FBP) method and PWLS with edge-preserving (EP) regularizer. It also outperformed recent advanced methods like PWLS with a learned multi-layer residual sparsifying transform (MARS) prior and PWLS with a union of learned transforms (ULTRA), especially for displaying clear edges and preserving subtle details.

CONCLUSIONS: In this work, a multi-layer sparse signal model with a nested network structure is proposed. We refer this novel model as the MCST model that exploits multi-layer residual maps to sparsify the underlying image and clusters the inputs in each layer for accurate sparsification. We presented a new PWLS framework with a learned MCST regularizer for LDCT reconstruction. Experimental results show that the proposed PWLS-MCST provides clearer reconstructions than several baseline methods. The code for PWLS-MCST is released at https://github.com/Xikai97/PWLS-MCST.

PMID:37535932 | DOI:10.1002/mp.16645

Altern Ther Health Med. 2023 Aug 4:AT9165. Online ahead of print.

ABSTRACT

BACKGROUND: Nephrotic syndrome is characterized by prolonged duration, frequent relapses, various comorbidities, and complex management. Although children with nephrotic syndrome generally adhere well to medical protocols during hospitalization under close supervision, post-discharge adherence to care plans often poses challenges.

OBJECTIVE: This study aims to investigate the impact of continuous home care on nursing compliance, immune function, and quality of life among pediatric patients diagnosed with nephrotic syndrome.

METHODS: A retrospective analysis was conducted on ninety-eight cases of discharged children with nephrotic syndrome admitted to our hospital from January 2020 to January 2023. Based on different nursing programs, the children were divided into two groups: 54 cases in the observation group and 54 cases in the comparison group. The observation group received continuous home care involving assessment of nursing problems, care, and effect evaluation, while the comparison group received conventional pre-discharge health education and regular telephone follow-up after discharge. Nursing care compliance, immune function, and quality of life were compared between the two groups.

RESULTS: The observation group demonstrated significantly higher compliance rates in areas such as diet, fluid intake, medication, dialysis regimen, daily life, and exercise compared to the control group (P < .05). Aftercare, the observation group showed greater disease cognitive ability, disease-related behaviors, beliefs about the disease, and overall scores compared to the control group, with statistical significance (P < .05). Moreover, the quality-of-life index scores of children in both groups improved aftercare, with the observation group showing higher scores in behavioral ability, physical function, psychological function, and social function compared to the control group, and these differences were statistically significant (P < .05).

CONCLUSIONS: Implementing ongoing home care for children diagnosed with nephrotic syndrome significantly enhances their overall quality of life, particularly in terms of familial dynamics, self-perception, and adherence to medical treatment.

PMID:37535920

Altern Ther Health Med. 2023 Aug 4:AT8581. Online ahead of print.

ABSTRACT

OBJECTIVE: Narrative nursing intervention was given to patients after bone and joint replacement to analyze the emotional effects of the intervention on patients after bone and joint replacement.

METHOD: Retrospective analysis was performed on the clinical information of 50 patients who underwent bone and joint replacement and were admitted to our hospital between January 2021 and February 2022. Depending on various nursing techniques, fifty patients who had undergone joint and bone replacements were randomly assigned into two groups consisting of 25 individuals each. One group served as the control group, while the other group acted as the observation group. Various nursing techniques were employed for both groups. Scores for quality of life, compliance with nursing standards, overall nursing satisfaction, complication rates, and anxiety and depression before and after nursing were compared between the two groups. Additionally, the pain scores before and 3 days, one week, and two weeks after nursing were compared between the two groups.

RESULTS: Before the nursing intervention, the differences in each observed index between the two groups were not significant. Following the nursing intervention, the observation group’s nursing compliance, total nursing satisfaction rate, and quality of life score were higher than those of the control group, and there was a statistically significant difference between the groups when comparing the corresponding data, with P < .05. After nursing, the observation group’s index of complication rate was lower than that of the control group, with P < .05. Three days, one week, and two weeks after nursing, both groups’ pain, anxiety, and depression scores decreased. The changing trend in the observation group after the nursing intervention compared to before was more significant, and there was a statistical difference when compared to the corresponding data in the control group with P < .05.

CONCLUSIONS: Patients benefited from narrative nursing interventions following the implementation of bone or joint replacement because they increased nurse compliance and satisfaction, significantly improved quality of life, decreased complication rates, and decreased pain levels, all of which helped to stabilize the patient’s emotional state.

PMID:37535918

Altern Ther Health Med. 2023 Aug 4:AT8582. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to investigate the effectiveness of levosimendan in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection complicated by cardiac insufficiency and myocardial injury.

METHODS: A total of 22 patients with SARS-CoV-2 infection and myocardial injury, admitted to the Cardiology Department of our hospital between December 2022 and February 2023, are randomly divided into two groups: a dobutamine general treatment group and a levosimendan observation treatment group. The treatment outcomes of the two groups are compared and analyzed.

RESULTS: The overall improvement rate in the general treatment group is 80%, while the levosimendan treatment group shows a 100% improvement rate. There is a statistically significant difference between the two groups (P < .05). Post-treatment, the left ventricular ejection fraction for the general treatment group and the levosimendan treatment group are (48 ± 7)% and (54 ± 6)%, respectively. Additionally, the left ventricular end-diastolic diameter is (55.0 ± 3.0) mm in the general treatment group and (51 ± 5.0) mm in the levosimendan group, with a statistically significant difference (P < .05). After active treatment, the plasma levels of B-type natriuretic peptide (Brain Natriuretic Peptide, NT-proBNP) are significantly lower in the levosimendan treatment group than in the general treatment group (P < .05). Moreover, the plasma levels of interleukin-6 (IL-6) and C-reactive protein (CRP) in the levosimendan group decrease slightly faster than those in the general treatment group, with a statistically significant difference (P < .05). The length of hospital stay in the levosimendan group is (12 ± 3) days, significantly lower than the general treatment group (16 ± 5) days, with a statistically different result (P < .05).

CONCLUSIONS: Levosimendan demonstrates significant efficacy in patients with novel coronavirus infection complicated by myocardial injury, resulting in improved clinical symptoms, enhanced cardiac function, shorter hospital stays, early discharge, and cost savings.

PMID:37535909

JCO Glob Oncol. 2023 Aug;9:e2300057. doi: 10.1200/GO.23.00057.

ABSTRACT

PURPOSE: Early integration of pediatric palliative care (PPC) for children with cancer is critical to improving the quality of life of both the patient and family. Understanding physician perceptions of palliative care and perceived barriers to early integration is necessary to develop PPC in Brazil.

METHODS: The Assessing Doctors’ Attitudes on Palliative Treatment survey was modified for use in Brazil. The survey was open from January 2022 to June 2022 and distributed to physicians of all specialties from participating institutions who treat children with cancer. Statistical analysis was complemented by qualitative analysis of open-ended responses.

RESULTS: A total of 272 respondents participated. Most respondents reported access to PPC experts for consultation (77.2%) and 34.5% indicated previous palliative care training. Physician knowledge of PPC was generally aligned with WHO guidance (median alignment, 93.0%; range, 80.5%-98.2%). However, about half (53.3%) felt comfortable addressing physical needs of patients receiving PPC, 35.3% addressing emotional needs, 25.8% addressing spiritual needs, and 33.5% addressing grief and bereavement needs. Most respondents (65.4%) felt palliative care should be involved from diagnosis, but only 10.3% stated that this occurred in their setting. The most important barriers identified were physician discomfort (89.0%), limited physician knowledge (88.6%), and lack of home-based services (83.8%).

CONCLUSION: Despite a strong understanding of the role of palliative care, physicians in Brazil reported low confidence delivering PPC to children with cancer. Additionally, physicians generally believed that PPC should be integrated earlier in the disease trajectory of children with cancer. This work will direct educational and capacity building initiatives to ensure greater access to high-quality PPC for children with cancer in Brazil to address patient and family suffering.

PMID:37535886 | DOI:10.1200/GO.23.00057

Sleep. 2023 Aug 3:zsad207. doi: 10.1093/sleep/zsad207. Online ahead of print.

ABSTRACT

Growing evidence linked inflammation with sleep. This study aimed to evaluate the associations and causal effects of sleep traits including insomnia, excessive daytime sleepiness (EDS) and sleep duration (short:<7h; normal:7-9h; long:≥9h), with levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α) and interleukins. Standard procedures of quantitative analysis were applied to estimate the expression differences for each protein in compared groups. Then, a two-sample Mendelian randomization (MR) analysis was performed to explore their causal relationships with published GWAS summary statistics. The inverse-variance weighted (IVW) was used as the primary method, followed by several complementary approaches as sensitivity analyses. A total of 44 publications with 51879 participants were included in the quantitative analysis. Our results showed that the levels of CRP, IL-1β, IL-6 and TNF-α were higher from 0.36 to 0.58 (after standardization) in insomnia compared to controls, while there was no significant difference between participants with EDS and controls. Besides, there was a U/J-shaped expression of CRP and IL-6 with sleep durations. In MR analysis, the primary results demonstrated the causal effects of CRP on sleep duration (estimate:0.017; 95% CI, [0.003, 0.031]) and short sleep duration (estimate:-0.006; 95% CI, [-0.011, -0.001]). Also, IL-6 was found to be associated with long sleep duration (estimate:0.006; 95% CI, [0.000, 0.013]). These results were consistent in sensitivity analyses. There are high inflammatory profiles in insomnia and extremes of sleep duration. Meanwhile, elevated CRP and IL-6 have causal effects on longer sleep duration. Further studies can focus on related upstream and downstream mechanisms.

PMID:37535878 | DOI:10.1093/sleep/zsad207

ACS Nano. 2023 Aug 3. doi: 10.1021/acsnano.3c04147. Online ahead of print.

ABSTRACT

Alloying offers an increasingly important handle in nanomaterials design in addition to the already widely explored size and geometry of nanostructures of interest. As the key trait, the mixing of elements at the atomic level enables nanomaterials with physical or chemical properties that cannot be obtained by a single element alone, and subtle compositional variations can significantly impact these properties. Alongside the great potential of alloying, the experimental scrutiny of its impact on nanomaterial function is a challenge because the parameter space that encompasses nanostructure size, geometry, chemical composition, and structural atomic-level differences among individuals is vast and requires unrealistically large sample sets if statistically relevant and systematic data are to be obtained. To address this challenge, we have developed a microshutter device for spatially highly resolved physical vapor deposition in the lithography-based fabrication of nanostructured surfaces. As we demonstrate, it enables establishing compositional gradients across a surface with single nanostructure resolution in terms of alloy composition, which subsequently can be probed in a single experiment. As a showcase, we have nanofabricated arrays of AuAg, AuPd, and AgPd alloy nanoparticles with compositions systematically controlled at the level of single particle rows, as verified by energy dispersive X-ray and single particle plasmonic nanospectroscopy measurements, which we also compared to finite-difference time-domain simulations. Finally, motivated by their application in state-of-the-art plasmonic hydrogen sensors, we investigated PdAu alloy gradient arrays for their hydrogen sorption properties. We found distinctly composition-dependent kinetics and hysteresis and revealed a composition-dependent contribution of a single nanoparticle response to the ensemble average, which highlights the importance of alloy composition screening in single experiments with single nanoparticle resolution, as offered by the microshutter nanofabrication approach.

PMID:37535838 | DOI:10.1021/acsnano.3c04147