Category: Statistics

Ann Med. 2023 Dec;55(1):2236013. doi: 10.1080/07853890.2023.2236013.

ABSTRACT

BACKGROUND AND AIMS: Hepatic encephalopathy (HE) implies high morbidity and mortality. The assessment of covert HE (CHE) [i.e. minimal HE (MHE) plus grade 1 HE] is often neglected in Taiwan. Therefore, the aim was to investigate the potential of the animal naming test (ANT₁ and simplified ANT₁ (S-ANT₁₎) for assessing CHE in Chinese-speaking regions, specifically Taiwan.

METHODS: A prospective cohort study was conducted, comprising 65 cirrhotic patients and 29 healthy controls (relatives of the patients). Patients were followed up every three months and censored after two years or until death. Hospitalization for overt HE (OHE) and mortality were considered. All subjects underwent ANT₁, psychometric HE score (PHES), and mini-mental state examination (MMSE). The patients underwent an electroencephalogram (EEG) to detect slowing indicative of MHE. Cut-off values for ANT₁ and S-ANT₁ were assessed by ROC analysis and Youden’s index, considering CHE as a reference. The prognostic values for OHE and OHE-free survival were assessed.

RESULTS: Preliminary analysis confirmed that PHES ≤-4 is a good discriminant point for abnormal results. CHE was found in 29 patients: 9 had MHE (PHES ≤ -4 or altered EEG) and 20 had grade 1 HE. ANT₁ and S-ANT₁ were found to have diagnostic values for CHE: AUC = 0.807, 0.786; cut off: 18 and 19, respectively. ANT₁ and S-ANT₁ were found to have prognostic value for OHE, number of hospitalization episodes for OHE, and OHE recurrence-free survival.

CONCLUSIONS: ANT₁ shows promise as a tool for CHE detection, quantification, and follow-up in Taiwan and other Chinese-speaking regions.Key messagesThe animal naming test (ANT₁) is a simple and valid semantic fluency test that can be easily performed in outpatient or bedside settings in one minute and can also be used as a tool for covert hepatic encephalopathy (CHE) detection, quantification, and follow-up in Taiwan, other Chinese-speaking regions, and many other countries.The diagnostic value of ANT₁ and S-ANT₁ for CHE were found to be significant, with area under the receiver operating characteristic curve (AUROC) values of 0.807 and 0.786 respectively, and cut-off scores of 18 and 19.ANT₁ and S-ANT₁ have prognostic value for the first breakthrough of overt hepatic encephalopathy (OHE), number of hospitalization episodes for OHE, and OHE recurrence-free survival, independent of the MELD score.

PMID:37494454 | DOI:10.1080/07853890.2023.2236013

Health Policy Plan. 2023 Jul 26:czad056. doi: 10.1093/heapol/czad056. Online ahead of print.

ABSTRACT

Smokeless tobacco (SLT) consumption increases risk of cardiovascular diseases, different cancers and leads to adverse reproductive health outcomes among women and new-borns. This study examines the factors associated with initiation, continuation and cessation of SLT use among women in the reproductive age so as to formulate and include prevention and cessation interventions from its inception. The study was conducted in the urban low-income communities in India. Using snowball and purposive sampling techniques, in-depth interviews were conducted with 20 pregnant and 22 lactating women who currently used SLT products. Data was analysed using thematic analysis with the help of QSR NVivo software. Findings revealed that factors such as people influencing usage, change with different life stages including pre-marital and post-marital periods. Perceived health benefits, altered taste preferences during pregnancy and social influences were also studied. Women were found to be more aware of the harmful effects of tobacco during pregnancy than during breastfeeding. Social stigma around women consuming tobacco acted as a major driving factor for cessation. Most of the participants were willing to quit, but were not aware of any technique or program for cessation. The findings of the study highlight the need to develop behavioural change intervention tools which are culturally and locally appropriate and have a gender sensitive approach. Different socio-cultural factors associated with initiation/cessation at different life stages should also be taken into consideration while developing these tools.

PMID:37494416 | DOI:10.1093/heapol/czad056

PLoS One. 2023 Jul 26;18(7):e0289059. doi: 10.1371/journal.pone.0289059. eCollection 2023.

ABSTRACT

BACKGROUND: Individuals with an Opioid Use Disorder (OUD) have increased rates of cannabis use in comparison to the general population. Research on the short- and long-term impacts of cannabis use in OUD patients has been inconclusive. A genetic component may contribute to cannabis cravings.

AIMS: Identify genetic variants associated with cannabis use through Genome-wide Association Study (GWAS) methods and investigate a Polygenic Risk Score (PRS). In addition, we aim to identify any sex differences in effect size for genetic variants reaching or nearing genome-wide significance in the GWAS.

METHODS: The study outcomes of interest were: regular cannabis use (yes/no) (n = 2616), heaviness of cannabis use (n = 1293) and cannabis cravings (n = 836). Logistic and linear regressions were preformed, respectively, to test the association between genetic variants and each outcome, regular cannabis use and heaviness of cannabis use. GWAS summary statistics from a recent large meta-GWAS investigating cannabis use disorder were used to conduct PRS’s. Findings are limited to a European ancestry sample.

RESULTS: No genome-wide significant associations were found. Rs1813412 (chromosome 17) for regular cannabis use and rs62378502 (chromosome 5) for heaviness of cannabis use were approaching genome-wide significance. Both these SNPs were nominally significant (p<0.05) within males and females, however sex did not modify the association. The PRS identified statistically significant association with cannabis cravings. The variance explained by all PRSs were less than 1.02×10-2.

CONCLUSION: This study provides promising results in understanding the genetic contribution to cannabis use in individuals living with OUD.

PMID:37494403 | DOI:10.1371/journal.pone.0289059

J Forensic Sci. 2023 Jul 26. doi: 10.1111/1556-4029.15342. Online ahead of print.

ABSTRACT

The recovery of identifiable fingerprints from fired cartridge cases is challenging. Therefore, the characterization of chemical modifications and their effects on fingerprint integrity post-firing is essential. In this study, the primary fingerprint lipids, including myristic acid, pentadecanoic acid, palmitoleic acid, palmitic acid, stearic acid, squalene, and cholesterol in fired and unfired cartridges, were extracted with acetonitrile, followed by derivatization using N,O-Bis(trimethylsilyl)trifluoroacetamide with 1% trimethylchlorosilane (BSTFA/1%TMCS). Squalane was used as the internal standard, and all quantifications were performed using gas chromatography coupled with mass spectrometry using a triple-quadrupole mass filter. All lipids identified in the unfired cartridges were also detected in the fired cartridges, and statistical analysis using Student’s t-test and F tests was performed with a 95% confidence level. The concentration of lipids in the unfired cartridges was found to be similar to that detected in the fired cartridges, except for squalene, the recovery of which was 28% lower in the fired cartridges.

PMID:37493034 | DOI:10.1111/1556-4029.15342

J Pediatr Orthop. 2023 Jul 26. doi: 10.1097/BPO.0000000000002481. Online ahead of print.

ABSTRACT

BACKGROUND: Tibial tuberosity to trochlear groove distance (TT-TG) has been reported to have different values according to imaging modalities, usually higher in computed tomography (CT) than in magnetic resonance imaging (MRI). This difference is thought to be caused by the degree of knee flexion during imaging, but few studies have aimed to elucidate the cause.

METHODS: Five hundred eight patients with knee CT or MRI performed between ages of 6 to 16 years without underlying diseases affecting the musculoskeletal system were included. This study was conducted in 2 statistical ways. (1) Propensity score matching was performed for the imaging modality, and the bony TT-TG was compared between the 2 matched groups. (2) A regression model was fitted with 484 patients with either CT or MRI (a training set), and validation of the fitted model was performed with 24 patients with both CT and MRI simultaneously taken within a week (a test set). The predicted TT-TG values were compared with the measured values.

RESULTS: (1) Eighty-one patients were successfully matched by propensity score (all the standardized mean differences < 0.1) for each modality. In the matched patients, there was no significant difference in TT-TG according to the imaging modality (11.3 ± 3.7 mm for CT, 10.4 ± 3.8 mm for MRI, P = 0.126). (2) For the model fitting, different linear models were fitted before and after 10 degrees of knee flexion angle because there was a sharp change in TT-TG when the knee flexion angle was <10 degrees. The predicted TT-TG values did not significantly differ from the measured values (10.2 ± 4.3 mm vs. 9.0 ± 5.1 mm, P = 0.124).

CONCLUSIONS: This study is the first to statistically prove that the difference between TT-TG in MRI and CT originates from the different degrees of knee flexion. In addition, although more studies are needed, authors recommend imaging to be performed with the knee flexed at least 10 degrees for more reliable measurements because TT-TG changes sharply if the knee flexion angle is <10 degrees.

LEVEL OF EVIDENCE: III.

PMID:37493032 | DOI:10.1097/BPO.0000000000002481

Int J Gynaecol Obstet. 2023 Jul 26. doi: 10.1002/ijgo.15016. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the aspartate aminotransferase to platelet ratio (APRI) score as a predictive and prognostic test in intrahepatic cholestasis of pregnancy (ICP).

METHODS: This study was conducted in 198 patients diagnosed with ICP and 204 healthy pregnant women who presented to a tertiary center between 2019 and 2022. APRI scores; laboratory findings in the first, second, and third trimesters; and perinatal outcomes were compared between the two groups. The ICP group was evaluated for correlation between APRI scores and composite adverse outcomes. Two different receiver operating characteristic analyses were performed to determine optimal cutoff values of predictive APRI score of ICP and composite adverse outcomes in patients with ICP.

RESULTS: Aspartate aminotransferase values and APRI scores were significantly higher in the ICP group in all trimesters (P < 0.001). The optimal cutoff values of APRI scores to predict ICP for the first, second, and third trimesters were 0.101 (79.7% sensitivity, 79.6% specificity), 0.103 (78.4% sensitivity, 76.3% specificity), and 0.098 (72.5% sensitivity, 72% specificity), respectively. APRI scores were statistically higher in patients with ICP with composite adverse outcomes in all trimesters (P values of 0.03, 0.04, and 0.01, respectively).

CONCLUSION: APRI score was found to be a valuable predictor of ICP and its adverse outcomes during the entire pregnancy.

PMID:37493015 | DOI:10.1002/ijgo.15016

Glob Chang Biol. 2023 Jul 26. doi: 10.1111/gcb.16891. Online ahead of print.

ABSTRACT

Climate change is one of the top three global threats to seabirds, particularly species that visit polar regions. Arctic terns migrate between both polar regions annually and rely on productive marine areas to forage, on sea ice for rest and foraging, and prevailing winds during flight. Here, we report 21st-century trends in environmental variables affecting arctic terns at key locations along their Atlantic/Indian Ocean migratory flyway during the non-breeding seasons, identified through tracking data. End-of-century climate change projections were derived from Earth System Models and multi-model means calculated in two Shared Socioeconomic Pathways: ‘middle-of-the-road’ and ‘fossil-fuelled development’ scenarios. Declines in North Atlantic primary production emerge as a major impact to arctic terns likely to affect their foraging during the 21st century under a ‘fossil-fuelled development’ scenario. Minimal changes are, however, projected at three other key regions visited by arctic terns (Benguela Upwelling, Subantarctic Indian Ocean and the Southern Ocean). Southern Ocean sea ice extent is likely to decline, but the magnitude of change and potential impacts on tern survival are uncertain. Small changes (<1 m s^-1 ) in winds are projected in both scenarios, but with minimal likely impacts on migration routes and duration. However, Southern Ocean westerlies are likely to strengthen and contract closer to the continent, which may require arctic terns to shift routes or flight strategies. Overall, we find minor effects of climate change on the migration of arctic terns, with the exception of poorer foraging in the North Atlantic. However, given that arctic terns travel over huge spatial scales and live for decades, they integrate minor changes in conditions along their migration routes such that the sum effect may be greater than the parts. Meeting carbon emission targets is vital to slow these end-of-century climatic changes and minimise extinction risk for a suite of polar species.

PMID:37492997 | DOI:10.1111/gcb.16891

Cancer Med. 2023 Jul 26. doi: 10.1002/cam4.6377. Online ahead of print.

ABSTRACT

BACKGROUND: HPV infection can cause cancer, and standard treatments often result in recurrence. The extent to which liquid biopsy using HPV circulating tumor DNA (HPV ctDNA) can be used as a promising marker for predicting recurrence in HPV-related cancers remains to be validated. Here we conducted a systematic review and meta-analysis to assess its effectiveness in predicting treatment response.

METHODS: We conducted a systematic literature search of online databases, including PubMed, Embase, Scopus, and the Cochrane Library, up to December 2022. The goal was to identify survival studies that evaluated the potential of plasma HPV ctDNA at baseline and end-of-treatment (EoT) in predicting recurrence of related cancers. Hazard ratios were estimated directly from models or extracted from Kaplan-Meier plots.

RESULTS: The pooled effect of HPV ctDNA presence on disease recurrence was estimated to be HR = 7.97 (95% CI: [3.74, 17.01]). Subgroup analysis showed that the risk of recurrence was HR = 2.17 (95% CI: [1.07, 4.41]) for baseline-positive cases and HR = 13.21 (95% CI: [6.62, 26.36]) for EoT-positive cases. Significant associations were also observed between recurrence of oropharyngeal squamous cell carcinoma (HR = 12.25 (95% CI: [2.62, 57.36])) and cervical cancer (HR = 4.60 (95% CI: [2.08, 10.17])) in plasma HPV ctDNA-positive patients.

CONCLUSIONS: The study found that HPV ctDNA detection can predict the rate of relapse or recurrence after treatment, with post-treatment measurement being more effective than baseline assessment. HPV ctDNA could be used as a surrogate or incorporated with other methods for detecting residual disease.

PMID:37492996 | DOI:10.1002/cam4.6377

Birth Defects Res. 2023 Jul 26. doi: 10.1002/bdr2.2225. Online ahead of print.

ABSTRACT

BACKGROUND: Given the lack of a national, population-based birth defects surveillance program in the United States, the National Birth Defects Prevention Network (NBDPN) has facilitated important studies on surveillance, research, and prevention of major birth defects. We sought to summarize NBDPN peer-reviewed publications and their impact.

METHODS: We obtained and reviewed a curated list of 49 NBDPN multistate collaborative publications during 2000-2022, as of December 31, 2022. Each publication was reviewed and classified by type (e.g., risk factor association analysis). Key characteristics of study populations and analytic approaches used, along with publication impact (e.g., number of citations), were tabulated.

RESULTS: NBDPN publications focused on prevalence estimates (N = 17), surveillance methods (N = 11), risk factor associations (N = 10), mortality and other outcomes among affected individuals (N = 6), and descriptive epidemiology of various birth defects (N = 5). The most cited publications were those that reported on prevalence estimates for a spectrum of defects and those that assessed changes in neural tube defects (NTD) prevalence following mandatory folic acid fortification in the United States.

CONCLUSIONS: Results from multistate NBDPN publications have provided critical information not available through other sources, including US prevalence estimates of major birth defects, folic acid fortification and NTD prevention, and improved understanding of defect trends and surveillance efforts. Until a national birth defects surveillance program is established in the United States, NBDPN collaborative publications remain an important resource for investigating birth defects and informing decisions related to health services planning of secondary disabilities prevention and care.

PMID:37492989 | DOI:10.1002/bdr2.2225

J Crohns Colitis. 2023 Jul 26:jjad113. doi: 10.1093/ecco-jcc/jjad113. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: The benefit of continuing 5-aminosalicylic acid [5-ASA] treatment when escalating to advanced therapies in patients with inflammatory bowel disease [IBD] is unclear. Vedolizumab is a gut-selective monoclonal anti-α4β7-integrin antibody used to treat moderate to severe IBD. Clinical trial data were analysed post hoc to assess the impact of 5-ASA co-treatment on vedolizumab efficacy and safety in patients with IBD.

METHODS: Data were analysed from patients aged 18-80 years with moderate to severe ulcerative colitis [UC]/Crohn’s disease [CD] receiving intravenous [IV]/subcutaneous [SC] vedolizumab. Efficacy data were from four studies [GEMINI 1 and 2 and VISIBLE 1 and 2]; safety data were from seven studies [GEMINI 1‒3 and long-term, VISIBLE 1, 2 and open-label extension]. Impact of 5-ASA co-treatment on clinical and endoscopic outcomes at Weeks 6 and 52 was assessed using multivariate analysis (adjusted odds ratios [aORs] with 95% confidence intervals [CIs]).

RESULTS: There were no significant differences in UC clinical remission [Mayo score ≤2, no subscore >1] rates with versus without 5-ASA at Week 6 (20.7% vs 20.4%, respectively; aOR 0.77, 95% CI 0.43-1.38) or at Week 52 (45.1% vs 40.6%; aOR 1.14, 0.70-1.86), and in CD clinical remission [CD activity index score ≤150] rates at Week 6 (41.4% vs 35.1%; 1.26, 0.86-1.85) or at Week 52 (49.6% vs 37.8%; 1.35, 0.91-1.99). Incidence of enteric and all infections in vedolizumab IV/SC-treated patients was low with and without 5-ASA.

CONCLUSION: Continuation of concomitant oral 5-ASA after starting vedolizumab had no significant impact on clinical and endoscopic outcomes.

PMID:37492976 | DOI:10.1093/ecco-jcc/jjad113