Category: Statistics

Clin Rev Allergy Immunol. 2023 Jul 25. doi: 10.1007/s12016-023-08964-2. Online ahead of print.

ABSTRACT

Many potential environmental risk factors, protective factors, and biomarkers of AR have been published, but so far, the strength and consistency of their evidence are unclear. We conducted a comprehensive review of environmental risk, protective factors, and biomarkers for AR to establish the evidence hierarchy. We systematically searched Embase, PubMed, Cochrane Library, and Web of Science electronic database from inception to December 31, 2022. We calculated summary effect estimate (odds ratio (OR), relative risk (RR), hazard ratio (HR), and standardized mean difference (SMD)), 95% confidence interval, random effects p value, I² statistic, 95% prediction interval, small study effects, and excess significance biases, and stratification of the level of evidence. Methodological quality was assessed by AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews 2). We retrieved 4478 articles, of which 43 met the inclusion criteria. The 43 eligible articles identified 31 potential environmental risk factors (10,806,206 total population, two study not reported), 11 potential environmental protective factors (823,883 total population), and 34 potential biomarkers (158,716 total population) for meta-analyses. The credibility of evidence was convincing (class I) for tic disorders (OR = 2.89, 95% CI 2.11-3.95); and highly suggestive (class II) for early-life antibiotic use (OR = 3.73, 95% CI 3.06-4.55), exposure to indoor dampness (OR = 1.49, 95% CI 1.27-1.75), acetaminophen exposure (OR = 1.54, 95% CI 1.41-1.69), childhood acid suppressant use (OR = 1.40, 95% CI 1.23-1.59), exposure to indoor mold (OR = 1.66, 95% CI 1.26-2.18), coronavirus disease 2019 (OR = 0.11, 95% CI 0.06-0.22), and prolonged breastfeeding (OR = 0.72, 95% CI 0.65-0.79). This study is registered in PROSPERO (CRD42022384320).

PMID:37490237 | DOI:10.1007/s12016-023-08964-2

Pharmacoeconomics. 2023 Jul 25. doi: 10.1007/s40273-023-01297-0. Online ahead of print.

ABSTRACT

BACKGROUND: Missing data in costs and/or health outcomes and in confounding variables can create bias in the inference of health economics and outcomes research studies, which in turn can lead to inappropriate policies. Most of the literature focuses on handling missing data in randomized controlled trials, which are not necessarily always the data used in health economics and outcomes research.

OBJECTIVES: We aimed to provide an overview on missing data issues and how to address incomplete data and report the findings of a systematic literature review of methods used to deal with missing data in health economics and outcomes research studies that focused on cost, utility, and patient-reported outcomes.

METHODS: A systematic search of papers published in English language until the end of the year 2020 was carried out in PubMed. Studies using statistical methods to handle missing data for analyses of cost, utility, or patient-reported outcome data were included, as were reviews and guidance papers on handling missing data for those outcomes. The data extraction was conducted with a focus on the context of the study, the type of missing data, and the methods used to tackle missing data.

RESULTS: From 1433 identified records, 40 papers were included. Thirteen studies were economic evaluations. Thirty studies used multiple imputation with 17 studies using multiple imputation by chained equation, while 15 studies used a complete-case analysis. Seventeen studies addressed missing cost data and 23 studies dealt with missing outcome data. Eleven studies reported a single method while 20 studies used multiple methods to address missing data.

CONCLUSIONS: Several health economics and outcomes research studies did not offer a justification of their approach of handling missing data and some used only a single method without a sensitivity analysis. This systematic literature review highlights the importance of considering the missingness mechanism and including sensitivity analyses when planning, analyzing, and reporting health economics and outcomes research studies.

PMID:37490207 | DOI:10.1007/s40273-023-01297-0

Environ Monit Assess. 2023 Jul 25;195(8):988. doi: 10.1007/s10661-023-11594-y.

ABSTRACT

Pesticide use has increased in the Lake Tana sub-basin due to increased agricultural activity, potentially endangering nontargeted organisms. To assess its potential impact on fish health and fish-consuming human populations, pesticide concentrations in the fillet and liver tissue of three fish species, namely Labeobarbus megastoma, Labeobarbus tsanensis, and Oreochromis niloticus, were investigated in Lake Tana. Fish samples were taken from the lake near the rivers of Ribb and Gumara, which flow through agricultural areas where considerable amounts of pesticides have been applied. A total of 96 fish samples were collected. Liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) revealed the presence of ten pesticides. Pyrimethanil was frequently detected in 96% of liver and 65% of fillet samples at a median concentration of 33.9 µg kg^-1 and 19.7 µg kg^-1, respectively. The highest concentration of pyrimethanil was found in L. megastoma (1850.0 µg kg^-1). Labeobarbus megastoma also had the highest concentration of oxamyl (507.0 µg kg^-1) and flazasulfuron (60.1 µg kg^-1) detected in the liver tissue. The highest concentration of carbaryl (56.5 µg kg^-1) was found in the liver tissue of O. niloticus. Fish tissue samples from the two study sites contained pyrimethanil, oxamyl, carbaryl, and flazasulfuron. Only pyrimethanil showed a statistically significant difference between the two sites and the species L. megastoma and L. tsanensis. The amounts of pesticides found in the fish species pose no direct risk to the health of fish consumer human population. However, the results show that the lake ecosystem needs immediate attention and regular monitoring of the rising pesticide usage in the lake watershed.

PMID:37490187 | DOI:10.1007/s10661-023-11594-y

Ann Biomed Eng. 2023 Jul 25. doi: 10.1007/s10439-023-03318-7. Online ahead of print.

ABSTRACT

PURPOSE: The study aims to assess ChatGPT performance on the Residency Admission National Exam to evaluate ChatGPT’s level of medical knowledge compared to graduate medical doctors in Italy.

METHODS: ChatGPT3 was used in June 2023 to undertake the 2022 Italian Residency Admission National Exam-a 140 multiple choice questions computer-based exam taken by all Italian medical graduates yearly, used to assess basic science and applied medical knowledge. The exam was scored using the same criteria defined by the national educational governing body. The performance of ChatGPT was compared to the performance of the 15,869 medical graduates who took the exam in July 2022. Lastly, the integrity and quality of ChatGPT’s responses were evaluated.

RESULTS: ChatGPT answered correctly 122 out of 140 questions. The score ranked in the top 98.8^th percentile among 15,869 medical graduates. Among the 18 incorrect answers, 10 were evaluating direct questions on basic science medical knowledge, while 8 were evaluating candidates’ applied clinical knowledge and reasoning under the form of case presentation. Errors were logical (2 incorrect answers) and informational in nature (16 incorrect answers). Explanations to the correct answers were all evaluated as “appropriate.” Comparison to national statistics related to the minimal score needed to match into each specialty, demonstrated that the performance of ChatGPT would have granted the candidate a match into any specialty.

CONCLUSION: ChatGPT proved to be proficient in basic science medical knowledge and applied clinical knowledge. Future research should assess the impact and reliability of ChatGPT in clinical practice.

PMID:37490183 | DOI:10.1007/s10439-023-03318-7

Mol Cell Biochem. 2023 Jul 25. doi: 10.1007/s11010-023-04796-y. Online ahead of print.

ABSTRACT

This research aimed to investigate the effect of PI3K (phosphatidylinositol 3-kinase)/AKT (protein kinase B)/mTOR (mammalian target protein of rapamycin) signaling pathway-based clustering care combined with papaverine injection on vascular inflammation and vascular crisis after finger amputation and replantation. 100 patients admitted in General Hospital of Ningxia Medical University from April 2022 to December 2022 for replantation of severed fingers were selected and divided into a control group (n = 50) and an observation group (n = 50) using the randomized grouping principle. The control group received a papaverine injection and general nursing care, the observation group received a papaverine injection and clustered care. The pain score; constipation incidence; replantation finger survival rate; physician, nurse, and patient satisfaction; serum inflammatory factors; vascular crisis parameters; and occurrence of adverse reactions were compared between the two patient groups. Enzyme-linked immunosorbent assay was performed to detect PI3K, AKT, and mTOR protein concentrations in the venous blood of the two groups, and statistical analysis of the data was performed. On postoperative day 7, the pain score and incidence of constipation in the observation group were lower than those in the control group (P < 0.05); the survival rate of reimplanted fingers in the observation group was 88.00%, which was higher than that in the control group 80.00% (P < 0.05); the satisfaction of doctors, nurses, and patients in the observation group was higher than that in the control group; the concentrations of interleukin-1 (IL-1), tumor necrosis factor (TNF-α), blood flow resistance index (RI), and arterial pulsatility index (PI) in the observation group were lower than those in the control group, while the concentration of interleukin-10 (IL-10), vascular diameter, and Vm (mean blood flow velocity) were higher in the observation group than those in the control group; the differences were statistically significant (P < 0.05). The difference in the incidence of adverse reactions between the two groups was not statistically significant (P > 0.05). The concentrations of PI3K, AKT, and mTOR proteins in the observation group were higher than those in the control group (P < 0.05). The concentrations of PI3K, AKT, and mTOR proteins in the observation group were higher than those in the control group (P < 0.05). Overall, these findings suggest that clustered care combined with papaverine injection reduces vascular inflammatory symptoms and vascular crisis in the treatment of severed finger replantation through the PI3K/AKT/mTOR signaling pathway.

PMID:37490177 | DOI:10.1007/s11010-023-04796-y

Ann Surg Oncol. 2023 Jul 25. doi: 10.1245/s10434-023-13969-4. Online ahead of print.

ABSTRACT

BACKGROUND: Although many formulas for predicting postoperative pancreatic fistula (POPF) have been introduced, POPF is generally predicted during pancreatic surgery due to pancreatic texture. This study was designed to verify the correlation between Hounsfield units (HU) and pancreatic texture and to suggest a fistula risk score (FRS) that can be used before surgery.

METHODS: Data from 545 patients who underwent pancreatoduodenectomy for malignant disease between January 2008 and December 2019 were retrospectively reviewed. The HU level of the pancreas was measured, and odds ratio (OR) of the HU for POPF was analyzed. Additionally, the assessed HU was compared with the pancreatic texture (soft vs. hard) and calculated cutoff level. Finally, the preoperatively chosen pancreatic texture according to HU level was applied to the FRS formula (preoperative-FRS: p-FRS), and the results were compared with a previously reported FRS formula (updated alternative-FRS: ua-FRS).

RESULTS: The Hounsfield unit levels were correlated with clinically relevant POPF (CR-POPF) (odds ratio [OR]: 1.04 (1.01-1.07), p = 0.015). In the receiver operating characteristic curve, the HU showed significant prediction potential for pancreatic texture (area under the curve [AUC]: 0.744, p < 0.001). The p-FRS also showed acceptable results in predicting CR-POPF (AUC = 0.702, p < 0.001). There was no statistically significant difference in the DeLong’s test compared with the ua-FRS (p = 0.314). In the Hosmer-Lemeshow test, observed probabilities were correlated with predicted probabilities (p = 0.596).

CONCLUSIONS: The HU level on preoperative computed tomography (CT) is a predictive factor for POPF and could represent for pancreatic texture.

PMID:37490165 | DOI:10.1245/s10434-023-13969-4

Anal Bioanal Chem. 2023 Jul 25. doi: 10.1007/s00216-023-04832-2. Online ahead of print.

ABSTRACT

We developed and evaluated two-level, namely 2017011 and 2017012, serum-based reference materials (RMs) for 17 beta-estradiol (17 β-E2) by the reference method of isotope dilution liquid chromatography tandem mass spectrometry (ID-LC-MS/MS) from the remaining serum samples after routine clinical tests, to help improve clinical routine testing and provide the traceability of results. This paper describes the development process of these RMs. The National Metrology Institute of Japan (NMIJ) certified reference material (CRM) 6004-a was used as the primary RM for the measurement of 17 β-E2. These serum-based RMs showed satisfactory homogeneity and stability. They also assessed the commutability between the reference method and the three routine clinical immunoassay systems. Besides, a collaborative study was carried out in five reference laboratories, all of which had been accredited by the China National Accreditation Service for Conformity Assessment (CNAS) in accordance with ISO/WD 15725-1. Statistical analysis of raw results and uncertainty assessment obtained certified values: 2017011 was 445.2 ± 39.0 pmol/L, and 2017012 was 761.9 ± 35.5 pmol/L.

PMID:37490154 | DOI:10.1007/s00216-023-04832-2

Dig Dis Sci. 2023 Jul 25. doi: 10.1007/s10620-023-08028-7. Online ahead of print.

ABSTRACT

BACKGROUND: Endoscopic band ligation (EBL) and radiofrequency ablation (RFA) have emerged as alternative therapies of gastric antral vascular ectasia (GAVE) in addition to endoscopic thermal therapy (ETT), but the optimum choice remains inconclusive.

AIM: We conducted a meta-analysis in order to compare these three treatments for GAVE.

METHODS: We searched the electronic databases of PubMed, Embase and Cochrane Central Register of Controlled Trials without any language restrictions and also performed a manual literature search of bibliographies located in both retrieved articles and published reviews for eligible publications prior to December 8, 2021. We included comparative trials which had evaluated the efficacy and safety of interventions in adults (aged ≥ 18 years) diagnosed with symptomatic GAVE and was confirmed according to clinical backgrounds and upper gastrointestinal endoscopy. We included reports that compared three interventions, ETT, EBL, and RFA. The study was comprised of adults diagnosed with GAVE and focused on overall mortality, bleeding cessation, endoscopic improvement, complications, hospitalization, hemoglobin improvement, number of sessions and transfusion requirements.

RESULTS: Twelve studies were performed involving a total of 571 participants for analysis. When compared with ETT, EBL achieved better bleeding cessation (OR 4.48, 95% CI 1.36-14.77, p = 0.01), higher hemoglobin improvement (MD 0.57, 95% CI 0.31-0.83, p < 0.01) and lower number of sessions (MD – 1.44, 95% CI – 2.54 to – 0.34, p = 0.01). Additionally, EBL was superior to ETT in endoscopic improvement (OR 6.00, 95% CI 2.26-15.97, p < 0.01), hospitalization (MD – 1.32, 95% CI – 1.91 to – 0.74, p < 0.01) and transfusion requirement (MD – 2.66, 95% CI – 4.67 to – 0.65, p = 0.01) with statistical significance, with the exception of mortality (OR 0.58, 95% CI 0.19-1.77, p = 0.34) and complication rate (OR 5.33, 95% CI 0.58-48.84, p = 0.14).

CONCLUSION: For GAVE, we suggest that EBL be initially recommended, and APC and RFA be used as alternative treatment choices based upon a very low quality of evidence.

PMID:37490152 | DOI:10.1007/s10620-023-08028-7

Eur J Neurol. 2023 Jul 25. doi: 10.1111/ene.15990. Online ahead of print.

ABSTRACT

INTRODUCTION: Motor fluctuations are a significant driver of healthcare resource utilization (HCRU) in people with Parkinson’s (PwP). A common management strategy is to include Catechol-O-methyl transferase (COMT) inhibition with either opicapone or entacapone in the levodopa regimen. However, to date, there has been a lack of head-to-head data comparing the two COMT inhibitors in real-world settings.

METHODS: In this retrospective cohort study, we assessed HCRU outcomes in PwP naïve to COMT inhibition via UK electronic healthcare records (Clinical Practice Research Datalink and Hospital Episodes Statistics databases, June 2016 to December 2019). HCRU outcomes were assessed before (baseline) and after COMT inhibitor prescription at 0-6 months, 7-12 months, and 13-18 months. Opicapone treated PwP were algorithm-matched (1:4) to entacapone-treated PwP.

RESULTS: By 6-months, treatment with opicapone resulted in 18.5% fewer neurology outpatient visits compared to entacapone treatment; this effect was maintained until the last follow-up (18-months). In the opicapone group, the mean levodopa equivalent daily dose (LEDD) decreased over the first year and then stabilised, whereas the entacapone-treated group showed an initial decrease in the first 6-months followed by a dose increase between 7-18-months. Neither COMT inhibitors had significant impact on sleep medication use.

CONCLUSIONS: This head-to-head study is the first to demonstrate using ‘real-world’ data that initiating COMT inhibition with opicapone is likely to decrease the need for post-treatment HCRU versus initiation of COMT inhibition with entacapone.

PMID:37489574 | DOI:10.1111/ene.15990

Clin Oral Implants Res. 2023 Jul 25. doi: 10.1111/clr.14146. Online ahead of print.

ABSTRACT

OBJECTIVES: Composition of implant material and its surface structure is decisive for oral biofilm accumulation. This study investigated biofilm formation on eight different materials.

MATERIALS AND METHODS: Eighteen healthy subjects wore intraoral splints fitted with two sets of eight materials for 24 h: zirconia [ZrO₂ ]; silver-gold-palladium [AgAuPd]; titanium zirconium [TiZr]; Pagalinor [PA]; hydroxyapatite [HA]; silver-platinum [AgPt]; titanium aluminum niobium [TAN]; titanium grade4 [TiGr4]. Total biomass was stained by safranin to assess plaque accumulation while conventional culturing (CFU) was conducted to investigate viable parts of the biofilm. Cell viability of human gingival fibroblasts (HGF-1) was assessed in vitro. Statistical evaluation was performed with linear mixed-effects models to compare materials (geometric mean ratios, 95% CI), with the level of significance set at ɑ = .05.

RESULTS: Less biofilm mass and CFU were found on noble metal alloys (AgPt, AgAuPd, and PA). Compared to AgPt, PA had 2.7-times higher biofilm mass value, AgAuPd was 3.9-times, TiGr4 was 4.1-times, TiZr was 5.9-times, TAN was 7.7-times, HA was 7.8-times, and ZrO₂ was 9.1-times higher (each p < .001). Similarly, CFU data were significantly lower on AgPt, AgAuPd had 4.1-times higher CFU values, PA was 8.9-times, TiGr4 was 11.2-times, HA was 12.5-times, TiZr was 13.3-times, TAN was 16.9-times, and ZrO₂ was 18.5-times higher (each p < .001). HGF-1 viability varied between 47 ± 24.5% (HA) and 94.4 ± 24.6% (PA).

CONCLUSION: Noble alloys are considered as beneficial materials for the transmucosal part of oral implants, as less biofilm mass, lower bacterial counts, and greater cell viability were detected than on titanium- or zirconia-based materials.

PMID:37489537 | DOI:10.1111/clr.14146