Category: Statistics

Chest. 2023 Aug 13:S0012-3692(23)05274-1. doi: 10.1016/j.chest.2023.08.013. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary involvement is the leading cause of death in systemic sclerosis (SSc) and may manifest as interstitial lung disease (ILD), pulmonary arterial hypertension (PAH), or in combination of both (ILD-pulmonary hypertension (PH)). Aim of this analysis was to determine prevalence, clinical characteristics, and survival of these different forms within the registry of the German Network for Systemic Sclerosis (DNSS).

RESEARCH QUESTION: Does SSc-associated ILD with or without PH affect survival differently and are there any risk factors that have an additional impact?

STUDY DESIGN AND METHODS: Clinical data of 5,831 SSc patients were collected in the DNSS registry, Kaplan-Meier estimates were used to compare overall survival (OS) in patients with SSc-ILD with PH (ILD-PH) and without PH (ILD-w/o-PH) to patients without pulmonary involvement and those with PAH. The Cox proportional hazard model was used to analyze the influence of pulmonary involvement and other potential predictors on patient survival.

RESULTS: Clinical data of 3,257 patients with a mean follow-up years of 3.45±1.63 have been included in our analysis. At baseline, ILD was present in 34.5%, while PH (w/o-ILD) had a lower prevalence with 4.5%. At the end of follow-up, 47.6% of SSc patients had ILD, 15.2% ILD-PH, and 6.5% PAH. ILD was more frequent in the diffuse cutaneous form (57.3%), while PAH did not differ significantly between SSc subtypes. Significant differences in baseline characteristics between PAH vs. ILD-PH vs. ILD-w/o-PH were found for age at diagnosis, gender, SSc-subsets, antibody-status, FVC, DLCO and therapy. OS at 5 years was 96.4% for patients without pulmonary involvement and differed significantly between patients with ILD-w/o-PH, PAH, being worst in patients with ILD-PH. Female gender (HR 0.3), a higher BMI (HR 0.9) and higher DLCO values (HR 0.98) were associated with a lower mortality risk.

INTERPRETATION: ILD is the most prevalent pulmonary involvement in SSc, while the combination of ILD and PH is associated with the most detrimental survival.

PMID:37582424 | DOI:10.1016/j.chest.2023.08.013

Neuroimage. 2023 Aug 13:120327. doi: 10.1016/j.neuroimage.2023.120327. Online ahead of print.

ABSTRACT

Selective use of new information is crucial for adaptive decision-making. Combining a gamble bidding task with assessing cortical responses using functional near-infrared spectroscopy (fNIRS), we investigated potential effects of information valence on behavioral and neural processes of belief and value updating during uncertainty reduction in young adults. By modeling changes in the participants’ expressed subjective values (i.e., value updating) using a Bayesian model, we dissociated processes of (i) updating beliefs about statistical properties of the gamble, (ii) updating values of a gamble based on new information about its winning probabilities, as well as (iii) expectancy violation. The results showed that participants used new information to update their beliefs and values about the gambles in a quasi-optimal manner, as reflected in the selective updating only in situations with reducible uncertainty. Furthermore, their updating was valence-dependent: information indicating an increase in winning probability was underweighted, whereas information about a decrease in winning probability was updated in good agreement with predictions of the Bayesian decision theory. Results of model-based and moderation analyses showed that this valence-dependent asymmetry was associated with a distinct contribution of expectancy violation, besides belief updating, to value updating after experiencing new positive information regarding winning probabilities. In line with the behavioral results, we replicated previous findings showing involvements of frontoparietal brain regions in the different components of updating. Furthermore, this study provided novel results suggesting a valence-dependent recruitment of brain regions. Individuals with stronger oxyhemoglobin responses during value updating was more in line with predictions of the Bayesian model while integrating new information that indicates an increase in winning probability. Taken together, this study provides first results showing expectancy violation as a contributing factor to valence-dependent updating during uncertainty reduction and suggests limitations of normative Bayesian decision theory.

PMID:37582418 | DOI:10.1016/j.neuroimage.2023.120327

Gynecol Endocrinol. 2023 Aug 8;39(1):2245479. doi: 10.1080/09513590.2023.2245479.

ABSTRACT

OBJECTIVE: To develop a model to identify women likely to be severely impacted by vulvovaginal atrophy (VVA), based on their experience of symptoms and non-clinical factors.

METHODS: Multivariate statistics and machine-learning algorithms were used to develop models using data from a cross-sectional, observational, multinational European survey. A set of independent variables were chosen to assess subjective VVA severity and its impact on daily activities.

RESULTS: A final composite model was selected that included three categories of variables: clinical severity, patient demographics/clinical characteristics and Day-to-Day Impact of Vaginal Aging (DIVA) variables related to emotion/mood, impact on lifestyle and frequency of sex. The model accurately classified 71% of women. Three DIVA variables (feeling bad about yourself, desire/interest in sex, physical comfort related to sitting) explained much of the variation in the dependent variable of the model. Over 90% of the impact of VVA relates to certain psychosocial and behavioral aspects that can be identified without the need to consider physical signs/symptoms.

CONCLUSION: Non-clinical factors can contribute significantly to the overall VVA burden.Questions used in developing the composite model could form the basis of an instrument to help screen women prior to clinical consultation and improve VVA management.

PMID:37582396 | DOI:10.1080/09513590.2023.2245479

Anasthesiol Intensivmed Notfallmed Schmerzther. 2023 Jul;58(7-08):436-447. doi: 10.1055/a-1977-7297. Epub 2023 Aug 15.

ABSTRACT

According to data from the German Federal Statistical Office, 424635 patients died in hospitals across Germany in 2020. That is 43% of all deaths. Deaths occur everywhere in hospitals – not just in palliative care units – and caring for the dying is considered a basic task of medical practice 1. The German Medical Association has published principles for end-of-life care and the S3 guideline on palliative medicine also provides instructions on what end-of-life care should look like. However, there is often uncertainty as to what the care of the dying should look like in concrete terms. The following explanations are intended to convey how ideal end-of-life care should be designed and provide concrete assistance and suggestions as to how this can also succeed outside a palliative care unit.

PMID:37582354 | DOI:10.1055/a-1977-7297

J Breath Res. 2023 Aug 15. doi: 10.1088/1752-7163/acf066. Online ahead of print.

ABSTRACT

In order to prevent long-term immunity-related complications after lung transplantation, close monitoring of immunosuppressant levels using therapeutic drug monitoring (TDM) is paramount. Novel electronic nose (eNose) technology may be a non-invasive alternative to the current invasive procedures for TDM. We investigated the diagnostic and categorization capacity of eNose breathprints for Tacrolimus trough blood plasma levels (TACtrough) in lung transplant recipients (LTR).&#xD;Method: We performed eNose measurements in stable LTR attending the outpatient clinic. We evaluated 1) the correlation between eNose measurements and TACtrough, 2) the diagnostic capacity of eNose technology for TACtrough, and 3) the accuracy of eNose technology for categorization of TACtrough into three clinically relevant categories (low: <7 µg/mL, medium: 7 – 10 µg/mL, and high: >10 µg/mL).&#xD;Results: A total of 186 measurements from 86 LTR were included. There was a weak but statistically significant correlation (r = 0.21, p = 0.004) between the eNose measurements and TACtrough. The root mean squared error of prediction (RMSEP) for the diagnostic capacity was 3.186 in the training and 3.131 in the validation set. The accuracy of categorization ranged between 45-63% for the training set and 52-69% in the validation set. &#xD;Conclusion: There is a weak correlation between eNose breathprints and TACtrough in LTR. However, the diagnostic as well as categorization capacity for TACtrough using eNose breathprints is too inaccurate to be applicable in TDM. &#xD.

PMID:37582348 | DOI:10.1088/1752-7163/acf066

Endocr Connect. 2023 Aug 1:EC-23-0314. doi: 10.1530/EC-23-0314. Online ahead of print.

ABSTRACT

CONTEXT: In individuals with hypothyroidism and overweight, levothyroxine substitution therapy is often expected to cause weight loss due to its effect on resting energy expenditure. However, despite levothyroxine-induced enhancement of resting energy expenditure, fat mass loss is rarely seen after levothyroxine substitution therapy. The mechanism behind this conundrum is unknown.

OBJECTIVE: To assess the effect of levothyroxine therapy on hunger sensations and ad libitum food intake in individuals with hypothyroidism.

DESIGN AND SETTING: Prospective cohort study of 18 newly diagnosed hypothyroid women (thyroid-stimulating hormone (TSH) >10 mU/L). Participants were investigated at diagnosis, after normalization of TSH (<4.0 mU/L), and after six months of successful treatment. Eighteen age and body mass index-matched healthy controls were also included.

INTERVENTION: Hypothyroid individuals were treated with levothyroxine according to European Thyroid Association guidelines.

MAIN OUTCOMES: Changes in hunger sensation were assessed using visual analog scales (cm) before and during a standardized mixed meal test, and food intake was measured during a subsequent ad libitum meal (g).

RESULTS: After six months of levothyroxine therapy, mean resting energy expenditure was increased by 144 kcal/day (10%) (P < 0.001). Weight loss was comprised of 0.8 kg fat-free mass while fat mass remained unchanged. Fasting hunger sensation increased from a mean of 4.5 (SD 2.2) cm to 5.5 (SD 2.2) cm (P = 0.047). The numerical increase in ad libitum meal intake did not reach statistical significance.

CONCLUSION: Our data suggest that levothyroxine-induced hunger may be a culprit in the lack of fat mass loss from levothyroxine therapy.

PMID:37582332 | DOI:10.1530/EC-23-0314

Zhonghua Wei Chang Wai Ke Za Zhi. 2023 Jul 25;26(7):689-696. doi: 10.3760/cma.j.cn441530-20221125-00493.

ABSTRACT

Objective: To assess the effectiveness of transanal drainage tube (TDT) in reducing the incidence of anastomotic leak following anterior resection in patients with rectal cancer. Methods: We conducted a systematic search for relevant studies published from inception to October 2022 across multiple databases, including PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP. Meta-analysis was performed using Review Manager 5.4 software. The primary outcomes included total incidence of anastomotic leak, grade B and C anastomotic leak rates, reoperation rate, anastomotic bleeding rate, and overall complication rate. Results: Three randomized controlled trials involving 1115 patients (559 patients in the TDT group and 556 in the non-TDT group) were included. Meta-analysis showed that the total incidences of anastomotic leak and of grade B anastomotic leak were 5.5% (31/559) and 4.5% (25/559), respectively, in the TDT group and 7.9% (44/556) and 3.8% (21/556), respectively, in the non-TDT group. These differences are not statistically significant (P=0.120, P=0.560, respectively). Compared with the non-TDT group, the TDT group had a lower incidence of grade C anastomotic leak (1.6% [7/559] vs. 4.5% [25/556]) and reoperation rate (0.9% [5/559] vs. 4.3% [24/556]), but a higher incidence of anastomotic bleeding (8.2% [23/279] vs. 3.6% [10/276]). These differences were statistically significant (P=0.003, P=0.001, P=0.030, respectively). The overall complication rate was 26.5%(74/279) in the TDT group and 27.2% (75/276) in the non-TDT group. These differences are not statistically significant (P=0.860). Conclusions: TDT did not significantly reduce the total incidence of anastomotic leak but may have potential clinical benefits in preventing grade C anastomotic leak. Notably, placement of TDT may increase the anastomotic bleeding rate.

PMID:37583027 | DOI:10.3760/cma.j.cn441530-20221125-00493

Zhonghua Wei Chang Wai Ke Za Zhi. 2023 Jun 25;26(6):595-602. doi: 10.3760/cma.j.cn441530-20230315-00083.

ABSTRACT

Objective: To compare the long-term outcomes of intersphincteric (trans-internal and external) sphincter resection (ISR) and abdominoperineal proctocolectomy (APR) for low-grade rectal cancer. Methods: We used a meta-analytic approach to compare these procedures . Published reports comparing ISR and APR for low rectal cancer in Pubmed, Medline, EMBASE and Cochrane, China Knowledge Network (CNKI), China Biomedical Literature Database, and Vipers databases between January 2005 and January 2023 were searched and those meeting the eligibility criteria were selected for extraction of data for analysis. Inclusion criteria were as follows: (1) all reports comparing ISR and APR for low rectal cancer before January 2023; and (2) prospective randomized controlled studies or well-designed cohort studies. Exclusion criteria were as follows: (1) full text not available; (2) duplicate publications, missing primary outcome indicators, and unknown data; and (3) invalid statistical analysis. Results: Sixteen studies with 2498 patients were included in this study. Compared with the APR group, patients in the ISR group were relatively younger (weighted mean difference [WMD]=-1.82, 95%CI=-2.94 to -0.70, P=0.01), had tumors farther from the anal verge (WMD=0.43, 95%CI=0.18 to 0.67, P<0.01), and lower pathological T-stage (T3-4 stage: OR=0.54, 95%CI=0.36 to 0.81, P<0.01). In contrast, there were no statistically significant differences between the two groups in gender (P=0.78), body mass index (P=0.77), or pathological N stage (P=0.09). Compared with the APR group, patients in the ISR group had a lower rate of postoperative complications (OR=0.77, 95%CI=0.60 to 0.99, P=0.04), shorter hospital stay (WMD=-4.30, 95%CI=-7.07 to -1.53, P<0.01), higher 5-year overall survival (HR=0.54, 95%CI=0.33 to 0.88, P=0.01), and higher 5-year disease-free survival (HR=0.65, 95%CI=0.47 to 0.90, P<0.01). Five-year locoregional failure (HR=0.66, 95%CI=0.40 to 1.10, P=0.11) and time to surgery (WMD=-9.71, 95%CI=-41.89 to 22.47, P=0.55) did not differ significantly between the two groups. Conclusion: ISR is a safe and effective alternative to APR for early-stage low-grade rectal cancer.

PMID:37583014 | DOI:10.3760/cma.j.cn441530-20230315-00083

J Urban Health. 2023 Aug 15. doi: 10.1007/s11524-023-00752-9. Online ahead of print.

ABSTRACT

We examined the impact of the first year of the COVID-19 pandemic on unmet healthcare need among New Yorkers and potential differences by race/ethnicity and health insurance. Data from the Community Health Survey, collected in 2018, 2019, and 2020, were merged to compare unmet healthcare need within the past 12 months during the pandemic versus the 2 years prior to 2020. Univariate and multivariable logistic regression models evaluated change in unmet healthcare need overall, and we assessed whether race/ethnicity or health insurance status modified the association. Overall, 12% of New Yorkers (N = 27,660) experienced unmet healthcare during the 3-year period. In univariate and multivariable models, the first year of the pandemic (2020) was not associated with change in unmet healthcare need compared with 2018-2019 (OR = 1.04, p = 0.548; OR = 1.03, p = 0.699, respectively). There was no statistically significant interaction between calendar year and race/ethnicity, but there was significant interaction with health insurance status (interaction p = 0.009). Stratifying on health insurance status, those uninsured had borderline significant lower odds of experiencing unmet healthcare need during 2020 compared to the 2 years prior (OR = 0.72, p = 0.051) while those with insurance had a slight increase that was not significant (OR = 1.12, p = 0.143). Unmet healthcare need among New Yorkers during the first year of the pandemic did not differ significantly from 2018-2019. Federal pandemic relief funding, which offered no-cost COVID-19 testing and care to all, irrespective of health insurance or legal status, may have helped equalized access to healthcare.

PMID:37583004 | DOI:10.1007/s11524-023-00752-9

Int J Legal Med. 2023 Aug 16. doi: 10.1007/s00414-023-03068-0. Online ahead of print.

ABSTRACT

Time since death estimation is a vital part of forensic pathology. Despite the known tissue degradation after death, the efficacy of using biomechanical tissue properties to estimate time since death remains unexplored. Here, eight brain tissue localizations were sampled from the frontal lobe, parietal lobe, anterior and posterior deep brain, superior colliculi, pons, medulla, and cerebellum of 30 sheep; were then stored at 20 °C; and subsequently subjected to rheometry tests on days zero to four after death. Overall, the measured tissue storage modulus, loss modulus, and complex shear modulus decreased after death for all of the tested regions in a site-specific manner. Day zero to day one changes were the only 24-h interval, for which statistically significant differences in tissue mechanical moduli were observed for some of the tested brain regions. Based on receiver operator characteristic analyses between day zero and the pooled data of days one to four, a post mortem interval of at least 1 day can be determined with a sensitivity of 90%, a specificity of 92%, and a positive likelihood ratio of 10.8 using a complex shear modulus cut-off value of 1461 Pa for cerebellar samples. In summary, biomechanical properties of brain tissue can discriminate between fresh and at least 1-day-old samples stored at 20 °C with high diagnostic accuracy. This supports the possible value of biomechanical analyses for forensic time since death estimations. A striking advantage over established methods to estimate the time since death is its usability in cases of disintegrated bodies, e.g. when just the head is found.

PMID:37582986 | DOI:10.1007/s00414-023-03068-0