Category: Statistics

J Comput Assist Tomogr. 2023 Aug 3. doi: 10.1097/RCT.0000000000001517. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the utility of texture analysis in detecting osseous changes associated with hyperparathyroidism on neck CT examinations compared with control patients and to explore the best regions in the head and neck to evaluate changes in the trabecular architecture secondary to hyperparathyroidism.

METHODS: Patients with hyperparathyroidism who underwent a 4D CT of the neck with contrast were included in this study. Age-matched control patients with no history of hyperparathyroidism who underwent a contrast-enhanced neck CT were also included. Mandibular condyles, bilateral mandibular bodies, the body of the C4 vertebra, the manubrium of the sternum, and bilateral clavicular heads were selected for analysis, and oval-shaped regions of interest were manually placed. These segmented areas were imported into an in-house developed texture analysis program, and 41 texture analysis features were extracted. A mixed linear regression model was used to compare differences in the texture analysis features contoured at each of the osseous structures between patients with hyperparathyroidism and age-matched control patients.

RESULTS: A total of 30 patients with hyperparathyroidism and 30 age-matched control patients were included in this study. Statistically significant differences in texture features between patients with hyperparathyroidism and control patients in all 8 investigated osseous regions. The sternum showed the greatest number of texture features with statistically significant differences between these groups.

CONCLUSIONS: Some CT texture features demonstrated statistically significant differences between patients with hyperparathyroidism and control patients. The results suggest that texture features may discriminate changes in the osseous architecture of the head and neck in patients with hyperparathyroidism.

PMID:37531643 | DOI:10.1097/RCT.0000000000001517

Biostatistics. 2023 Aug 2:kxad015. doi: 10.1093/biostatistics/kxad015. Online ahead of print.

ABSTRACT

Cluster randomized trials (CRTs) often enroll large numbers of participants; yet due to resource constraints, only a subset of participants may be selected for outcome assessment, and those sampled may not be representative of all cluster members. Missing data also present a challenge: if sampled individuals with measured outcomes are dissimilar from those with missing outcomes, unadjusted estimates of arm-specific endpoints and the intervention effect may be biased. Further, CRTs often enroll and randomize few clusters, limiting statistical power and raising concerns about finite sample performance. Motivated by SEARCH-TB, a CRT aimed at reducing incident tuberculosis infection, we demonstrate interlocking methods to handle these challenges. First, we extend Two-Stage targeted minimum loss-based estimation to account for three sources of missingness: (i) subsampling; (ii) measurement of baseline status among those sampled; and (iii) measurement of final status among those in the incidence cohort (persons known to be at risk at baseline). Second, we critically evaluate the assumptions under which subunits of the cluster can be considered the conditionally independent unit, improving precision and statistical power but also causing the CRT to behave like an observational study. Our application to SEARCH-TB highlights the real-world impact of different assumptions on measurement and dependence; estimates relying on unrealistic assumptions suggested the intervention increased the incidence of TB infection by 18% (risk ratio [RR]=1.18, 95% confidence interval [CI]: 0.85-1.63), while estimates accounting for the sampling scheme, missingness, and within community dependence found the intervention decreased the incident TB by 27% (RR=0.73, 95% CI: 0.57-0.92).

PMID:37531621 | DOI:10.1093/biostatistics/kxad015

Biostatistics. 2023 Aug 2:kxad019. doi: 10.1093/biostatistics/kxad019. Online ahead of print.

ABSTRACT

Modeling longitudinal and survival data jointly offers many advantages such as addressing measurement error and missing data in the longitudinal processes, understanding and quantifying the association between the longitudinal markers and the survival events, and predicting the risk of events based on the longitudinal markers. A joint model involves multiple submodels (one for each longitudinal/survival outcome) usually linked together through correlated or shared random effects. Their estimation is computationally expensive (particularly due to a multidimensional integration of the likelihood over the random effects distribution) so that inference methods become rapidly intractable, and restricts applications of joint models to a small number of longitudinal markers and/or random effects. We introduce a Bayesian approximation based on the integrated nested Laplace approximation algorithm implemented in the R package R-INLA to alleviate the computational burden and allow the estimation of multivariate joint models with fewer restrictions. Our simulation studies show that R-INLA substantially reduces the computation time and the variability of the parameter estimates compared with alternative estimation strategies. We further apply the methodology to analyze five longitudinal markers (3 continuous, 1 count, 1 binary, and 16 random effects) and competing risks of death and transplantation in a clinical trial on primary biliary cholangitis. R-INLA provides a fast and reliable inference technique for applying joint models to the complex multivariate data encountered in health research.

PMID:37531620 | DOI:10.1093/biostatistics/kxad019

J Thorac Imaging. 2023 Aug 2. doi: 10.1097/RTI.0000000000000731. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the role of quantitative features of intranodular vessels based on deep learning in distinguishing pulmonary adenocarcinoma invasiveness.

MATERIALS AND METHODS: This retrospective study included 512 confirmed ground-glass nodules from 474 patients with 241 precursor glandular lesions (PGL), 126 minimally invasive adenocarcinomas (MIA), and 145 invasive adenocarcinomas (IAC). The pulmonary blood vessels were reconstructed on noncontrast computed tomography images using deep learning-based region-segmentation and region-growing techniques. The presence of intranodular vessels was evaluated based on the automatic calculation of vessel prevalence, vascular categories, and vessel volume percentage. Further comparisons were made between different invasive groups by the Mantel-Haenszel χ2 test, χ2 test, and analysis of variance.

RESULTS: The detection rate of intranodular vessels in PGL (33.2%) was significantly lower than that of MIA (46.8%, P = 0.011) and IAC (55.2%, P < 0.001), while the vascular categories were similar (all P > 0.05). Vascular changes were more common in IAC and MIA than in PGL, mainly in increased vessel volume percentage (12.4 ± 19.0% vs. 6.3 ± 13.1% vs. 3.9 ± 9.4%, P < 0.001). The average intranodular artery and vein volume percentage of IAC (7.5 ± 14.0% and 5.0 ± 10.1%) was higher than that of PGL (2.1 ± 6.9% and 1.7 ± 5.8%) and MIA (3.2 ± 9.1% and 3.1 ± 8.7%), with statistical significance (all P < 0.05).

CONCLUSIONS: The quantitative analysis of intranodular vessels on noncontrast computed tomography images demonstrated that the ground-glass nodules with increased internal vessel prevalence and volume percentages had higher possibility of tumor invasiveness.

PMID:37531613 | DOI:10.1097/RTI.0000000000000731

Chem Biodivers. 2023 Aug 2:e202300881. doi: 10.1002/cbdv.202300881. Online ahead of print.

ABSTRACT

This study analysed some physicochemical and quality parameters of 176 royal jelly (RJ) samples from different regions of Türkiye, collected over different years and seasons. According to the obtained results, the moisture percentage varied between 47.36% and 69.58%, with no statistically significant differences seen across various seasons and areas (p>0.05). The average value of 10-hydroxy-2-decenoic acid (10-HDA), which varies according to factors such as season, region, and year, was determined to be 2.32%. It was also seen that this value was close to the international standard. The values of total acidity ranged from 28-58 mL 1N NaOH/100 g. Furthermore, statistical significance (p<0.001) was observed for the year-region interaction in relation to 10-HDA and total acidity. The pH measurement results for all samples confirmed the acidic nature of the samples and resulted in a range between 3.45 and 3.80. And the pH variability was also found to be statistically significant for years (p=0.002) and regions (p=0.011). Finally, the correlation analysis between moisture (%), 10-HDA (%), total acidity, and pH revealed no statistically significant or strong differences. This comprehensive study, supported by statistical analyses, is thought to be a useful reference for future research on RJ.

PMID:37531600 | DOI:10.1002/cbdv.202300881

J Clin Oncol. 2023 Aug 2:JCO2300697. doi: 10.1200/JCO.23.00697. Online ahead of print.

ABSTRACT

PURPOSE: Adjuvant endocrine therapy (AET) adherence among breast cancer survivors is often suboptimal, leading to higher cancer recurrence and mortality. Intervention studies to promote AET adherence have burgeoned, more than doubling in number since this literature was last reviewed. The current aim is to provide an up-to-date systematic review and meta-analysis of interventions to enhance AET adherence and to identify strengths and limitations of existing interventions to inform future research and clinical care.

METHODS: Systematic searches were conducted in three electronic databases. Studies were included in the systematic review if they examined an intervention for promoting AET adherence among breast cancer survivors. Studies were further included in the meta-analyses if they examined a measure of AET adherence (defined as compliance or persistence beyond initiation) and reported (or provided upon request) sufficient information to calculate an effect size.

RESULTS: Of 5,045 unique records, 33 unique studies representing 375,951 women met inclusion criteria for the systematic review. Interventions that educated patients about how to manage side effects generally failed to improve AET adherence, whereas policy changes that lowered AET costs consistently improved adherence. Medication reminders, communication, and psychological/coping strategies showed varied efficacy. Of the 33 studies that met the inclusion criteria for the systematic review, 25 studies representing 367,873 women met inclusion criteria for the meta-analysis. The meta-analysis showed statistically significant effects of the adherence interventions overall relative to study-specified control conditions (number of studies [k] = 25; odds ratio, 1.412; 95% CI, 1.183 to 1.682; P = .0001). Subgroup analyses showed that there were no statistically significant differences in effect sizes by study design (randomized controlled trial v other), publication year, directionality of the intervention (unidirectional v bidirectional contact), or intervention type.

CONCLUSION: To our knowledge, this is the first known meta-analysis to demonstrate a significant effect for interventions to promote AET adherence. The systematic review revealed that lowering medication costs and a subgroup of psychosocial and reminder interventions showed the most promise, informing future research, policy, and clinical directions.

PMID:37531593 | DOI:10.1200/JCO.23.00697

Sao Paulo Med J. 2023 Jul 31;142(2):e2022557. doi: 10.1590/1516-3180.2022.0557.R1.010623. eCollection 2023.

ABSTRACT

BACKGROUND: Given the characteristics of military missions, intense interpersonal contact, and wide variation in casual relationships, the military has long been recognized as a high-risk population for sexually transmitted infections (STIs).

OBJECTIVE: To assess the prevalence of STIs and socioepidemiological profile of women in the military garrison of Campinas.

DESIGN AND SETTING: This prospective, cross-sectional epidemiological study, assisted by the Health Fund in the military garrison of Campinas, assessed the prevalence of human immunodeficiency virus (HIV), hepatitis B and C, syphilis, human papillomavirus (HPV), chlamydia, and gonococcus in military women or companions of soldiers with active or previously active sexual life.

METHODS: This study included 647 women based on the non-inclusion criteria. They underwent clinical and laboratory tests for diagnosis of STIs. For statistical analysis, patients were divided into groups according to the presence or absence of STIs and into age groups.

RESULTS: Most women were military dependents, and the majority were asymptomatic. The prevalence of STIs, in ascending order, was 0.3% for hepatitis B and C, 0.62% for syphilis, 0.62% for gonorrhea, 1.08% for chlamydia, and 2.63% for HPV. There were no cases of HIV infection.

CONCLUSIONS: The Brazilian Army has the most women-like dependents in the military, belonging to the hierarchical circle of the squares. Early onset of sexual activity favored STIs approximately twice, and younger women had approximately seven times more chlamydia infections. In the general population studied, the prevalence of STIs was lower than expected than in the armed forces of other nations.

PMID:37531524 | DOI:10.1590/1516-3180.2022.0557.R1.010623

Braz Oral Res. 2023 Jul 28;37:e078. doi: 10.1590/1807-3107bor-2023.vol37.0078. eCollection 2023.

ABSTRACT

The aim of this study was to describe the initial oral microbiota and how delivery mode and feeding practices impact its diversity in 0-2-month-old infants. This was a cross-sectional study that consisted of one collection of saliva samples from 0-2-month infants at baseline. Ten pairs of mothers and infants were selected. Medical health history, pregnancy, birth, feeding practices (breastfeeding or milk formula), and infant health status was obtained. Pooled microbial samples were obtained from the oral surfaces using a sterile cotton swab. Infants did not receive any breast milk before sampling. After collection, each swab was analyzed through microbiological culture-based procedures, using selective mediums. Cultures were analyzed for the presence of Streptococci, Lactobacillus, Staphylococcus, Enterobacterium , and Candida albicans . Twenty percent of the samples were serially diluted (10-2) to assess the number of bacteria expressed as CFU. Bacillota was the leading phylogenetic group in the infant’s pooled microbial sample. The most prevalent genera were Streptococcus, Lactobacillus , and Staphylococcus . Two participants had a positive growth of Candida albicans . The association between genus group, type of delivery, and feeding practices was not statistically significant (p > 0.05). Lactobacillus genus was frequently present in the cesarean delivery group but with slightly higher counts in a vaginal delivery study subject. Exclusively breastfed infants showed presence of Streptococcus, Lactobacillus, Staphylococcus . The oral microbiome in infants (0-2 month-old) is highly heterogeneous and dynamic. Microbiota composition seems to be impacted by mode of delivery, with slight differences among groups. Breastmilk appears as an essential factor in maintaining the oral microbiome’s stability and diversity.

PMID:37531514 | DOI:10.1590/1807-3107bor-2023.vol37.0078

Rev Col Bras Cir. 2023 Jul 28;50:e20233520. doi: 10.1590/0100-6991e-20233520-en. eCollection 2023.

ABSTRACT

INTRODUCTION: obesity is one of the most common diseases worldwide, and the most effective treatment to it is the bariatric surgery. One of the negative impacts of this procedure is the body dysmorphia caused by overhanging skin. In Brazil, the national health system – Sistema Único de Sáude (SUS) – provide body contouring surgery to treat post-bariatric patients, since 2007. This article aims to describe the Brazilian public health approach to post bariatric patients and perform an analyze in the Brazilian health care database.

METHODS: in Brazilian Health System database, a search for the post-bariatric procedures performed between 2007 to 2021 was done. The variables analyzed were geographic location, year, mean days of hospitalization, death, and mortality rate. Also, we evaluated the number of bariatric procedures done in the same period. Statistical analysis was performed using the Student-t and the chi-square tests and p-value <0.5 was considered significant.

RESULTS: a total of 12,717 plastic surgery procedures in post bariatric patients were done, with a national prevalence of 13.8%. Dermolipectomy was the most performed procedure, with 6,719. The years of 2020 and 2021 suffered a decreased of 64.3% and 70.9% in the number of surgeries (p<0,001). Bariatric Procedures had a high rate and a higher percentage of growth comparing to post bariatric surgery (p<0,001), totalizing 93,589 surgeries.

CONCLUSIONS: Brazil had a significant number of body contouring surgery, however with a low prevalence. Dermoliepctomy was the most common procedure performed. We could notice a significant impact of COVID pandemic in those procedures .

PMID:37531503 | DOI:10.1590/0100-6991e-20233520-en

Sao Paulo Med J. 2023 Jul 31;142(1):e2022666. doi: 10.1590/1516-3180.2022.0666.R1.190523. eCollection 2023.

ABSTRACT

BACKGROUND: The epidemiology of potentially inappropriate medications (PIMs) in critical care units remains limited, especially in terms of the factors associated with their use.

OBJECTIVE: To estimate the incidence and factors associated with PIMs use in intensive care units.

DESIGN AND SETTING: Historical cohort study was conducted in a high-complexity hospital in Brazil.

METHODS: A retrospective chart review was conducted on 314 patients aged ≥ 60 years who were admitted to intensive care units (ICUs) at a high-complexity hospital in Brazil. The dates were extracted from a “Patient Safety Project” database. A Chi-square test, Student’s t-test, and multivariable logistic regression analyses were performed to assess which factors were associated with PIMs. The statistical significance was set at 5%.

RESULTS: According to Beers’ criteria, 12.8% of the identified drugs were considered inappropriate for the elderly population. The incidence rate of PIMs use was 45.8%. The most frequently used PIMs were metoclopramide, insulin, antipsychotics, non-steroidal anti-inflammatory drugs, and benzodiazepines. Factors associated with PIMs use were the number of medications (odds ratio [OR] = 1.17), length of hospital stay (OR = 1.07), and excessive potential drug interactions (OR = 2.43).

CONCLUSIONS: Approximately half of the older adults in ICUs received PIM. Patients taking PIMs had a longer length of stay in the ICU, higher numbers of medications, and higher numbers of potential drug interactions. In ICUs, the use of explicit methods combined with clinical judgment can contribute to the safety and quality of medication prescriptions.

PMID:37531493 | DOI:10.1590/1516-3180.2022.0666.R1.190523