Category: Statistics

Clin Res Hepatol Gastroenterol. 2023 Jun 11:102154. doi: 10.1016/j.clinre.2023.102154. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: Autoimmune gastritis (AIG) is a prominent risk factor for pernicious anemia (PA) and gastric neoplasia. This study aimed to investigate the clinicopathological characteristics of AIG patients in China, with a focus on those who had positive anti-intrinsic factor antibodies (AIFA).

METHODS: A total of 103 AIG patients who were diagnosed between January 2018 and August 2022 were reviewed in a large academic tertiary teaching hospital. Patients were divided into two groups based on the presence or absence of AIFA, and their serologic and histopathological characteristics were analyzed.

RESULTS: The mean age of the 103 AIG patients was 54.16±11.92 years (range 23-79), with 69 (66.99%) being women. AIFA were present in 28.16% of patients. Patients with AIFA-positive had a higher risk of PA than those with AIFA-negative, as demonstrated by a larger mean corpuscular volume (MCV), lower hemoglobin level, and lower vitamin B-12 level (P<0.05). There were no statistically significant differences in gastric histopathology, gastrin level, and pepsinogen level when patients were divided into AIFA-positive and AIFA-negative group. Of the 103 cases, 34 (33.01%) were concomitant with other autoimmune diseases, with autoimmune thyroid diseases being the most common (25.24%, 26/103). Thyroid peroxidase antibody, which accounted for 45.45% (25/55), was the most prevalent thyroid antibody, followed by anti-thyroglobulin antibody (34.55%, 19/55), thyroid stimulating antibody (12.73%, 7/55), and thyrotropin receptor antibody (3.64%, 2/55).

CONCLUSION: This study highlights the increased risk of severe anemia in AIFA-positive AIG patients, particularly for PA. Clinicians should consider the presence of AIFA as a warning sign for PA and prioritize early diagnosis and appropriate treatment to prevent serious complications.

PMID:37311519 | DOI:10.1016/j.clinre.2023.102154

J Clin Epidemiol. 2023 Jun 11:S0895-4356(23)00144-0. doi: 10.1016/j.jclinepi.2023.06.003. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop a methodological framework to identify and prioritize personomic markers (e.g., psychosocial situation, beliefs…) to consider for personalizing interventions and to test in smoking cessation interventions.

STUDY DESIGN AND SETTING: (1) We identified potential personomic markers considered in protocols of personalized interventions, in reviews of predictors of smoking cessation, and in interviews with general practitioners. (2) Physicians, and patient smokers or former smokers selected the markers they considered most relevant during online paired comparison experiments. Data were analyzed with Bradley Terry Luce models.

RESULTS: Thirty-six personomic markers were identified from research evidence. They were evaluated by 795 physicians (median age: 34, IQR [30-38]; 95% general practitioners) and 793 patients (median age: 54, IQR [42-64], 71.4% former smokers) during 11963 paired comparisons. Physicians identified patients’ motivation for quitting (e.g., Prochaska stages), patients’ preferences, and patients’ fears/beliefs (e.g., concerns about weight gain) as the most relevant elements to personalize smoking cessation. Patients considered their motivation for quitting, smoking behavior (e.g., smoking at home/at work), and tobacco dependence (e.g., Fagerström Test) as the most relevant elements to consider.

CONCLUSION: We provide a methodological framework to prioritize which personomic markers should be considered when developing smoking cessation interventions.

PMID:37311514 | DOI:10.1016/j.jclinepi.2023.06.003

Transplant Cell Ther. 2023 Jun 11:S2666-6367(23)01353-2. doi: 10.1016/j.jtct.2023.06.008. Online ahead of print.

ABSTRACT

INTRODUCTION: Graft-versus host disease (GVHD) is the major toxicity of allogeneic hematopoietic cell transplant (HCT). We hypothesized that the GVHD prophylaxis regimen of post-transplant cyclophosphamide (PTCy), tacrolimus (Tac) and mycophenolate mofetil (MMF) would be associated with a low incidence of acute and chronic GVHD in patients receiving a matched or single antigen mismatched HCT.

METHODS: This is a phase II study conducted at the University of Minnesota using a myeloablative regimen of either: (A) total body irradiation (TBI, total dose 1320 cGy, administered in 165 cGy fractions, twice a day from days -4 to -1) or (B) Busulfan 3.2mg/kg daily (cumulative AUC 19,000 – 21,000 μmol/min/L) plus fludarabine 40 mg/m² once daily days -5 to -2, followed by a GVHD prophylaxis regimen of PTCy (50mg/kg days +3 and +4), Tac and MMF (beginning day +5). The primary endpoint was cumulative incidence of chronic GVHD requiring systemic immunosuppression (IST) at 1-year post-transplant.

RESULTS: From March 2018 – May 2022, we enrolled 125 pediatric and adult patients with a median follow-up of 813 days. The incidence of chronic GVHD requiring systemic IST at 1 year was 5.5%. Grade II-IV acute GVHD occurred in 17.1%; Grade III-IV acute GVHD was 5.5%. Two-year overall survival (OS) was 73.7%, and 2-year graft-versus-host disease-free, relapse-free survival (GRFS) 52.2%. The 2-year cumulative incidence of non-relapse mortality was 10.2% and relapse was 39.1%. There was no statistically significant difference in survival outcomes between recipients of matched versus 7/8 donors.

CONCLUSION: Myeloablative HCT with PTCy/Tac/MMF results in an extremely low incidence of severe acute and chronic GVHD in well-matched allotransplantation.

PMID:37311510 | DOI:10.1016/j.jtct.2023.06.008

Am J Obstet Gynecol MFM. 2023 Jun 11:101049. doi: 10.1016/j.ajogmf.2023.101049. Online ahead of print.

ABSTRACT

OBJECTIVE: Tranexamic acid (TXA) is a cost-effective intervention for the prevention of postpartum hemorrhage (PPH) in women undergoing cesarean section but the evidence to support its use is conflicting. We conducted this meta-analysis to evaluate the efficacy and safety of TXA in low- and high-risk cesarean deliveries.

DATA SOURCES: We searched MEDLINE (via PubMed), Embase, the Cochrane Library, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform (ICTRP) portal from inception to April 2022 (updated October 2022 and February 2023) with no language restrictions. Additionally, grey literature sources were also explored.

STUDY ELIGIBILITY CRITERIA: All randomized controlled trials (RCTs) investigating the prophylactic use of intravenous TXA in addition to standard uterotonic agents in women undergoing cesarean deliveries as compared to placebo, standard treatment, or prostaglandins were included in this meta-analysis.

METHODS: We used the revised Cochrane “Risk of Bias” tool (RoB 2.0) to assess the quality of included RCTs. RevMan 5.4 was used to conduct all statistical analyses under a random-effects model.

RESULTS: We included 50 RCTs (6 in only high-risk patients and 2 with prostaglandins as the comparator) evaluating TXA in our meta-analysis. TXA reduced the risk of blood loss >1000 mL, mean total blood loss, and the need for blood transfusion in both low- and high-risk patients. TXA was associated with a beneficial effect in our secondary outcomes including decline in hemoglobin levels and the need for additional uterotonic agents. TXA increased the risk of non-thromboembolic adverse events but, based on limited data, did not increase the incidence of thromboembolic events. The administration of TXA before skin incision, but not after cord clamping, was associated with a large benefit. The quality of evidence was rated as low to very low for outcomes in the low-risk population and moderate for most outcomes in the high-risk subgroup.

CONCLUSIONS: TXA may reduce the risk of blood loss in cesarean deliveries with a higher benefit observed in high-risk patients but the lack of high-quality evidence precludes any strong conclusions. Additional studies, especially in the high-risk population and evaluating the timing of TXA administration, are needed to confirm or refute these findings.

PMID:37311484 | DOI:10.1016/j.ajogmf.2023.101049

Rev Esp Cir Ortop Traumatol. 2023 Jun 11:S1888-4415(23)00157-1. doi: 10.1016/j.recot.2023.06.010. Online ahead of print.

ABSTRACT

INTRODUCTION: Topical tranexamic acid (TXA) has been shown to decrease blood loss in knee and hip arthroplasty. Despite evidence about its effectiveness when administered intravenous, its effectiveness and optimal dose when used topically has not been established. We hypothesized that the use of 1.5 g (30 mL) of topical TXA could decrease the amount of blood loss in patients after reverse total shoulder arthroplasty (RTSA).

MATERIAL AND METHODS: One hundred and seventy-seven patients receiving a RTSA for arthropathy or fracture were retrospectively reviewed. Preoperative-to-postoperative change in haemoglobin (ΔHb) and haematocrit (ΔHct) level drain volume output, length of stay and complications were evaluated for each patient.

RESULTS: Patients receiving TXA has significant less drain output in both for arthropathy (ARSA) (104 vs. 195 mL, p = 0.004) and fracture (FRSA) (47 vs. 79 mL, p = 0.01). Systemic blood loss was slightly lower in TXA group, but this was not statistically significant (ARSA, ΔHb 1.67 vs. 1.90 mg/dL, FRSA 2.61 vs. 2.7 mg/dL, p = 0.79). This was also observed in hospital length of stay (ARSA 2.0 vs. 2.3 days, p = 0.34; 2.3 vs. 2.5, p = 0.56) and need of transfusion (0% AIHE; AIHF 5% vs. 7%, p = 0.66). Patients operated for a fracture had a higher rate of complications (7% vs. 15.6%, p = 0.04). There were no adverse events related to TXA administration.

CONCLUSION: Topical use of 1.5 g of TXA decreases blood loss, especially on the surgical site without associated complications. Thus, hematoma decrease could avoid the systematic use of postoperative drains after reverse shoulder arthroplasty.

PMID:37311478 | DOI:10.1016/j.recot.2023.06.010

J Antimicrob Chemother. 2023 Jun 13:dkad187. doi: 10.1093/jac/dkad187. Online ahead of print.

ABSTRACT

OBJECTIVES: Concerns have been raised regarding neuropsychiatric adverse drug reactions of integrase inhibitors (INSTIs) in patients living with HIV. The aim of this study was to assess the risk of depression and suicidality reporting with INSTIs based on a global pharmacovigilance database.

METHODS: Depression and suicidality cases in patients treated with INSTIs were identified within the WHO global database of individual case safety reports, VigiBase. Risk of depression and suicidality reporting with INSTIs compared with other ART was assessed using disproportionality analyses (case/non-case statistical approach).

RESULTS: Of 19 991 410 reports over the study period, 124 184 reports concerned patients exposed to ART, including 22 661 patients exposed to an INSTI. Among patients treated with an INSTI, 547 cases of depression and 357 cases of suicidality were identified. Disproportionality analyses showed that depression [reporting OR (ROR) 3.6; 95% CI: 3.2-4.0] and suicidality (ROR 4.7; 95% CI: 4.1-5.4) were more reported with the use of INSTIs compared with other ART. Amongst INSTIs, depression reporting was significantly greater for bictegravir and dolutegravir, whereas suicidality reporting was significantly greater for dolutegravir only.

CONCLUSIONS: Our findings suggest that depression and suicidality are adverse drug reactions of all INSTI agents, especially dolutegravir, which may occur within the first months of therapy.

PMID:37311223 | DOI:10.1093/jac/dkad187

G3 (Bethesda). 2023 Jun 13:jkad132. doi: 10.1093/g3journal/jkad132. Online ahead of print.

ABSTRACT

Alzheimer’s disease (AD) is characterized by two pathological proteins, amyloid beta 42 (Aβ42) and tau. The majority of AD cases in the population are sporadic and late-onset AD (LOAD), which exhibits high levels of heritability. While several genetic risk factors for LOAD have been identified and replicated in independent studies, including the ApoE ε4 allele, the great majority of the heritability of LOAD remains unexplained, likely due to the aggregate effects of a very large number of genes with small effect size, as well as to biases in sample collection and statistical approaches. Here, we present an unbiased forward genetic screen in Drosophila looking for naturally occurring modifiers of Aβ42- and tau-induced ommatidial degeneration. Our results identify 14 significant SNPs, which map to 12 potential genes in 8 unique genomic regions. Our hits that are significant after genome-wide correction identify genes involved in neuronal development, signal transduction and organismal development. Looking more broadly at suggestive hits (P < 10-5), we see significant enrichment in genes associated with neurogenesis, development and growth as well as significant enrichment in genes whose orthologs have been identified as significantly or suggestively associated with AD in human GWAS studies. These latter genes include ones whose orthologs are in close proximity to regions in the human genome that are associated with AD, but where a causal gene has not been identified. Together, our results illustrate the potential for complementary and convergent evidence provided through multi-trait GWAS in Drosophila to supplement and inform human studies, helping to identify the remaining heritability and novel modifiers of complex diseases.

PMID:37311212 | DOI:10.1093/g3journal/jkad132

Am J Respir Crit Care Med. 2023 Jun 13. doi: 10.1164/rccm.202301-0070LE. Online ahead of print.

NO ABSTRACT

PMID:37311208 | DOI:10.1164/rccm.202301-0070LE

Games Health J. 2023 Jun 13. doi: 10.1089/g4h.2022.0212. Online ahead of print.

ABSTRACT

Introduction: We investigated the effects of an exergames-based exercise program for older adults, and its benefits on their physical literacy (PL) domains, such as physical (mobility skills), affective (motivation and confidence), cognitive (knowledge about physical activity [PA]), and behavioral (daily exertion) when compared with a conventional exercise program and no training (NT) (control). Material and Methods: Forty older adults (mean age 72 years) volunteered and were randomized within three groups-exergame training (ET; n = 15), conventional training (CT; n = 14), and NT (n = 11). ET group performed training sessions based on a commercially available exergame console, while the CT group enrolled in a convention exercise program (aerobic, strength, balance, and flexibility exercises). The training program was conducted three times a week for 6 weeks. The Timed Up and Go Test (TUG), Exercise Confidence Survey (ECS), Motives for Physical Activity Measure-Revised (MPAM-R), Knowledge and Understanding Questionnaire (K&UQ), and total PA tracking (using wearable technology) were used as the study’s outcomes. Outcome variables were measured at preintervention (week 0), postintervention (week 6), and at the time of final follow-up (week 9). Results: We observed a reduction in the ET TUG time at postintervention and follow-up. Also, a significant main effect for group and moment of measurement was observed for the Fitness-Health subscore, derived from MPAM-R. The values demonstrated by ET and CT were statistically different (P = 0.01) and a within-group comparison revealed significant differences in the ET from preintervention to both postintervention and follow-up (both, P = 0.01). We did not observe any other significant difference. Conclusion: Our results suggest that a 6-week exergame-based training program may have the potential in improving the physical and affective domains of PL in community-dwelling older adults. The topics related to fitness and health seem to be of interest in this population and programs can make use of them to improve the PL domains.

PMID:37311178 | DOI:10.1089/g4h.2022.0212

Cyberpsychol Behav Soc Netw. 2023 Jun 13. doi: 10.1089/cyber.2022.0240. Online ahead of print.

ABSTRACT

The benefits of nature tourism, or nature-based travel, are plentiful. For example, participation in nature tours has positively impacted environmental attitudes and behaviors. Unfortunately, while psychologically beneficial, nature-based tourism can hurt the environment through a myriad of factors. Therefore, we must continue to explore ways to make the benefits of nature-based travel more sustainable and impactful. Research suggests that nature-based travel in virtual reality (VR) may impart numerous travel benefits, such as improving conservational behavior and interconnectedness with nature. While these early findings are promising, questions remain regarding the theoretical mechanisms underlying the effects of nature-based VR travel. Therefore, this study explores how VR may provide an avenue to make nature tourism more environmentally friendly while simultaneously making people more environmentally connected and conscious. Furthermore, a theoretical framework is posited that combines concepts from the spatial presence and narrative persuasion literature to help explain the effects. To accomplish these goals, an experiment was conducted using a two-condition (VR travel vs. TV control) between-subjects factorial design with random assignment. The participants were 66 college students from a large Midwestern University in the United States. Results indicated that there wasn’t a statistically significant difference between the VR travel condition and the television (TV) control condition regarding the environmental outcome variables. However, while the nature-based VR travel experience did not appear to influence the environmental outcome variables directly, it did indirectly affect them through the mediating roles of spatial presence and narrative engagement.

PMID:37311166 | DOI:10.1089/cyber.2022.0240