Category: Statistics

Chem Biodivers. 2022 Aug 26. doi: 10.1002/cbdv.202200361. Online ahead of print.

ABSTRACT

Background Curcumae Radix (CW) is traditionally used to treat dysmenorrhea caused by uterine spasm. However, the changes of its composition and anti-uterine spasms during vinegar processing and the mechanism in treating dysmenorrhea are not clear. Objective To elucidate the changes of anti-uterine spasm and its substance basis, and the mechanism of treating dysmenorrhea before and after vinegar processing. Methods The uterine spasm contraction model was established, and the uterine activity and its inhibition rate were calculated to evaluate the differences. The main chemical constituents of CW were quickly analyzed by UPLC-Q-TOF-MS/MS technology, and the differences between them were explored by multivariate statistical analysis. Then, the regulatory network of “active ingredients-core targets-signal pathways” related to dysmenorrhea was constructed by using network pharmacology, and the combination between differential active components and targets was verified by molecular docking. Results CW extract relaxed the isolated uterine by reducing the contractile tension, amplitude, and frequency. Compared with CW, the inhibitory effect of vinegar products was stronger, and the inhibition rate was 70.08%. 39 compounds were identified from CW and 13 differential components were screened out ( p <0.05). Network pharmacology screened 11 active components and 32 potential targets, involving 10 key pathways related to dysmenorrhea. The results of molecular docking showed that these differentially active components had good binding activity to target. Conclusion It was preliminarily revealed that CW could treat dysmenorrhea mainly through the regulation of inflammatory reaction, relaxing smooth muscle and endocrine by curcumenone, 13-hydroxygermacrone, (+)-cuparene, caryophyllene oxide, zederone, and isocurcumenol.

PMID:36017755 | DOI:10.1002/cbdv.202200361

J Cosmet Dermatol. 2022 Aug 26. doi: 10.1111/jocd.15332. Online ahead of print.

ABSTRACT

BACKGROUND: Primary cutaneous amyloidosis (PCA) and post-inflammatory hyperpigmentation (PIH) are common causes of cutaneous hyperpigmentation that are usually diagnosed clinically. However, their presentations are sometimes atypical, and their differentiation is difficult. Dermoscopy is a valuable diagnostic tool for pigmented diseases that might aid in their diagnosis.

OBJECTIVE: To describe the characteristic dermoscopic features of PCA and PIH together with histopathological correlation, and to differentiate between these conditions in a non-invasive way.

METHODS: Fifty-two patients with PCA (n=26) and PIH (n=26) were enrolled. A detailed history, skin examination, dermoscopic examination using handheld and video dermoscopy, and histopathological evaluation were performed.

RESULTS: A statistically significant difference could be detected between PCA and PIH in terms of the duration of the disease (p = 0.027), symmetry (p = 0.044), rippling (p <0.001) and back affection (p = 0.048). On dermoscopic examination, central hubs were seen more in the PCA group (p<0.001) with different patterns of peripheral pigmentation. Histopathologically, the number of melanophages per high-power field was significantly higher in the PCA group (p = 0.013).

CONCLUSION: The results of this study shed the light on the potential of dermoscopy as a non-invasive diagnostic tool in differentiating between doubtful cases of PCA and PIH.

PMID:36017750 | DOI:10.1111/jocd.15332

Liver Int. 2022 Aug 26. doi: 10.1111/liv.15413. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: There is limited data on natural course and interventions in stage-3 acute kidney injury (AKI-3) in patients with acute-on-chronic liver failure (ACLF). We studied the factors of AKI-3 reversal and outcomes on dialysis in ACLF patients.

METHODS: Consecutive patients with ACLF were prospectively enrolled (n=1022) and variables determining AKI and its outcomes were analyzed.

RESULTS: At one-month, 337(33%) patients had AKI-3, of which, 131 had AKI-3 at enrolment, 206 developed AKI-3 during hospital stay. Of patients with AKI-3 at enrolment, 18% showed terlipressin response, 21% had AKI resolution and 59% required dialysis. High MELD (≥35) (model 1), serum bilirubin (≥ 23 mg/dl) (model 2) and AARC score (≥11) (model 3) were independent risk factors for dialysis. Dialysis was associated with worse survival in all AKI patients but improved outcomes in patients with AKI-3 [p=0.022, HR 0.69(0.50-0.95). Post-mortem kidney biopsies (n= 61) revealed cholemic nephropathy (CN) in 54%, acute tubular necrosis (ATN) in 31%, and a combination (CN and ATN) in 15%. Serum bilirubin was significantly higher in patients with CN, CN and ATN compared with ATN respectively [(30.8 ± 12.2) vs. (26.7 ± 12.0) vs. (18.5 ± 9.8); p=0.002].

CONCLUSION: AKI-3 rapidly increases from 13% to 33% within 30 days in ACLF patients. Histopathological data suggested cholemic nephropathy as the predominant cause which correlated with high bilirubin levels. AKI-3 resolves in only one in five patients. Patients with AARC grade 3 and MELD >35 demand need for early dialysis in AKI-3 for improved outcomes.

PMID:36017749 | DOI:10.1111/liv.15413

Eur Heart J. 2022 Aug 26:ehac495. doi: 10.1093/eurheartj/ehac495. Online ahead of print.

ABSTRACT

BACKGROUND: Sodium glucose co-transporter 2 (SGLT2) inhibitors improve cardiovascular outcomes in diverse patient populations, but their mechanism of action requires further study.

AIMS: To explore the effect of empagliflozin on circulating levels of intracellular proteins in patients with heart failure, using large-scale proteomics.

METHODS: Over 1250 circulating proteins were measured at baseline, week 12 and week 52 in 1134 patients from EMPEROR-Reduced and EMPEROR-Preserved, using the Olink® Explore 1536 platform. Statistical and bioinformatical analyses identified differentially expressed proteins (empagliflozin vs placebo), which were then linked to demonstrated biological actions in the heart and kidneys.

RESULTS: At week 12, 32 of 1283 proteins fulfilled our threshold for being differentially expressed, i.e., their levels were changed by ≥10% with a false discovery rate < 1% (empagliflozin vs placebo). Among these, nine proteins demonstrated the largest treatment effect of empagliflozin: insulin-like growth factor-binding protein 1, transferrin receptor protein 1, carbonic anhydrase 2, erythropoietin, protein-glutamine gamma-glutamyltransferase 2, thymosin beta-10, U-type mitochondrial creatine kinase, insulin-like growth factor-binding protein 4, and adipocyte fatty acid-binding protein 4. The changes of the proteins from baseline to week 52 were generally concordant with the changes from baseline to week 12, except empagliflozin reduced levels of kidney injury molecule-1 by ≥10% at week 52, but not at week 12. The most common biological action of differentially-expressed proteins appeared to be the promotion of autophagic flux in the heart, kidney or endothelium, a feature of 6 proteins. Other effects of differentially-expressed proteins on the heart included the reduction of oxidative stress, inhibition of inflammation and fibrosis, and the enhancement of mitochondrial health and energy, repair and regenerative capacity. The actions of differentially expressed proteins in the kidney involved promotion of autophagy, integrity and regeneration, suppression of renal inflammation and fibrosis, and modulation of renal tubular sodium reabsorption.

CONCLUSIONS: Changes in circulating protein levels in patients with heart failure are consistent with the findings of experimental studies that have shown that the effects of SGLT2 inhibitors are likely related to actions on the heart and kidney to promote autophagic flux, nutrient deprivation signaling and transmembrane sodium transport.

PMID:36017745 | DOI:10.1093/eurheartj/ehac495

Swiss Dent J. 2022 Aug 26;132(10). Online ahead of print.

ABSTRACT

In this retrospective study, it was investigated whether the use of a fifth-generation rotary system (ProTaper Next) resulted in improved radiological root filling quality compared to a first-generation counterpart (ProFile) in a controlled student course setting. Cases treated by fourth-year dental students in the 2020/21 academic year were collected and compared to those treated in 2019/20. Root canals in the former group were all instrumented using the ProTaper Next system, and the latter using the ProFile system. All other clinical parameters were similar between the two academic years, including the time of pre-clinical teaching, hands-on course hours, endodontic auxiliaries, and chemicals used for treatment. After excluding patients who were not available or refused to give their informed consent to this study (n = 20), and excluding teeth with missing or poor radiographs (n = 16), the fillings in 178 roots could be assessed by two calibrated observers blinded to the system that was used. The primary outcome was the radiographic quality of the root fillings according to the five-scale modified MOLANDER score. The secondary outcome was the number of separated rotary instruments by group. Both instrumenting systems resulted in a similar number of “excellent” root fillings (score I), 59 % in the ProTaper Next group and 60% in the ProFile group, with no statistically significant difference in outcome scores between groups (Probability > ChiSquare = 0.70). Furthermore, there was merely one separated instrument in the ProTaper Next group, and none in the ProFile group (Fisher’s exact test, p = 1.00).

PMID:36017710

Stroke. 2022 Aug 26:101161STROKEAHA122039172. doi: 10.1161/STROKEAHA.122.039172. Online ahead of print.

ABSTRACT

BACKGROUND: A previously published conditional probability model optimizes prehospital emergency transport protocols for patients with suspected large-vessel occlusion by recommending the transport strategy, drip-and-ship or mothership, that results in a higher probability of an excellent outcome. In this study, we create generalized models to quantify the change in annual hospital patient volume, the expected annual increase in the number of patients with an excellent outcome, and the annual cost savings to a single-payer healthcare system resulting from these optimized transport protocols.

METHODS: We calculated the expected number of patients with suspected large-vessel occlusion transported by ambulance over a 1-year period in a region of interest, using the annual stroke incidence rate and a large-vessel occlusion screening tool. Assuming transport to the closest hospital is the baseline transport policy across the region (drip-and-ship), we determined the change in annual hospital patient volume from implementing optimized transport protocols. We also calculated the resulting annual increase in the number of patients with an excellent outcome (modified Rankin Score of 0-1 at 90 days) and associated cost savings to a single-payer healthcare system. We then performed a case study applying these generalized models to the stroke system serving the Greater Vancouver and Fraser Valley Area, BC, Canada.

RESULTS: In the Greater Vancouver and Fraser Valley Area, there was an annual increase of 36 patients with an excellent outcome, translating to an annual cost savings of CA$2 182 824 to the British Columbia healthcare system. We also studied how these results change depending on our assumptions of treatment times at the regional stroke centers.

CONCLUSIONS: Our framework quantifies the impact of optimized emergency stroke transport protocols on hospital volume, outcomes, and cost savings to a single-payer healthcare system. When applied to a specific region of interest, these models can help inform health policies concerning emergency transport of patients with suspected large-vessel occlusion.

PMID:36017703 | DOI:10.1161/STROKEAHA.122.039172

Circ Res. 2022 Aug 26:101161CIRCRESAHA122321295. doi: 10.1161/CIRCRESAHA.122.321295. Online ahead of print.

ABSTRACT

BACKGROUND: Despite mechanistic studies linking retinol and RBP4 (retinol binding protein 4) to the pathogenesis of cardiovascular diseases (CVD) and type 2 diabetes (T2D), epidemiological evidence is still conflicting. We investigated whether conflicting results of previous studies may be explained by differences in the association of retinol and RBP4 with cardiometabolic risk across subgroups with distinct sex, hypertension state, liver, or kidney function.

METHODS: We used case-cohorts nested in the EPIC (European Prospective Investigation Into Cancer and Nutrition)-Potsdam cohort (n=27 548) comprising a random sample of participants (n=2500) and all physician-verified cases of incident CVD (n=508, median follow-up time 8.2 years) and T2D (n=820, median follow-up time 6.3 years). We estimated nonlinear and linear multivariable-adjusted associations between the biomarkers and cardiometabolic diseases by restricted cubic splines and Cox regression, respectively, testing potential interactions with hypertension, liver, and kidney function. Additionally, we performed 2-sample Mendelian Randomization analyses in publicly available data.

RESULTS: The association of retinol with cardiometabolic risk was modified by hypertension state (P interaction CVD<0.001; P interaction T2D<0.001). Retinol was associated with lower cardiometabolic risk in participants with treated hypertension (hazard ratio_{per SD}, 95% CI: CVD, 0.71 [0.56-0.90]; T2D, 0.81 [0.70-0.94]) but with higher cardiometabolic risk in normotensive participants (CVD, 1.32 [1.06-1.64]; T2D, 1.15 [0.98-1.36]). Our analyses also indicated a significant interaction between RBP4 and hypertension on CVD risk (P interaction=0.04). Regarding T2D risk, we observed a u-shaped association with RBP4 in women (P nonlinearity=0.01, P effect=0.02) and no statistically significant association in men. The biomarkers’ interactions with liver or kidney function were not statistically significant. Hypertension state-specific associations for retinol concentrations with cardiovascular mortality risk were replicated in National Health and Nutrition Examination Survey III.

CONCLUSIONS: Our findings suggest a hypertension-dependent relationship between plasma retinol and cardiometabolic risk and complex interactions of RBP4 with sex and hypertension on cardiometabolic risk.

PMID:36017698 | DOI:10.1161/CIRCRESAHA.122.321295

J Nurs Manag. 2022 Aug 26. doi: 10.1111/jonm.13773. Online ahead of print.

ABSTRACT

AIM: This study aimed to explore the mediating effects of adversity quotient and the moderating effect of self-efficacy on the relationship between the organizational climate and the work engagement of intensive care unit nurses.

BACKGROUND: A good organizational climate can contribute to a high level of work engagement. Adversity quotient and self-efficacy are the key factors affecting nurses’ work engagement, while the mechanism of these factors in the organizational climate and work engagement remains unclear. This study was conducted to contribute to the relevant field research.

METHODS: The study used a cross-sectional research design and surveyed 323 intensive care unit nurses working in a public hospital in China. The data were analyzed using descriptive statistical methods: Pearson correlation analysis and PROCESS macro Model 7 in the regression analysis.

RESULTS: Organizational climate was positively correlated with work engagement and adversity quotient. The indirect effect of organizational climate on work engagement through adversity quotient was positive. Furthermore, self-efficacy moderated the relationship between the two factors.

CONCLUSION: Cultivating organizational climate and adversity quotients is an important strategy to improve the work engagement of intensive care unit nurses, particularly for nurses with high self-efficacy.

IMPLICATIONS FOR NURSING MANAGEMENT: Administrators should make efforts to create a good organizational climate and cultivate nurses’ adversity quotients and self-efficacy to decrease their intent to leave.

PMID:36017688 | DOI:10.1111/jonm.13773

Cytopathology. 2022 Aug 26. doi: 10.1111/cyt.13174. Online ahead of print.

ABSTRACT

This article serves as the second in a series that offers recommendations for optimal data reporting, specifically focusing on statistical methods most frequently reported by the Cytopathology audience. The inaugural article, Recommendations for Reporting Statistical Results when Comparing Proportions, dealt with the most common category of reported statistical tests over 2.5 years of Cytopathology articles – comparing proportions. Comparing samples using t-tests, Mann-Whitney U, Analysis of Variance, and Kruskal-Wallis tests was another common category of statistical test reported among this audience. An important distinction between these tests is based on whether the samples follow a normal distribution. Therefore, Parametric or Nonparametric Statistical Tests: Choosing the Most Appropriate Option for your Data is the second topic in the series. While this article will review considerations when selecting parametric or nonparametric statistical tests, an extensive review of each method is beyond the scope of this summary. The author encourages the reader to consult with a trained statistician to map out a thorough analytical plan (including their recommendations for the appropriate statistical test(s) to use) prior to data collection.

PMID:36017662 | DOI:10.1111/cyt.13174

Pediatrics. 2022 Aug 26:e2022057346. doi: 10.1542/peds.2022-057346. Online ahead of print.

ABSTRACT

OBJECTIVES: Antibiotics are commonly administered during labor and delivery, and research has suggested that fetal exposure to antibiotics can increase risk for autism spectrum disorder (ASD). We assessed whether antibiotic exposure during labor and delivery increased the risk of ASD in the offspring.

METHODS: This retrospective cohort study included everyone who delivered a live singleton-term infant in British Columbia, Canada, between April 1, 2000, and December 31, 2014. This cohort included 569 953 deliveries. To examine the association among pregnant individuals being treated for the same indication, we studied a subcohort of those who tested positive for group B Streptococcus. Cox proportional hazards models were used to estimate unadjusted and adjusted hazard ratios in both cohorts. A sensitivity analysis was conducted using length of first stage of labor as a proxy measure for dose to assess for a dose-response relationship.

RESULTS: In this population-based study, antibiotic use during labor and delivery was not associated with an increased risk of ASD in offspring. The unadjusted and adjusted hazard ratios were 1.29 (95% confidence interval, 1.24-1.35) and 0.99 (0.94-1.04), respectively; and 1.07 (0.90-1.27) and 0.88 (0.74-1.05), respectively, in the group B Streptococcus-positive cohort. We observed no substantial difference in the association between antibiotic exposure and ASD depending on length of the first stage of labor.

CONCLUSIONS: Our findings suggest that concern for ASD should not factor into the clinical decision on whether to administer antibiotics during labor and delivery. Future research is needed to examine longer durations of prenatal antibiotic exposure.

PMID:36017659 | DOI:10.1542/peds.2022-057346