Category: Statistics

Echocardiography. 2022 Feb 14. doi: 10.1111/echo.15315. Online ahead of print.

ABSTRACT

BACKGROUND: Recurrence of any atrial arrhythmia after surgical ablation is known as a negative predictor of cardiovascular events and total mortality. However, there have been no focused studies for atrial fibrillation (AF) recurrence prediction in patients with significant tricuspid regurgitation (TR), and the risk-benefit estimation of surgical ablation in tricuspid valve (TV) surgery is not fully established.

METHOD: We screened 385 patients who underwent a TV operation between 2001 and 2017. After excluding patients who did not undergo a maze operation, 158 patients were enrolled. Enrolled patients were divided by recurrence of AF. We analyzed the difference between the AF recurrence group and no AF recurrence group, and AF recurrence factors in terms of clinical risk factors and echocardiographic risk factors. The hazard ratio (HR) and 95% confidence intervals (CIs) were presented using a Cox proportional hazard model.

RESULTS: Among 158 patients, AF recurred in 65 patients within 10 years. For AF prediction, age was most the important clinical factor and right atrium (RA) diameter was the most important echocardiographic parameters. In patients with a larger RA diameter over 49.2 mm, the prevalence of AF recurrence was higher (HR 4.322, 95% CI [2.185-8.549], log rank p value < .001). In clinical outcome, there was no significant difference between the AF recurrence group and the no recurrence group in terms of death, TR recurrence, heart failure, and stroke. However, the risk of permanent pacemaker (PPM) insertion was higher in the AF recurrence group (HR 10.240, 95% CI [1.257-83.480], log rank p value .007) compared to the no recurrence group.

CONCLUSION: Age and RA enlargement are key predictors of AF recurrence after TV operation with the CM procedure in patients with significant TR.

PMID:35165935 | DOI:10.1111/echo.15315

Stat Med. 2022 Feb 14. doi: 10.1002/sim.9335. Online ahead of print.

ABSTRACT

Civil registration vital statistics (CRVS) systems provide data on maternal mortality that can be used for monitoring trends and to inform policies and programs. However, CRVS maternal mortality data may be subject to substantial reporting errors due to misclassification of maternal deaths. Information on misclassification is available for selected countries and periods only. We developed a Bayesian hierarchical bivariate random walk model to estimate sensitivity and specificity for multiple populations and years and used the model to estimate misclassification errors in the reporting of maternal mortality in CRVS systems. The proposed Bayesian misclassification (BMis) model captures differences in sensitivity and specificity across populations and over time, allows for extrapolations to periods with missing data, and includes an exact likelihood function for data provided in aggregated form. Validation exercises using maternal mortality data suggest that BMis is reasonably well calibrated and improves upon the CRVS-adjustment approach used until 2018 by the UN Maternal Mortality Inter-Agency Group (UN-MMEIG) to account for bias in CRVS data resulting from misclassification error. Since 2019, BMis is used by the UN-MMEIG to account for misclassification errors when estimating maternal mortality using CRVS data.

PMID:35165916 | DOI:10.1002/sim.9335

Br J Clin Pharmacol. 2022 Feb 14. doi: 10.1111/bcp.15276. Online ahead of print.

ABSTRACT

AIMS: Proton pump inhibitors (PPIs) are often prescribed to prevent or treat gastrointestinal disease. Whether the combination of systemic anti-tumor therapy and PPIs leads to poor outcomes in patients with advanced non-small cell lung cancer (NSCLC) is unclear. This systematic review explored the relationship between PPIs and survival outcomes of patients with advanced NSCLC who are receiving systemic anti-tumor therapy.

METHODS: We searched studies reporting the overall survival (OS) and/or progression-free survival (PFS) of advanced NSCLC patients who are receiving systemic anti-tumor therapy with or without PPIs on PubMed, EMBASE, and the Cochrane Library for literature published prior to 31 August 2021. The meta-analysis used a random effects model to estimate the risk ratio (HR) with 95% confidence intervals (CI) and I² to assess statistical heterogeneity. Publication bias and sensitivity analysis were performed.

RESULTS: Fourteen retrospective studies comprising 13,709 advanced NSCLC patients were identified. Subgroup analyses showed that the use of PPI was correlated with the OS or PFS of patients receiving chemotherapy, targeted therapy, and immunotherapy (PPI users’ group versus non-users’ group: HR for OS = 1.35, 95% CI = 1.21-1.51, P < 0.00001; HR for PFS = 1.50, 95% CI = 1.25-1.80, P < 0.0001). Publication bias and sensitivity analyses confirmed that the results were robust.

CONCLUSION: Meta-analysis demonstrated that PPI use in advanced NSCLC patients who were undergoing systemic anti-tumor therapy was correlated with increased mortality risk. Until results are further confirmed, caution should be applied when administering PPIs and systemic anti-tumor therapy to advanced NSCLC patients.

PMID:35165922 | DOI:10.1111/bcp.15276

Community Dent Oral Epidemiol. 2022 Feb 14. doi: 10.1111/cdoe.12733. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to perform a systematic review and meta-analysis regarding the prevalence of traumatic dental injuries (TDI) in emergency dental services.

METHODS: Seven electronic and two grey literature databases were searched, up to December 2021, for studies that reported the TDI prevalence among dental emergencies. The Joanna Briggs Institute critical appraisal checklist for prevalence studies, and The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach were used to assess the risk of bias and quality of evidence respectively. The R software was used to perform a proportion meta-analysis on a random-effects model to estimate the pooled prevalence and respective 95% CI.

RESULTS: From a total of 1476 studies identified after excluding duplicates, 38 met the inclusion criteria, and another five were identified through hand searching, summing 43 included observational studies with a total sample of 209099 individuals searching for emergency dental care. The overall pooled prevalence of TDI was 15.4% (95% CI: 11%-21%, I² = 100%). Paediatric dental emergency services and age group from 0 to 21 years presented the highest prevalence, 29% (95% CI: 22%-38%, I² = 99.5%) and 24% (95% CI: 15%-35%, I² = 98%) respectively.

CONCLUSIONS: The overall pooled prevalence of TDI in emergency dental services was 15.4%, and 24% in the age group under 21 years. Considering the impact of prompt and correct emergency care in the long-term prognosis of TDI, such knowledge is relevant to organize emergency healthcare and support public policies in this area.

PMID:35165912 | DOI:10.1111/cdoe.12733

Stat Med. 2022 Feb 14. doi: 10.1002/sim.9344. Online ahead of print.

ABSTRACT

A rate ratio (RR) is an important metric for comparing cancer risks among different subpopulations. Inference for RR becomes complicated when populations used for calculating age-standardized cancer rates involve sampling errors, a situation that arises increasingly often when sample surveys must be used to obtain the population data. We compare a few strategies of estimating the standardized RR and propose bias-corrected ratio estimators as well as the corresponding variance estimators and confidence intervals that simultaneously consider the sampling error in estimating populations and the traditional Poisson error in the occurrence of cancer case or death. Performance of the proposed methods is evaluated empirically based on simulation studies. An application to immigration disparities in cancer mortality among Hispanic Americans is discussed. Our simulation studies show that a bias-corrected RR estimator performs the best in reducing the bias without increasing the coefficient of variation; the proposed variance estimators for the RR estimators and associated confidence intervals are fairly accurate. Finding of our application study are both interesting and consistent with the common sense as well as the results of our simulation studies.

PMID:35165903 | DOI:10.1002/sim.9344

Planta Med. 2022 Feb 14. doi: 10.1055/a-1770-7581. Online ahead of print.

ABSTRACT

Essential oils are often utilized for therapeutic purposes and are composed of complex structural molecules, including sesquiterpenes, with high molecular weight and potential for stereochemistry. A detailed study on the properties of selected sesquiterpenes was conducted as part of a broader investigation on the effects of sesquiterpenes on the central nervous system. A set of 18 sesquiterpenes, rigorously selected from an original list of 114, was divided into 2 groups i.e., the training and test sets, with each containing 9 compounds. The training set was evaluated for the sedative activity in mice through inhalation, and all compounds were sedatives at any dose in the range of 4 × 10-4-4 × 10-2 mg/cage, except for curzerene. Molecular determinants of the sedative activities of sesquiterpenes were evaluated using quantitative structure-activity relationship (QSAR) and structure-activity relationship (SAR) analyses. An additional test set of six compounds obtained from the literature was utilized for validating the QSAR model. The parental carbonyl cation and an oxygen-containing groups are possible determinants of sedative activity. The QSAR study using multiple regression models could reasonably predict the sedative activity of sesquiterpenes with statistical parameters such as the correlation coefficient r² = 0.82 > 0.6 and q²_LOO = 0.71 > 0.5 obtained using the leave-one-out cross-validation technique. Molar refractivity and the number of hydrogen bond acceptors were statistically important in predicting the activities. The present study could help predict the sedative activity of additional sesquiterpenes, thus accelerating the process of drug development.

PMID:35158383 | DOI:10.1055/a-1770-7581

Dermatology. 2022 Feb 14:1-10. doi: 10.1159/000522053. Online ahead of print.

ABSTRACT

BACKGROUND: Primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL, LT) is an aggressive lymphoma variant. Anthracycline-based chemotherapy with rituximab is recommended as first-line treatment. Radiotherapy (RT) has been considered as a therapeutic option for local disease control in patients with solitary or localized lesions.

METHODS: We report the results of a retrospective analysis of PCDLBC, LT patients treated either with RT alone or with physician’s decision as first-line treatment, aiming to assess disease progression and/or first recurrence in these treatment groups.

RESULTS: We retrospectively analyzed 20 patients treated either with RT alone (n = 8) or with investigator’s choice treatment (n = 12), which included chemotherapy alone or combined with local therapy (RT and wide local excision). Complete response (CR) was achieved in 8 patients from the first group and 9 patients from the second group, with 1 treatment failure. Six patients treated with RT alone progressed with a median time to progression (TTP) of 12.5 months. In the second group, 5 patients progressed with a median TTP of 5.2 months. RT showed good local disease control in both groups without any skin relapses during the follow-up period.

CONCLUSION: RT as first-line monotherapy followed by watchful waiting did not significantly improve the overall risk of disease progression but resulted in good local disease control. After progression, RT could still easily be combined with systemic treatment. The strength of this analysis needs to be evaluated in a larger patient cohort.

PMID:35158362 | DOI:10.1159/000522053

Ophthalmologica. 2022 Feb 14. doi: 10.1159/000522527. Online ahead of print.

ABSTRACT

Objective and purpose: To explore the relation between retinal neurodegenerative changes and vessel closure (VC) in individuals with non-proliferative diabetic retinopathy (NPDR) in a follow-up period of 3 years.

DESIGN: 3-year prospective longitudinal study with four annual visits.

PARTICIPANTS: 74 individuals with type 2 diabetes, NPDR and ETDRS grades from 10 to 47, one eye/person. An age-matched healthy control population of 84 eyes was used as control group.

METHODS: Participants were annually examined by color fundus photography (CFP), spectral domain-optical coherence tomography (SD-OCT) and OCT-Angiography (OCTA). Vessel closure was assessed by OCTA vessel density maps. SD-OCT segmentations was performed to access central retinal thickness (CRT) and retinal neurodegeneration considered as thinning of the ganglion cell plus inner plexiform layer (GCL+IPL).

RESULTS: Type 2 diabetic individuals presented significantly higher CRT (p=0.001), GCL+IPL thinning (p=0.042), and decreased vessel density at the superficial capillary plexus (p<0.001) and full retina (p=0.001). When looking at changes occurring over the 3-year period of follow up (Table 2), there were statistically significant decreases in GCL+IPL thickness (-0.438 µm/year; p=0.038), foveal avascular zone circularity (-0.009; p=0.047), and vessel density, in superficial capillary plexus (-0.172 mm-1/year; p<0.001), deep capillary plexus (-0.350 mm-1/year; p<0.001) and full retina (-0.182 mm-1/year; p<0.001). A statistically significant association was identified between GCL+IPL thinning and decrease in deep capillary plexus vessel density (β = 0.196 [95% CI 0.037, 0.355], z = 2.410, p = 0.016), after controlling for age, gender, diabetes duration, hemoglobin A1c level, and CRT.

CONCLUSIONS: Retinal neurodegenerative changes show a steady progression during a 3-year period of follow-up in eyes with NPDR and appear to be directly associated with progression in decreased vessel density including vascular closure through preferential involvement of the deep capillary plexus. Our findings provide evidence that retinal neuropathy is linked with microvascular changes occurring in diabetic patients.

PMID:35158351 | DOI:10.1159/000522527

Kidney Blood Press Res. 2022;47(2):81-93. doi: 10.1159/000518866. Epub 2022 Jan 11.

ABSTRACT

INTRODUCTION: Diabetic kidney disease (DKD) remains the leading cause of chronic kidney disease. Dysregulation of circulating miRNAs has been reported, suggesting their pathological roles in DKD. This study aimed to investigate differentially expressed miRNAs in the sera of type 2 diabetes mellitus (T2DM) patients with and without albuminuria in a selected Malaysian population.

METHOD: Forty-one T2DM patients on follow-up at a community clinic were divided into normo-(NA), micro-(MIC), and macroalbuminuria (MAC) groups. Differential levels of miRNAs in 12 samples were determined using the pathway-focused (human fibrosis) miScript miRNA qPCR array and was validated in 33 samples, using the miScript custom qPCR array (CMIHS02742) (Qiagen GmbH, Hilden, Germany).

RESULTS: Trends of upregulation of 3 miRNAs in the serum, namely, miR-874-3p, miR-101-3p, and miR-145-5p of T2DM patients with MAC compared to those with NA. Statistically significant upregulation of miR-874-3p (p = 0.04) and miR-101-3p (p = 0.01) was seen in validation cohort. Significant negative correlations between the estimated glomerular filtration rate (eGFR) and miR-874-3p (p = 0.05), miR-101-3p (p = 0.03), and miR-145-5p (p = 0.05) as well as positive correlation between miR-874-3p and age (p = 0.03) were shown by Pearson’s correlation coefficient analysis.

CONCLUSION: Upregulation of previously known miRNA, namely, miR-145-5p, and possibly novel ones, namely, miR-874-3p and miR-101-3p in the serum of T2DM patients, was found in this study. There was a significant correlation between the eGFR and these miRNAs. The findings of this study have provided encouraging evidence to further investigate the putative roles of these differentially expressed miRNAs in DKD.

PMID:35158353 | DOI:10.1159/000518866