Category: Statistics

J Clin Nurs. 2022 Aug 7. doi: 10.1111/jocn.16483. Online ahead of print.

ABSTRACT

AIM AND OBJECTIVES: To assess (1) the experience, knowledge and preferences of end-of-life care among frail nursing home residents and (2) the preferences of residents’ family caregivers.

BACKGROUND: Globally, nursing homes are becoming an important place where many older people will receive their end-of-life care. Thus, assessing the end-of-life care preferences among nursing home residents is crucial.

DESIGN: Cross-sectional survey.

METHODS: Residents aged ≥65 years, with frail or pre-frail status (n = 286) in 34 nursing homes were interviewed using a structured questionnaire. Descriptive statistics were used to describe the outcomes and regression analyses were used to evaluate factors related to the outcomes. Kappa statistics were used to examine the agreement between the preferences among 21 residents and their family caregivers. The manuscript was guided by the STROBE checklist.

RESULTS: 5.9% and 10.5% of the participants had heard of advance care planning and advance directive respectively. After explanations of the terms by the research team, 42.3% of the participants preferred advance care planning, whereas 22.0% preferred advance directive. The top reason for not preferring advance care planning/advance directive is perceiving them as ‘not necessary’. Nursing homes were the most preferred place to receive end-of-life care (41.6%). Whereas hospitals were the most preferred place for death (36.0%). The agreement among resident and family caregiver dyads ranged from none to minimal in most outcomes.

CONCLUSIONS: This study revealed the lack of awareness around advance care planning and advance directive among frail nursing home residents. Future research should focus on developing effective educational interventions to enhance the residents’ awareness of these topics.

RELEVANCE TO CLINICAL PRACTICE: To increase awareness among nursing home residents, more educational programs should be implemented. Frail older residents might not see the relevance of advance care planning; interventions need to include both current and future care to increase its relevance.

PMID:35933614 | DOI:10.1111/jocn.16483

J Periodontol. 2022 Aug 6. doi: 10.1002/JPER.21-0226. Online ahead of print.

ABSTRACT

BACKGROUND: to determine the prevalence of periodontitis and if poor glycemic control is associated with increasing prevalence of the disease.

METHODS: This was a cross-sectional study involving children and adolescents with type 2 diabetes. A questionnaire related to oral health care history and oral health behaviors was administered to each participant and they then underwent a full mouth oral evaluation. In addition, clinical and metabolic parameters were extracted from the clinical chart.

RESULTS: 121 children and adolescents (8 – 17 years, 11months) participated. Overall, 45.5% presented some degree of periodontitis, with 10 (8.3%) mild, 36 (29.8%) moderate and 9 (7.4%) severe. The periodontitis group (PD-group) had higher mean gingival and plaque indexes, periodontal probing depth and clinical attachment loss than the group without periodontitis (NoPD-group) (p<0.05). A statistically significant relationship between the prevalence of periodontitis and glycosylated hemoglobin (HbA1c) was verified in the bivariate (OR = 1.31, [CI 95% 1.13-1.53], p = 0.001) and multivariate (OR = 1.29, [CI 95% 1.03-1.61], p = 0.03) analysis. For the adjustment variables, associations were verified for duration of diabetes, age, BMIz, lack of running water, insulin use and acanthosis nigricans.

CONCLUSIONS: Children and adolescents with type 2 diabetes presented high rates of periodontitis comparable to that seen in previous studies with youth with diabetes. Uncontrolled HbA1c influences prevalence of periodontal disease. The lack of matched control group and radiographs are limitations of the study. Comprehensive periodontal examination is essential for children and adolescents with type 2 diabetes to prevent, identify and treat periodontitis early. This article is protected by copyright. All rights reserved.

PMID:35933589 | DOI:10.1002/JPER.21-0226

Rapid Commun Mass Spectrom. 2022 Aug 6:e9374. doi: 10.1002/rcm.9374. Online ahead of print.

ABSTRACT

RATIONALE: The exact etiology and pathogenesis of CPT are not clear. Quantitative proteomics analysis plays a vital role in disease pathology research. TMT-based proteomics technique were employed to identify and analyze the differentially expressed proteins in the tibia periosteum tissues of CPT.

METHODS: The samples were divided into three groups: CPT with NF1 group, CPT without NF1 group (non-NF1-CPT), and control group (patients with open tibial fracture). A fold change ≥ 1.5 or ≤ 0.66, and P-value <0.05 were used as the thresholds to screen differentially expressed proteins (DEPs). Subsequently, bioinformatics resources such as online tools DAVID and String were subjected to generate GO annotation, KEGG pathways enrichment and PPI network for these DEPs.

RESULTS: According to statistics, a total of 347 proteins differentially expressed in NF1-CPT groups, 212 of which were up-regulated and 135 were down-regulated. There were more DEPs in nonNF1-CPT groups, we identified 467 DEPs, including 281 up-regulated and 186 down-regulated. Among of them, NF1-CPT groups and nonNF1-CPT groups shared 231 DEPs, the remaining 230 DEPs showed the same expression trend in the two disease groups, 117 were up-regulated and 113 were down-regulated. In particular, 116 proteins were altered only in NF1-CPT groups (94 were up-regulated and 22 were down-regulated), while 236 proteins were altered only in nonNF1-CPT groups (164 were up-regulated and 72 were down-regulated). Finally, compared with nonNF1-CPT, 47 proteins changed 1.5-fold and p-Value<0.05 in NF1-CPT groups.

CONCLUSIONS: To sum up, we found that common differential proteins in periosteum of NF1-CPT and nonNF1-CPT are mainly involved in cell matrix assembly, cell adhesion, AKT-PI3K signal pathway activation and vascular agglutination, which indicate that these are the pathological characteristics of CPT. The osteogenic ability is weak, the osteoclastic ability is strong, the vascular lumen is narrow, the invasive growth and the proliferation of fibroblasts are enhanced in CPT patients.

PMID:35933588 | DOI:10.1002/rcm.9374

Environ Monit Assess. 2022 Aug 6;194(9):653. doi: 10.1007/s10661-022-10325-z.

ABSTRACT

Kolkata has a reputation for being one of the world’s most polluted cities, particularly in the post-monsoon months of October, November, and December. Diwali, a Hindu festival, coincides with these months where a large number of firecrackers are set off followed by high emissions of air pollutants. As a result, the air quality index (AQI) deteriorates to “very poor” (301 ≤ AQI ≤ 400) and “poor” (201 ≤ AQI ≤ 300) categories. This situation stays for several days to a month. The present study aims to identify the thresholds for PM_2.5 and PM₁₀ that cause the AQI of Kolkata to deteriorate to “very poor” and “poor.” For this purpose, we have used a rough set theory-based condition-decision support system to predict the aforementioned categories of AQI. We have developed a Z-number-based novel quantification measure of semantic information of AQI to assess the reliability of the outcomes, as generated from the condition-decision-based decision rules, during post-monsoon season. The result reveals the best possible forecast of AQI with linguistic summarization of the reliability or confidence for different threshold ranges of PM₁₀ and PM_2.5. Inverse-decision rules based on rough set theory are utilized to justify and validate the forecasts. The explainability of the condition-decision support system is demonstrated/visualized using a flow graph that maps rough-rule-based different decision paths between input and output with strength, certainty, and coverage. The investigation resulted in an advanced intelligent environmental decision support system (IEDSS) for air-quality prediction.

PMID:35933570 | DOI:10.1007/s10661-022-10325-z

J Neurooncol. 2022 Aug 6. doi: 10.1007/s11060-022-04092-7. Online ahead of print.

ABSTRACT

PURPOSE: Limited progress has been made in treating glioblastoma, and we hypothesise that poor concordance between preclinical and clinical efficacy in this disease is a major barrier to drug development. We undertook a systematic review to quantify this issue.

METHODS: We identified phase I trials (P1Ts) of tumor targeted drugs, subsequent trial results and preceding relevant preclinical data published in adult glioblastoma patients between 2006-2019 via structured searches of EMBASE/MEDLINE/PUBMED. Detailed clinical/preclinical information was extracted. Associations between preclinical and clinical efficacy metrics were determined using appropriate non-parametric statistical tests.

RESULTS: A total of 28 eligible P1Ts were identified, with median ORR of 2.9% (range 0.0-33.3%). Twenty-three (82%) had published relevant preclinical data available. Five (18%) had relevant later phase clinical trial data available. There was overall poor correlation between preclinical and clinical efficacy metrics on univariate testing. However, drugs that had undergone in vivo testing had significantly longer median overall survival (7.9 vs 5.6mo, p = 0.02). Additionally, drugs tested in ≥ 2 biologically-distinct in vivo models (‘multiple models’) had a significantly better median response rate than those tested using only one (‘single model’) or those lacking in vivo data (6.8% vs 1.2% vs. 0.0% respectively, p = 0.027).

CONCLUSION: Currently used preclinical models poorly predict subsequent activity in P1Ts, and generally over-estimate the anti-tumor activity of these drugs. This underscores the need for better preclinical models to aid the development of novel anti-glioblastoma drugs. Until these become widely available and used, the use of multiple biologically-distinct in vivo models should be strongly encouraged.

PMID:35933567 | DOI:10.1007/s11060-022-04092-7

NPJ Parkinsons Dis. 2022 Aug 6;8(1):99. doi: 10.1038/s41531-022-00363-2.

ABSTRACT

A number of genetic risk factors have been identified over the past decade for Parkinson’s Disease (PD), with variants in GBA prominent among them. GBA encodes the lysosomal enzyme that degrades the glycosphingolipid, glucosylceramide (GlcCer), with the activity of this enzyme defective in Gaucher disease. Based on the ill-defined relationship between glycosphingolipid metabolism and PD, we now analyze levels of various lipids by liquid chromatography/electrospray ionization-tandem mass spectrometry in four brain regions from age- and sex-matched patient samples, including idiopathic PD, PD patients with a GBA mutation and compare both to control brains (n = 21 for each group) obtained from individuals who died from a cause unrelated to PD. Of all the glycerolipids, sterols, and (glyco)sphingolipids (251 lipids in total), the only lipid class which showed significant differences were the gangliosides (sialic acid-containing complex glycosphingolipids), which were elevated in 3 of the 4 PD-GBA brain regions. There was no clear correlation between levels of individual gangliosides and the genetic variant in Gaucher disease [9 samples of severe (neuronopathic), 4 samples of mild (non-neuronopathic) GBA variants, and 8 samples with low pathogenicity variants which have a higher risk for development of PD]. Most brain regions, i.e. occipital cortex, cingulate gyrus, and striatum, did not show a statistically significant elevation of GlcCer in PD-GBA. Only one region, the middle temporal gyrus, showed a small, but significant elevation in GlcCer concentration in PD-GBA. We conclude that changes in ganglioside, but not in GlcCer levels, may contribute to the association between PD and GBA mutations.

PMID:35933559 | DOI:10.1038/s41531-022-00363-2

Sci Rep. 2022 Aug 6;12(1):13517. doi: 10.1038/s41598-022-17512-5.

ABSTRACT

Simulation in surgical training is a growing field and this study aims to understand the force and torque experienced during lumbar spine surgery to design simulator haptic feedback. It was hypothesized that force and torque would differ among lumbar spine levels and the amount of tissue removed by ≥ 7%, which would be detectable to a user. Force and torque profiles were measured during vacuum curette insertion and torsion, respectively, in multiple spinal levels on two cadavers. Multiple tests per level were performed. Linear and torsional resistances of 2.1 ± 1.6 N/mm and 5.6 ± 4.3 N mm/°, respectively, were quantified. Statistically significant differences were found in linear and torsional resistances between all passes through disc tissue (both p = 0.001). Tool depth (p < 0.001) and lumbar level (p < 0.001) impacted torsional resistance while tool speed affected linear resistance (p = 0.022). Average differences in these statistically significant comparisons were ≥ 7% and therefore detectable to a surgeon. The aforementioned factors should be considered when developing haptic force and torque feedback, as they will add to the simulated lumbar discectomy realism. These data can additionally be used inform next generation tool design. Advances in training and tools may help improve future surgeon training.

PMID:35933556 | DOI:10.1038/s41598-022-17512-5

Ann Surg Oncol. 2022 Aug 6. doi: 10.1245/s10434-022-12369-4. Online ahead of print.

ABSTRACT

BACKGROUND: The present study was conducted to evaluate the clinical, pathological response, and prognosis characteristics of human epidermal growth factor receptor 2 (HER2)-low breast cancer in the neoadjuvant chemotherapy setting.

METHODS: Patients with HER2-negative breast cancer who received neoadjuvant chemotherapy from January 2017 to December 2019 were retrospectively analyzed. HER2-negative breast cancer was divided into two groups: HER2-zero (defined as immunohistochemistry [IHC] 0) and HER2-low (defined as IHC 1+, or IHC 2+ and fluorescence in-situ hybridization-negative.

RESULTS: Overall, 314 patients with HER2-negative breast cancer were analyzed. The proportion of HER2-low patients with hormone receptor (HR)-positive disease was higher than in triple-negative breast cancer (TNBC; 75.3% vs. 63.2%, p = 0.032). In HR-positive breast cancer, HER2-low tumors presented less nodal involvement (p = 0.023) and earlier clinical stage (p = 0.015) compared with HER2-zero tumors; however, in TNBC, HER2-low patients had a later clinical stage (p = 0.028). With the pathological complete response (pCR) defined as ypTis/0ypN0, there was no difference in pCR rates among the entire cohort, HR-positive disease, and TNBC. However, with the pCR defined as ypT0ypN0, the pCR rate in HER2-low breast cancer was significantly lower than HER2-zero breast cancer in the entire cohort (24.3% vs. 36.4%, p = 0.032) and the HR-positive subgroup (18.7% vs. 32.1%, p = 0.035), but not for TNBC. Multivariate analysis demonstrated that HER2 status (low vs. zero) was an independent predictive factor for pCR (p = 0.013) in HR-positive breast cancer. There were no statistically significant differences in 3-year disease-free survival and overall survival between HER2-low and HER2-zero breast cancer among the entire cohort, HR-positive disease, and TNBC.

CONCLUSIONS: HER2-low breast cancer exhibits specific clinical features and different response to treatment associated with HR status in the neoadjuvant chemotherapy setting.

PMID:35933542 | DOI:10.1245/s10434-022-12369-4

Sci Rep. 2022 Aug 6;12(1):13513. doi: 10.1038/s41598-022-17794-9.

ABSTRACT

The rate of cholangiocarcinoma (CCA) is increasing every year, especially in northeastern Thailand. Screening for CCA using ultrasonography (US) is the fastest technique to identify patients in early stage of CCA development. Currently, few studies have examined patterns of hepatobiliary abnormalities identified using US, which can be indicative of CCA. We aim to evaluate the rate of CCA and its relations to history of US findings. Our study included participants who underwent US and pathological diagnosis of CCA from the Cholangiocarcinoma Screening and Care Program, Northeast Thailand between 2013 and 2020. Data on histological findings were based on the standard protocol of the tertiary hospital at Khon Kaen University. CCA data is categorized into two groups (yes/no) to find the relationship with history of US findings. The adjusted odds ratio (AOR) and their 95% confidence intervals (CI) were used to evaluate the relationship obtained by multiple logistic regression. Of 1880 subjects who underwent US and a pathological diagnosis of CCA, the overall rate of CCA was 35.74%. CCA rate among those with liver mass (LM) was 54.85% and with dilated bile duct (DBD) was 62.01%. The relationship between DBD and CCA was highly significant (AOR = 3.46; 95% CI 2.74-4.36) followed by LM (AOR = 2.28; 95% CI 1.81-2.86) P value < 0.001. Our study reveals that US findings history have a strong association with CCA, especially in people diagnosed with DBD and LM. Therefore, these abnormalities can be indicators for suspected CCA diagnosis through US.

PMID:35933509 | DOI:10.1038/s41598-022-17794-9

World J Surg. 2022 Aug 6. doi: 10.1007/s00268-022-06685-9. Online ahead of print.

ABSTRACT

OBJECTIVE: The effectiveness of intraperitoneal local anesthesia (IPLA) has been confirmed in other fields, but its use in bariatric surgery remains debatable. This study aimed to evaluate the analgesic effect of IPLA in bariatric surgery.

METHODS: PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to February 2022. All randomized controlled trials (RCTs) assessing IPLA’s analgesic effect in bariatric surgery were included in this study. Pain-related indicators were the outcome.

RESULTS: Ten RCTs with 979 patients were included. Postoperative pain scores were significantly lower in IPLA group. Subgroup analysis demonstrated that IPLA was associated with lower pain scores in 6 h and at 24 h compared to the control group, without significant differences at 8, 12, and 48 h. Meanwhile, IPLA reduced the dose of opioids taken postoperatively. Additionally, there were no differences in adverse events between the two groups. As far as the number of postoperative analgesics used and hospital stays were concerned, our results did not show statistical differences between the two groups.

CONCLUSION: IPLA can reduce postoperative pain safely and effectively, particularly during the early postoperative stage.

PMID:35933496 | DOI:10.1007/s00268-022-06685-9