Category: Statistics

J Phys Act Health. 2021 Jun 17:1-6. doi: 10.1123/jpah.2020-0746. Online ahead of print.

ABSTRACT

BACKGROUND: Both genetic and environmental influences have been shown to contribute to the association between physical activity and overall academic performance. The authors examined whether leisure-time physical activity (LTPA) shares genetic and environmental variances between spelling, essay writing, reading aloud, reading comprehension, and mathematics in early adolescence. Moreover, they investigated whether genetic polymorphisms associated with physical activity behavior affect these academic skills.

METHODS: Participants were 12-year-old Finnish twins (n = 4356-4370 twins/academic skill, 49% girls). Academic skills were assessed by teachers, and LTPA was self-reported. Polygenic scores for physical activity behavior were constructed from the UK Biobank. Quantitative genetic modeling and linear regression models were used to analyze the data.

RESULTS: The trait correlations between LTPA and academic skills were significant but weak (r = .05-.08). The highest trait correlation was found between LTPA and mathematics. A significant genetic correlation was revealed between LTPA and essay writing (rA = .14). Regarding polygenic scores of physical activity, the highest correlations were found with reading comprehension, spelling, and essay writing, but these results only approached statistical significance (P values = .09-.15).

CONCLUSIONS: The authors’ results suggest that reading and writing are the academic skills that most likely share a common genetic background with LTPA.

PMID:34140420 | DOI:10.1123/jpah.2020-0746

AJNR Am J Neuroradiol. 2021 Jun 17. doi: 10.3174/ajnr.A7156. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: The developing nervous system is particularly vulnerable to late adverse effects of cranial radiation therapy, such as leukoencephalopathy, microbleeds, and cavernomas. Cystlike lesions have been rarely described and characterized in the literature. We aimed to characterize cystlike lesions, their risk factors, and association with other late adverse effects.

MATERIALS AND METHODS: Children treated for brain tumors during a 30-year period (n = 139) were included. We documented imaging findings, focusing on cystlike lesion development and its relationship with clinical history and other imaging findings. Multivariable analysis was performed using logistic regression and negative binomial regression models.

RESULTS: Cystlike lesions developed in 16.5% of patients treated with radiotherapy, with a median of 2 years until the development of the first lesion. For every 4-year age increase, there were 50% decreased odds of developing lesions and a 50% decrease in the average count of lesions. Females demonstrated a 4.00 rate ratio of developing a higher number of lesions. Patients who underwent chemoradiotherapy had 3.20 increased odds of developing cystlike lesions compared with patients with radiation therapy alone. A larger proportion of patients treated with methotrexate (25%) developed cystlike lesions, but this was not statistically significant. Cystlike lesions tended to develop in cerebral locations where leukoencephalopathy was worse. A strong relationship was found between the development of cystlike lesions and leukoencephalopathy severity.

CONCLUSIONS: Cystlike lesions are frequent and under-reported late adverse effects of cranial radiation therapy in children. Younger age, chemoradiotherapy, and the severity of leukoencephalopathy represent risk factors for the development of cystlike lesions.

PMID:34140275 | DOI:10.3174/ajnr.A7156

BMJ Open. 2021 Jun 17;11(6):e050717. doi: 10.1136/bmjopen-2021-050717.

ABSTRACT

INTRODUCTION: People who are homeless experience higher morbidity and mortality than the general population. These outcomes are exacerbated by inequitable access to healthcare. Emerging evidence suggests a role for peer advocates-that is, trained volunteers with lived experience-to support people who are homeless to access healthcare.

METHODS AND ANALYSIS: We plan to conduct a mixed methods evaluation to assess the effects (qualitative, cohort and economic studies); processes and contexts (qualitative study); fidelity; and acceptability and reach (process study) of Peer Advocacy on people who are homeless and on peers themselves in London, UK. People with lived experience of homelessness are partners in the design, execution, analysis and dissemination of the evaluation.

ETHICS AND DISSEMINATION: Ethics approval for all study designs has been granted by the National Health Service London-Dulwich Research Ethics Committee (UK) and the London School of Hygiene and Tropical Medicine’s Ethics Committee (UK). We plan to disseminate study progress and outputs via a website, conference presentations, community meetings and peer-reviewed journal articles.

PMID:34140346 | DOI:10.1136/bmjopen-2021-050717

Actas Urol Esp (Engl Ed). 2021 Jun 14:S2173-5786(21)00074-3. doi: 10.1016/j.acuroe.2020.09.008. Online ahead of print.

ABSTRACT

BACKGROUND: Repeat prostate biopsy (PBx) is recommended under persistent suspicion of prostate cancer (PCa) or in the face of the following findings: atypical small acinar proliferation (ASAP); extense (≥3 biopsy sites) high-grade prostatic intraepithelial neoplasia (HGPIN); or HGPIN with atypical glands; suspicious for adenocarcinoma (PIN-ATYP). Nowadays; multiparametric magnetic resonance imaging (mpMRI) and mpMRI targeted PBx (MRI-TBx) are recommended in repeat PBx. Our objective was to analyze the current value of ASAP; mHGPIN; PIN-ATYP and other histological findings to predict clinically significant PCa (csPCa) risk.

METHODS: Retrospective analysis of 377 repeat PBxs. MRI-TBx was performed when Prostate Imaging-Reporting and Data System (PI-RADS) score >3 and 12-core transrectal ultrasound (TRUS) systematic PBx when ≤2. ASAP; HGPIN; mHGPIN; PIN-ATYP; and 8 other histological findings were prospectively reported in negative PBx. CsPCa was defined as ISUP group grade >2.

RESULTS: Incidence of ASAP; multifocal HGPIN (mHGPIN) and PINATYP was 4.2%; 39.7% and 3.7% respectively; and csPCa rate was statistically similar among men with these histological findings. However; the rate of csPCa was 22.2% when proliferative inflammatory atrophy (PIA) was present; and 36.1% when it was not. PIA was the only histological finding which predicted lower risk of csPCa; with an OR of 0.54 (95%CI: 0.308-0.945; P = .031). In addition; PIA was an independent predictor of a model combining clinical variables and mpMRI which reached area under de ROC curve of 0.86 (95%CI: 0.83-0.90).

CONCLUSION: PIA emerged as the only predictive histological finding of csPCa risk and can contribute to a predictive model. mHGPIN failed to predict csPCa risk. The low incidence of ASAP (4.2%) and PIN-ATYP (3.7%) prevented us from drawing conclusions.

PMID:34140257 | DOI:10.1016/j.acuroe.2020.09.008

Rev Esp Anestesiol Reanim (Engl Ed). 2021 Jun 14:S2341-1929(21)00087-1. doi: 10.1016/j.redare.2020.11.004. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer is the most commonly occurring cancer among women. Among its treatment sequelae is chronic neuropathic pain after breast surgery (CNPBS). Pain management is difficult and classicaly consists in a pharmacological approach, however recent studies have advocated the use of locoregional techniques as adjuvants. Serratus plane block (SPB) has recently emerged as a potential tool for the control of CNPBS. This study aims to evaluate the efficacy and potencial role of the ultrasound-guided SPB on CNPBS.

METHODS: A retrospective analysis was performed on 30 patients with CNPBS refractory to drug therapy, who underwent SPB between 2017-2019. The following parameters were analyzed: basal pain, pain at 24 h, 1 week and at 1 month. The Mann-Whitney test was applied. Statistical significance was considered at the level of p < 0.05. All statistical analysis was performed with SPSS 20.

RESULTS: 3 patients were excluded. At 24 h, we report pain improvement (at least 30% reduction on basal pain score) on 20 patients and after 1 week on 12. At 1 month after, 22 patients had improved, from these: 11 improved with no therapeutic adjustment; 11 patients improved with therapeutic adjustment (8 in gabapentinoid monotherapy, 3 with introduction of polytherapy). 5 patients didn’t improve.

CONCLUSION: Our study demonstrated SPB as a valid alternative for CNPBS management when pharmacologic therapy has been proven insufficient, with no side effects reported. Randomized studies are needed to assess the magnitude of SPB on CNPBS and to identify the patients who benefit the most from SPB.

PMID:34140270 | DOI:10.1016/j.redare.2020.11.004

Oral Surg Oral Med Oral Pathol Oral Radiol. 2021 May 6:S2212-4403(21)00422-3. doi: 10.1016/j.oooo.2021.04.054. Online ahead of print.

ABSTRACT

OBJECTIVE: We examined whether steroid ointment (0.1% dexamethasone) is an effective treatment for mucoceles.

STUDY DESIGN: Using a retrospective cohort study design, a statistical study was conducted of 91 patients diagnosed with mucoceles at the Department of Dental and Oral Surgery, Saga University Hospital, Saga, Japan, between January 2006 and December 2016. The patients’ age and sex; shape, size, and site of the lesion; duration; and treatment response rate were evaluated.

RESULTS: The most frequent site of mucoceles was the lower labial mucosa, and several were <10 mm in size. The age of onset was often <20 years, with no sex-based differences. The treatment response rate was 65.8% for steroid ointment and 100% for surgical removal. In the subgroup analysis according to each clinical factor, some subgroups showed statistically nonsignificant differences compared with the surgery group. Among them, the older age and short disease duration subgroups showed small risk differences, suggesting that application of ointment may lead to a response in these subgroups.

CONCLUSIONS: Although its response rate was lower than that of surgical removal, topical steroid application is a noninvasive and useful treatment method that can be used for patients in whom surgical treatment is infeasible.

PMID:34140272 | DOI:10.1016/j.oooo.2021.04.054

Urol Oncol. 2021 Jun 14:S1078-1439(21)00211-8. doi: 10.1016/j.urolonc.2021.05.006. Online ahead of print.

ABSTRACT

OBJECTIVE: Some attempts have previously been made to stratify patients with CIS for the purpose of risk-adapted clinical management and clinical trial design. In particular, two classification systems have been proposed: clinical classification, comprising primary (P-CIS), concomitant (C-CIS), and secondary (S-CIS) disease, and pathological classification, comprising P-CIS, cTa-CIS, and cT1-CIS. The aim of the present study was to assess the impact of both classifications on BCG response, recurrence-free survival (RFS), progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS).

PATIENTS AND METHODS: We performed a retrospective analysis of 386 patients with bladder CIS, with or without associated cTa/cT1 disease, treated with BCG instillations between 2008 and 2015. Patients were stratified according to the two classification systems. Cox multivariate regression models were used to assess the impact of these subtypes on BCG response, RFS, PFS, OS, and CSS. We also performed a cumulative meta-analysis according to PRISMA guidelines.

RESULTS: The median follow-up was 70.5 months. According to the clinical classification, 34 (8.8%) patients had P-CIS, 81 (21%) S-CIS, and 271 (70.2%) C-CIS. The pathological classification showed 34 (8.8%) patients to have P-CIS, 190 (49.2%) cTa-CIS, and 162 (42%) cT1-CIS. In the overall cohort, BCG response was reported in 296 (76.7%); 159 (41.2%) had recurrence, 55 (14.2%) had progression, and 67 (17.4%) underwent radical cystectomy. Death from any cause was recorded in 135 (35%) and death from urothelial carcinoma in 38 (9.9%). Cox multivariate regression analysis showed that neither clinical classification nor pathological classification is an independent predictive factor for BCG response, RFS, PFS, OS, or CSS after adjusting for confounders. In the pooled meta-analysis, two studies and the present series were included for evidence synthesis, recruiting a total of 941 patients. We found no statistically significant difference across the groups for both classifications with respect to BCG response, RFS, PFS, and CSS.

CONCLUSIONS: Currently, the supporting evidence for an impact of clinical classification and pathological classification on oncological outcomes of CIS of the bladder is insufficient to justify their use to guide clinical management or follow-up.

PMID:34140244 | DOI:10.1016/j.urolonc.2021.05.006

J Cyst Fibros. 2021 Jun 14:S1569-1993(21)00162-4. doi: 10.1016/j.jcf.2021.05.011. Online ahead of print.

ABSTRACT

BACKGROUND: Non-invasive ventilation (NIV) is an established treatment option for cystic fibrosis (CF) patients with type 2 respiratory failure but the benefits of this therapy remain unclear. This study examined the long-term outcomes and response to NIV in a large adult CF cohort.

METHODS: All patients attending a UK adult CF Centre receiving NIV as treatment for hypercapnic respiratory failure over a nine-year period were studied prospectively. Detailed clinical data was recorded and longitudinal data measurements were examined for the three years pre and post NIV initiation to assess effect of this intervention.

RESULTS: 94 patients, mean age 29.9 (SD 9.7) years, percent predicted FEV₁ 21.5 (7.3), received NIV. All patients commenced NIV in a hospital setting. 21 remain alive, 24 received double lung transplant, 49 died without lung transplantation. NIV use was associated with a stabilisation and improvement in both FEV₁ and FVC from NIV set up to three years post follow-up, in addition to an increase in body mass index and attenuation of PCO₂ (all p<0.001). No single parameter was found to predict long-term NIV response but baseline PCO₂ (p=0.005), CRP (p=0.004) and age (p=0.009) were identified as independent predictors of mortality.

CONCLUSIONS: NIV use in CF adults is associated with improvements in lung function and attenuation of hypercapnia which is maintained for up to three years post NIV initiation. Outcomes for CF patients with severe pulmonary disease commenced on NIV have significantly improved with fifty percent of patients expected to survive for approximately five years.

PMID:34140250 | DOI:10.1016/j.jcf.2021.05.011

Arch Pediatr. 2021 May 28:S0929-693X(21)00094-4. doi: 10.1016/j.arcped.2021.05.002. Online ahead of print.

ABSTRACT

INTRODUCTION: At the end of April 2020, three European pediatric societies published an alert on a new hyperinflammatory disorder linked to SARS-CoV-2. This disease has alternatively been called Kawasaki-like disease, pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS), and multisystem inflammatory syndrome in children (MIS-C). These alerts provide a clear starting point from which to study the early response of the medical and scientific community to a new disease in terms of scientific publications, and to compare the timeline of this response with levels of general public interest. To this aim, we conducted a bibliometric analysis of articles on this disease published between 1 April and 5 July 2020.

METHOD: A literature search was performed using PubMed and in three preprint repositories. For each article, the name used for the disease in the title, the number of authors, the number of patients, the citations according to Google Scholar, the journal impact factor, and the Altmetric score were retrieved. Google search trends for the terms “Kawasaki” and “COVID,” “COVID-19,” and “coronavirus” were also retrieved, as was the number of Reuters news articles published on the topic. These data were compared longitudinally on a weekly basis. The quality of the reporting of the study was evaluated using the STROBE guidelines for observational studies with more than three patients and using the CARE guidelines for case reports of three or fewer patients.

RESULTS: Eighty-six articles were included, among which ten were preprints (three of which were subsequently published) and 49 were clinical articles (57%). A total of 857 patients were described. The median number of authors per article was five (range, 1-45), the median number of patients was four (1-186), the median number of citations was one (0-170), the median Altmetric score was 12 (0-7242), and the median journal impact factor was 3.7 (1-74.7). For the clinical articles, the median percentage of STROBE or CARE checklist items satisfied was 70% (IQR, 56.75-79.25; range, 40-90). Guideline adherence was significantly higher for observational studies than for case reports (median percentage of checklist items satisfied, 78.5% vs 61.5%; P<0.001); however, guideline adherence did not differ significantly between peer-reviewed and preprint articles (median percentage of checklist items satisfied, 57% vs 72%; P=0.205). The only statistically significant difference between clinical articles and other types of articles was the number of authors (median, 7 vs 2; P=2.53E-9). Fifty-seven of the 86 articles were authored by researchers from just three countries (the USA, 31; France, 14; and the UK, 12). The names most frequently used in the title were Kawasaki-like disease (n=37), followed by MIS-C (n=27), PIM-TS (n=14), and other names involving the term “inflammatory” (n=12). Google searches for related terms peaked between weeks 18 and 21, following the initial alerts and decreased rapidly thereafter. The number of Reuters articles on the subject was correlated with Google search trends (ρ: 0.86, 95% CI [0.59; 0.96]; P=0.00016), but the number of medical articles published was not (ρ: -0.54, 95% CI [-0.87; 0.14]; P=0.11). The first small case series was published less than 2 weeks after the initial alert; however, if all articles had been deposited as preprints when they were submitted to journals, the cumulative number of reported cases would have been 300% higher in week 18 (3 vs 1), 400% higher in week 19 (44 vs 11), 70% higher in week 20 (124 vs 73), and 54% higher in week 21 (129 vs 84).

CONCLUSION: In a period of 9 weeks after the initial alerts from European pediatric societies, 85 medical articles were published, involving 856 patients (one case report was published before the alerts), allowing rapid dissemination of research information. However, general public interest followed the news cycle rather than scientific releases. The quality of the reporting, as assessed by adherence to STROBE or CARE guidelines, was adequate with more than two-thirds of checklist items satisfied. Learned societies play an important role in the early dissemination of up-to-date peer-reviewed information. Preprint deposition should be encouraged to accelerate the dissemination of research information.

PMID:34140220 | DOI:10.1016/j.arcped.2021.05.002

Neurocirugia (Astur). 2021 Jun 14:S1130-1473(21)00054-3. doi: 10.1016/j.neucir.2021.04.004. Online ahead of print.

ABSTRACT

OBJECTIVE: It is difficult to demonstrate the success of the procedure in patients with third ventriculostomy. We evaluated that optic nerve sheath diameter (ONSD) measurement, which can reflect intracranial pressure, may be a criterion for decision of endoscopic third ventriculostomy (ETV) success.

METHODS: 28 adult patients suffering long overt standing ventriculomegaly (LOVA) who performed ETV were included in this retrospective study. The patients were divided into two groups as successful (group A) and failed ETV group (group B) according to their postoperative evaluation. ONSD was measured on pre- and post-operative computed tomography (CT) and Evan’s index (EI), diameter of third ventricule (V3), the patency of ETV stoma and periventricular edema were evaluated by magnetic resonance imaging (MRI).

RESULTS: The mean ONSD was measured as 6.39±0.92mm for the right eye, 6.50±0.91mm for the left eye on preoperative CT. The mean ONSD by CT (after surgery) was 4.89±0.87mm for the right eye, 5.02±0.1mm for the left eye (p<0.05). Postoperative group A and group B were compared according to ONSD measurement; mean ONSD in group A was 4.52±0.69mm for the right and 4.59±0.9mm for the left, mean ONSD in group B was 5.82±0.51mm for the right and 6.1±0.32mm for the left (p<0.05). The best ONSD value for detecting failed ETV was 5.40mm (sensitivity 90%, specifity 75%, AUROC 0.938) for right and 5.91mm (sensitivity 90%, specifity 75%, AUROC 0.950) for left. EE was measured as 0.39±0.12mm on preoperative MRI and 0.39±0.12mm on postoperative MRI (p=0.3). V3 was measured as 14.7±2.47mm on preoperative MRI and 10.47±1.99mm on postoperative MRI (p<0.05).

CONCLUSION: The statistical values obtained from study show that the ONSD measurement can help in the postoperative evaluation of patients, who had a ETV surgery.

PMID:34140223 | DOI:10.1016/j.neucir.2021.04.004