Category: Statistics

Complement Med Res. 2021 Mar 18:1-10. doi: 10.1159/000515003. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: The present systematic review and meta-analysis of randomized controlled trials aimed to determine the effects of saffron supplementation on liver function tests among adults.

METHODS: Electronic databases including PubMed, ISI Web of Science, and Scopus were searched up to January 2021. The risk of bias in individual studies was assessed using the Cochrane Collaboration tool. The overall estimates and their 95% CIs were calculated using random-effects models. Egger’s test and Begg’s rank-correlation were run to assess the presence of publication bias. p < 0.05 was considered statistically significant.

RESULTS: A total of 12 trials involving 608 participants were included in this systematic review and meta-analysis. Saffron supplementation had no significant effect on liver function tests including aspartate transaminase (AST) (weighted mean difference [WMD] = 0.23 U/L; 95% CI -2.22 to 2.69; p = 0.851; I2 = 74.0%), alanine aminotransferase (ALT) (WMD = -1.49 U/L; 95% CI -3.84 to 0.86; p = 0.213; I2 = 60.2%), and alkaline phosphatase (ALP) (WMD = -0.70 U/L; 95% CI -11.35 to 9.95; p = 0.898; I2 = 40.8%) compared to placebo.

CONCLUSION: Based on what was discussed, it seems that saffron supplementation could not improve liver function tests including AST, ALT, and ALP among the adult population. Further clinical trials with larger sample size, longer duration, and higher doses of saffron should be conducted exclusively among patients with liver dysfunction to elucidate the beneficial role of saffron consumption on liver function.

PMID:33735877 | DOI:10.1159/000515003

Physiol Meas. 2021 Mar 18. doi: 10.1088/1361-6579/abf01e. Online ahead of print.

ABSTRACT

OBJECTIVE: Clinical assessment of upper limb hemiparesis in acute stroke involves repeated manual examination of hand movements during instructed tasks. This process is labour-intensive and prone to human errors while also being strenuous for the patient. Wearable motion sensors can automate the process by measuring characteristics of hand activity. Existing work in this direction either use multiple sensors or complex instructed movements, or analyze only the quantity of upper limb motion. These methods are obtrusive and strenuous for acute stroke patients and also sensitive to noise. In this work, we propose to use only two wrist-worn accelerometer sensors to study the quality of completely spontaneous upper limb motion and investigate correlation with clinical scores for acute stroke care.

APPROACH: Velocity time series estimated from acquired acceleration data during spontaneous motion is decomposed into smaller movement elements. Measures of density, duration and smoothness of these component elements are extracted and their disparity is studied across the two hands.

MAIN RESULTS: Spontaneous upper limb motion in acute stroke can be decomposed into movement elements that resemble point-to-point reaching tasks. These elements are smoother and sparser in the normal hand than the hemiparetic hand, and the amount of smoothness correlates with hemiparetic severity. Features characterizing the disparity of these movement elements between two hands show statistical significance in differentiating mild-to-moderate and severe hemiparesis. Using data from 67 acute stroke patients, the proposed method can classify the two levels of hemiparetic severity with 85% accuracy. Additionally, compared to activity based features, the proposed method is robust to the presence of noise in acquired data.

SIGNIFICANCE: This work demonstrates that the quality of upper limb motion can characterize and identify hemiparesis in stroke survivors. This is clinically significant towards continuous automated assessment of hemiparesis in acute stroke using minimally intrusive wearable sensors.

PMID:33735840 | DOI:10.1088/1361-6579/abf01e

Phys Med Biol. 2021 Mar 18. doi: 10.1088/1361-6560/abf00f. Online ahead of print.

ABSTRACT

The Most Likely Path formalism (MLP) is widely established as the most statistically precise method for proton path reconstruction in proton computed tomography (pCT). However, while this method accounts for small-angle Multiple Coulomb Scattering (MCS) and energy loss, inelastic nuclear interactions play an influential role in a significant number of proton paths. By applying cuts based on energy and direction, tracks influenced by nuclear interactions are largely discarded from the MLP analysis. In this work we propose a new method to estimate the proton paths based on a Deep Neural Network (DNN). Through this approach, estimates of proton paths equivalent to MLP predictions have been achieved in the case where only MCS occurs, together with an increased accuracy when nuclear interactions are present. Moreover, our tests indicate that the DNN algorithm can be considerably faster than the MLP algorithm.

PMID:33735852 | DOI:10.1088/1361-6560/abf00f

Complement Med Res. 2021 Mar 18:1-4. doi: 10.1159/000515139. Online ahead of print.

ABSTRACT

INTRODUCTION: Saliva is increasingly used as a diagnostic tool as it is non-invasive, easily accessible, and less stressful compared to blood sampling. Saliva has a vital role in maintaining oral health. It is necessary for the salivary pH to be neutral in the oral cavity for the optimal functioning of its components. Stress has an effect on salivary pH.

OBJECTIVE: To study the effect of a mind-body intervention like Sudarshan Kriya yoga (SKY) on the salivary pH.

METHODS AND MATERIALS: An exploratory pilot study involving an open trial on 321 healthy individuals who were novice to SKY was conducted. The salivary pH was measured before and after a single 90-min session of SKY.

RESULTS: The salivary pH continued to be neutral after the intervention in the group that had initial neutral pH. There was a statistically significant shift of pH towards neutral in both the groups that had either acidic or alkaline pH initially.

CONCLUSION: Mind-body interventions like SKY modulate the salivary pH to bring it to the range of optimal functioning. This pilot study provides information for future long-term studies that can be implemented with measures of anxiety and stress along with measuring other salivary biomarkers.

PMID:33735857 | DOI:10.1159/000515139

Blood Purif. 2021 Mar 18:1-11. doi: 10.1159/000512350. Online ahead of print.

ABSTRACT

BACKGROUND: Continuous renal replacement therapy (CRRT) is the standard treatment for severe acute kidney injury in critically ill patients. However, a practical consensus for discontinuing CRRT is lacking. We aimed to develop a prediction model with simple clinical parameters for successful discontinuation of CRRT.

METHODS: Adult patients who received CRRT at Samsung Medical Center from 2007 to 2017 were included. Patients with preexisting ESRD and patients who progressed to ESRD within 1 year or died within 7 days after CRRT were excluded. Successful discontinuation of CRRT was defined as no requirement for renal replacement therapy for 7 days after discontinuing CRRT. Patients were assigned to either a success group or failure group according to whether discontinuation of CRRT was successful or not.

RESULTS: A total of 1,158 patients were included in the final analyses. The success group showed greater urine output on the day before CRRT discontinuation (D-1) and the discontinuation day (D0). Multivariable analysis identified that urine output ≥300 mL on D-1, and mean arterial pressure 50∼78 mm Hg, serum potassium <4.1 mmol/L, and BUN <35 mg/dL (12.5 mmol/L) on D0 were predictive factors for successful discontinuation of CRRT. A scoring system using the 4 variables above (area under the receiver operating curve: 0.731) was developed.

CONCLUSIONS: Scoring system composed of urine output ≥300 mL/day on D-1, and adequate blood pressure, serum potassium <4.1 mmol/L, and BUN <35 mg/dL (12.5 mmol/L) on D0 was developed to predict successful discontinuation of CRRT.

PMID:33735858 | DOI:10.1159/000512350

ESMO Open. 2021 Mar 15;6(2):100078. doi: 10.1016/j.esmoop.2021.100078. Online ahead of print.

ABSTRACT

BACKGROUND: To stratify the prognosis of patients with programmed cell death-ligand 1 (PD-L1) ≥ 50% advanced non-small-cell lung cancer (aNSCLC) treated with first-line immunotherapy.

METHODS: Baseline clinical prognostic factors, the neutrophil-to-lymphocyte ratio (NLR), PD-L1 tumour cell expression level, lactate dehydrogenase (LDH) and their combination were investigated by a retrospective analysis of 784 patients divided between statistically powered training (n = 201) and validation (n = 583) cohorts. Cut-offs were explored by receiver operating characteristic (ROC) curves and a risk model built with validated independent factors by multivariate analysis.

RESULTS: NLR < 4 was a significant prognostic factor in both cohorts (P < 0.001). It represented 53% of patients in the validation cohort, with 1-year overall survival (OS) of 76.6% versus 44.8% with NLR > 4, in the validation series. The addition of PD-L1 ≥ 80% (21% of patients) or LDH < 252 U/l (25%) to NLR < 4 did not result in better 1-year OS (of 72.6% and 74.1%, respectively, in the validation cohort). Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 2 [P < 0.001, hazard ratio (HR) 2.04], pretreatment steroids (P < 0.001, HR 1.67) and NLR < 4 (P < 0.001, HR 2.29) resulted in independent prognostic factors. A risk model with these three factors, namely, the lung immuno-oncology prognostic score (LIPS)-3, accurately stratified three OS risk-validated categories of patients: favourable (0 risk factors, 40%, 1-year OS of 78.2% in the whole series), intermediate (1 or 2 risk factors, 54%, 1-year OS 53.8%) and poor (>2 risk factors, 5%, 1-year OS 10.7%) prognosis.

CONCLUSIONS: We advocate the use of LIPS-3 as an easy-to-assess and inexpensive adjuvant prognostic tool for patients with PD-L1 ≥ 50% aNSCLC.

PMID:33735802 | DOI:10.1016/j.esmoop.2021.100078

Epilepsy Behav. 2021 Mar 15;118:107918. doi: 10.1016/j.yebeh.2021.107918. Online ahead of print.

ABSTRACT

BACKGROUND: Psychogenic nonepileptic seizures (PNES) are major challenges for diagnosis and management. The heterogeneity of psychogenic seizures is attributed to diverse psychopathological comorbidities, and the causal relationship between PNES and underlying psychopathologies is still enigmatic.

OBJECTIVE: Our objective was to study psychiatric comorbidities and personality constructs in patients with PNES and compare them to a control group of patients with epilepsy.

METHOD: We randomly recruited 33 patients with PNES and 33 patients with epilepsy. All patients completed the Mini-International Neuropsychiatric Interview (MINI) to screen for psychiatric comorbidities, the Structured Clinical Interview for psychiatric disorders in Axis II (SCID II) to screen for personality disorders, and Goldberg’s International Personality Item Pool (IPIP) Big Five personality questionnaire to study the psychological constructs of extroversion-introversion, agreeableness, conscientiousness, emotional stability-neuroticism, and intellect.

RESULT: Mood and anxiety disorders were highly prevalent in patients with PNES (72.7% and 54.5%, respectively); however, the prevalence of only cluster B personality disorder was higher in patients with PNES (69.7%) compared to 33.3% among patients with epilepsy (p < 0.05). Screening for personality disorders using SCID II showed that the prevalence of borderline and depressive personality disorders was significantly higher in patients with PNES (p < 0.001). Patients with psychogenic seizures were more likely to be receiving polydrug therapy (75.8%) compared to patients with epileptic seizures (45.5%); this difference was statistically significant (p < 0.05).

CONCLUSION: Psychiatric comorbidities are highly prevalent among patients with PNES.

PMID:33735815 | DOI:10.1016/j.yebeh.2021.107918

Int J Med Inform. 2021 Mar 5;149:104437. doi: 10.1016/j.ijmedinf.2021.104437. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate recording of ethnicity in electronic healthcare records is important for the monitoring of health inequalities. Yet until the late 1990s, ethnicity information was absent from more than half of records of patients who received inpatient care in England. In this study, we report on the usefulness of a names-based ethnicity classification, Ethnicity Estimator (EE), for addressing this gap in the hospital records.

MATERIALS AND METHODS: Data on inpatient hospital admissions were obtained from Hospital Episode Statistics (HES) between April 1999 and March 2014. The data were enhanced with ethnicity coding of participants’ surnames using the EE software. Only data on the first episode for each patient each year were included.

RESULTS: A total of 111,231,653 patient-years were recorded between April 1999 and March 2014. The completeness of ethnicity records improved from 59.5 % in 1999 to 90.5 % in 2013 (financial year). Biggest improvement was seen in the White British group, which increased from 55.4 % in 1999 to 73.9 % in 2013. The correct prediction of NHS-reported ethnicity varied by ethnic group (2013 figures): White British (89.8 %), Pakistani (81.7 %), Indian (74.6 %), Chinese (72.9 %), Bangladeshi (63.4 %), Black African (57.3 %), White Other (50.5 %), White Irish (45.0 %). For other ethnic groups the prediction success was low to none. Prediction success was above 70 % in most areas outside London but fell below 40 % in parts of London.

CONCLUSION: Studies of ethnic inequalities in hospital inpatient care in England are limited by incomplete data on patient ethnicity collected in the 1990s and 2000s. The prediction success of a names-based ethnicity classification tool has been quantified in HES for the first time and the results can be used to inform decisions around the optimal analysis of ethnic groups using this data source.

PMID:33735828 | DOI:10.1016/j.ijmedinf.2021.104437

Environ Pollut. 2021 Mar 3;278:116868. doi: 10.1016/j.envpol.2021.116868. Online ahead of print.

ABSTRACT

Air pollution has been an important risk factor for female reproductive health. However, epidemiological evidence of ambient air pollution on the predictor for ovarian reserve (antral follicle count, AFC) is deficient. We aim to comprehensively evaluate the association of long-term exposure to ambient air pollution with AFC among women of reproductive age in Shanxi of north China. 600 women with spontaneous menstrual cycle, not using controlled ovarian stimulation, were enrolled in the retrospective study. Two distinct periods of antral follicle development were designed as exposure windows. Generalized linear model was employed to estimate the change of AFC associated with exposure of atmospheric pollutants (SO₂, NO₂, PM₁₀, PM_2.5, CO and O₃). Stratification analysis based on age (<30, ≥30 years), university degree (yes, no), years of exposure (2013-2016, 2017-2019) and duration of infertility (<2, 2-5, >5 years) along with two pollutants model were employed to further illustrate the association. We found every 10 μg/m³ increase in SO₂ concentration level during the entire development stage of antral follicle was associated with a -0.01 change in AFC (95% confidence interval: -0.016, -0.002) adjusting for the confounders including age, BMI, parity and infertility diagnosis factors. The significant association of increased SO₂ level with decreased AFC was particularly observed during the early transition from primary follicle to preantral follicle stage by 10 μg/m³ increase in SO₂ exposure level with a -0.01 change (95% CI: -0.015, -0.002) in AFC. The negative association was pronounced among women aged ≥30 years old, and also significant in two pollutants model after adjusting the confounders. No significant associations between other air pollutants and AFC were observed. Our finding suggests that long-term exposure to air pollutant SO₂ is associated with lower AFC, raising our concern that atmospheric SO₂ exposure may have potential adverse impact on women ovarian reserve.

PMID:33735795 | DOI:10.1016/j.envpol.2021.116868

Cortex. 2021 Feb 25;138:241-252. doi: 10.1016/j.cortex.2021.02.009. Online ahead of print.

ABSTRACT

Some eye diseases, especially macular degeneration, can cause central vision loss (CVL), impairing goal-driven guidance of attention. Does CVL also affect implicit, experience-driven attention? We investigated how simulated central scotomas affected young adults’ ability to prioritize locations frequently containing visual search targets (location probability learning). Participants searched among distractor letter ‘L’s for a target ‘T’ that appeared more often in one screen quadrant than others. To dissociate potential impairments to statistical learning of target locations and attentional guidance, two experiments each included search with and without simulated scotomas. Experiment 1 successfully induced probability learning in a no-scotoma phase. When participants later searched both with and without simulated scotomas, they showed persistent, statistically equivalent spatial biases in both no-scotoma and scotoma search. Experiment 2 trained participants with a central scotoma. While Experiment 1’s participants acquired probability learning regardless of their self-reported awareness of the target’s location probability, in Experiment 2 only aware participants learned to bias attention to the high probability region. Similarly, learning with a scotoma affected search with no scotoma in aware but not unaware participants. Together, these results show that simulated central vision loss interferes with the acquisition of implicitly learned location probability learning, supporting a role of central vision in implicit spatial attentional biases.

PMID:33735796 | DOI:10.1016/j.cortex.2021.02.009