Category: Statistics

Cell Mol Biol (Noisy-le-grand). 2021 Nov 1;67(4):135-142.

ABSTRACT

Spinal tuberculosis or tuberculous spondylitis is one of the most common types of skeletal tuberculosis. Complications of the spine and spinal cord tuberculosis include destruction of the vertebrae, deformity, and paraplegia. Since in some patients, the clinical manifestations of tuberculosis are unusual and timely diagnosis and treatment of this disease can prevent its serious consequences, so in the present study, some cases of rare manifestations of tuberculosis were investigated. The expression of the NF-κB gene in these patients was also evaluated. In this regard, 36 patients with spinal tuberculosis and 30 healthy individuals (as a control group) were assessed. Clinical symptoms, imaging, laboratory tests, pathology, and response to treatment related to patients with spinal tuberculosis and spinal cord tuberculosis were evaluated. NF-κB expression was also evaluated using the PCR technique in peripheral white blood cell samples. The obtained results were analyzed using SPSS ver. 16, χ2 and T-test statistical methods. Mann-Whitney U test and Kruskal-Wallis non-parametric tests were used to analyze non-parametric data. The results showed that out of 36 cases of spinal tuberculosis, 29 cases had spinal tuberculosis, five cases had tuberculous radiculomyelitis, one case had spinal intramedullary tuberculoma, and one case had syringomyelia. 52.78% of patients were male, and 70% of cases were observed between the ages of 35 and 55 years. Fever and back pain were seen in more than 80% of cases. The study of NF-κB expression in the control and case groups showed that the NF-κB expression in the case group increased compared to the control group. This increase was statistically significant (P = 0.0071). In general, in the present study, the methods of clinical diagnosis of spinal tuberculosis were evaluated. Also, the amount of NF-κB transcription factor was evaluated as an effective genetic factor in the diagnosis of this disease.

PMID:35809264

Braz J Psychiatry. 2022 Jul 9. doi: 10.47626/1516-4446-2022-2601. Online ahead of print.

ABSTRACT

BACKGROUND: Multimorbidity, or the occurrence of two or more chronic conditions, is a global challenge, with implications for mortality, morbidity, disability and life quality. Psychiatric disorders are common among the chronic diseases that affect patients with multimorbidity. It is still not well understood whether psychiatric symptoms, especially depressive symptoms, moderate the effect of multimorbidity on cognition.

METHODS: We used a large (n=2681) dataset to assess whether there is a moderation of depressive symptomatology on the effect of multimorbidity on cognition using structural equation modelling.

RESULTS: It was found that the more depressive symptoms and chronic conditions, the worse the cognitive performance, and the higher the educational level, the better the cognitive performance. We found a significant but weak (0.009; p-value = 0.04) moderation effect.

CONCLUSIONS: We have provided the first estimate of the moderating effect of depression on the effect of multimorbidity on cognition, though it is small. Although this moderation was implicit in numerous previous works, it was never previously estimated.

PMID:35809247 | DOI:10.47626/1516-4446-2022-2601

J Clin Hypertens (Greenwich). 2022 Jul 9. doi: 10.1111/jch.14541. Online ahead of print.

ABSTRACT

Primary Sjögren’s syndrome (pSS) patients with hypertension (pSS-HT) have a significantly increased risk of cardio-cerebrovascular events. Serum uric acid (SUA), a potential inflammatory substance, is considered to be closely related to hypertension in the general population. Our aim is to assess the association between SUA and pSS-HT. This is a retrospective cohort study. The diagnosis of pSS is based on the American European Consensus Classification criteria. Primary outcome was incident hypertension in pSS patients. Cox regression model was used to estimate the hazard ratios (HR) and 95% CI of SUA in pSS-HT. The authors also plotted Kaplan-Meier plots to assess the cumulative risk of first hypertension in patients with hyperuricemia and normal uric acid. In addition, the dose-response curve was also used to discuss the relationship between SUA and pSS-HT. Finally, three hundred and fifty-one pSS patients were enrolled from May 2011 to May 2020, of which 166 cases developed hypertension within a mean follow-up of 3.91 years. Univariate Cox regression demonstrated that SUA was associated with the onset of hypertension in pSS (HR: 1.005 95%Cl: 1.002-1.009). After adjusting for the potential risk factors, the relationship remained unchanged (HR: 1.003, 95%Cl: 1.001-1.005). Kaplan-Meier survival analysis showed a statistically significant difference of hypertension risk between hyperuricemia patients and normal uric acid patients (P = .026). There was also a significant dose-effect relationship between SUA and hypertension in pSS in dose-response model. In this study, the authors find that SUA may be closely associated with the development of hypertension in pSS, which is also confirmed by our dose-response model. Therefore, SUA could be considered in the management of pSS-HT.

PMID:35809227 | DOI:10.1111/jch.14541

Transl Stroke Res. 2022 Jul 9. doi: 10.1007/s12975-022-01060-1. Online ahead of print.

ABSTRACT

Previous studies investigating the relationship between aspirin use and subarachnoid haemorrhage (SAH) have yielded conflicting results. In this study, we aimed to clarify the association between aspirin and SAH in the general population. The UK Biobank is a prospective population-based cohort study. Sex, age, smoking, alcohol, medication use, hypertension, blood pressure, ischaemic heart disease and stroke were recorded at baseline assessments. Follow-up is conducted through linkages to National Health Service data including electronic, coded death certificate, hospital and primary care data. Cox proportional hazards modelling was used to analyse the association between aspirin use and SAH. Of the 501,060 participants included in the analysis, a total of 579 suffered from spontaneous SAH after their baseline assessment. There was no relationship between aspirin and SAH of all causes (HR, 1.16 [0.92-1.46]), aneurysmal SAH (HR, 1.15 [0.91-1.47]) or non-aneurysmal SAH (HR, 1.29 [0.54-3.09]). Aspirin use was associated with SAH resulting in death (HR, 1.69 [1.14-2.51]), especially out of hospital death (HR, 2.10 [1.13-3.91]). Despite reports of a protective association between aspirin and SAH in patients with known unruptured aneurysms, this study has not demonstrated the same effect in the general population. However, aspirin users were more likely to suffer SAH resulting in death, especially out of hospital.

PMID:35809217 | DOI:10.1007/s12975-022-01060-1

Int Urol Nephrol. 2022 Jul 9. doi: 10.1007/s11255-022-03277-3. Online ahead of print.

ABSTRACT

BACKGROUND: Deceased donor kidneys with acute kidney injury (AKI) are often discarded because of concerns about inferior transplant outcomes. A means of grading the quality of such kidneys is the performance of procurement biopsies.

METHODS: This is a retrospective study of 221 brain death donors with marginal kidneys transplanted in 223 recipients in Germany. Marginal kidneys were defined as kidneys with procurement biopsies done exceptionally to assess suitability for transplantation in otherwise potentially discarded organs. The impact of deceased donor AKI on patient survival and death-censored graft survival at 1, 3 and 5 years and graft function at 1 and 3 years after transplantation was investigated.

RESULTS: Recipients of kidneys with stage 3 AKI had a greater incidence of delayed graft function [DGF; OR_{Stage 1}: 1.435 (95% CI 0.438-0.702), OR_{Stage 2}: 2.463 (95% CI 0.656-9.245), OR_{Stage 3}: 4.784 (95% CI 1.421-16.101)] but a similar graft and patient survival compared to recipients of donors without AKI and with AKI stage 1 and 2 as well. The coexistence of recipient DGF and donor AKI was associated with the lowest graft survival and function rates.

CONCLUSION: The transplantation of deceased donor marginal kidneys with AKI confers a higher risk for DGF but is associated with acceptable graft and patient outcomes, which do not differ in comparison with marginal donor kidneys without AKI. Graft prognosis is especially poor if donor AKI and recipient DGF concur. Donor AKI was a risk factor independent of the histological lesions of procurement biopsies.

PMID:35809204 | DOI:10.1007/s11255-022-03277-3

Drugs Real World Outcomes. 2022 Jul 9. doi: 10.1007/s40801-022-00303-9. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic generated a massive amount of clinical data, which potentially hold yet undiscovered answers related to COVID-19 morbidity, mortality, long-term effects, and therapeutic solutions.

OBJECTIVES: The objectives of this study were (1) to identify novel predictors of COVID-19 any cause mortality by employing artificial intelligence analytics on real-world data through a hypothesis-agnostic approach and (2) to determine if these effects are maintained after adjusting for potential confounders and to what degree they are moderated by other variables.

METHODS: A Bayesian statistics-based artificial intelligence data analytics tool (bAIcis^®) within the Interrogative Biology^® platform was used for Bayesian network learning and hypothesis generation to analyze 16,277 PCR+ patients from a database of 279,281 inpatients and outpatients tested for SARS-CoV-2 infection by antigen, antibody, or PCR methods during the first pandemic year in Central Florida. This approach generated Bayesian networks that enabled unbiased identification of significant predictors of any cause mortality for specific COVID-19 patient populations. These findings were further analyzed by logistic regression, regression by least absolute shrinkage and selection operator, and bootstrapping.

RESULTS: We found that in the COVID-19 PCR+ patient cohort, early use of the antiemetic agent ondansetron was associated with decreased any cause mortality 30 days post-PCR+ testing in mechanically ventilated patients.

CONCLUSIONS: The results demonstrate how a real-world COVID-19-focused data analysis using artificial intelligence can generate unexpected yet valid insights that could possibly support clinical decision making and minimize the future loss of lives and resources.

PMID:35809196 | DOI:10.1007/s40801-022-00303-9

J Appl Clin Med Phys. 2022 Jul 9:e13714. doi: 10.1002/acm2.13714. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to dosimetrically compare volumetric-modulated arc therapy (VMAT) with intensity-modulated radiotherapy (IMRT) techniques using either 6- or 10-MV photon beam energies in lung stereotactic body radiation therapy (SBRT) plans.

METHODS: Thirty patients with primary or metastatic lung tumors eligible for SBRT were randomly selected. VMAT and IMRT treatment plans using either 6- or 10-MV photon energies were generated through automatic SBRT planning software in the RayStation treatment planning system.

RESULTS: For planning target volume, there was no difference in D_95% for all plans, whereas D_2% and D_50% were significantly increased by 5.22%-5.98% and 2.47%-2.59%, respectively, using VMAT_6/10-MV plans compared to IMRT_6/10-MV plans. When comparing the D_max of organs at risk (OARs), VMAT_6/10-MV was 18.32%-47.95% lower than IMRT_6/10-MV for almost all OARs. VMAT_6/10-MV obviously decreased D_mean , V_5Gy , V_10Gy , and V_20Gy of whole lung by 9.68%-20.92% than IMRT_6/10-MV . Similar results were found when comparing VMAT_6-MV with IMRT_10-MV or VMAT_10-MV with IMRT_6-MV . The differences in the D_2% , heterogeneity index, and conformity index between 6- and 10-MV plans are not statistically significant. Plans using 6-MV performed 4.68%-8.91% lower levels of D_max of spinal cord, esophagus, great vessels, and trachea and proximal bronchial tree than those using 10-MV plans. Similarly, D_mean , V_5Gy , V_10Gy , and V_20Gy of whole lung were also reduced by 2.79%-5.25% using 6-MV. For dose fall-off analysis, the D_2cm and R_50% of VMAT_6/10-MV were lower than those of IMRT_6/10-MV . Dose fall-off curve based on 10 rings was steeper for VMAT plans than IMRT plans regardless of the energy used.

CONCLUSIONS: For lung SBRT plans, VMAT-based plans significantly reduced OARs dose and steepened dose fall-off curves compared to IMRT-based plans. A 6-MV energy level was a better choice than 10-MV for lung SBRT. In addition, the dose differences between different techniques were more obvious than those between different energy levels.

PMID:35808973 | DOI:10.1002/acm2.13714

J Appl Clin Med Phys. 2022 Jul 9:e13719. doi: 10.1002/acm2.13719. Online ahead of print.

ABSTRACT

PURPOSE: We have developed a software to automatically find the contrast-detail (C-D) curve based on the statistical low-contrast detectability (LCD) in images of computed tomography (CT) phantoms at multiple cell sizes and to generate minimum detectable contrast (MDC) characteristics.

METHODS: A simple graphical user interface was developed to set the initial parameters needed to create multiple grid region of interest of various cell sizes with a 2-pixel increment. For each cell in the grid, the average CT number was calculated to obtain the standard deviation (SD). Detectability was then calculated by multiplying the SD of the mean CT numbers by 3.29. This process was automatically repeated as many times as the cell size was set at initialization. Based on the obtained LCD, the C-D curve was obtained and the target size at an MDC of 0.6% (i.e., 6-HU difference) was determined. We subsequently investigated the consistency of the target sizes for a 0.6% MDC at four locations within the homogeneous image. We applied the software to images with six noise levels, images of two modules of the American College of Radiology CT phantom, images of four different phantoms, and images of four different CT scanners. We compared the target sizes at a 0.6% MDC based on the statistical LCD and the results from a human observer.

RESULTS: The developed system was able to measure C-D curves from different phantoms and scanners. We found that the C-D curves follow a power-law fit. We found that higher noise levels resulted in a higher MDC for a target of the same size. The low-contrast module image had a slightly higher MDC than the distance module image. The minimum size of an object detected by visual observation was slightly larger than the size using statistical LCD.

CONCLUSIONS: The statistical LCD measurement method can generate a C-D curve automatically, quickly, and objectively.

PMID:35808971 | DOI:10.1002/acm2.13719

Health Serv Res. 2022 Jul 9. doi: 10.1111/1475-6773.14028. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify the association between strained intensive care unit (ICU) capacity during the COVID-19 pandemic and hospital racial and ethnic patient composition, federal pandemic relief, and other hospital characteristics.

DATA SOURCES: We used government data on hospital capacity during the pandemic and Provider Relief Fund (PRF) allocations, Medicare claims and enrollment data, hospital cost reports, and Social Vulnerability Index data.

STUDY DESIGN: We conducted cross-sectional bivariate analyses relating strained capacity and PRF award per hospital bed with hospital patient composition and other characteristics, with and without adjustment for hospital referral region (HRR).

DATA COLLECTION: We linked PRF data to CMS Certification Numbers based on hospital name and location. We used measures of racial and ethnic composition generated from Medicare claims and enrollment data. Our sample period includes the weeks of 9/18/2020 through 11/5/2021, and we restricted our analysis to short-term, general hospitals with at least one intensive care unit (ICU) bed. We defined “ICU strain share” as the proportion of ICU days occurring while a given hospital had an ICU occupancy rate ≥90%.

PRINCIPAL FINDINGS: After adjusting for HRR, hospitals in the top tercile of Black patient shares had higher ICU strain shares than did hospitals in the bottom tercile (30% versus 22%, p<0.05) and received greater PRF amounts per bed ($118,864 versus $92,407, p<0.05). Having high versus low ICU occupancy relative to pre-pandemic capacity was associated with a modest increase in PRF amounts per bed after adjusting for HRR ($107,319 versus $96,627, p<0.05), but there were no statistically significant differences when comparing hospitals with high versus low ICU occupancy relative to contemporaneous capacity.

CONCLUSIONS: Hospitals with large Black patient shares experienced greater strain during the pandemic. Although these hospitals received more federal relief, funding was not targeted overall towards hospitals with high ICU occupancy rates.

PMID:35808952 | DOI:10.1111/1475-6773.14028

Health Serv Res. 2022 Jul 9. doi: 10.1111/1475-6773.14035. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the association between adoption of presumptive eligibility for pregnancy Medicaid in Kansas in 2016 and timely prenatal care access.

DATA SOURCE: 2012-2019 National Center for Health Statistics natality files.

STUDY DESIGN: We used difference-in-differences to compare outcomes before (2012-2015) and after (2017-2019) presumptive eligibility in Kansas relative to seven control group states overall and stratified by maternal education. Outcomes included first trimester prenatal care, month of first prenatal visit, and adequate prenatal care.

DATA COLLECTION/EXTRACTION METHODS: All live births among adults aged 20 or older in Kansas, Idaho, Missouri, Nebraska, Tennessee, Utah, Wisconsin, and Wyoming.

PRINCIPAL FINDINGS: Among all births, we found no evidence that presumptive eligibility in Kansas resulted in changes in prenatal care use. Among individuals with high school education or less, presumptive eligibility was associated with a 1.92 percentage-point increase (95% CI: 0.64, 4.35) in first trimester prenatal care, driven by earlier month of first prenatal care visit.

CONCLUSIONS: Presumptive eligibility in Medicaid non-expansion states may lead to small improvements in early prenatal care among individuals with lower education; but other interventions may be needed. This article is protected by copyright. All rights reserved.

PMID:35808941 | DOI:10.1111/1475-6773.14035