Category: Statistics

J Magn Reson Imaging. 2021 Apr 30. doi: 10.1002/jmri.27664. Online ahead of print.

ABSTRACT

BACKGROUND: The Liver Imaging Reporting and Data System (LI-RADS) is a comprehensive system for standardizing liver imaging in patients at risk for hepatocellular carcinoma (HCC).

PURPOSE: To systematically compare the performance of computed tomography (CT)/MRI LI-RADS category 5 (LR-5) for diagnosing HCC between versions 2017 and 2018.

STUDY TYPE: Systematic review and meta-analysis.

SUBJECTS: Six articles with 1181 lesions.

FIELD STRENGTH/SEQUENCE: 1.5 T and 3.0 T.

ASSESSMENT: Data extraction was independently performed by two reviewers who identified and reviewed articles comparing the performance of LR-5 for diagnosing HCC between CT/MRI LI-RADS versions 2017 and 2018. Study and patient characteristics, index test characteristics, reference standards, and study outcomes were extracted from included studies. Risk of bias and concerns regarding applicability were evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.

STATISTICAL TESTS: Bivariate random-effects models were used to calculate the pooled per-observation sensitivity and specificity of LR-5 using both versions. The summary receiver operating characteristic curves were plotted. Meta-regression analysis was performed to explore heterogeneity. A P-value <0.05 was considered to be statistically significant for all analyses other than heterogeneity, where the significance threshold was 0.1.

RESULTS: The pooled per-observation sensitivity of LR-5 for diagnosing HCC did not show statistically significant difference between versions 2017 (60%; 95% confidence interval [CI], 49%-70%) and 2018 (67%; 95% CI, 56%-76%; P = 0.381). The pooled per-observation specificities of LR-5 were not significantly different between versions 2017 (92%; 95% CI, 90%-95%) and 2018 (91%; 95% CI, 88%-93%; P = 0.332). Meta-regression analyses revealed that the most common underlying liver disease (hepatitis B or hepatitis C) was a significant factor contributing to the heterogeneity of sensitivities among studies for both versions.

DATA CONCLUSION: In this meta-analysis using intraindividual paired comparisons, the pooled sensitivity and pooled specificity of LR-5 were not significantly different between 2017 and 2018 LI-RADS versions.

LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 2.

PMID:33929784 | DOI:10.1002/jmri.27664

Dent Med Probl. 2021 Apr 29. doi: 10.17219/dmp/131115. Online ahead of print.

ABSTRACT

BACKGROUND: Dental professionals are at great risk of contracting coronavirus disease 2019 (COVID-19).

OBJECTIVES: The objectives of this study were to determine the levels of stress and anxiety among dental professionals, and to determine which dental procedures cause the greatest amount of stress and anxiety during the COVID-19 pandemic.

MATERIAL AND METHODS: This cross-sectional survey was conducted by requesting voluntary participation of dental healthcare workers through the authors’ own e-form, which consisted of our self-developed questionnaire, the Perceived Stress Scale (PSS) and the Generalized Anxiety Disorder-7 scale (GAD-7). The simple and multiple linear regression analyses were used to assess the effect of dental procedures and other factors associated with stress and anxiety among the participants. A p-value ≤0.05 was considered statistically significant.

RESULTS: This survey included 85 participants (32 males, 53 females) with a mean age of 31.6 ±6.0 years. Significant associations were found between severe stress for scaling (p < 0.001; p < 0.001), complex fillings (p < 0.001; p < 0.001), root canal treatment (RCT) (p = 0.001; p = 0.007), crown and bridge work (p < 0.001; p < 0.001), denture work (p = 0.034; p = 0.001), third molar extractions (p < 0.001; p < 0.001), surgical procedures (p < 0.001; p = 0.001), and implant placement (p = 0.001; p = 0.022) and the PSS and GAD-7 scores, respectively.

CONCLUSIONS: Dental healthcare workers exhibit severe stress and anxiety associated with elective dental procedures. Dental emergencies should take precedence and elective dental treatment should be carried out with utmost caution, ensuring all protective measures. Psychological support for dental healthcare professionals should be made accessible.

PMID:33929792 | DOI:10.17219/dmp/131115

Br J Clin Pharmacol. 2021 Apr 30. doi: 10.1111/bcp.14883. Online ahead of print.

ABSTRACT

AIMS: There are several limitations to the existing method of administering cefoxitin as a prophylactic antibiotic, and the limitations may be overcome by applying the target-concentration controlled infusion (TCI) method. Population pharmacokinetic parameters are required to administer cefoxitin by the TCI method. The aim of this study was to construct a new pharmacokinetic model of cefoxitin for the TCI method in colorectal surgical patients METHODS: In patients undergoing colorectal surgery, 2 g cefoxitin was dissolved in 50 mL saline and administered for 10 min prior to skin incision. Arterial blood samples were obtained at pre-set intervals to measure the total and free plasma concentrations of cefoxitin. Population pharmacokinetic analysis was performed using the NONMEM software (ICON Development Solutions, Dublin, Ireland). Additionally, the stochastic simulation was used to indirectly evaluate the effectiveness of the two administration methods (standard method vs. TCI) RESULTS: In total, 297 plasma concentration measurements from 31 patients were used to characterize the pharmacokinetics of cefoxitin. A three-compartment mammillary model well-described the pharmacokinetics of cefoxitin. Body weight and creatinine clearance were significant covariates for clearance. The stochastic simulation showed that when compared with the standard method, the TCI method has a significantly higher fraction of time that the free concentration of cefoxitin is maintained above the minimum inhibitory concentration (P < 0.001).

CONCLUSIONS: TCI has the potential to become a new infusion method for patient-tailored dosing in surgical patients. To administer cefoxitin via TCI in clinical practice, the newly constructed pharmacokinetic model should undergo proper external validation.

PMID:33929765 | DOI:10.1111/bcp.14883

J Food Sci. 2021 Apr 30. doi: 10.1111/1750-3841.15723. Online ahead of print.

ABSTRACT

Aroma plays an important role in the quality of Pu-erh tea. However, the quality evaluation of Pu-erh tea aroma is heavily relied on the experience of sensory evaluation, and the theoretical research is relatively scarce. In the present work, the volatile compounds in Pu-erh tea were characterized by using gas phase electronic nose (e-nose) and microchamber/thermal extractor (µ-CTE) combined with thermal desorption coupled to gas chromatography-mass spectrometry (TD-GC-MS). A satisfactory discrimination model (R² Y = 0.95, Q² = 0.807) was obtained by using orthogonal partial least squares discriminant analysis (OPLS-DA) based on the odor fingerprint of different brands of Pu-erh tea. In addition, based on the double criterion of multivariate analysis with VIP >1.0 and univariate analysis with p ≤ 0.001, 39 volatile components were identified to contribute greatly to the discrimination of five brands of Pu-erh tea. The results suggested that gas phase e-nose and µ-CTE combined with TD-GC/MS were simple, rapid techniques to characterize the volatile compounds in Pu-erh tea and were allowed to effectively distinguish different brands of Pu-erh tea, which would provide an important reference on the quality assessment of Pu-erh tea. PRACTICAL APPLICATION: This work demonstrates that the volatile compounds in Pu-erh tea are simply and rapidly characterized by using µ-CTE/TD-GC/MS and gas phase e-nose, allowing to effectively distinguish different brands of Pu-erh tea, which can provide an important reference for the quality assessment and authentication of Pu-erh tea.

PMID:33929725 | DOI:10.1111/1750-3841.15723

Laryngoscope. 2021 Apr 30. doi: 10.1002/lary.29586. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine whether subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT) better improves patient outcomes and quality of life for adults with allergic rhinitis or rhinoconjunctivitis (AR/C) with or without mild to moderate asthma.

METHODS: Systematic review methodology was based on the Cochrane Collaboration handbook and Preferred Reporting Items for Systematic Reviews and Meta-analyses. Four databases (PubMed, Cochrane Library, EMBASE, and Web of Science) were queried from inception to July 30, 2020. Two independent reviewers screened potentially relevant studies and assessed risk of bias. Outcomes of interest were symptom score (SS), medication score (MS), combined symptom medication score (CSMS), and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Meta-analyses with an adjusted indirect comparison were conducted in RevMan 5.4.1.

RESULTS: Seven SCIT versus SLIT randomized controlled trials (RCTs) demonstrated no significant differences for any outcomes, but insufficient data precluded direct meta-analysis. For the adjusted indirect comparison, 46 RCTs over 39 studies were included for SCIT versus placebo (n = 13) and SLIT versus placebo (n = 33). Statistically significant results favoring SCIT were found for SS (standardized mean difference [SMD] = 0.40; 95% confidence interval [CI] = 0.31-0.49), MS (SMD = 0.26; 95% CI = 0.14-0.39), CSMS (SMD = 0.42; 95% CI = 0.17-0.67), and RQLQ (MD = 0.24; 95% CI = 0.04-0.44). Statistically significant results favoring SLIT were found for SS (SMD = 0.42; 95% CI = 0.32-0.53), MS (SMD = 0.40; 95% CI = 0.28-0.53), CSMS (SMD = 0.37; 95% CI = 0.29-0.45), and RQLQ (MD = 0.32; 95% CI = 0.20-0.43). No significant differences were found between SCIT and SLIT for SS (SMD = -0.02; 95% CI = -0.15 to 0.11), MS (SMD = -0.14; 95% CI = -0.31 to 0.03), CSMS (SMD = 0.05; 95% CI = -0.21 to 0.31), or RQLQ (MD = -0.08; 95% CI = -0.31 to 0.15).

CONCLUSION: SCIT and SLIT are comparably effective treatments for adults with AR/C. More RCTs analyzing SCIT versus SLIT are needed to directly compare the two. Laryngoscope, 2021.

PMID:33929726 | DOI:10.1002/lary.29586

Child Care Health Dev. 2021 Apr 30. doi: 10.1111/cch.12875. Online ahead of print.

ABSTRACT

BACKGROUND: This paper reports part of a wider systematic review commissioned by the English National Safeguarding Panel on Sudden Unexpected Death in Infancy (SUDI). The wider review covered three areas: interventions to improve safer sleep practices in high-risk families, interventions to improve engagement with services, and decision making by parents at high risk of SUDI about infant sleep environments. Here we report the qualitative and quantitative studies reviewed under the engagement strand. Parental engagement is understood to be a multidimensional task for health and social care professionals comprising attitudinal, relational, and behavioural components.

METHODS: Following a PROSPERO registered systematic review synthesising the three strands outlined, twenty-eight papers were found to be relevant in the review of interventions to improve engagement with services in families with children at risk of significant harm through abuse or neglect. No studies were found that specifically focused on engagement of families at high risk for SUDI, so these wider engagement studies were included.

RESULTS: The different types of intervention reported in the included studies are described under two broad themes: Enablers (including parental motivation and working with families) and Barriers. Given the focus in the studies on interventions that support parental engagement the Enablers theme is more extensive than the Barriers reported although all studies noted well understood barriers. The evidence underpinning these interventions and approaches are reviewed in this paper.

CONCLUSIONS: We conclude that effective engagement is facilitated by experienced professionals given time to develop supportive non-judgemental relationships with families in their homes, working long-term, linking with communities and other services. Whilst these conclusions have been drawn from wider studies aimed at reducing child maltreatment, we emphasise lessons to be drawn for SUDI prevention work with families with children at risk of significant harm.

PMID:33929753 | DOI:10.1111/cch.12875

J Nephrol. 2021 Apr 30. doi: 10.1007/s40620-021-01041-x. Online ahead of print.

ABSTRACT

BACKGROUND: Association between physical activity and decline in renal function among the general population is not fully understood.

METHODS: This is a longitudinal study on subjects who participated in the Japanese nationwide Specific Health Checkup program between 2008 and 2014. The exposure of interest was baseline self-reported walking habit. The outcomes were annual change and incidence of 30% decline in estimated glomerular filtration rate (eGFR). Changes in eGFR were compared using a linear mixed-effects model. Cox proportional hazard models were used to examine the association between self-reported walking habit and 30% decline in eGFR.

RESULTS: Among 332,166 subjects, 168,574 reported walking habit at baseline. The annual changes in eGFR [95% confidence interval (CI)] among subjects with and without baseline self-reported walking habit were – 0.17 (- 0.19 to – 0.16) and – 0.26 (- 0.27 to – 0.24) mL/min/1.73 m²/year, respectively (P for interaction between time and baseline self-reported walking habit, < 0.001). During a median follow-up of 3.3 years, 9166 of 314,489 subjects exhibited 30% decline in eGFR. The incidence of 30% decline in eGFR was significantly lower among subjects with self-reported walking habit after adjustment for potential confounders including time-varying blood pressure, body mass index, lipid profile, and hemoglobin A1c, with hazard ratio (95% CI) of 0.93 (0.89-0.97). Sensitivity analysis restricted to subjects with unchanged self-reported walking habit from baseline or analysis with time-varying self-reported walking habit yielded similar results.

CONCLUSIONS: Self-reported walking habit was associated with significantly slower decline in eGFR. This association appeared to be independent of its effects on metabolic improvement.

PMID:33929690 | DOI:10.1007/s40620-021-01041-x

Eat Weight Disord. 2021 Apr 30. doi: 10.1007/s40519-021-01198-1. Online ahead of print.

ABSTRACT

PURPOSE: Little is known about how behaviors to control weight are associated with diet quality among youth from low- and middle-income countries. The aim of this study was to examine associations between efforts to control weight (ECW) and diet quality among Brazilian adolescents and young adults.

METHODS: Data from 731 participants (17.89 ± 4.92 years, 51.1% female) of the 2015 Health Survey of São Paulo were used for this cross-sectional study. Dietary intake was assessed using a 24 h dietary recall and diet quality was calculated using the Brazilian Healthy Eating Index-Revised (BHEI-R). Participants reported their ECW, weight satisfaction, and socio-demographics. Descriptive statistics and linear regressions were calculated to investigate associations between ECW and diet quality.

RESULTS: Approximately 47.7% of participants were dissatisfied with their current weight, and 41.0% reported ECW. Reported strategies to control weight included increased physical activity, taking care of what they eat, and dieting (8.2, 3.1, and 2.5%, respectively). After adjusting for age, sex, race/ethnicity, and body mass index, reporting at least one ECW (ß = 0.08; 95% CI 0.02, 0.13), taking care of what to eat (ß = 0.15; 0.08, 0.22) and being satisfied with their weight (0.08; 0.02, 0.13) were all associated with a higher overall BHEI-R score.

CONCLUSION: Overall diet quality score showed a small increase in participants reporting ECW. Further studies should be conducted to provide strategies used by adolescents from low- and middle-income countries to control their weight. Thus, developing public health policies, and behavioral-change strategies. Level V: Cross-sectional descriptive study.

PMID:33929700 | DOI:10.1007/s40519-021-01198-1

Obes Surg. 2021 Apr 30. doi: 10.1007/s11695-021-05445-3. Online ahead of print.

ABSTRACT

INTRODUCTION/PURPOSE: Some clinical indicators suggest hypercoagulability/hyperaggregability in patients with morbid obesity. Thromboelastography (TEG®) has been used to profile coagulation status in surgical patients. We aimed to assess coagulation profiles in patients with morbid obesity undergoing bariatric surgery by correlating demographic and patient characteristics to pre-operative TEG® values.

MATERIALS AND METHODS: Pre-operative TEG® values from 422 patients undergoing bariatric surgery were evaluated. TEG® results were analyzed by gender, use of medications known to alter the coagulation profile, and body mass index (BMI).

RESULTS: Patients have a mean of 45.03 ± 11.8 years, female (76.3%), and with a mean BMI of 42 kg/m ¹. The overall coagulation profile of female patients was significantly different from males, even in the sub-cohort without use of medications known to alter coagulation. The majority of patients (94%) with a G value > 15 dynes/cm ¹ (clot strength) were female. In females, there was no association between BMI and TEG® values; however, in men, there was a statistically significant difference in TEG® values for those with BMI < 40 kg/m ¹ compared to those with BMI > 50 kg/m².

CONCLUSIONS: TEG®-based analysis of coagulation profiles offers unique insights. Compared to laboratory normal values (R time, angle, maximal amplitude, and G values), patients with morbid obesity may have a tendency for hypercoagulability/hyperaggregability, with mean values at the higher limit. A significant hypercoagulable difference in TEG® values was identified in female as compared to male patients. Male patients with a BMI greater than 50 kg/m² were also found to be increasingly hypercoagulable.

PMID:33929657 | DOI:10.1007/s11695-021-05445-3

Adv Ther. 2021 Apr 30. doi: 10.1007/s12325-021-01732-8. Online ahead of print.

ABSTRACT

INTRODUCTION: Ketamine treatment is capable of significant and rapid symptom improvement in adults with treatment-resistant depression (TRD). A limitation of ketamine treatment in TRD is the relatively short duration of time to relapse (e.g., median 2-4 weeks). The objective of the systematic review herein is to identify strategies capable of prolonging the acute efficacy of ketamine in adults with TRD.

METHODS: PubMed/MEDLINE databases were searched from inception to December 2020 for clinical studies written in English using the following key terms: ketamine, prolong, and depression. A total of 454 articles were identified from the literature search which included all clinical studies regarding prolonging the antidepressant effects of ketamine. Twenty-two articles were included: ten randomized controlled trials (RCTs), eight prospective open-label trials, one retrospective chart review, and three case reports. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for data extraction. The primary outcome was prolonged effect, defined as statistically significant antidepressant effects following acute ketamine treatment.

RESULTS: A total of 454 articles were identified, and 22 articles were included. Different treatment modalites including pharmacological interventions, manualized-based psychotherapies, electroconvulsive therapy, transcranial magnetic stimulation, and intravenous monotherapy were examined to determine their impact on the prolongation of antidepressant effects following acute ketamine treatment. No treatment modality, other than repeat-dose IV ketamine, has demonstrated ability to significantly prolong the acute efficacy of IV ketamine in TRD.

CONCLUSION: Hitherto, available open-label data and controlled trial data support repeat administration of IV ketamine as an effective strategy to prolong the efficacy of ketamine’s antidepressant effects (although not the focus of the study herein, maintenance repeat-dose esketamine treatment is proven effective in esketamine responders). There is a need to identify multimodality strategies that are safe and capable of prolonging the efficacy of ketamine in adults with TRD.

PMID:33929660 | DOI:10.1007/s12325-021-01732-8