Category: Statistics

J Travel Med. 2022 Jan 4:taab199. doi: 10.1093/jtm/taab199. Online ahead of print.

ABSTRACT

BACKGROUND: Monitoring the characteristics and associated factors for death among pregnant and postpartum women with COVID-19 is necessary. We investigated the clinical characteristics and risk factors associated with maternal deaths in a nationwide cohort of Brazil.

METHODS: This was a population-based cohort of all pregnant and postpartum women hospitalised with COVID-19 notified to the Sistema de Informação de Vigilância Epidemiológica da Gripe of Brazil (SIVEP-Gripe), from February 2020 to September 2021. The primary outcome was time to in-hospital death, with risks factors analysed with univariable and multivariable Cox proportional hazards regression models.

RESULTS: Cumulative observation time was 248 821 person-days from hospital admission to the end of follow-up for 15 105 individuals. There were 1858 deaths (12.3%) for a maternal mortality rate of 7.5 (95% CI 7.1-7.8) per 1000 patients-days. The cumulative mortality increased over time. Black/Brown ethnicity had a higher risk of death than women self-identifying as White. Women in the North, Northeast, Central-West and Southeast regions had higher risk of death than women in the South region. The characteristics independently associated with death were a postpartum status on admission (adjusted HR 1.4 [95%CI 1.2-1.6]), pre-existing clinical conditions (adjusted HRs 1.2 [95%CI 1.1-1.3] for one and 1.3 [95%CI 1.1-1.5] for two comorbidities), hypoxemia on admission (adjusted HR 1.2 [95%CI 1.1-1.4]) and requiring non-invasive (adjusted HR 2.6 [95%CI 2.1-3.3]) or invasive ventilatory support (adjusted HR 7.1 [95%CI 5.6-9.2]).

CONCLUSION: In Brazil, the in-hospital maternal mortality rate due to COVID-19 is high and the risk of death increases with the length of hospitalisation. Socio-demographic and biological factors are associated with an increased risk of maternal death. The presence of respiratory signs and symptoms should be considered as an early markers of disease severity and an adequate management is necessary. Our findings reinforce the need for vaccination of pregnant and postpartum women against COVID-19.

PMID:34983057 | DOI:10.1093/jtm/taab199

Bioinformatics. 2022 Jan 4:btab879. doi: 10.1093/bioinformatics/btab879. Online ahead of print.

ABSTRACT

MOTIVATION: Existing microbiome-based disease prediction relies on the ability of machine learning methods to differentiate disease from healthy subjects based on the observed taxa abundance across samples. Despite numerous microbes have been implicated as potential biomarkers, challenges remain due to not only the statistical nature of microbiome data, but also the lack of understanding of microbial interactions which can be indicative of the disease.

RESULTS: We propose CACONET (classification of Compositional-Aware COrrelation NETworks), a computational framework that learns to classify microbial correlation networks and extracts potential signature interactions, taking as input taxa relative abundance across samples and their health status. By using Bayesian compositional-aware correlation inference, a collection of posterior correlation networks can be drawn and used for graph-level classification, thus incorporating uncertainty in the estimates. CACONET then employs a deep learning approach for graph classification, achieving excellent performance metrics by exploiting the correlation structure. We test the framework on both simulated data and a large real-world dataset pertaining to microbiome samples of colorectal cancer (CRC) and healthy subjects, and identify potential network substructure characteristic of CRC microbiota. CACONET is customizable and can be adapted to further improve its utility.

AVAILABILITY: CACONET is available at https://github.com/yuanwxu/corr-net-classify.

SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

PMID:34983063 | DOI:10.1093/bioinformatics/btab879

Pain Med. 2022 Jan 4:pnab354. doi: 10.1093/pm/pnab354. Online ahead of print.

ABSTRACT

OBJECTIVE: In fibromyalgia, central sensitization is a key mechanism, and repetitive transcranial magnetic stimulation (rTMS) has been reported to potentially manage symptoms of fibromyalgia. In this meta-analysis, we evaluated the therapeutic effect of rTMS in patients with fibromyalgia according to stimulation locations and follow-up time points.

METHODS: We searched the MEDLINE, Cochrane, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature, and Web of Science databases for articles published from January 1, 1990 to August 26, 2021, including randomized controlled studies investigating the effectiveness of rTMS on managing fibromyalgia.

RESULTS: In total, 10 papers and 299 participants were included. The high-frequency rTMS on the left primary motor cortex (Lt. M1) had a significant effect on pain reduction immediately and 1-4 weeks after the end of the session but had no significant effect after 5-12 weeks. Additionally, after high-frequency rTMS sessions on the Lt. M1, the effect on patients’ quality of life (QoL) appeared late at 5-12 weeks of follow-up. In contrast, high-frequency rTMS on the left dorsolateral prefrontal cortex (Lt. DLPFC) did not reduce pain from fibromyalgia. The effect on controlling the affective problem was not observed after rTMS treatment on both the Lt. M1 and Lt. DLPFC.

CONCLUSIONS: High-frequency rTMS had a positive pain-reducing effect immediately and at 1-4 weeks after completing the rTMS sessions, and the patients’ QoL improved after 5-12 weeks. However, Lt. DLPFC stimulation was not effective in controlling fibromyalgia symptoms.

PMID:34983056 | DOI:10.1093/pm/pnab354

Water Res. 2021 Dec 24;210:118003. doi: 10.1016/j.watres.2021.118003. Online ahead of print.

ABSTRACT

Eutrophication substantially influences the community structure of aquatic organisms and has become a major threat to biodiversity. However, whether eutrophication is linked to homogenization of microbial communities and the possible underlying mechanisms are poorly understood. Here, we studied bacterial and fungal communities from water and sediments of 40 shallow lakes in the Yangtze-Huaihe River basin, a representative area characterized by intensifying eutrophication in China, and further examined the beta diversity patterns and underlying mechanisms under eutrophication conditions. Our results indicate that eutrophication generally caused biotic homogenization of bacterial and fungal communities in both habitats showing decreased community variations for the sites with a higher trophic state index (TSI). In the two habitats, community dissimilarities were positively correlated with TSI changes for both taxonomic groups, while the local contribution to beta diversity (LCBD) remarkably declined with increasing TSI for the fungal community. These phenomena were consistent with the pivotal importance of the TSI in statistically accounting for beta diversity of bacterial and fungal communities in both habitats. In addition, we found that physicochemical factors such as water temperature and pH were also important for bacterial and fungal communities in water, while heavy metal elements were important for the communities in sediments. Interestingly, generalist species, rather than specialist species, were revealed to more dominantly affect the variations in beta diversity along the trophic gradient, which were quantified by Bray-Curtis dissimilarity and LCBD. Collectively, our findings reveal the importance of generalist species in contributing to the change of beta diversity of microbial communities along trophic gradients, which have profound implications for a comprehensive understanding of the effects of eutrophication on microbial community.

PMID:34982976 | DOI:10.1016/j.watres.2021.118003

Sci Total Environ. 2022 Jan 1:152780. doi: 10.1016/j.scitotenv.2021.152780. Online ahead of print.

ABSTRACT

The climate change and population growth led to a severe water shortage that limits fresh water availability in some areas of Togo. Thus, the farmers of Adjougba District have no other choice than using treated wastewater as an alternative for irrigated agriculture. The purpose of this study is to compare the suitability of three types of water for uses with identification of the reliable parameters in the assessment of water suitability for irrigation and domestic purposes. The raw water quality parameters, water quality indices (WQIs) and water suitability indicators for irrigation purpose (WSI-IPs) were applied for the comparison while statistical analysis and, with some experts’ consensus were used to identify reliable parameters. The results suggested that the treated wastewater is more suitable than groundwater for irrigation purpose. Treated wastewater constitutes a viable fertilizer supply and is placed like surface water from permissible to excellent classes according to WSI-IPs values. The sodium absorption ratio (SAR), electrical conductivity (EC), residual sodium carbonate (RSC), Cl^– and faecal coliforms (FC) are the most reliable parameters in the detection of water suitability for irrigation purpose. EC, DO, pH, turbidity or TSS, COD or COD_Mn, hardness, FC, NO₃^–, national sanitation foundation’s water quality index (NSFWQI), and overall index of pollution (OPI) are the most reliable in the detection of water suitability for domestic use. The reliable parameters identified in this study are potential candidates for the development of a single water quality index for both irrigation and domestic uses in Adjougba District. However further study will be necessary for the identification of reliable parameters and the development of a water quality index at the country scale.

PMID:34982995 | DOI:10.1016/j.scitotenv.2021.152780

Am J Speech Lang Pathol. 2022 Jan 4:1-13. doi: 10.1044/2021_AJSLP-21-00175. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to determine the prevalence of reported dysphagia and associated pneumonia risk among patients with stroke in India.

METHOD: We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome of interest was dysphagia and pneumonia among patients with stroke in India. Two review authors independently assessed the quality of studies using the Newcastle-Ottawa Scale and extracted related data. Meta-analysis was performed for frequency of dysphagia, associated pneumonia, and its relative risk using a random-effects model. Statistical heterogeneity was computed using the I² index.

RESULTS: A total of 3,644 titles were screened, and only eight studies met our inclusion criteria. Based on data from these studies, we calculated the pooled prevalence of dysphagia (47.71%; 95% confidence interval [CI] [20.49%, 70.92%], p < .001) and pneumonia (20.43%; 95% CI [10.73%, 30.14%], p < .001) for patients with stroke in India. We found that the relative risks of pneumonia in patients with stroke and dysphagia versus those patients with stroke and no dysphagia was 9.41 (95% CI [5.60, 15.80], p < .001). Data on length of hospital stay and rates of mortality secondary to pneumonia are also presented.

CONCLUSIONS: Despite the high incidence of dysphagia and associated pneumonia, the methodological quality of studies is fair and there is little research focused on epidemiological data. We call to arms to those SLPs working with patients with stroke in India to become proactive in both clinical practice and research domains. Supplemental Material https://doi.org/10.23641/asha.17701022.

PMID:34982940 | DOI:10.1044/2021_AJSLP-21-00175

Neurosurgery. 2022 Jan 1;90(1):148-153. doi: 10.1227/NEU.0000000000001756.

ABSTRACT

BACKGROUND: With increasing interest in cost optimization, costs of adult spinal deformity (ASD) surgery intersections with frailty merit investigation.

OBJECTIVE: To investigate costs associated with ASD and frailty.

METHODS: Patients with ASD (scoliosis ≥20°, sagittal vertical axis [SVA] ≥5 cm, pelvic tilt ≥ 25°, or thoracic kyphosis ≥ 60°) with baseline and 2-yr radiographic data were included. Patients were severely frail (SF), frail (F), or not frail (NF). Utility data were converted from Oswestry Disability Index to Short-Form Six-Dimension. Quality-adjusted life years (QALYs) used 3% rate for decline to life expectancy. Costs were calculated using PearlDiver. Loss of work costs were based on SRS-22rQ9 and US Bureau of Labor Statistics. Accounting for complications, length of stay, revisions, and death, cost per QALY at 2 yr and life expectancy were calculated.

RESULTS: Five hundred ninety-two patients with ASD were included (59.8 ± 14.0 yr, 80% F, body mass index: 27.7 ± 6.0 kg/m2, Adult Spinal Deformity-Frailty Index: 3.3 ± 1.6, and Charlson Comorbidity Index: 1.8 ± 1.7). The average blood loss was 1569.3 mL, and the operative time was 376.6 min, with 63% undergoing osteotomy and 54% decompression. 69.3% had a posterior-only approach, 30% combined, and 0.7% anterior-only. 4.7% were SF, 22.3% F, and 73.0% NF. At baseline, 104 were unemployed losing $971.38 weekly. After 1 yr, 62 remained unemployed losing $50 508.64 yearly. With propensity score matching for baseline SVA, cost of ASD surgery at 2 yr for F/SF was greater than that for NF ($81 347 vs $69 722). Cost per QALY was higher for F/SF at 2 yr than that for NF ($436 473 vs $430 437). At life expectancy, cost per QALY differences became comparable ($58 965 vs $58 149).

CONCLUSION: Despite greater initial cost, F and SF patients show greater improvement. Cost per QALY for NF and F patients becomes similar at life expectancy.

PMID:34982882 | DOI:10.1227/NEU.0000000000001756

Oper Neurosurg (Hagerstown). 2022 Jan 1;22(1):14-19. doi: 10.1227/ONS.0000000000000011.

ABSTRACT

BACKGROUND: Facial nerve palsy is a rare presenting symptom of vestibular schwannomas and has not been investigated in detail.

OBJECTIVE: To investigate the incidence, clinical features, and postoperative long-term outcomes of facial nerve function in patients with vestibular schwannomas causing preoperative facial nerve palsy.

METHODS: After excluding patients with neurofibromatosis type 2 and those with prior treatment, 1228 consecutive patients who underwent vestibular schwannoma surgery were retrospectively investigated. Patients with and without preoperative facial nerve palsy were compared statistically to clarify their clinical features.

RESULTS: Preoperative tumoral facial nerve palsy was seen in 34 patients (2.8%). Their clinical features included older age, having large cystic tumors with significant meatal extension, and showing abnormal electrogustometric responses, compared with patients without preoperative facial nerve palsy. Owing to the frequent insufficient intraoperative responses on facial nerve electromyography, the tumor resection rate was lower in the group with preoperative facial nerve palsy (mean: 95.2%). Among the 33 patients with sufficient follow-up data (mean: 63.9 mo), additional treatment was required only in 1 patient and facial nerve function improved in 25 patients (75.8%) within 2 yr postoperatively.

CONCLUSION: Facial nerve palsy is a rare preoperative symptom that occurs in less than 3% of patients with vestibular schwannoma. Tumor resection in such patients tends to be challenging owing to their advanced age, having large cystic tumors with significant meatal extension, and difficulties in intraoperative facial nerve monitoring, but surgical decompression of the facial nerve can assist in the improvement of their long-term functions.

PMID:34982900 | DOI:10.1227/ONS.0000000000000011

Neurosurgery. 2022 Jan 1;90(1):114-123. doi: 10.1227/NEU.0000000000001751.

ABSTRACT

BACKGROUND: Meningiomas are the most common intracranial neoplasms. Although genomic analysis has helped elucidate differences in survival, there is evidence that racial disparities may influence outcomes. African Americans have a higher incidence of meningiomas and poorer survival outcomes. The etiology of these disparities remains unclear, but may include a combination of pathophysiology and other factors.

OBJECTIVE: To determine factors that contribute to different clinical outcomes in racial populations.

METHODS: We retrospectively reviewed 305 patients who underwent resection for meningiomas at a single tertiary care facility. We used descriptive statistics and univariate, multivariable, and Kaplan-Meier analyses to study clinical, radiographical, and histopathological differences.

RESULTS: Minority patients were more likely to present through the emergency department than an outpatient clinic (P < .0001). They were more likely to present with more advanced clinical symptoms with lower Karnofsky Performance scores, more frequently had peritumoral edema (P = .0031), and experienced longer postoperative stays in the hospital (P = .0053), and African-American patients had higher hospitalization costs (P = .046) and were more likely to be publicly insured. Extent of resection was an independent predictor of recurrence freedom (P = .039). Presentation in clinic setting trended toward an association with recurrence-free survival (P = .055). We observed no significant difference in gross total resection rates, postoperative recurrence, or recurrence-free survival.

CONCLUSION: Minority patients are more likely to present with severe symptoms, require longer perioperative hospitalization, and generate higher hospitalization costs. This may be due to socioeconomic factors that affect access to health care. Targeting barriers to access, especially to subspecialty care, may facilitate more appropriate and timely diagnosis, thereby improving patient care and outcomes.

PMID:34982878 | DOI:10.1227/NEU.0000000000001751

Neurosurgery. 2022 Jan 1;90(1):39-50. doi: 10.1227/NEU.0000000000001737.

ABSTRACT

BACKGROUND: Traumatic brachial plexus injuries (BPIs) often lead to devastating upper extremity deficits. Treatment frequently prioritizes restoring elbow flexion through transfer of various donor nerves; however, no consensus identifies optimal donor nerve sources.

OBJECTIVE: To complete a meta-analysis to assess donor nerves for restoring elbow flexion after partial and total BPI (TBPI).

METHODS: Original English language articles on nerve transfers to restore elbow flexion after BPI were included. Using a random-effects model, we calculated pooled, weighted effect size of the patients achieving a composite motor score of ≥M3, with subgroup analyses for patients achieving M4 strength and with TBPI. Meta-regression was performed to assess comparative efficacy of each donor nerve for these outcomes.

RESULTS: Comparison of the overall effect size of the 61 included articles demonstrated that intercostal nerves and phrenic nerves were statistically superior to contralateral C7 (cC7; P = .025, <.001, respectively) in achieving ≥M3 strength. After stratification by TBPI, the phrenic nerve was still superior to cC7 in achieving ≥M3 strength (P = .009). There were no statistical differences among ulnar, double fascicle, or medial pectoral nerves in achieving ≥M3 strength. Regarding M4 strength, the phrenic nerve was superior to cC7 (P = .01) in patients with TBPI and the ulnar nerve was superior to the medial pectoral nerve (P = .036) for partial BPI.

CONCLUSION: Neurotization of partial BPI or TBPI through the intercostal nerve or phrenic nerve may result in functional advantage over cC7. In patients with upper trunk injuries, neurotization using ulnar, median, or double fascicle nerve transfers has similarly excellent functional recovery.

PMID:34982869 | DOI:10.1227/NEU.0000000000001737