Category: Statistics

Drug Alcohol Depend. 2022 Mar 9;234:109389. doi: 10.1016/j.drugalcdep.2022.109389. Online ahead of print.

ABSTRACT

BACKGROUND: Opioid use disorder (OUD) seriously impacts public health in the United States. However, few investigations of long-term outcomes following treatment with medication for OUD exist. Additionally, these studies have prioritized opioid use and treatment utilization outcomes, and a gap in knowledge regarding long-term, multidimensional trajectories of OUD recovery exists. This study investigated a diverse array of outcomes for individuals with OUD at an average of 4.2 years post clinical trial participation.

METHODS: Individuals who previously participated in long-acting buprenorphine subcutaneous injection clinical trials (NCT023579011; NCT025100142; NCT02896296) and enrolled in The Remission from Chronic Opioid Use-Studying Environmental and SocioEconomic Factors on Recovery (RECOVER; NCT03604861) Study participated in a follow up assessment (n = 216). Substance use, psychosocial, opioid dependence, and delay discounting outcomes were assessed. Regression analyses were conducted to determine significant associations between psychosocial/opioid dependence variables and both recent opioid use and delay discounting.

RESULTS: The majority of participants reported abstinence from opioids since the last RECOVER study assessment (mean 2.26 years; 55%) and in the past 30 days (69%). Participants reported low levels of depression and psychological distress. Positive associations between depression and opioid craving with past 30-day opioid misuse and delay discounting, and negative associations between quality of life and treatment effectiveness with these outcomes were observed.

CONCLUSIONS: This study examined longer term OUD recovery outcomes. Participants reported high levels of abstinence from opioids and psychosocial functioning. These encouraging results highlight the multidimensional nature of recovery from OUD, and further support the effectiveness of buprenorphine as an OUD treatment.

PMID:35287034 | DOI:10.1016/j.drugalcdep.2022.109389

J Stroke Cerebrovasc Dis. 2022 Mar 11;31(5):106378. doi: 10.1016/j.jstrokecerebrovasdis.2022.106378. Online ahead of print.

ABSTRACT

OBJECTIVE: This study investigates the differences and changing trend of posterior circulation blood perfusion between different levels of vertebrobasilar dolichoectasia(VBD) patients. The relationship between the deviation of the basilar artery(BA) in different directions and the location of pontine infarction are also investigated.

METHODS: A cohort of 106 patients(74 males and 32 females) who satisfied the diagnostic criteria for VBD were recruited for this study and classified according to the bifurcation height and the deviation position of the BA, as well as the measured blood perfusion value of the pontine, which includes rCBF, rCBV, MTT, and TTP.

RESULTS: Out of the 106 patients, 19 cases were classified as Level 1, 74 cases were classified as Level 2, and 13 cases were classified as Level 3. The different levels between the VBD groups were statistically significant (P<0.05, P<0.01), and it was found that as the level increases, rCBF and rCBV gradually decreased, while MTT and TTP gradually increased. The statistic results of different perfusion parameters were also significant, when pairwise comparisons between Level 1 and Level 3, and Level 2 and Level 3 were performed. However, when comparing Level 1 and Level 2, only the TTP showed significant result. Among 106 patients, 22 cases had brainstem infarction, 13 cases had left brainstem infarction, 8 cases had right brainstem infarction, and 1 case had brainstem infarction on both sides. Brainstem infarction generally occurs on the opposite side of the direction of BA deviation(P<0.05). Regardless of the BA was deviated to the left or right, perfusion analysis showed that there was significant difference in blood perfusion on both sides of the pontine when BA is deviated(P<0.05, P<0.01). The rCBF and rCBV on the contralateral side of deviation were lower than those on the same side, and the MTT and TTP were longer than those on the same side. There were 37 cases with vertebral artery dominance(VAD), 16 cases with left VAD, and 21 cases with right VAD. Statistical analysis showed that BA was more likely to deflect to the opposite side of the dominant artery(P<0.05), and compared with non-VAD, there was no significant difference in pontine blood perfusion (p>0.05).

CONCLUSION: As VBD level increases, rCBF and rCBV will gradually decreases while MTT and TTP showed sign of increasing. The location of brainstem infarction is opposite to the direction of the BA deviation, and BA is more likely to deviate to the opposite side of the dominant artery.

PMID:35287024 | DOI:10.1016/j.jstrokecerebrovasdis.2022.106378

J Surg Res. 2022 Mar 11;275:181-193. doi: 10.1016/j.jss.2022.01.012. Online ahead of print.

ABSTRACT

INTRODUCTION: Despite advances, readmission and mortality rates for surgical patients with colon cancer remain high. Prediction models using regression techniques allows for risk stratification to aid periprocedural care. Technological advances have enabled large data to be analyzed using machine learning (ML) algorithms. A national database of colon cancer patients was selected to determine whether ML methods better predict outcomes following surgery compared to conventional methods.

METHODS: Surgical colon cancer patients were identified using the 2013 National Cancer Database (NCDB). The negative outcome was defined as a composite of 30-d unplanned readmission and 30- and 90-d mortality. ML models, including Random Forest and XGBoost, were built and compared with conventional logistic regression. For the accounting of unbalanced outcomes, a synthetic minority oversampling technique (SMOTE) was implemented and applied using XGBoost.

RESULTS: Analysis included 528,060 patients. The negative outcome occurred in 11.6% of patients. Model building utilized 30 variables. The primary metric for model comparison was area under the curve (AUC). In comparison to logistic regression (AUC 0.730, 95% CI: 0.725-0.735), AUC’s for ML algorithms ranged between 0.748 and 0.757, with the Random Forest model (AUC 0.757, 95% CI: 0.752-0.762) outperforming XGBoost (AUC 0.756, 95% CI: 0.751-0.761) and XGBoost using SMOTE data (AUC 0.748, 95% CI: 0.743-0.753).

CONCLUSIONS: We show that a large registry of surgical colon cancer patients can be utilized to build ML models to improve outcome prediction with differential discriminative ability. These results reveal the potential of these methods to enhance risk prediction, leading to improved strategies to mitigate those risks.

PMID:35287027 | DOI:10.1016/j.jss.2022.01.012

Macromol Biosci. 2022 Mar 14:e2100479. doi: 10.1002/mabi.202100479. Online ahead of print.

ABSTRACT

Manufacturing of porous carbon with biomass resources has been intensively investigated in recent decades. The diversity of biomass species and great variety of processing methods enable the structural richness of porous carbon as well as their wide applications. In this review, we specifically focused on the structure of biomass-derived porous carbon either inherited from natural biomass or created by post-treatment. The intrinsic structure of plant biomass was briefly introduced and the utilization of the unique structures at different length-scales were discussed. In term of post-treatment, the structural features of activated carbon by traditional physical and chemical activation were summarized and compared in a wide spectrum of biomass species, statistical analysis were performed to evaluate the effectiveness of different activation methods in creating specific pore structures. The similar pore structure of biomass-derived carbon and coal-derived carbon suggested a promising replacement with more sustainable biomass resources in producing porous carbon. In summary, using biomass as porous carbon precursor endows the flexibility of using its naturally patterned micro-structure and the tunability of controlled pore-creation by post treatment. This article is protected by copyright. All rights reserved.

PMID:35286776 | DOI:10.1002/mabi.202100479

Prostate. 2022 Mar 14. doi: 10.1002/pros.24325. Online ahead of print.

ABSTRACT

BACKGROUND: An updated systematic review and meta-analysis of relevant studies to evaluate the effectiveness of prostate-specific membrane antigen (PSMA)-targeted endoradiotherapy/radioligand therapy (PRLT) in castration resistant prostate cancer (CRPC).

METHODS: A systematic search was performed in July 2020 using PubMed/Medline database to update our prior systematic review. The search was limited to papers published from 2019 to June 2020. A total of 472 papers were reviewed. The studied parameters included pooled proportion of patients showing any or ≥50% prostate-specific antigen (PSA) decline after PRLT. Survival effects of PRLT were assessed based on pooled hazard ratios (HRs) of the overall survival (OS) according to any PSA as well as ≥50% PSA decline after PRLT. Response to therapy based on ≥50% PSA decrease after PRLT versus controls was evaluated using Mantel-Haenszel random effect meta-analysis. All p values < 0.05 were considered as statistically significant.

RESULTS: A total of 45 publications were added to the prior 24 studies. 69 papers with total of 4157 patients were included for meta-analysis. Meta-analysis of the two recent randomized controlled trials showed that patients treated with ¹⁷⁷ Lu-PSMA 617 had a significantly higher response to therapy compared to controls based on ≥50% PSA decrease. Meta-analysis of the HRs of OS according to any PSA decline and ≥50% PSA decline showed survival prolongation after PRLT.

CONCLUSIONS: PRLT results in higher proportion of patients responding to therapy based on ≥50% PSA decline compared to controls. Any PSA decline and ≥50% PSA decline showed survival prolongation after PRLT.

ADVANCES IN KNOWLEDGE: This is the first meta-analysis to aggregate the recent randomized controlled trials of PRLT which shows CRPC patients had a higher response to therapy after PRLT compared to controls.

PMID:35286735 | DOI:10.1002/pros.24325

Oral Dis. 2022 Mar 14. doi: 10.1111/odi.14187. Online ahead of print.

ABSTRACT

AIM: To describe the particular craniofacial characteristics of Van der Woude syndrome(VWS) patients compared to patients with a non-syndromic cleft(CG1) and to a malocclusive healthy population(CG2).

MATERIAL AND METHODS: Retrospective case-control study. A sample of 110matched-patients was recruited(VWS(n=7),CG1(n=49),CG2(n=49)).Subsequently, 37 radiometric-variables were analysed and the dental-skeletal ages were determined. The intra/inter-observer method errors were quantified.Descriptive statistics were computed, and different inferential analysis tests were used depending on the normality of the data(Chi-square-test,Fisher-exact-test,paired-Student’sT-test,Mann-Whitney´s-test)(p-value<0.05).Pairwise comparisons were corrected by Bonferroni´s criteria.

RESULTS: VW-patients presented specific craniofacial characteristics and morphology. A marked tendency to the vertical growth pattern was found in VW-patients compared to CG1-CG2(p<0.001); at the sagittal level, skeletal class II caused by mandibular retrognathism, with a greatly increased ANB angle compared to CG1(p=0.042). Dental analysis showed that the lower incisor was more retruded and retroclined(p<0.05 in all cases)and the interincisal angulation was increased(p<0.001(CG2)).At the profile level, an open nasolabial angle(p=0.040;CG1) and a more protruding lower lip with respect to the Sn-Pg plane(p=0.040(CG1);p=0.044(CG2))were observed.

CONCLUSIONS: VW-patients present particular characteristics in the facial skeletal structures. There is a critical necessity to increase the evidence regarding specific clinical features and orofacial pathology of rare diseases such as VWS, which will help to these minorities to gain access in the future to a better quality of care with precise treatment and diagnostic necessities.

PMID:35286743 | DOI:10.1111/odi.14187

Epilepsia. 2022 Mar 14. doi: 10.1111/epi.17224. Online ahead of print.

ABSTRACT

OBJECTIVE: The primary purpose is to determine if the time between epilepsy surgery and first seizure recurrence can estimate the timing of the next seizure event for temporal and extratemporal epilepsy. A secondary endpoint aimed to compare temporal and extratemporal epilepsy surgery and examine which subgroup has a higher hazard of subsequent seizure recurrence.

METHODS: Data was used from a retrospective database at Thomas Jefferson University Hospital. Records were stratified into temporal (N = 943) and extratemporal (N = 125) surgeries. Analyses were done using SAS and utilized Cox-Proportional hazards models while controlling for demographics and clinical factors. The primary predictor of time between surgery and first recurrence was treated as a nominal variable binned into six segments, while secondary endpoints used a categorical predictor of epilepsy location while controlling for seizure latency.

RESULTS: Generally, as seizure latency following surgery increased, the time between first seizure and second seizure increased. These results were statistical meaningful in the temporal set (Wald Chi Square: 40.4715, df = 5, p<0.0001). Outcomes could also be interpreted based on predictor group, for instance, if seizure one occurred between one to two months following surgery in the temporal set, the median number of days until the next seizure was 35.5 days (95% CIs: 21 – 89 days). Secondary analysis showed that temporal lobe epilepsy had a lower hazard of a second seizure than extratemporal lobe epilepsy (89.2% reduction in hazard; 95% CIs: 0.015 – 0.795).

SIGNIFICANCE: This analysis provides a framework to use initial seizure latency to predict the median number of days until the next seizure event, while stratifying based on epilepsy location and controlling for multiple variables. It also suggests that the hazard of seizure recurrence in temporal lobe epilepsy is lower than extratemporal lobe epilepsy.

PMID:35286721 | DOI:10.1111/epi.17224

J Surg Oncol. 2022 Mar 14. doi: 10.1002/jso.26845. Online ahead of print.

ABSTRACT

INTRODUCTION: Adrenocortical carcinoma (ACC) is associated with a poor prognosis. We reviewed the National Cancer Database (NCDB) to analyze the prognostic factors in surgically resected ACC patients and the association of surgical approaches with overall survival (OS).

METHODS: A retrospective NCDB (2004-2014) review of patients undergoing curative-intent surgical resection for ACC was performed. Effects of patient demographics, tumor characteristics, histopathology, and perioperative course on OS were analyzed. Log-rank statistics were used to associate clinical variables with OS. The multivariable Cox proportional hazard model included only statistically significant variables.

RESULTS: A total of 1599 patients with ACC were included. A majority of patients were female (60.73%) and presented with a Charlson-Deyo score of zero (75.42%). A majority of the ACC cases were Grade 3 (45.69%), and almost a third (30.64%) underwent margin-positive resections. Univariate analysis demonstrated a decrease in OS associated with increasing age and comorbidities. A negative resection margin and lack of lymphovascular invasion predicted better OS. Multivariable analysis showed that age, grade, surgical resection margins, and hospital length of stay were associated with OS.

CONCLUSIONS: Advanced age, grade, presence of lymphovascular invasion, and positive surgical margins predicted a worse overall survival for adrenocortical cancer in our analysis. Resection with negative margins improves outcomes.

PMID:35286718 | DOI:10.1002/jso.26845

Sports Med. 2022 Mar 14. doi: 10.1007/s40279-022-01668-1. Online ahead of print.

ABSTRACT

BACKGROUND: Continued participation after sport-related concussion (SRC) worsens outcomes, but it is unknown if duration of continued participation after SRC impacts recovery outcomes, and which athletes who continue to participate are at greatest risk for poor SRC outcomes. The purpose of this National Collegiate Athletic Association/Department of Defense (NCAA/DoD) Concussion Assessment, Research, and Education (CARE) Consortium study was to evaluate the association of estimated duration of continued participation after SRC with symptom severity and recovery time in collegiate athletes.

METHODS: Clinicians estimated if/how long athletes continued participation after SRC. Collegiate athletes who continued participation after suspected SRC (n = 195/373, 52.3%) completed the Graded Symptom Checklist to evaluate the severity of total symptoms and migraine/fatigue, cognitive/ocular, and affective symptom clusters. Linear regression analyzed the associations between estimated duration of continued participation, symptom severity, and recovery time. Binary logistic regression examined the association of estimated duration of continued participation with the odds of recovery ≥ 14 and ≥ 21 days. Statistical significance was p < 0.05.

RESULTS: Athletes who continued to participate did so for 27.9 ± 25.3 min (mean ± standard deviation; range 1-90 min). Longer estimated continued participation (1-90 min) was associated with greater symptom severity (β = 0.122, p = 0.02), affective (β = 0.171, p = 0.001) and migraine/fatigue symptoms (β = 0.104, p = 0.049), longer symptom duration (β = 0.193, p < 0.001), and longer time missed (β = 0.156, p = 0.003). Longer estimated continued participation positively interacted with female sex (cognitive/ocular: female R² = 0.03, male R² = 0.01, p = 0.02; affective: female R² = 0.06, male R² = 0.02, p = 0.006), migraine history (affective symptoms: no migraine R² = 0.02; migraine R² = 0.18; p = 0.04), and concussion history (affective: 2 + prior concussions [R² = 0.14] compared with those with 1 [R² = 0.07] or 0 [R² < 0.01] prior concussions [p = 0.003]).

CONCLUSIONS: Longer estimated duration of continued participation after SRC was associated with higher symptom severity, particularly affective and migraine/fatigue; longer symptom duration; and more time missed from sport. SRC outcomes in those who continue to play may be especially severe for female athletes, athletes with migraine history, and athletes with prior concussion(s). The findings can help clinicians and administrators to educate athletes on the importance of immediate removal following a suspected SRC.

PMID:35286616 | DOI:10.1007/s40279-022-01668-1

Med Phys. 2022 Mar 14. doi: 10.1002/mp.15597. Online ahead of print.

ABSTRACT

PURPOSE: Radiochromic material used in recent commercial films has been suggested as a candidate for in vivo dosimetry because of its dose sensitivity, real-time response, and atomic composition. It was observed that its sensitive material, Lithium Pentacosa-10,12-diynoate (LiPCDA), can have two distinct forms, with main absorbance peaks at ∼635 nm and ∼674 nm. The spectrum of the latter is similar to that of Pentacosa-10,12-diynoic acid (PCDA) used in the commercial predecessor, obtained through desiccation of the commercial film. Water was suggested to be a part of the crystal structure and thus its presence or absence would affect dosimetric parameters. The objective of this study was to: (a) investigate how desiccated commercial films compare to the native form in terms of macroscopic crystal structure, dose-response, signal linearity and post-exposure kinetics; (b) demonstrate proof of concept that the two versions can be combined into one optical dosimeter and measured simultaneously.

METHODS: Commercial radiochromic film, EBT-3, was desiccated for 10 days at 45°C. Using a 6 MV LINAC beam and standard set-up of 100 SAD, 10 cm x 10 cm field size, and 1.5 cm depth, commercial and desiccated films were irradiated to 50, 100, 200, 500, 1000, 2000, 3000 cGy and the latter to 4000, 5000 and 7000 cGy. A custom phantom equipped with optical fibres for real-time read-out was used for all measurements. Absorbance spectra were collected at ∼ 1 Hz before, during, and after irradiation. Data was collected for ∼1 hour after the end of irradiation for 200 cGy experiments. The radiation-induced change in optical density (∆OD) was calculated with a 10 nm band around the primary absorbance peak. The post-exposure percent optical density change was calculated and compared to ∆OD at the end of irradiation. Both commercial and desiccated films were also irradiated and measured simultaneously as proof of concept for using two materials within one optical path. For electron microscopy imaging, active material from commercial and desiccated films were imaged on a scanning electron microscope at an accelerating voltage of 10 kV.

RESULTS: Scanning electron microscope images showed that desiccated film was similar in topographical structure to the commercial EBT-3 form. It maintained a non-linear ∆OD with dose but resulted in ∼1/3 signal compared to the commercial film. Evaluation of post-exposure response showed significantly lower percent increase in ∆OD for desiccated film initially, with no statistically significant difference at 1 h after the end of irradiation. Combining both films and simultaneously measuring their absorbance illustrated that the two absorbance peaks were identifiable and resolvable to allow for an independent determination of dose from each.

CONCLUSIONS: Water is implicated in the crystal structure of the EBT-3 radiochromic film, with its removal through desiccation affecting both dosimetric and spectroscopic characteristics of the material. The two forms of radiochromic material (with and without water) are spectrally resolvable allowing for independent dose determination from each, opening up possibilities for dose measurements at different locations along a single fiber. This article is protected by copyright. All rights reserved.

PMID:35286716 | DOI:10.1002/mp.15597