Category: Statistics

J Craniomaxillofac Surg. 2021 Dec 4:S1010-5182(21)00262-6. doi: 10.1016/j.jcms.2021.11.015. Online ahead of print.

ABSTRACT

The purpose of this study was to determine the expression patterns of specific desmosomal cadherins (desmogleins [DSG] 1/2/3) in oral squamous cell carcinoma (OSCC), and to examine possible associations with clinicopathological parameters and recurrence rates. Changes in desmosomal cadherin assembly may promote tumor metastasis formation. Patients with surgically treated OSCC with 36-60 months of follow-up (median 46 months) qualified for inclusion in this retrospective cohort study. Demographic, clinical and pathohistological data were collected. DSG-1/2/3 expression patterns were determined by an immunohistochemical approach on tissue microarrays. Descriptive and inferential statistics and survival analyses were computed (p ≤ 0.05). The study sample consisted of 88 patients (female: 38; male: 50; average age: 63.02 ± 17.5 years). DSG-3 overexpression was detected in 45 of 88 specimens. The expression rates for DSG-1 (28/88) and DSG-2 (14/88) were low and inconspicuous. DSG-3 overexpression was significantly associated with poor histologic differentiation (G3, p = 0.001), the presence of cervical node metastasis at primary diagnosis (N+ status, p = 0.001) and early recurrence (p = 0.001). Due to its possible relevance for lymph node metastasis formation and early OSCC recurrence, determination of DSG-3 expression in OSCC specimens may be a valuable tool for treatment planning and post-therapeutic risk assessment.

PMID:34887169 | DOI:10.1016/j.jcms.2021.11.015

Eur Urol. 2021 Dec 6:S0302-2838(21)02194-1. doi: 10.1016/j.eururo.2021.11.019. Online ahead of print.

ABSTRACT

A biopsy-free diagnostic pathway in prostate cancer (PC) is limited by the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI). The improved accuracy of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) raises the question whether this imaging modality can complement mpMRI to safely avoid biopsy prior to radical prostatectomy (RP). In this case series, we report the feasibility of primary RP without prior biopsy based on a high suspicion of significant PC in both mpMRI (Prostate Imaging Reporting and Data System [PI-RADS] score ≥4) and PSMA-PET (PET score ≥4 on a five-point Likert scale and maximum standardized uptake value ≥4.0) in 25 patients. All patients showed International Society of Urological Pathology (ISUP) grade ≥2 PC in postoperative histopathology. We report patient- and lesion-based comparisons with histopathology of the prostate specimen. Results of our case series may trigger the discussion about RP without prior biopsy as a possible option in well-selected patients. Our case series is limited by retrospective design and small sample size. We want to emphasize clearly that this practice should not be regarded as a standard procedure at the moment. Future studies with larger cohorts only inside a prospective, ethically approved study design are necessary to confirm these results.

PMID:34887117 | DOI:10.1016/j.eururo.2021.11.019

Curr Probl Diagn Radiol. 2021 Nov 11:S0363-0188(21)00173-0. doi: 10.1067/j.cpradiol.2021.09.005. Online ahead of print.

ABSTRACT

OBJECTIVE: To help quantify the potential microeconomic impact of patient satisfaction in radiology, we tested the hypothesis that patient volume trends reflect patient satisfaction trends in outpatient magnetic resonance imaging (MRI).

METHODS: Patient visits (N = 39,595) at distinct outpatient MRI sites within a university-affiliated hospital system during a 1-year period were retrospectively analyzed. Individual sites were grouped as having “decreasing,” “stable,” or “increasing” volume using an average quarterly volume change threshold of 5%. Based on Press Ganey outpatient services surveys, changes in satisfaction scores from the baseline quarter were calculated. Mood’s median tests were applied to assess statistical significance of differences in satisfaction score improvements among the three volume trend designations during the 3 post-baseline fiscal quarters.

RESULTS: Quarterly volume was stable at 6 sites, increased at 1 site (by 18%), and decreased at 2 sites (by 20%-24%). There was a statistically significant association between volume trend and net change in satisfaction scores for all 5 domains assessed on the Press Ganey survey: Overall assessment (P < 0.0001), Facilities (P = 0.026), Personal issues (P = 0.013), Registration (P = 0.0004), and Test or treatment (P < 0.0001), with median score changes generally higher at facilities with higher volume trends.

DISCUSSION: It can be inferred that patient satisfaction drives volume in this scenario, whereas the converse relationship of volume adversely affecting satisfaction is not observed. Patient satisfaction and volume at MRI sites are interrelated, and patient experiences or perceptions of quality may influence decisions regarding what imaging sites are preferentially utilized.

PMID:34887134 | DOI:10.1067/j.cpradiol.2021.09.005

Surgery. 2021 Dec 6:S0039-6060(21)00941-7. doi: 10.1016/j.surg.2021.09.021. Online ahead of print.

ABSTRACT

BACKGROUND: Laparoscopic liver resection for hepatic lesions is increasingly performed worldwide. However, parenchyma-sparing laparoscopic liver resection for hepatic lesions in the right posterosuperior segments is very technically demanding. This study aimed to compare postoperative outcomes between patients undergoing laparoscopic liver resection and open liver resection for hepatic lesions in the right posterosuperior segments.

METHODS: In total, 617 patients who underwent liver resection of hepatic lesions in the right posterosuperior segments (segment Ⅶ or Ⅷ) at 8 centers were included in this study. We lessened the impact of confounders through propensity score matching, inverse probability weighting, and double/debiased machine learning estimations.

RESULTS: After matching and weighting, the imbalance between the 2 groups significantly decreased. Compared with open liver resection, laparoscopic liver resection was associated with a lower volume of intraoperative blood loss and incidence of postoperative complications in the matched and weighted cohorts. After surgery, the incidence of pulmonary complication and cardiac disease was lower in the laparoscopic liver resection group than in the open liver resection group in both the matched and weighted cohorts. The odds ratios of laparoscopic liver resection for postoperative complications in the matched and weighted cohorts were 0.49 (95% confidence interval, 0.29-0.83) and 0.40 (95% confidence interval, 0.25%-0.64%), respectively. The double/debiased machine learning risk difference estimator for postoperative complications of laparoscopic liver resection was -19.8% (95% confidence interval, -26.8% to -13.4%).

CONCLUSION: Parenchyma-sparing laparoscopic liver resection for hepatic lesions in the right posterosuperior segments had clinical benefits, including lower volume of intraoperative blood loss and incidence of postoperative complications.

PMID:34887090 | DOI:10.1016/j.surg.2021.09.021

Stat Med. 2021 Dec 9. doi: 10.1002/sim.9277. Online ahead of print.

ABSTRACT

In this article, we investigate parameter estimation, kink points testing and statistical inference for a longitudinal multikink expectile regression model. The estimators for the kink locations and regression coefficients are obtained by using a bootstrap restarting iterative algorithm to avoid local minima. A backward selection procedure based on a modified BIC is applied to estimate the number of kink points. We theoretically demonstrate the number selection consistency of kink points and the asymptotic normality of all estimators. In particular, the estimators of kink locations are shown to achieve root-n consistency. A weighted cumulative sum type statistic is proposed to test the existence of kink effects at a given expectile, and its limiting distributions are derived under both the null and the local alternative hypotheses. The traditional Wald-type and cluster bootstrap confidence intervals for kink locations are also constructed. Simulation studies show that the proposed estimators and test have desirable finite sample performance in both homoscedastic and heteroscedastic errors. Two applications to the Nation Growth, Lung and Health Study and Capital Bike sharing dataset in Washington D.C. are also presented. The R codes for simulation studies and the real data are available at https://github.com/wangleink/MKER.

PMID:34883531 | DOI:10.1002/sim.9277

Neuropsychobiology. 2021 Dec 9:1-8. doi: 10.1159/000520152. Online ahead of print.

ABSTRACT

INTRODUCTION: Chronic low-grade inflammation is suggested to play a pathophysiological role in bipolar disorder (BD) and its related cognitive dysfunctions. Although kynurenine (KYN) pathway metabolites are key inflammatory mediators, studies investigating the association between KYN metabolism and cognition in BD are scarce. We aimed to explore the relationship between KYN metabolism and cognitive functioning across different mood states in BD.

METHODS: Sixty-seven patients with BD (35 depressed and 32 [hypo] manic) and 29 healthy controls were included. Cognitive functioning was assessed at 3 time intervals (baseline, 4, and 8 months) assessing processing speed, sustained attention, verbal memory, working memory, and response inhibition. Plasma samples for quantification of 3-hydroxykynurenine, quinolinic acid, and kynurenic acid (KYNA) were concurrently provided. Linear mixed models were used for statistical analysis.

RESULTS: The manic group showed deficits in all assessed cognitive domains with the exception of verbal memory at all test moments. The bipolar depression group showed deficits in the processing speed at all test moments. Throughout the whole follow-up period, KYNA was significantly lower in both patient groups than in controls. Only in the bipolar depression group, low KYNA was associated with worse global cognitive functioning (B = 0.114, p = 0.02) and slower processing speed in particular (B = 0.139, p = 0.03).

CONCLUSION: Only in the bipolar depression group, lower KYNA was associated with worse cognitive functioning. Future large-scale longitudinal studies are warranted to confirm the role of KYN metabolites in cognitive impairment in patients with BD and the possible therapeutic implications of this relationship.

PMID:34883494 | DOI:10.1159/000520152

Nucleic Acids Res. 2021 Dec 9:gkab1200. doi: 10.1093/nar/gkab1200. Online ahead of print.

ABSTRACT

Multi-omics integration is key to fully understand complex biological processes in an holistic manner. Furthermore, multi-omics combined with new longitudinal experimental design can unreveal dynamic relationships between omics layers and identify key players or interactions in system development or complex phenotypes. However, integration methods have to address various experimental designs and do not guarantee interpretable biological results. The new challenge of multi-omics integration is to solve interpretation and unlock the hidden knowledge within the multi-omics data. In this paper, we go beyond integration and propose a generic approach to face the interpretation problem. From multi-omics longitudinal data, this approach builds and explores hybrid multi-omics networks composed of both inferred and known relationships within and between omics layers. With smart node labelling and propagation analysis, this approach predicts regulation mechanisms and multi-omics functional modules. We applied the method on 3 case studies with various multi-omics designs and identified new multi-layer interactions involved in key biological functions that could not be revealed with single omics analysis. Moreover, we highlighted interplay in the kinetics that could help identify novel biological mechanisms. This method is available as an R package netOmics to readily suit any application.

PMID:34883510 | DOI:10.1093/nar/gkab1200

Med Princ Pract. 2021 Dec 9. doi: 10.1159/000521408. Online ahead of print.

ABSTRACT

OBJECTIVES: We aimed to describe the clinical characteristics of SARS-CoV-2 infection and estimate viral shedding duration in respiratory specimens.

METHODS: A retrospective cohort study was performed from Feb 25th to March 25th, 2020. In Kuwait, all suspected coronavirus disease 2019 (COVID-19) cases, contacts of cases, and returning travelers were systematically tested for SARS-CoV-2 by RT-PCR. All infected persons, regardless of symptoms, were hospitalized and serially tested until they had two negative results. Descriptive statistics and regression analyses were performed.

RESULTS: 207 cases of SARS-CoV-2 infection were identified. About half of cases were asymptomatic and 1.9% died. The median time to negative RT-PCR was 22 days. Increasing age, ARDS, and low peripheral white blood cell count were associated with prolonged PCR positivity.

CONCLUSION: Predictors for prolonged RT-PCR positivity included increasing age, ARDS, and low white blood cell count. The findings of this study may aid in better understanding SARS-CoV-2 infection epidemiology and molecular testing dynamics.

PMID:34883487 | DOI:10.1159/000521408

Urol Int. 2021 Dec 9:1-7. doi: 10.1159/000520372. Online ahead of print.

ABSTRACT

INTRODUCTION: Urolithiasis is a common disease leading to a high socioeconomic burden due to treatment costs and sickness leave. The aim of this study was to evaluate recent trends in the incidence of urolithiasis in Germany and in the use of therapeutic interventions.

METHODS: Treatment data for all in-patient hospital episodes for urolithiasis between 2005 and 2016 were extracted from the national DRG statistics at DESTATIS and analysed with regard to the corresponding procedures according to the OPS code.

RESULTS: Incidence for urolithiasis was stable at around 120,000 cases per year during the observation period with a male:female ratio of 2:1. Rising numbers were noted for patients >80 years. Nevertheless, the number of coded procedures rose significantly with a marked disproportionate transition from extracorporeal shock wave lithotripsy towards ureterorenoscopy. Percutaneous nephrolithotomy was performed more frequently on a smaller scale.

DISCUSSION/CONCLUSION: While the global incidence of urolithiasis is still rising, Germany, as other Western countries, has reached a plateau. There is a remarkable trend towards invasive treatment of even asymptomatic kidney stones. Besides the effects on individual patients with increased risk for complications, this results in a higher monetary burden to the health care system and society.

PMID:34883491 | DOI:10.1159/000520372

Epilepsy Behav. 2021 Dec 6;126:108457. doi: 10.1016/j.yebeh.2021.108457. Online ahead of print.

ABSTRACT

PURPOSE OF THE RESEARCH: The geriatric population is the fastest-growing population in the United States and the impact of incident epilepsy on the cognitively intact geriatric population is not well-studied. Understanding how epilepsy affects the elderly is important to improve the quality of treatment and care for our aging population. This study sought to address the impact of incident epilepsy on the perceived Quality of Life (QOL) in cognitively intact elderly using the SF-36 questionnaire.

METHODS: Nine hundred and twenty-seven participants were assessed from a community-based cohort. Based on a history of subsequent development of new-onset seizures, participants were divided into two groups, an incident seizure group that developed new-onset seizures after 65 years of age and the control group without incident seizures. Of this, six hundred eleven were analyzed with the SF-36 questionnaire after excluding for cognitive decline and inconsistent medical data.

PRINCIPAL RESULTS: Statistically significant differences were found in 9 items on SF-36, involving perception of increased physical disability (p < 0.01; t-test), frailty (p < 0.04; t-test), emotional health limitations (p < 0.03; t-test), anxiety and sadness (p < 0.04; t-test), problems interfering with social activities (p < 0.0001; t-test). No between-group differences were found for demographic variables including age, education, gender, or minority status. Among the 611 subjects who remained cognitively normal across all longitudinal visits, 12 reported a history of new-onset seizures. Ten of these 12 subjects were seizure free as a result of treatment, with only 2 experiencing recent seizures. The incidence of seizures in our population was 300 per 100,000 person years.

MAJOR CONCLUSIONS: This study identified the elderly population with incident epilepsy as a subgroup with an unmet health need, and healthcare professionals should address the potential impact of seizures with their geriatric patients to ensure comprehensive care.

PMID:34883464 | DOI:10.1016/j.yebeh.2021.108457