Category: Statistics

Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2021 Apr 23;42(1):53-66. doi: 10.2478/prilozi-2021-0004.

ABSTRACT

Aims: The aim of this paper is to indicate if carotid stenosis is predictive for the prognosis of coronary artery disease.Method and materials: Our study is a prospective cohort study. 1031 patients with proven coronary artery disease (CAD) were recruited consecutively. Carotid ultrasound was used to assess IMT, plaque, or stenosis. They were followed for 24 months for adverse cardiovascular events. Selected demographic date such as smoking history, dyslipidemia, hypertension, laboratory values, and clinical data (associated diseases and risk) were collected from each patient. Total cardiovascular events and mortality rate were followed up for the study population. The results were collected prospectively and retrospectively. The study was organized as a clinical, cross-sectional study and comparative study.From the data collected with the clinical research, a file was formed in the statistical program with the help of which the data were statistically analyzed.From the methods of descriptive statistics, absolute frequencies, percentages, arithmetic mean, median, measures of variability, minimum, maximum, standard deviation and logistic regression models were used.Result: Of the total number of patients 1026 had arterial hypertension (HTA). Data on hyperlipidemia (HLP) had been reported in 895 patients. 1.023 patients had peripheral artery disease (PAB). 1031 patients were presented with multivessel coronary artery disease (CAD). There were 1,029 patients with diabetes mellitus (DM), while 1,013 patients had coronary artery by-pass (CABG), and 1,012 had stroke (CVI). Elevated systolic blood pressure was reported in 966 patients. 184 patients had elevated triglycerides and 187 had elevated cholesterol. 1,008 patients have had a history of myocardial infarction. Carotid artery stenosis (CAS) has been found in 1,009 patients, increased body mass index (BMI) in 270 patients.1.031 patients were followed for 24 months. Cardiovascular events were reported in 54 patients (or 5.2%). Revascularization was performed in 28 (4.1%) patients, while 12 (1.8%) of patients died. Diabetes mellitus (OR 1.878 95% CI 0.491 7.184) and Carotid stenosis (OR 2.185 95% CI 0.731 6.53) were found to be predictive factors for future cardiovascular events.Conclusion: Due to our results carotid ultrasound may be a useful tool for risk stratification of coronary artery disease pts.

PMID:33894121 | DOI:10.2478/prilozi-2021-0004

J Magn Reson Imaging. 2021 Apr 24. doi: 10.1002/jmri.27659. Online ahead of print.

ABSTRACT

BACKGROUND: Recent studies suggest that macromolecular fraction (MMF) derived from three-dimensional ultrashort echo time magnetization transfer (UTE-MT) imaging is insensitive to the magic angle effect. However, its clinical use in osteoarthritis (OA) remains to be investigated.

PURPOSE: To investigate the feasibility of 3D UTE-MT-derived MMF in differentiating normal from degenerated cartilage.

STUDY TYPE: Prospective.

SUBJECTS: Sixty-two participants (54.8 ± 16.7 years, 30 females) with and without OA, plus two healthy volunteers (mean age 35.0 years) for reproducibility test.

FIELD STRENGTH/SEQUENCE: 3 T/UTE-MT sequence.

ASSESSMENT: A 3D UTE-MT sequence was employed to calculate MMF based on a two-pool model. Kellgren-Lawrence (KL) grade and Whole-Organ Magnetic Resonance Imaging Score (WORMS) were evaluated by three experienced musculoskeletal radiologists. KL grade was condensed into three groups: KL0, KL1-2, and KL3-4. WORMS was regrouped based on extent of lesion (extent group) and depth of lesion (depth group), respectively. The performance of MMF at evaluating the degeneration of cartilage was assessed via Spearman’s correlation coefficient and the area under the curve (AUC) calculated according to the receiver-operating characteristic curve.

STATISTICAL TESTS: After normality check, one-way analysis of variance was used to evaluate the performance. Tukey-Kramer test was performed for post hoc testing.

RESULTS: MMF showed significant negative correlations with KL grade (r = -0.53, P < 0.05) and WORMS (r = -0.49, P < 0.05). Significantly lower MMFs were found in subjects with greater KL grade (11.8 ± 0.8% for KL0; 10.9 ± 0.9% for KL1-2; 10.6 ± 1.1% for KL3-4; P < 0.05) and in cartilage with greater extent (12.1 ± 1.6% for normal cartilage; 10.9 ± 1.6% for regional lesions; 9.6 ± 1.7% for diffuse lesions; P < 0.05) and depth (12.1 ± 1.6% for normal cartilage; 10.6 ± 1.6% for partial-thickness lesions; 8.8 ± 1.7% for full-thickness lesions; P < 0.05) of lesions. AUC values of MMF for doubtful-minimal OA (KL1-2) and mild cartilage degradation (WORMS1-2) were 0.8 and 0.7, respectively.

DATA CONCLUSION: This study highlights the clinical potential of MMF in the detection of early OA.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 2.

PMID:33894091 | DOI:10.1002/jmri.27659

J Magn Reson Imaging. 2021 Apr 24. doi: 10.1002/jmri.27654. Online ahead of print.

ABSTRACT

BACKGROUND: Current registration methods for diffusion-MRI (dMRI) data mostly focus on white matter (WM) areas. Recently, dMRI has been employed for the characterization of gray matter (GM) microstructure, emphasizing the need for registration methods that consider all tissue types.

PURPOSE: To develop a dMRI registration method based on GM, WM, and cerebrospinal fluid (CSF) tissue probability maps (TPMs).

STUDY TYPE: Retrospective longitudinal study.

POPULATION: Thirty-two healthy participants were scanned twice (legacy data), divided into a training-set (n = 16) and a test-set (n = 16), and 35 randomly-selected participants from the Human Connectome Project.

FIELD STRENGTH/SEQUENCE: 3.0T, diffusion-weighted spin-echo echo-planar sequence; T1-weighted spoiled gradient-recalled echo (SPGR) sequence.

ASSESSMENT: A joint segmentation-registration approach was implemented: Diffusion tensor imaging (DTI) maps were classified into TPMs using machine-learning approaches. The resulting GM, WM, and CSF probability maps were employed as features for image alignment. Validation was performed on the test dataset and the HCP dataset. Registration performance was compared with current mainstream registration tools.

STATISTICAL TESTS: Classifiers used for segmentation were evaluated using leave-one-out cross-validation and scored using Dice-index. Registration success was evaluated by voxel-wise variance, normalized cross-correlation of registered DTI maps, intra- and inter-subject similarity of the registered TPMs, and region-based intra-subject similarity using an anatomical atlas. One-way ANOVAs were performed to compare between our method and other registration tools.

RESULTS: The proposed method outperformed mainstream registration tools as indicated by lower voxel-wise variance of registered DTI maps (SD decrease of 10%) and higher similarity between registered TPMs within and across participants, for all tissue types (Dice increase of 0.1-0.2; P < 0.05).

DATA CONCLUSION: A joint segmentation-registration approach based on diffusion-driven TPMs provides a more accurate registration of dMRI data, outperforming other registration tools. Our method offers a “translation” of diffusion data into structural information in the form of TPMs, allowing to directly align diffusion and structural images.

LEVEL OF EVIDENCE: 1 Technical Efficacy Stage: 1.

PMID:33894095 | DOI:10.1002/jmri.27654

J Cosmet Dermatol. 2021 Apr 24. doi: 10.1111/jocd.14171. Online ahead of print.

ABSTRACT

BACKGROUND: Oxidative stress parameters have been reported to be significantly higher than controls in diverse disorders of pigmentation but no such data seems to be extant for IGH.

OBJECTIVES: To verify if heightened oxidative stress levels are seen in patients with IGH (compared with matched controls), and quantify the same in blood using appropriate bio-chemical markers. Further, to attempt determining if there might be any correlation between the amount of oxidative stress and the severity of the disease.

METHODOLOGY: This prospective case-control study was conducted in Northern India. Thirty Indian patients (Fitzpatrick skin phototype (SPT) IV-V) were included. The diagnosis of IGH lesions was confirmed based on characteristic clinical, and dermoscopic characteristics, and confirmed on histopathological examination (H & E) of one of the lesions.

RESULTS: The oxidative stress enzyme level were significantly higher among the cases compared to controls which were statistically significant (P < 0.05). A positive correlation was also observed between the levels of these markers and number of lesions; but this finding was statistically not significant [p>0.05] Assessment of melanin level by Dopa staining method in the IGH lesions revealed irregularly distributed melanin with areas of high and low melanin content and greater accumulation in the basement layer.

CONCLUSION: The results of this probably the first study evaluating oxidative stress in IGH show that the oxidative stress is increased in patients with IGH. Level of oxidative stress seems to be correlates with both age of the patient (more in the elderly) and number of lesions.

PMID:33894101 | DOI:10.1111/jocd.14171

J Magn Reson Imaging. 2021 Apr 24. doi: 10.1002/jmri.27655. Online ahead of print.

ABSTRACT

BACKGROUND: There is increasing interest in noncontrast-enhanced MRI due to safety concerns for gadolinium contrast agents.

PURPOSE: To investigate the clinical feasibility of MR-based conductivity imaging for breast cancer detection and lesion differentiation.

STUDY TYPE: Prospective.

SUBJECTS: One hundred and ten women, with 112 known cancers and 17 benign lesions (biopsy-proven), scheduled for preoperative MRI.

FIELD STRENGTH/SEQUENCE: Non-fat-suppressed T2-weighted turbo spin-echo sequence (T2WI), dynamic contrast-enhanced MRI and diffusion-weighted imaging (DWI) at 3T.

ASSESSMENT: Cancer detectability on each imaging modality was qualitatively evaluated on a per-breast basis: the conductivity maps derived from T2WI were independently reviewed by three radiologists (R1-R3). T2WI, DWI, and pre-operative digital mammography were independently reviewed by three other radiologists (R4-R6). Conductivity and apparent diffusion coefficient (ADC) measurements (mean, minimum, and maximum) were performed for 112 cancers and 17 benign lesions independently by two radiologists (R1 and R2). Tumor size was measured from surgical specimens.

STATISTICAL TESTS: Cancer detection rates were compared using generalized estimating equations. Multivariable logistic regression analysis was performed to identify factors associated with cancer detectability. Discriminating ability of conductivity and ADC was evaluated by using the areas under the receiver operating characteristic curve (AUC).

RESULTS: Conductivity imaging showed lower cancer detection rates (20%-32%) compared to T2WI (62%-71%), DWI (85%-90%), and mammography (79%-88%) (all P < 0.05). Fatty breast on MRI (odds ratio = 11.8, P < 0.05) and invasive tumor size (odds ratio = 1.7, P < 0.05) were associated with cancer detectability of conductivity imaging. The maximum conductivity showed comparable ability to the mean ADC in discriminating between cancers and benign lesions (AUC = 0.67 [95% CI: 0.59, 0.75] vs. 0.84 [0.76, 0.90], P = 0.06 (R1); 0.65 [0.56, 0.73] vs. 0.82 [0.74, 0.88], P = 0.07 (R2)).

DATA CONCLUSION: Although conductivity imaging showed suboptimal performance in breast cancer detection, the quantitative measurement of conductivity showed the potential for lesion differentiation.

EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 2.

PMID:33894088 | DOI:10.1002/jmri.27655

Pediatr Allergy Immunol. 2021 Apr 24. doi: 10.1111/pai.13526. Online ahead of print.

ABSTRACT

BACKGROUND: Exposure to indoor moisture damage and visible mould has been found to be associated with asthma and respiratory symptoms in several questionnaire-based studies by self-report. We aimed to define the prospective association between the early life exposure to residential moisture damage or mould and fractional exhaled nitric oxide (FeNO) and lung function parameters as objective markers for airway inflammation and asthma in 6-year old children.

METHODS: Home inspections were performed in children’s homes when infants were on average 5 months old. At age 6 years, data on FeNO (n=322) as well as lung function (n=216) measurements were collected. Logistic regression and generalized additive models were used for statistical analyses.

RESULTS: Early age major moisture damage and moisture damage or mould in the child’s main living areas was significantly associated with increased FeNO levels (>75th percentile) at the age of 6 years (adjusted Odds Ratios, 95% Confidence Intervals, aOR (95%CI): 3.10 (1.35-7.07)) and 3.16 (1.43-6.98), respectively). Effects were more pronounced in those who did not change residential address throughout the study period. For lung function, major structural damage within the whole home was associated with reduced FEV1 and FVC, but not with FEV1/FVC. No association with lung function was observed with early moisture damage or mould in the child’s main living areas.

CONCLUSION: These results underline the importance of prevention and remediation efforts of moisture and mould damaged buildings in order to avoid harmful effects within the vulnerable phase of the infants and children’s immunological development.

PMID:33894090 | DOI:10.1111/pai.13526

Health Soc Care Community. 2021 Apr 24. doi: 10.1111/hsc.13398. Online ahead of print.

ABSTRACT

Falls impose substantial health and economic burdens on older adults. Over half of falls in older adults occur at home, with many involving bathroom areas. Limited information is available on the presence of bathroom modifications for those who experience them. Therefore, we examined factors associated with bathroom modifications among older adults with at least one fall in the United States. We analysed the nationally representative 2016 Medicare Current Beneficiary Survey Public Use File of Medicare beneficiaries aged ≥65 years with ≥1 fall (n = 2,404). A survey-weighted logistic model was used to examine associations between bathroom modifications and factors including socio-demographic characteristics, health-related conditions, and fear of falling. Among Medicare beneficiaries with ≥1 fall, 55.5% had bathroom modifications and 50.1% had repeated falls (≥2 falls). Approximately 40.2% of those with repeated falls had no bathroom modifications. In the adjusted model, non-Hispanic Blacks (odds ratio [OR] = 0.38; p < 0.001) and Hispanics (OR = 0.64; p = 0.039) had lower odds of having bathroom modifications than non-Hispanic Whites. Fear of falling and activities of daily living limitations had incremental impacts on having bathroom modifications. This study highlights the need to improve disparities in bathroom modifications for non-Hispanic Black and Hispanic Medicare beneficiaries, including those with repeated falls. With the aging population and growing number of older minorities in the United States, reducing these disparities is vital for fall prevention efforts and aging-in-place.

PMID:33894087 | DOI:10.1111/hsc.13398

J Dermatol. 2021 Apr 24. doi: 10.1111/1346-8138.15908. Online ahead of print.

ABSTRACT

Dermoscopy is an efficient and non-invasive technique which has been widely used in the diagnosis of nail disorders including nail psoriasis (NP). Many nail dermoscopic features are considered as clues to NP. The aim of this study was to investigate specific dermoscopic features of fingernail psoriasis and the correlation between the severity of nail lesions or systemic inflammation, and psoriasis severity of skin and nail. This observational study recruited 135 patients with fingernail psoriasis (1186 fingernails) and 30 patients with onychomycosis (80 fingernails). All of the involved fingernails were examined with a handheld dermatoscope. The Nail Psoriasis Severity Index score (NAPSI) score, Psoriasis Area and Severity Index (PASI) score, body surface area (BSA), and detailed history of patients with psoriasis were recorded. Mann-Whitney U-test, χ² -test, Spearman’s correlation, and Kruskal-Wallis H-test were used for statistical analysis, and the significance threshold was p < 0.05. The trial registration number was 2020-SR-045. We identified onycholysis as the most common feature (93.3%) of fingernail psoriasis. Red lunula, longitudinal fissures, transverse grooves, nail plate crumbling, trachyonychia, oil-dropping sign, erythematous border of an onycholytic area, subungual hyperkeratosis, and dilated streaky capillaries were relevant to NP severity (p < 0.05). Red lunula, transverse grooves, nail plate crumbling, trachyonychia, oil-dropping sign, erythematous border of an onycholytic area, splinter hemorrhages, and dilated streaky capillaries were relevant to systemic inflammation severity (p < 0.05). The total NAPSI score was positively associated with the PASI score and BSA (p < 0.0001). The thumb had a higher NAPSI score than the other fingers (p < 0.05). In conclusion, dermoscopic features can improve the accuracy of diagnosis of nail psoriasis, and have correlations with psoriasis severity.

PMID:33894071 | DOI:10.1111/1346-8138.15908

Health Soc Care Community. 2021 Apr 24. doi: 10.1111/hsc.13402. Online ahead of print.

ABSTRACT

Distress secondary to the COVID-19 pandemic has been substantial, especially in vulnerable Latinx communities who are carrying an undue share of the pandemic-related social, health and economic burden in the United States. In collaboration with 43 community health workers (CHWs) and Promotor/as serving the needs of underserved Latinx communities in South Texas and guided by principles of community-based participatory research (CBPR), the purpose of this study was to identify relevant mental health stressors and related consequences, and to identify strategies for coping with distress among underserved Latinx communities during the COVID-19 pandemic. Data were collected on July 2020 using mixed methods to obtain more in-depth information. Surveys were administered, and three focus groups were conducted. Quantitative data were analysed using descriptive statistics, whereas qualitative data were analysed systematically by starting with a priori questions and themes followed by data categorisation, reduction, display and conclusion drawing. Results showed six themes related to mental health stressors including economics (e.g., job insecurity), immigration (e.g., undocumented status), misinformation, family stress (e.g., changes in family dynamics and the home environment), health (e.g., limited healthcare access) and social isolation. Coping skills of the community were categorised into four themes with multiple codes including behavioural strategies (e.g., identifying reliable information), cognitive strategies (e.g., collectivistic thinking), social support and spirituality. Findings indicate that underserved Latinx communities are dealing with substantial distress and mental health concerns secondary to the COVID-19 pandemic; yet these are resilient communities. Implications of these findings can inform development of resources, interventions, best practices and training avenues to address the mental health needs of underserved Latinx communities, while considering relevant cultural and contextual factors that may influence their effectiveness.

PMID:33894080 | DOI:10.1111/hsc.13402

J Viral Hepat. 2021 Apr 24. doi: 10.1111/jvh.13519. Online ahead of print.

ABSTRACT

Some studies have exposed an increase in liver cirrhosis in hepatitis E seropositive individuals living with human immunodeficiency virus. The interrelation between HEV seroprevalence and risk of liver disease in immune-competent individuals remains under-investigated. Using the National Health and Nutrition Examination Survey (NHANES) data containing >30.000 subjects we addressed if HEV exposure leads to subclinical effects that can influence liver health. We determined the association between HEV IgM and ALT and that of HEV IgG and Fib-4 – a composite score reflecting potential liver fibrosis. These analyses were repeated in populations at risk for liver disease as well as among different races and ethnicities. The prevalence of HEV IgG was significantly associated with age as IgG positive individuals were, on average, 20 years older than IgG negative patients. We found a statistically significant increase in the likelihood of having a Fib-4 score >1.45 (significant fibrosis) in those positive for HEV IgG (RR: 1.03; 95% CI: 1.01 – 1.05). However, due to the small effect, it is unlikely that this association has clinical significance. Moreover, the effect was not present in those with pre-existing liver disease. We found no association between ALT levels and the presence of HEV IgM or IgG.This is the first study examining subclinical effects of HEV infection in the United States. Our study found that in the general U.S. population, predominantly asymptomatic HEV infections do not contribute to the overall burden of liver disease.

PMID:33894038 | DOI:10.1111/jvh.13519