Category: Statistics

J Appl Clin Med Phys. 2021 Aug 28. doi: 10.1002/acm2.13405. Online ahead of print.

ABSTRACT

PURPOSE: This paper proposes a model for the angular dependency of MatriXX response and investigates whether MatriXX, with the angular-model-based approach can be applied to true composite dose verification for IMRT plans.

METHOD: This model attributes the angular dependence of MatriXX response to dynamical translation of its effective measurement plane (EMP) due to the change of beam angle. Considering this mechanism, true composite dose verifications for IMRT plans specified in AAPM TG 119 report using both MatriXX and Gafchromic EBT3 films were undertook and compared to validate the applicability of MatriXX for patient specific QA of composite beam IMRT plans. Dose verifications using MatriXX with and without angular-model-based approach were performed.

RESULTS: MatriXX with angular-model-based approach achieved gamma passing rates with 3%/3 mm and 3%/2 mm criteria better than 98.3% and 98.1% respectively for true composite dose verification of plans in AAPM TG 119 report. The 3%/3 mm and 3%/2 mm gamma passing rates using MatriXX without angular-model-based approach ranged from 85.8% to 98.2% and from 81.3% to 96.5%, respectively. The p-values from the single sided paired t-test indicated no statistical difference between the passing rates from MatriXX with angular-model-based approach and from films, and significant difference between the passing rates from uncorrected MatriXX and from films.

CONCLUSION: The proposed model for angular dependent MatriXX response is necessary and effective. Dose verification using MatriXX with angular-model-based approach is acceptable for true composite beam IMRT plans with required accuracy to simplify patient specific QA.

PMID:34453876 | DOI:10.1002/acm2.13405

Pediatr Allergy Immunol. 2021 Aug 28. doi: 10.1111/pai.13656. Online ahead of print.

ABSTRACT

BACKGROUND: The Global Asthma Network (GAN), by using the International Study of Asthma and Allergies in Childhood (ISAAC) methodology, has updated trends in prevalence of symptoms of childhood allergic diseases, including non-infective rhinitis and conjunctivitis (“rhinoconjunctivitis”) which is reported here.

METHODS: Prevalence and severity of rhinoconjunctivitis were assessed by questionnaire among schoolchildren in GAN Phase I and ISAAC Phases I and III surveys 15-23 years apart. Absolute rates of change in prevalence were estimated for each centre and modelled by multi-level linear regression to compare trends by age group, time period and per-capita national income.

RESULTS: 27 GAN centres in 14 countries surveyed 74,361 13-14-year-olds (“adolescents”) and 45,434 6-7-year-olds (“children”), with average response proportions of 90% and 79% respectively. Many centres showed highly significant (p<0.001) changes in prevalence of rhinoconjunctivitis in the past year (“current rhinoconjunctivitis”), compared to ISAAC. The direction and magnitude of centre-level trends varied significantly (p<0.001) both within and between countries. Overall, current rhinoconjunctivitis prevalence decreased slightly from ISAAC Phase III to GAN: -1.32% per 10 years, 95%CI [-2.93%, +0.30%] among adolescents; -0.44% [-1.29%, +0.42%] among children. Together, these differed significantly (p<0.001) from the upward trend within ISAAC. Among adolescents, centre-level trends in current rhinoconjunctivitis were highly correlated with those for eczema symptoms (rho=0.72, p<0.0001) but not with centre-level trends in asthma symptoms (rho=0.15, p=0.48). Among children, these correlations were positive but not significant.

CONCLUSION: Symptoms of non-infective rhinoconjunctivitis among schoolchildren may no longer be on the increase globally, although trends vary substantially within and between countries.

PMID:34453861 | DOI:10.1111/pai.13656

Electrophoresis. 2021 Aug 28. doi: 10.1002/elps.202100211. Online ahead of print.

ABSTRACT

Proteomic characterization of alveolar bones in oral surgery represents an analytical challenge due to their insoluble character. The implementation of a straightforward technique could lead to the routine use of proteomics in this field. We have thus developed a simple technique for the characterization of bone tissue for human maxillary and mandibular bones. It is based on the direct in-bone tryptic digestion of proteins in both healthy and pathological human maxillary and mandibular bone samples. The released peptides were then identified by the LC-MS/MS. Using this approach, a total of 1120 proteins were identified in the maxillary bone and 1151 proteins in the mandibular bone. The subsequent partial least squares – discrimination analysis of protein data made it possible to reach 100% discrimination between the samples of healthy alveolar bones and those of the bone tissue surrounding the inflammatory focus. These results indicate that the in-bone protein digestion followed by the LC-MS/MS and subsequent statistical analysis can provide a deeper insight into the field of oral surgery at the molecular level. Furthermore, it could also have a diagnostic potential in the differentiation between the proteomic patterns of healthy and pathological alveolar bone tissue. Data are available via ProteomeXchange with the identifier PXD026775. This article is protected by copyright. All rights reserved.

PMID:34453862 | DOI:10.1002/elps.202100211

Eur Heart J Acute Cardiovasc Care. 2021 Aug 28:zuab072. doi: 10.1093/ehjacc/zuab072. Online ahead of print.

ABSTRACT

Risk stratification dates to the dawn of the cardiac intensive care unit (CICU). As the CICU has evolved from a dedicated unit caring for patients with acute myocardial infarction to a complex healthcare environment encompassing a broad array of acute and chronic cardiovascular pathology, an expanding array of risk scores are available that can be applied to CICU patients. Most of these scores were designed for use either in patients with a specific acute cardiovascular diagnosis or unselected critically ill patients, and risk scores developed in other populations often underperform in the CICU. More recently, risk scores have been developed specific to the CICU population, demonstrating improved performance. All existing risk scores have relevant limitations, both in terms of performance and applicability to patient care. Risk scores have been predominantly developed to predict short-term mortality, either by quantifying severity of illness or by incorporating other risk factors for mortality. It is essential to distinguish mortality risk attributable to severity of illness, which may be modifiable through intervention, from mortality risk attributable to non-modifiable risk factors. This review discusses established risk scores applicable to the CICU population, details how risk score performance is characterized, describes how new risk scores can be developed, explains how the information provided by risk scores can be used in clinical practice, and highlights how novel risk stratification approaches can be developed.

PMID:34453848 | DOI:10.1093/ehjacc/zuab072

Aliment Pharmacol Ther. 2021 Aug 28. doi: 10.1111/apt.16580. Online ahead of print.

ABSTRACT

BACKGROUND: Increase in lipid levels associated with the treatment of inflammatory bowel disease (IBD) has previously been reported. However, it is unknown if this effect is similar for all IBD drug classes.

AIM: To precisely assess the effect of different IBD drug classes on lipid profiles METHODS: We performed a systematic literature search of randomised controlled trials and observational cohort studies that assessed lipid levels before and after induction (≤10 weeks) and maintenance (>10 weeks) of IBD treatment. Data of 11 studies (1663 patients) were pooled using random effects models. The influence of patient and disease characteristics on treatment effects on total cholesterol levels was analysed in 6 studies (1211 patients) for which individual data were available, using linear mixed models.

RESULTS: A statistically significant increase in total cholesterol was observed after induction treatment with corticosteroids (+1.19 mmol/L, 95% confidence interval [CI₉₅ ] +0.52 to +2.59), and tofacitinib (+0.66 mmol/L, CI₉₅ +0.42 to +0.79), but not after anti-TNFα treatment (-0.11 mmol/L, CI₉₅ -0.26 to +0.36 mmol/L). Similar differences were observed after maintenance treatment. Treatment effects were significantly related to age, but not with other factors. Lipid changes were inversely correlated with but not modified by CRP changes.

CONCLUSIONS: Increase in total cholesterol levels was strongest for corticosteroids followed by tofacitinib but was not observed for anti-TNFα agents. Whether total cholesterol change associated with IBD treatment has an effect on cardiovascular risk requires further study.

PMID:34453860 | DOI:10.1111/apt.16580

J Natl Cancer Inst. 2021 Aug 28:djab174. doi: 10.1093/jnci/djab174. Online ahead of print.

ABSTRACT

BACKGROUND: Activity and safety of the SARS-CoV2 BNT162b2 vaccine in actively treated patients with solid tumors is currently unknown.

METHODS: We conducted a retrospective study of 326 patients with solid tumors treated with anti-cancer medications to determine the proportion of cancer patients with immunogenicity against SARS-CoV2, following two doses of the BNT162b2 vaccine. Control group was comprised of 164 vaccinated healthy adults. Anti-SARS-CoV-2 S IgG (Immunoglobulin G) antibodies (Abs) were measured, using level>50 AU/ml as cutoff for seropositivity. Adverse effects were collected using a questionnaire. All statistical tests were 2-sided.

RESULTS: Most patients (205, 62.9%) were treated with chemotherapy, either alone or with additional therapy, 55 (16.9%) were treated with immune checkpoint inhibitors (ICI) and 38 (11.7%) with targeted therapy alone, 28 (8.6%) received other combinations. The vaccine was well tolerated and no severe side effects were reported. Among patients with cancer 39 (11.9%) were seronegative, compared to 5 (3.0%) of the control group (P=0.001). Median IgG titers were statistically significant lower among patients with cancer compared to control (931 AU/ml vs. 2817 AU/ml, P=0.003). Seronegativity proportions were higher in the chemotherapy treated group (19, 18.8%) compared to the ICI-treated patients (5, 9.1%) and to those treated with targeted therapy (1, 2.6%) (P=0.02. Titers were also statistically significant different among treatment types (P=0.002).

CONCLUSION: The BNT162b2 vaccine is safe and effective in actively treated patients with cancer. The relatively lower antibody titers and lower proportion of seropositive patients, especially among chemotherapy treated patients, call for continuing the use of personal protective measures in these patients, even following vaccination.

PMID:34453830 | DOI:10.1093/jnci/djab174

Eur Heart J Acute Cardiovasc Care. 2021 Aug 28:zuab074. doi: 10.1093/ehjacc/zuab074. Online ahead of print.

NO ABSTRACT

PMID:34453838 | DOI:10.1093/ehjacc/zuab074

Egypt J Immunol. 2021 Jul;28(3):138-144.

ABSTRACT

Asthma is a common chronic illness among school children, where different cytokines, including IL-8 play a role in its pathogenesis. IL-8 induces chemotaxis and migration of immune cells, especially neutrophils to the site of inflammation. IL-8 level was significantly increased in sputum of severely asthmatic patients, but can it be linked to some asthma phenotypes. Our aim of the study was to detect the IL 8 gene expression in different asthma phenotypes and to determine its relation to asthma severity. This case control study included 320 subjects (160 asthmatic and 160 matched controls) aged from 5 to 16 years old in Beni-Suef governorate. IL-8 gene expression was assessed by a real-time quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and studied regarding its level in cases versus controls and its relations to severity, phenotype and other laboratory parameters. IL-8 gene expression was statistically higher in asthmatic cases (P<0.001) and was significantly correlated to the phenotype (presence of other allergy as urticaria and drug eruption) and degree of asthma symptoms (r=0.869, P<0.001), FEV1(r=0.757, P<0.001) and serum IgE level (r=0.789, P<0.001). IL-8 gene expression level is increased with the degree of severity in asthmatic children and can be looked for in certain asthma phenotypes especially in presence of other atopic manifestation.

PMID:34453785

Egypt J Immunol. 2021 Jul;28(3):145-156.

ABSTRACT

Human tumors including colorectal cancers (CRC) are often infiltrated by immune cells predominantly T lymphocytes especially regulatory T (Treg) cells expressing the forkhead box protein 3 (Foxp3). It has been suggested that CD25+CD4+Foxp3+ regulatory T cells (Tregs) might hamper effective immunosurveillance of emerging cancer cell. The aim of this study was to measure the frequency of total CD4+CD25+ Tregs & CD4+CD25+Foxp3+ subset of Treg cells in peripheral blood of Egyptian CRC patients and their correlation with the tumor stage, histopathology of the tumor and lymph node affection. A total of 31 CRC patients were enrolled in the study. The tumor was categorized using a TNM staging system. Peripheral blood samples were collected within the first 24 h of surgery. The frequency of total CD4+CD25+ Tregs & CD4+CD25+ Foxp3+ subset of Treg cells in peripheral blood mononuclear cells (PBMCs) were measured by flow cytometry and absolute count was determined. High frequency of Tregs was detected in cancer patients with distal margin involvement (44-48 cells/μL) compared with those with free distal margin (5-32 cells/μL). Similarly, higher frequency of Tregs were detected (16-44 cells/μL) in cancers with lymph node involvement compared with cancers without lymph node involvement (5-32 cells/μL). Higher frequency of CD4+CD25+Foxp3+ Tregs were found in mucinous adenocarcinomas than in other histopathological types, although both observations were statistically insignificant. The median value for total absolute lymphocyte count/ μL was 639, out of which CD4+CD25+ subset constituted 35 cells, and about half of this subset were Foxp3+Tregs. In conclusion, CD4+CD25+Foxp3+ Tregs may be a useful marker for predicting invasion, metastasis, and prognosis of colorectal cancer in Egyptian patients.

PMID:34453786

Medicina (B Aires). 2021;81(4):597-601.

ABSTRACT

Medical attention is not free from committing mistakes that can increase mortality and costs. The International Goals for Patient Safety include correct patient identification. The use of wristbands reduces the number of adverse events. The rate of nonidentified patients at the moment of phlebotomy was investigated retrospectively during 2019. The annual rate of non-identified patients was 9.8% and higher rates were observed from April to September. Monday was the day with the highest rate of non-identified. There was statistically significant relationship between the month rate of non-identified patients and the number of discharges from operative unit per month (r=0.6465; p=0.0237) and the bed turnover rate (r=0.7776; p=0.0029). Other wristband identification errors are unknown. The investigation detected failures in patient identification that allowed to make recommendations. In order to reduce the number of missing wristbands it will be necessary to monitor the indicator, especially during the months with the highest number of discharges and bed turnover rate, to evaluate the adherence of the personnel to the current protocol and to carry out training programs.

PMID:34453802