Category: Statistics

Clin Neurol Neurosurg. 2021 Nov 14;211:107031. doi: 10.1016/j.clineuro.2021.107031. Online ahead of print.

ABSTRACT

BACKGROUND: Brain natriuretic peptide (BNP), often used to evaluate degree of heart failure, has been implicated in fluid dysregulation and inflammation in critically-ill patients. Twenty to 30% of patients with aneurysmal subarachnoid hemorrhage (aSAH) will develop some degree of neurogenic stress cardiomyopathy (NSC) and in turn elevation of BNP levels. We sought to explore the association between BNP levels and development of delayed cerebral ischemia (DCI) in patients with aSAH.

METHODS: We retrospectively evaluated the records of 149 patients admitted to the Neurological Intensive Care Unit between 2006 and 2015 and enrolled in an existing prospectively maintained aSAH database. Demographic data, treatment and outcomes, and BNP levels at admission and throughout the hospital admission were noted.

RESULTS: Of the 149 patients included in the analysis, 79 developed DCI during their hospital course. We found a statistically significant association between DCI and the highest recorded BNP (OR 1.001, 95% CI-1.001-1.002, p = 0.002). The ROC curve analysis for DCI based on BNP showed that the highest BNP level during hospital admission (AUC 0.78) was the strongest predictor of DCI compared to the change in BNP over time (AUC 0.776) or the admission BNP (AUC 0.632).

CONCLUSION: Our study shows that DCI is associated not only with higher baseline BNP values (admission BNP), but also with the highest BNP level attained during the hospital course and the rapidity of change or increase in BNP over time. Prospective studies are needed to evaluate whether routine measurement of BNP may help identify SAH patients at high risk of DCI.

PMID:34837820 | DOI:10.1016/j.clineuro.2021.107031

Accid Anal Prev. 2021 Nov 24;164:106502. doi: 10.1016/j.aap.2021.106502. Online ahead of print.

ABSTRACT

The rear-end crash is one of the most common types of crashes, and key risk factors have been broadly identified in the car-following behaviors preceding a crash. However, the relationships between rear-end crash risk and daily car-following behaviors, or habits, have not been well examined. This study aims to identify the daily car-following behaviors on urban surface roads and urban expressways that have the most influence on rear-end crashes and near-crashes (CNC). Two months of naturalistic driving study data were used to investigate the daily car-following behavior of 54 drivers. A paired t-test and a Wilcoxon matched-pairs signed rank test were conducted to find the differences in behaviors on the two road types, and basic Poisson regression and Poisson hurdle regression models were used to explore significant risk factors. Results revealed that (1) drivers’ longitudinal vehicle control, time control, and emergency behaviors are significantly different on urban surface roads and urban expressways; (2) for surface roads, three key influencing factors were ranked, in descending order, as the standard deviation of relative speed, percentage of time gap less than 1 s, and maximum acceleration; (3) for expressways, four key factors were ranked: minimum time gap, maximum deceleration, percentage of TTC less than 5 s, and the percentage of large positive jerk. The knowledge achieved on risky daily driving behaviors can be applied to training drivers to improve safe practices, assist insurance companies in creating usage-based insurance strategies, and support driver assistant systems design.

PMID:34837850 | DOI:10.1016/j.aap.2021.106502

Complement Ther Clin Pract. 2021 Nov 23;46:101515. doi: 10.1016/j.ctcp.2021.101515. Online ahead of print.

ABSTRACT

OBJECTIVE: A systematic review was conducted to investigate the efficacy of Guilu Erxian Jiao (GEJ) in the treatment of knee osteoarthritis (OA).

METHODS: We searched PubMed, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Chinese Electronic Periodical Services, and ClinicalTrials.gov to identify relevant randomized controlled trials or controlled clinical trials, from the inception of each source to April 20, 2021. Primary outcome included overall efficacy, pain score, and Lequesne index score; secondary outcome included adverse events. Methodological quality was assessed using the Cochrane risk of bias tool (RoB 1.0). The meta-analysis was performed based on a random-effects model due to anticipated clinical heterogeneity. The grading of overall evidence was assessed using the GRADE system. The study protocol was registered on PROSPERO (CRD42021233573).

RESULTS: Eight studies were included. Compared to controls, GEJ exhibited superior overall efficacy for treating OA (risk ratio (RR) = 1.20; 95% confidence interval (CI) = 1.06-1.35). Regarding pain score, there was no statistical difference between GEJ and controls (standardized mean difference (SMD) = 0.27; 95% CI = -0.91 – 1.46). No significant difference was found in Lequesne score between GEJ and controls (MD = -0.25; 95% CI = -0.52 – 0.01). No statistical difference in adverse reactions was observed between GEJ and controls (risk difference (RD) = -0.01; 95% CI = -0.05-0.03).

CONCLUSION: Our findings suggest that GEJ may have positive effects on overall efficacy in treating OA. However, there is insufficient evidence regarding pain score, Lequesne score, and knee joint function score.

PMID:34837805 | DOI:10.1016/j.ctcp.2021.101515

J Stroke Cerebrovasc Dis. 2021 Nov 24;31(2):106225. doi: 10.1016/j.jstrokecerebrovasdis.2021.106225. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Post-stroke depression (PSD) is a common psychiatric complication of stroke and is associated with the subsequent prognosis, yet still lacking of enough attention. PSD is preventable, and psychotherapy is an alternative prophylactic treatment which needs more solid evidences to confirm its efficacy. In this study, group Acceptance and Commitment Therapy (G-ACT) was performed in acute stroke patients to see if it can effectively relieve depressive symptoms and improve neurological function. The efficacy was also evaluated in stroke patients of different severity.

METHODS: One hundred and four hospitalized patients with acute ischemic stroke were enrolled according to the inclusion criteria and exclusion criteria. After baseline evaluation, they were randomly allocated to the intervention (G-ACT) group and the control (usual care) group. Patients in the control group received routine stroke treatment, while those in the intervention group were given additional G-ACT treatment (5 sessions, 45-55 min/session). Both of the two groups were assessed with 24-item Hamilton Depression Scale (HAMD-24), National Institutes of Health Stroke Scale (NIHSS), and Barthel Index (BI) at baseline, 2 weeks, 1 month, and 3 months follow-up. Patients were further divided into the mild stroke group (NIHSS 0-3) and the moderate stroke group (NIHSS 4-9), HAMD scores at different time points were also assessed.

RESULTS: The HAMD score of G-ACT group was significantly lower than that of control group at 1 month (p = 0.018) and 3 months follow-up (p = 0.001). As to the NIHSS score, there was no significant difference between the two groups within the follow-up period (p > 0.05). The BI score of the two groups was statistically different at 2 weeks (p = 0.033) and 1 month (p = 0.019), while no difference was shown at 3 months (p = 0.191). In acute phase, the HAMD score of moderate stroke patients was significantly higher than that of mild ones (p < 0.001). After G-ACT treatment, both mild and moderate stroke patients showed lower HAMD score at 3 months follow-up (p = 0.004; p = 0.033).

CONCLUSIONS: G-ACT seems to be a viable and effective treatment for preventing PSD in the acute phase of stroke, while the efficacy of which on improving neurological deficits needs to be further evaluated.

PMID:34837758 | DOI:10.1016/j.jstrokecerebrovasdis.2021.106225

Eur J Radiol. 2021 Nov 15;145:110041. doi: 10.1016/j.ejrad.2021.110041. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop and validate a deep learning nomogram (DLN) model constructed from non-contrast computed tomography (CT) images for discriminating minimally invasive adenocarcinoma (MIA) from invasive adenocarcinoma (IAC) in patients with subsolid pulmonary nodules (SSPNs).

MATERIALS AND METHODS: In total, 365 consecutive patients who presented with SSPNs and were pathologically diagnosed with MIA or IAC after surgery, were recruited from two medical institutions from 2016 to 2019. Deep learning features were selected from preoperative CT images using convolutional neural network. Deep learning signature (DLS) was developed via the least absolute shrinkage and selection operator (LASSO). New DLN integrating clinical variables, subjective CT findings, and DLS was constructed. The diagnostic efficiency and discriminative capability were analyzed using the receiver operating characteristic method and decision curve analysis (DCA).

RESULTS: In total, 18 deep learning features with non-zero coefficients were enrolled to develop the DLS, which was statistically different between the MIA and IAC groups. Independent predictors of DLS and lobulated sharp were used to build the DLN. The areas under the curves of the DLN were 0.889 (95% confidence interval (CI): 0.824-0.936), 0.915 (95% CI: 0.846-0.959), and 0.914 (95% CI: 0.848-0.958) in the training, internal validation, and external validation cohorts, respectively. After stratification analysis and DCA, the DLN showed potential generalization ability.

CONCLUSION: The DLN incorporating the DLS and subjective CT findings have strong potential to distinguish MIA from IAC in patients with SSPNs, and will facilitate the suitable treatment method selection for the management of SSPNs.

PMID:34837794 | DOI:10.1016/j.ejrad.2021.110041

J Surg Res. 2021 Nov 24;271:41-51. doi: 10.1016/j.jss.2021.10.018. Online ahead of print.

ABSTRACT

BACKGROUND: Less than half of medical school professorships and decanal ranks are held by women. Our study investigates the gender-based geographical distribution and differences in lifetime peer-reviewed publications, H-index, and grant funding by the National Institutes of Health (NIH) of all allopathic medical school deans in the United States (US).

METHODS: A cross-sectional cohort study utilizing data from US allopathic medical school websites, PubMed, and the NIH Research Portfolio Online Reporting Tools regarding lifetime peer-reviewed publications and quantity/monetary sum of NIH grants received by medical school deans. Descriptive statistics, independent sample T-tests, and ANOVA were performed with statistical significance defined as P < 0.05.

RESULTS: Women occupied 33/157 (21.0%) dean positions overall. Compared to women, men possess higher mean number of lifetime peer-reviewed publications (112.0 vs. 55.2, P = 0.001) and H-index (43.2 vs. 25.7, P = 0.001); however, there are no differences in the mean number of NIH grants (27.5 vs. 19.1, P = 0.323) nor mean total NIH funding received ($18,931,336 vs. $14,289,529, P = 0.524). While significant differences in mean H-index between all US regions were found (P = 0.002), no significant differences exist between major US regions regarding the mean lifetime publication count (P = 0.223), NIH grants received (P = 0.200), nor total NIH funding (P = 0.824) received.

CONCLUSION: A significant discrepancy in the gender distribution, lifetime peer-reviewed publications, and H-index of allopathic medical school deans exists across the US, highlighting the need for adequate support for women in academic medicine. Greater implementation of mentorship, increased institutional support, and diversity training can improve the representation of women in medical school decanal positions.

PMID:34837733 | DOI:10.1016/j.jss.2021.10.018

J Appl Clin Med Phys. 2021 Nov 27. doi: 10.1002/acm2.13480. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to investigate the matching error that occurs when the Mobius3D fingerprinting system is applied in conjunction with an Elekta linear accelerator (LINAC) and to offer an acceptable and alternative method for circumventing this problem.

MATERIAL AND METHODS: To avoid the multileaf collimator (MLC) conflicting error in the Mobius3D fingerprinting system, we developed an in-house program to move the MLC in the Digital Imaging and Communications in Medicine (DICOM) radiotherapy (RT)-Plan to pertinent positions, considering the relationship between log data and planned data. The re-delivered log files were calculated in the Mobius3D system, and the results were compared with those of corrected data (i.e., we analyzed a pair of re-collected log data and the previous DICOM RT-Plan data). The results were then evaluated by comparing several items, such as point dose errors, gamma index (GI) passing rates, and MLC root-mean-square (RMS) values.

RESULTS: For the point dose error, the maximum difference found was below 2.0%. In the case of GI analysis of all plans, the maximum difference in the passing rates was below 1.4%. The statistical results obtained using a paired Student’s t-test showed that there were no significant differences within the uncertainty. In the case of the RMS test, the maximum difference found was approximately 0.08 mm.

CONCLUSIONS: Our results showed that all the mismatched log files were sufficiently acceptable within the uncertainty. We conclude that the matching error obtained when applying Mobius3D to an Elekta LINAC may be addressed using a simple modification of the fingerprinting system, and we expect that our study findings will help vendors resolve this issue in the near future.

PMID:34837723 | DOI:10.1002/acm2.13480

Cell J. 2021 Oct;23(5):516-522. doi: 10.22074/cellj.2021.7849. Epub 2021 Oct 30.

ABSTRACT

OBJECTIVE: Trimethylamine-N-Oxide (TMAO) is considered as a risk factor for atherosclerosis which further leads to inflammation during atherosclerosis. The exact mechanism(s) by which TMAO induces the inflammatory reactions remains to be determined. TMAO can cause the endoplasmic reticulum (ER) stress that triggers activation of Toll-Like Receptors (TLRs). In macrophages, this process stimulates the production of proinflammatory cytokines. This study designed to evaluate the expression level of TLR4 in TMAO-treated macrophages.

MATERIALS AND METHODS: In this experimental study, different concentrations of TMAO (37.5, 75, 150, and 300 μM) were exposed to murine macrophage (J774A.1 cell line) for 8, 18, 24, and 48 hours. The cells were also treated with 2.5 mM of 4-phenyl butyric acid as well as 2μg/ml of tunicamycin respectively as negative and positive controls for inducing ER-stress. We measured the viability of treated cells by the MTT test. Besides, the expression levels of TLR4 gene and protein were evaluated using western blotting and reverse transcription- quantitative polymerase chain reaction (RT-qPCR) analysis. One-Way ANOVA was used for statistical analysis.

RESULTS: No cell death was observed in treated cells. The cells treated with 150 and 300 μM doses of TMAO for 24 hours showed a significant elevation in the protein and/or mRNA levels of TLR4 when compared to normal control or tunicamycin-treated cells.

CONCLUSION: Our results may in part elucidate the mechanism by which TMAO induces the macrophage inflammatory reactions in response to the induction of ER stress, similar to what happens during atherosclerosis. It also provides documentation to support the direct contribution of TLR4 in TMAO-induced inflammation.

PMID:34837678 | DOI:10.22074/cellj.2021.7849

Cell J. 2021 Oct;23(5):544-551. doi: 10.22074/cellj.2021.7606. Epub 2021 Oct 30.

ABSTRACT

OBJECTIVE: In cancer treatments, smart gene delivery via nanoparticles (NPs) can be targeted for cancer cells, while concurrently minimizing damage to healthy cells. This study assessed the efficiency of poly lactic-co-glycolic acid (PLGA)-miR 143/206 transfection on apoptosis in mouse leukemia cancer cells (El4) and spermatogonial stem cells (SSCs).

MATERIALS AND METHODS: In this experimental study, neonatal mouse spermatogonia cells and EL4 cancer cell lines were used. MicroRNA-PLGA NPs were prepared, characterized, and targeted with folate. Several doses were evaluated to obtain a suitable miR dose that can induce appropriate apoptosis in EL4 cells, while not harming SSCs. Cells were treated separately at 3 doses of each miR (for miR 143, doses of 25, 50 and 75 nmol and for miR 206, doses of 50, 100 and 150 nmol). The experiments were performed at 24, 48 and 72 hours. Viability and apoptosis were investigated by MTT and Annexin Kits.

RESULTS: Based on MTT assay results, the optimal dose of miR 143 was 75 nmol (59.87 ± 2.85 % SSC and 35.3 ± 0.78 % EL4) (P≤0.05), and for miR 206, the optimal dose was 150 nmol (54.82 ± 6.7 % SSC and 33.92 ± 3.01% EL4) (P≤0.05). The optimal time was 48 hours. At these doses, the survival rate of the EL4 cells was below the half maximal inhibitory concentration (IC₅₀) and SSC survival was above 50%. Annexin V staining also confirmed the selected doses (for miR 143 total apoptosis was 6.62% ± 1.8 SSC and 37.4% ± 4.2 EL4 (P≤0.05), and miR 206 was (10.98% ± 1.5 SSC and 36.4% ± 3.7 EL4, P≤0.05).

CONCLUSION: Using intelligent transfection by NPs, we were able to induce apoptosis on EL4 cells and maintain acceptable SSC survival rates.

PMID:34837682 | DOI:10.22074/cellj.2021.7606

PM R. 2021 Nov 27. doi: 10.1002/pmrj.12741. Online ahead of print.

ABSTRACT

INTRODUCTION: Better tools are needed to predict functional decline and oncologic prognosis in inpatient cancer rehabilitation. The Karnofky Performance Status (KPS) is a widely used scale of functional performance in oncology, although the scale differs from current rehabilitation terminology. Use of the KPS in inpatient rehabilitation may support a shared method of communication between cancer rehabilitation providers and the primary oncology teams.

OBJECTIVE: To establish interrater reliability for translation of the KPS for use in inpatient cancer rehabilitation.

DESIGN: Retrospective interrater reliability review.

SETTING: A large inpatient rehabilitation hospital system.

PARTICIPANTS: Fifty randomized charts were chosen for review from a larger database of all patients admitted to an inpatient cancer rehabilitation program in 2020.

INTERVENTION: Not applicable.

MAIN OUTCOME MEASURES: The KPS scale was translated into common inpatient rehabilitation grading consistent with the Continuity and Assessment Record and Evaluation (CARE) Item Set to support its use in this specialty area. Additionally, a list of best practice guidelines and scoring instructions were created to assist raters in determining appropriate levels within the scale. Members of the inpatient cancer rehabilitation team scored all patients within the larger database (n=424) throughout 2020. A blinded rater completed retrospective chart reviews to score the 50- chart sample. A two-way random effects model was used to calculate an intraclass correlation coefficient (ICC) for the KPS scores at each of three time points (premorbid, admission, and discharge).

RESULTS: The KPS interpretation for rehabilitation proved to be statistically reliable for the 50- chart sample. The premorbid KPS interrater reliability was acceptable (ICC=0.67, 95% CI: 0.40, 0.82), admission KPS reliability was good (ICC=0.88, 95% CI: 0.78, 0.93), and discharge reliability was excellent (ICC= 0.96, 95% CI: 0.91, 0.98).

CONCLUSION: The KPS translation at three time points (pre-morbid, admission and discharge) during the inpatient rehabilitation continuum has acceptable interrater reliability. This article is protected by copyright. All rights reserved.

PMID:34837660 | DOI:10.1002/pmrj.12741