Category: Statistics

JAMA Netw Open. 2023 Oct 2;6(10):e2336767. doi: 10.1001/jamanetworkopen.2023.36767.

ABSTRACT

IMPORTANCE: Although early outpatient follow-up after psychiatric inpatient discharge may prevent suicide, the association between early follow-up care and a reduced risk of suicide after discharge has not been fully explored.

OBJECTIVES: To investigate outpatient follow-up care after psychiatric inpatient discharge and determine whether the timing of the first outpatient follow-up is associated with a reduced risk of suicide.

DESIGN, SETTING, AND PARTICIPANTS: This population-based, retrospective cohort study used the National Health Claim Database from 2017 to 2018 in Korea. Patients were observed until December 31, 2021, to confirm the occurrence of suicide. The study population included all patients aged 18 years or older who were newly admitted to hospitals with psychiatric illness except for dementia from January 1, 2017, to December 31, 2018. Statistical analysis was performed from January to May 2023.

EXPOSURE: The timing of the first mental health outpatient care follow-up within 30 days after discharge.

MAIN OUTCOMES AND MEASURES: The outcome of interest was suicide after hospital discharge. The timing of the first follow-up visit was observed within 30 days after discharge. The Cox proportional hazard model was used to explore the association between the risk of suicide and the timing of outpatient follow-up.

RESULTS: Of the 76 462 patients admitted to hospitals from 2017 to 2018, 225 (52.6%) were male; 21 313 (27.9%) had a primary diagnosis of substance use disorder, 17 608 (23.0%) had schizophrenia, and 15 018 (19.6) had depression; mean (SD) age was 46.4 (16.3) years. A total of 49 319 patients (64.5%) received follow-up outpatient care within 30 days of discharge. The mean (SD) follow-up period was 30.8 (20.2) months, and 1536 patients died of suicide during the study period. The hazard ratio for suicide risk in patients who received outpatient care within 7 days compared with those who did not receive any care within 30 days after discharge was 0.82 (95% CI, 0.80-0.83). The earlier the time of outpatient follow-up care, the lower the risk of suicide for those with substance use disorder, schizophrenia, bipolar disorder, and depression.

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with psychiatric illness, early follow-up outpatient care after discharge was associated with a lower risk of suicide. These results suggest that those at high risk of suicide during hospitalization need intensive follow-up immediately after discharge.

PMID:37812420 | DOI:10.1001/jamanetworkopen.2023.36767

JAMA Netw Open. 2023 Oct 2;6(10):e2337020. doi: 10.1001/jamanetworkopen.2023.37020.

ABSTRACT

IMPORTANCE: Immune-mediated inflammatory diseases (IMIDs) and COVID-19 are independently associated with venous thromboembolisms (VTEs).

OBJECTIVE: To determine if individuals with IMIDs are at higher risk of VTE following COVID-19 infection compared with individuals without IMIDs.

DESIGN, SETTING, AND PARTICIPANTS: Population-based matched cohort study using multiple deterministically linked health administrative databases from Ontario, Canada, and including patients testing positive for COVID-19 between January 1, 2020, and December 30, 2021, and followed up until March 31, 2022. Individuals with IMIDs (n = 28 440) who tested positive for COVID-19 were matched with up to 5 individuals without an IMID (n = 126 437) who tested positive for COVID-19. Matching was based on year of birth, sex, neighborhood income, and rural/urban residence. Data analysis was performed from August 6, 2022, to August 21, 2023.

EXPOSURE: Diagnosis of an IMID, identified using algorithms based on diagnostic codes, procedures, and specialist visits.

MAIN OUTCOME AND MEASURE: The main outcome was estimated age- and sex-standardized incidence of VTE. Proportional cause-specific hazard models compared the risk of VTE in people with and without IMIDs. Death was a competing risk. Models adjusted for history of VTE, 2 or more doses of a COVID-19 vaccine 14 or more days prior to COVID-19 diagnosis, and the Charlson Comorbidity Index. Routinely collected health data were used, so the hypothesis tested was formulated after data collection but prior to being granted access to data.

RESULTS: The study included 28 440 individuals (16 741 [58.9%] female; 11 699 [41.1%] male) with an IMID diagnosed prior to first COVID-19 diagnosis, with a mean (SD) age of 52.1 (18.8) years at COVID-19 diagnosis. These individuals were matched to 126 437 controls without IMIDs. The incidence of VTE within 6 months of COVID-19 diagnosis among 28 440 individuals with an IMID was 2.64 (95% CI, 2.23-3.10) per 100 000 person-days compared with 2.18 (95% CI, 1.99-2.38) per 100 000 person-days among 126 437 matched individuals without IMIDs. The VTE risk was not statistically significantly different among those with vs without IMIDs (adjusted hazard ratio, 1.12; 95% CI, 0.95-1.32).

CONCLUSIONS AND RELEVANCE: In this retrospective population-based cohort study of individuals with IMIDs following COVID-19, individuals with IMIDs did not have a higher risk of VTE compared with individuals without an IMID. These data provide reassurance to clinicians caring for individuals with IMIDs and COVID-19.

PMID:37812417 | DOI:10.1001/jamanetworkopen.2023.37020

Int Urol Nephrol. 2023 Oct 9. doi: 10.1007/s11255-023-03816-6. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the effects of smoking on semen parameters and spontaneous pregnancy development by comparing smoker and non-smoker varicocelectomy patients.

METHODS: This study included 63 male patients with primary infertility for at least one year, and underwent microscopic subinguinal varicocelectomy at the Erzurum City Hospital urology clinic between 2020 and 2023. Patient files were retrospectively evaluated, and 27 patients were assigned to smoker group, whereas 36 patients were assigned to non-smoker group. Demographic data, semen parameters, spontaneous pregnancy development and timing were compared between two groups.

RESULTS: No statistically significant differences were observed in age, partner’s age, BMI, clinical presentation, varicocele grade, side of varicocele, testicular volume, or testicular vein diameters (p > 0.05). The mean age of the study group was determined to be 30.7 ± 4.9 years. In the non-smoker group, 27 patients (75%) had only subfertility complaints, while 9 patients (25%) also experienced scrotal pain. Progressive motility was significantly higher in the non-smoker group at the 3rd month (28.11 ± 5.78 vs. 24.51 ± 4.24, p < 0.05) and 6th month (29.61 ± 5.16 vs. 26.22 ± 4.14, p < 0.05) evaluations. When comparing the rates of pregnancy development, the non-smoker group was determined to have a higher rate (53%), but this comparison was not statistically significant. (p < 0.05) Regarding the timing of pregnancy, the non-smoker group was associated with earlier spontaneous pregnancy. (5.84 ± 2.26 vs. 9.20 ± 2.30, p < 0.05).

CONCLUSION: Smoking negatively affects the outcomes of varicocelectomy in terms of semen parameters, spontaneous pregnancy development and timing. Prospective, randomized, and larger sample-sized studies are required on this subject.

TRIAL REGISTRATION: This study was approved by the Ataturk University Local Ethics Committee (approval number: B.30.2.ATA.0.01.00/234).

PMID:37812377 | DOI:10.1007/s11255-023-03816-6

Breast Cancer Res Treat. 2023 Oct 9. doi: 10.1007/s10549-023-07129-1. Online ahead of print.

ABSTRACT

PURPOSE: Evidence supporting the use of neoadjuvant chemotherapy (NAC) in early breast cancer is based on studies mainly including women, whereas the utilization and effectiveness of NAC in men is less studied. The present study aimed to investigate the utilization and effectiveness of NAC in men and women with early breast cancer.

METHODS: Eligible patients were identified through the Swedish National Breast Cancer Quality Register, that includes all newly diagnosed breast cancer cases in Sweden from 2008 and onwards. For the treatment utilization analysis, all patients with stage I-III between 2008 and 2020 were included (n = 82,888), whereas for the effectiveness analysis the cohort was restricted to patients receiving NAC (n = 6487). For both analyses, multivariate logistic regression models were applied to investigate potential sex disparities in NAC utilization and effectiveness, adjusted for patient- and tumor characteristics.

RESULTS: In the NAC utilization analysis, 487 men and 82,401 women with stage I-III were included. No statistically significant difference between sexes in terms of NAC utilization was observed (adjusted Odds Ratio (adjOR): 1.135; 95% Confidence Interval (CI) 0.606-2.128) with an overall utilization rate of 4.9% in men compared to 7.8% in women. Among the 24 men and 6463 women who received NAC, the pathologic complete response (pCR) rates were 16.7% and 21.2%, respectively (adjOR: 1.141; 95% CI 0.141-9.238).

CONCLUSION: The present study did not find any sex disparities in NAC utilization or effectiveness in terms of pCR. This supports the current recommendations of treating men with breast cancer with the same indications for NAC as women.

PMID:37812362 | DOI:10.1007/s10549-023-07129-1

J Genet Eng Biotechnol. 2023 Oct 9;21(1):96. doi: 10.1186/s43141-023-00546-1.

ABSTRACT

BACKGROUND: Indonesian local rabbit (Oryctolagus cuniculus) is a local breed in Indonesia. We reveal the mitochondrial genome sequence of the Indonesian local Rabbit for the first time. A better understanding of the mechanisms underlying these beneficial aspects of local breeds over imported ones requires detailed genetic investigations, of which mtDNA genome sequencing is of particular importance. Such an investigation will solve the major issues of misidentification with Javanese hares (Lepus nigricollis) and maternal lineage. In addition, this information will guide better statistics on the Indonesian local rabbit breed population and strategies for its conservation and breeding plans. This study aimed to identify and explore the characteristics of the mtDNA genomes of Indonesian local rabbits.

RESULT: This study observed that the length of the mtDNA genome is 17,469 bp, consisting of two ribosomal RNA (12S rRNA, 16S rRNA), 22 transfer RNA genes (trnR, trnG, trnK, trnD, trnS, trnY, trnC, trnN, trnA, trnW, trnM, trnQ, trnl, trnL, trnV, trnF, trnP, trnT, trnE, trnL, trnS, trnH), 13 protein-coding genes (PCGs) (ND4l, ND3, COX3, ATP6, ATP8, COX2, COX1, ND2, ND1, CYTB, ND6, ND5, ND4), a replication origin, and a noncoding control region (D-loop).

CONCLUSIONS: mtDNA genome of Indonesian local rabbit was the longest and had the most extended D-loop sequence among the other references of Oryctolagus cuniculus. Other specific differences were also found in the percentage of nucleotides and variation in most of the PCGs when they were aligned with Oryctolagus cuniculus references from GenBank. Indonesian local Rabbits strongly suspected brought from Europe during the colonial period in Indonesia.

PMID:37812313 | DOI:10.1186/s43141-023-00546-1

Radiol Phys Technol. 2023 Oct 9. doi: 10.1007/s12194-023-00741-2. Online ahead of print.

ABSTRACT

This study aimed to evaluate the detection accuracy of the AlignRT-InBore system in surface-guided radiation therapy using a phantom and to determine the feasibility of the system by conducting a comparative analysis with cone-beam computed tomography (CBCT) registration. The AlignRT-InBore system integrated with the ETHOS Therapy was used. A phantom and a QUASAR phantom were employed to examine the specific areas of interest relevant to clinical cases. The evaluation involved monitoring translations for approximately 30 min and assessing the position detection accuracy for static and moving objects. Fifty clinical cases were used to evaluate the position detection accuracy and its relationship with the localization accuracy of CBCT before treatment. The detection accuracy of static and moving objects was within 1.0 mm using the phantom. However, the longitudinal direction tended to be larger than the other directions. Regarding the accuracy of localization in clinical cases, a strong and statistically significant (p < 0.01) correlation was observed in each direction. A detection accuracy within 1.0 mm is possible for static and moving objects. The detection accuracy of the patient setup using the InBore optical patient positioning system was extremely high, and the patient could be detected with high precision, suggesting its usefulness.

PMID:37812309 | DOI:10.1007/s12194-023-00741-2

Intern Emerg Med. 2023 Oct 9. doi: 10.1007/s11739-023-03435-0. Online ahead of print.

ABSTRACT

Mild traumatic brain injury (mTBI) is a common cause of admission to the Emergency Department (ED). Many patients are elderly on oral anticoagulant therapy (OAT) at increased risk of immediate and delayed intracranial hemorrhage (ICH). To investigate the frequency of delayed ICH (DICH) in old patients with mTBI in OAT and the occurrence of complications related to the ED stay. In this single-center retrospective study, we recruited all patients in OAT aged 65 and over, admitted for mTBI to the ED of our Hospital in Florence from March 2019 to February 2021. Clinical variables were collected and cranial computed tomography (CT) scans reviewed. The primary outcome was the frequency of DICH occurring within 30 days since the trauma after a first negative CT. Secondary outcomes included need of neurosurgical intervention and death for DICH, and hospital-related complications. Statistical analyses were conducted using IBM SPSS Statistics (version 22). Among 363 enrolled patients, there were 31 acute ICH (8.5%) at the first CT scan, while in the 316 negative included patients, 10 DICH (3.2%) were identified. Among the latter, no neurosurgical treatment, or death due to ICH occurred. Overall, 25 cases (6.9%) had iatrogenic complications during the 24-h observation period, often serious, such as respiratory failure after sedation due to restlessness, or COVID-19 infection. The low frequency of DICH and the occurrence of several iatrogenic complications suggest that the risk-benefit ratio of a 24-h ED observation is not advantageous in elderly with mTBI.

PMID:37812308 | DOI:10.1007/s11739-023-03435-0

Ophthalmol Ther. 2023 Oct 9. doi: 10.1007/s40123-023-00814-w. Online ahead of print.

ABSTRACT

INTRODUCTION: During phacoemulsification, the infusion pressure can cause the liquefied vitreous fluid to escape through the ciliary fiber interspace in highly myopic eyes, leading to reduced vitreous cavity pressure similar to vitrectomized eyes. This study assessed the probability of low intraocular pressure (IOP) in high myopic eyes with different axial length (AL) group undergoing cataract surgery, as well as the impact of balanced salt solution (BSS) supplementation and the optimal IOP value for such supplementation.

METHODS: The control group consisted of cataract eyes with normal AL (group 1: 22 mm ≤ AL < 24.5 mm), while cataract eyes with high axial myopia were categorized into three groups (group 2: 26 mm ≤ AL < 28 mm, group 3: 28 mm ≤ AL < 30 mm, group 4: AL ≥ 30 mm). IOP was measured using the iCare pro tonometer intraoperatively. BSS supplementation was performed to raise IOP in cases of low IOP, before intraocular lens (IOL) implantation and before the end of surgery. The probability of low IOP was calculated, and the IOP before and after supplementation were compared.

RESULTS: Ninety-five eyes were included. The total probability of low IOP in groups 2, 3, and 4 was 56.52, 62.50, and 70.83%, respectively, significantly higher than that in group 1 (16.67%). Similarly, the probability of low IOP before IOL implantation was significantly higher in groups 2, 3, 4 (43.48, 41.67, and 62.50%) compared to group 1 (4.17%, P < 0.05). The IOP before and after the first BSS supplementation in three high myopia groups were statistically significant (P < 0.05), increasing from 12.10 mmHg (range, 6.0-24.9 mmHg) to 16.60 mmHg (range, 10.2-34.4 mmHg). After the second BSS supplementation before the end of surgery, the IOP of high myopia groups increased from 12.60 mmHg (range, 7.0-25.3 mmHg) to 14.60 mmHg (range, 9.8-25.3 mmHg).

CONCLUSIONS: The condition of highly myopic eyes seems more likely to develop low IOP during cataract surgery. There is an observed correlation: as AL increases, the total probability of low IOP rises. In patients with IOP < 9.5 mmHg intraoperatively, fluid supplementation via a side-port incision can effectively raise IOP to about 16 mmHg before IOL implantation and about 14 mmHg after incision sealing, facilitating smoother IOL implantation and reducing the risk of postoperative low IOP.

TRIAL REGISTRATION: NCT, NCT05201677. Registered 23 November 2021-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05201677 .

PMID:37812307 | DOI:10.1007/s40123-023-00814-w

Eur Radiol. 2023 Oct 9. doi: 10.1007/s00330-023-10254-6. Online ahead of print.

ABSTRACT

OBJECTIVES: To develop a multitask deep learning (DL) algorithm to automatically classify mammography imaging findings and predict the existence of extensive intraductal component (EIC) in invasive breast cancer.

METHODS: Mammograms with invasive breast cancers from 2010 to 2019 were downloaded for two radiologists performing image segmentation and imaging findings annotation. Images were randomly split into training, validation, and test datasets. A multitask approach was performed on the EfficientNet-B0 neural network mainly to predict EIC and classify imaging findings. Three more models were trained for comparison, including a single-task model (predicting EIC), a two-task model (predicting EIC and cell receptor status), and a three-task model (combining the abovementioned tasks). Additionally, these models were trained in a subgroup of invasive ductal carcinoma. The DeLong test was used to examine the difference in model performance.

RESULTS: This study enrolled 1459 breast cancers on 3076 images. The EIC-positive rate was 29.0%. The three-task model was the best DL model with an area under the curve (AUC) of EIC prediction of 0.758 and 0.775 at the image and breast (patient) levels, respectively. Mass was the most accurately classified imaging finding (AUC = 0.915), followed by calcifications and mass with calcifications (AUC = 0.878 and 0.824, respectively). Cell receptor status prediction was less accurate (AUC = 0.625-0.653). The multitask approach improves the model training compared to the single-task model, but without significant effects.

CONCLUSIONS: A mammography-based multitask DL model can perform simultaneous imaging finding classification and EIC prediction.

CLINICAL RELEVANCE STATEMENT: The study results demonstrated the potential of deep learning to extract more information from mammography for clinical decision-making.

KEY POINTS: • Extensive intraductal component (EIC) is an independent risk factor of local tumor recurrence after breast-conserving surgery. • A mammography-based deep learning model was trained to predict extensive intraductal component close to radiologists’ reading. • The developed multitask deep learning model could perform simultaneous imaging finding classification and extensive intraductal component prediction.

PMID:37812297 | DOI:10.1007/s00330-023-10254-6

Biochem Genet. 2023 Oct 9. doi: 10.1007/s10528-023-10507-5. Online ahead of print.

ABSTRACT

Breast cancer (BC) is the most abundant and aggressive cancer that impacts millions of women with poorly understood mechanisms. Here, we aimed to investigate the function of LINC01806 in BC development. Human BC tissues and nearby normal specimens were taken from diagnosed BC patients. The expression levels of LINC01806, miR-1286, ZEB1, and EMT-related markers were evaluated by qRT-PCR and western blotting. FISH was used to visualize the subcellular localization of LINC01806. The viability, proliferation, migration and invasion capacities of BC cells were assessed by MTT, colony formation, and transwell assays. Interactions among LINC01806, miR-1286 and ZEB1 were validated by dual luciferase assay. The unpaired Student t-test (for two groups) or one-way ANOVA following with Tukey post-hoc test (for more than three groups) was employed for statistical analysis. LINC01806 level was elevated in BC tissues. Knockdown of LINC01806 suppressed EMT process and BC cell proliferation, migration, and invasion. LINC01806 co-localized and directly bound with miR-1286 in the cytoplasm. MiR-1286 inhibitor blocked the effects of LINC01806 knockdown on BC cell EMT, proliferation and migration. MiR-1286 targeted ZEB1 and overexpression of ZEB1 blocked the regulatory functions of miR-1286 mimics in BC. LINC01806 facilitates EMT and accelerates BC cell proliferation, migration, and invasion via acting as miR-1286 sponge to disinhibit ZEB1 expression.

PMID:37812283 | DOI:10.1007/s10528-023-10507-5