Category: Statistics

Eur Respir J. 2021 May 13:2100944. doi: 10.1183/13993003.00944-2021. Online ahead of print.

NO ABSTRACT

PMID:33986032 | DOI:10.1183/13993003.00944-2021

Int J Spine Surg. 2021 May 13:8064. doi: 10.14444/8064. Online ahead of print.

ABSTRACT

BACKGROUND: Incidental durotomies (IDs) are frequent complications of spinal surgeries which are mostly posterior or lateral. Anterior IDs are rare; however, they may lead to severe complications. We compared the transthecal approach with the conservative approach for primary closure after durotomy in anterior lumbar dural tear to assess the efficacy of these approaches to decrease postsurgical complications and clinical outcomes.

METHODS: A total of 21 patients undergoing L2-S1 laminectomy with anterior ID were randomly divided into a transthecal group (n = 9) and a conservative group (n = 12) based on the surgical dural closure technique. Postoperative pseudomeningocele, wound infection, rootlet herniation, pneumocephalus, cerebrospinal fluid (CSF) leakage, headache, meningitis, in addition to surgery duration and length of hospitalization were examined and compared in both groups.

RESULTS: The frequency of pseudomeningocele and CSF leakage in patients undergoing the transthecal approach was significantly lower than those undergoing the conservative approach (P = .045 and .008, respectively). Furthermore, although the differences in the frequency of meningitis, pneumocephalus, headache, and wound infection were not statistically significant between the 2 groups, the effect sizes of the comparison were obtained as 49.4, 19.8, 7.1, and 2.6, respectively. This indicated that the differences were clinically significant between the 2 groups.

CONCLUSIONS: We found that the transthecal approach was significantly more successful in managing CSF leakage as well as its complications and clinical outcomes. However, further clinical trials with bigger sample sizes are needed to substantiate this claim.

PMID:33985999 | DOI:10.14444/8064

Int J Spine Surg. 2021 May 13:8082. doi: 10.14444/8082. Online ahead of print.

ABSTRACT

BACKGROUND: Accidental dural tears (DTs) are familiar complications of spinal surgery. Their reported incidence varies widely, and several risk factors have been proposed in the literature. The aim of this study was to conduct a systematic review and meta-analysis to determine the rate of DTs and assess their associated risk factors.

METHODS: A systematic literature search was conducted using specific MeSH and Text terms. Only articles with prospective data reporting the incidence and risk factors were selected and reviewed based on specific inclusion and exclusion criteria.

RESULTS: Twenty-three studies were included. The reported incidence rate ranged from 0.4% to 15.8%, giving an overall pooled incidence rate of 5.8% (95% confidence interval [CI] 4.4-7.3). The incidence rate varied in relation to the part of the spine and the type of surgery. Three factors were associated with a high rate of DTs: age (overall mean difference of 3.04, 95% CI 2.49-3.60), revision surgery (overall odds ratio of 2.28, 95% CI 1.84-2.83), and lumbar stenosis (overall odds ratio of 2.03, 95% CI 1.50-2.75). Diabetes was weakly associated with DTs, with an odds ratio of 1.40 (95% CI 1.01-1.93). The overall effects of sex and obesity were not statistically significant.

CONCLUSION: Advancing age, revision surgery, and lumbar stenosis were significantly associated with increased risk of DTs. These factors should be taken into consideration during the consenting process for spinal surgery.

CLINICAL RELEVANCE: Risk of dural tear during spine surgery.

PMID:33986000 | DOI:10.14444/8082

Clin J Am Soc Nephrol. 2021 May 13:CJN.14730920. doi: 10.2215/CJN.14730920. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: In the rare disease primary hyperoxaluria type 1, overproduction of oxalate by the liver causes kidney stones, nephrocalcinosis, kidney failure, and systemic oxalosis. Lumasiran, an RNA interference therapeutic, suppresses glycolate oxidase, reducing hepatic oxalate production. The objective of this first-in-human, randomized, placebo-controlled trial was to evaluate the safety, pharmacokinetic, and pharmacodynamic profiles of lumasiran in healthy participants and patients with primary hyperoxaluria type 1.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This phase 1/2 study was conducted in two parts. In part A, healthy adults randomized 3:1 received a single subcutaneous dose of lumasiran or placebo in ascending dose groups (0.3-6 mg/kg). In part B, patients with primary hyperoxaluria type 1 randomized 3:1 received up to three doses of lumasiran or placebo in cohorts of 1 or 3 mg/kg monthly or 3 mg/kg quarterly. Patients initially assigned to placebo crossed over to lumasiran on day 85. The primary outcome was incidence of adverse events. Secondary outcomes included pharmacokinetic and pharmacodynamic parameters, including measures of oxalate in patients with primary hyperoxaluria type 1. Data were analyzed using descriptive statistics.

RESULTS: Thirty-two healthy participants and 20 adult and pediatric patients with primary hyperoxaluria type 1 were enrolled. Lumasiran had an acceptable safety profile, with no serious adverse events or study discontinuations attributed to treatment. In part A, increases in mean plasma glycolate concentration, a measure of target engagement, were observed in healthy participants. In part B, patients with primary hyperoxaluria type 1 had a mean maximal reduction from baseline of 75% across dosing cohorts in 24-hour urinary oxalate excretion. All patients achieved urinary oxalate levels ≤1.5 times the upper limit of normal.

CONCLUSIONS: Lumasiran had an acceptable safety profile and reduced urinary oxalate excretion in all patients with primary hyperoxaluria type 1 to near-normal levels.

CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: Study of Lumasiran in Healthy Adults and Patients with Primary Hyperoxaluria Type 1, NCT02706886.

PMID:33985991 | DOI:10.2215/CJN.14730920

J Epidemiol Community Health. 2021 May 13:jech-2021-216772. doi: 10.1136/jech-2021-216772. Online ahead of print.

ABSTRACT

INTRODUCTION: Air pollution has been suggested to be associated with depression. However, current evidence is conflicting, and no study has considered different sources of ambient particulate matter with an aerodynamic diameter below 2.5 µm (PM_2.5). We evaluated the associations of long-term exposure to PM_2.5 from road traffic and residential wood combustion with the prevalence of depression in the Helsinki region, Finland.

METHODS: We conducted a cross-sectional analysis based on the Helsinki Capital Region Environmental Health Survey 2015-2016 (N=5895). Modelled long-term outdoor concentrations of PM_2.5 were evaluated using high-resolution emission and dispersion modelling on an urban scale and linked to the home addresses of study participants. The outcome was self-reported doctor-diagnosed or treated depression. We applied logistic regression and calculated the OR for 1 μg/m³ increase in PM_2.5, with 95% CI. Models were adjusted for potential confounders, including traffic noise and urban green space.

RESULTS: Of the participants, 377 reported to have been diagnosed or treated for depression by a doctor. Long-term exposure to PM_2.5 from road traffic (OR=1.23, 95% CI 0.86 to 1.73; n=5895) or residential wood combustion (OR=0.78, 95% CI 0.43 to 1.41; n=5895) was not associated with the prevalence of depression. The estimates for PM_2.5 from road traffic were elevated, but statistically non-significant, for non-smokers (OR=1.38, 95% CI 0.94 to 2.01; n=4716).

CONCLUSIONS: We found no convincing evidence of an effect of long-term exposure to PM_2.5 from road traffic or residential wood combustion on depression.

PMID:33985992 | DOI:10.1136/jech-2021-216772

Clin Chem Lab Med. 2021 May 13. doi: 10.1515/cclm-2020-1877. Online ahead of print.

ABSTRACT

More than 2 million people have died as a result of the COVID-19 outbreak. Angiotensin-converting enzyme 2 (ACE2) is a counter-regulatory enzyme that converts angiotensin-2 to Ang-(1-7) form in the renin-angiotensin system. Several studies have been analyzed the correlation between ACE2 and COVID-19. Indeed, ACE2/Ang (1-7) system protects the lung against acute respiratory distress syndrome by its anti-inflammatory/anti-oxidant function. However, SARS-Cov-2 can use ACE2 for host cell entry. Expression of ACE2 can be altered by several factors, including hypertension, diabetes and obesity, which also could increase the severity of COVID-19 infection. Besides, since androgens increase the expression of ACE-2, males are at higher risks of COVID-19 infection. Although reported statistics showed a significantly different infection risks of COVID-19 between adults and children, the reason behind the different responses is still unclear. This review proposes the effect of ACE polymorphism on the severity of SARS-COV-2 induced pneumonia. The previous meta-analysis regarding the effect of ACE polymorphism on the severity of pneumonia showed that polymorphism only affects the adult’s illness severity and not the children. Two recent meta-analyses examined the effect of ACE polymorphism on the prevalence and mortality rate of COVID-19 and reported contradicting results. Our opinion paper suggests that the effect of ACE polymorphism on the severity of COVID-19 depends on the patients age, same as of the pneumonia.

PMID:33984877 | DOI:10.1515/cclm-2020-1877

Am J Epidemiol. 2021 May 12:kwab140. doi: 10.1093/aje/kwab140. Online ahead of print.

ABSTRACT

Chronic kidney disease in its later stages is associated with increased kidney cancer risk. We investigated whether chronic kidney disease at milder stages is associated with increased risk of kidney cancer, using a retrospective cohort of 9,809,317 adults in Republic of Korea who participated in a nationwide health screening (2009-2016). We examined the impact of estimated glomerular filtration rate (eGFR), dipstick proteinuria, and interactive associations of the two factors on the risk of incident kidney cancer. During a median follow-up of 7.3 years, 10,634 kidney cancers were identified. After adjustment for multiple confounders, participants with reduced eGFR were associated with an increased risk of kidney cancer (adjusted hazard ratio = 1.18, 95% confidence interval: 1.01, 1.39 for eGFR <30; adjusted hazard ratio = 1.22, 95% confidence interval: 1.14, 1.31 for eGFR 30-58), compared to those with eGFR of 60-89mL/min/1.73m2. A dose-response relationship was observed between the severity of proteinuria and incident kidney cancer. Analyses of joint effects of eGFR and dipstick proteinuria showed that with the presence of proteinuria, the kidney cancer incidence was markedly increased along with decreasing eGFR. Reduced eGFR and proteinuria are significantly associated with subsequent risk of kidney cancer, possibly in a synergistic manner.

PMID:33984862 | DOI:10.1093/aje/kwab140

J Reconstr Microsurg. 2021 May 13. doi: 10.1055/s-0041-1726030. Online ahead of print.

ABSTRACT

BACKGROUND: There is a paucity of research investigating the impact of patient comorbidities, such as obesity and smoking, on nerve transfer outcomes. The objective of this retrospective cohort study was to evaluate the impact of body mass index (BMI) and comorbidities on the clinical outcomes of upper extremity nerve transfers.

METHODS: A retrospective cohort study was executed. Patients were eligible for inclusion if they had an upper extremity nerve transfer with a minimum of 12-months follow-up. Data was collected regarding demographics, comorbidities, injury etiology, nerve transfer, as well as preoperative and postoperative clinical assessments. The primary outcome measure was strength of the recipient nerve innervated musculature. Statistical analysis used the Mann-Whitney U test, Wilcoxon signed-rank test, and Spearman’s rho.

RESULTS: Thirty-eight patients undergoing 43 nerve transfers were eligible for inclusion. Patients had a mean age of 48.8 years and a mean BMI of 27.4 kg/m² (range:19.7-39.0). Injuries involved the brachial plexus (32%) or its terminal branches (68%) with the most common etiologies including trauma (50%) and compression (26%). Anterior interosseous nerve to ulnar motor nerve (35%) was the most common transfer performed. With a mean follow-up of 20.1 months, increased BMI (p = 0.036) and smoking (p = 0.021) were associated with worse postoperative strength.

CONCLUSION: This retrospective cohort study demonstrated that increased BMI and smoking may be associated with worse outcomes in upper extremity nerve transfers-review of the literature yields ambiguity in both regards. To facilitate appropriate patient selection and guide expectations regarding prognosis, further experimental and clinical work is warranted.

PMID:33984870 | DOI:10.1055/s-0041-1726030

JMIR Med Inform. 2021 May 12. doi: 10.2196/29242. Online ahead of print.

ABSTRACT

BACKGROUND: Care for children with autism spectrum disorder (ASD) can be challenging for families and medical care systems. This is especially true in Low-and-Middle-Income-countries (LMIC) like Bangladesh. To improve family-practitioner communication and developmental monitoring of children with ASD, [spell out] (mCARE) was developed. Within this study, mCARE was used to track child milestone achievement and family socio-demographic assets to inform mCARE feasibility/scalability and family-asset informed practitioner recommendations.

OBJECTIVE: The objectives of this paper are three-fold. First, document how mCARE can be used to monitor child milestone achievement. Second, demonstrate how advanced machine learning models can inform our understanding of milestone achievement in children with ASD. Third, describe family/child socio-demographic factors that are associated with earlier milestone achievement in children with ASD (across five machine learning models).

METHODS: Using mCARE collected data, this study assessed milestone achievement in 300 children with ASD from Bangladesh. In this study, we used four supervised machine learning (ML) algorithms (Decision Tree, Logistic Regression, k-Nearest Neighbors, Artificial Neural Network) and one unsupervised machine learning (K-means Clustering) to build models of milestone achievement based on family/child socio-demographic details. For analyses, the sample was randomly divided in half to train the ML models and then their accuracy was estimated based on the other half of the sample. Each model was specified for the following milestones: Brushes teeth, Asks to use the toilet, Urinates in the toilet or potty, and Buttons large buttons.

RESULTS: This study aimed to find a suitable machine learning algorithm for milestone prediction/achievement for children with ASD using family/child socio-demographic characteristics. For, Brushes teeth, the three supervised machine learning models met or exceeded an accuracy of 95% with Logistic Regression, KNN, and ANN as the most robust socio-demographic predictors. For Asks to use toilet, 84.00% accuracy was achieved with the KNN and ANN models. For these models, the family socio-demographic predictors of “family expenditure” and “parents’ age” accounted for most of the model variability. The last two parameters, Urinates in toilet or potty and Buttons large buttons had an accuracy of 91.00% and 76.00%, respectively, in ANN. Overall, the ANN had a higher accuracy (Above ~80% on average) among the other algorithms for all the parameters. Across the models and milestones, “family expenditure”, “family size/ type”, “living places” and “parent’s age and occupation” were the most influential family/child socio-demographic factors.

CONCLUSIONS: mCARE was successfully deployed in an LMIC (i.e., Bangladesh), allowing parents and care-practitioners a mechanism to share detailed information on child milestones achievement. Using advanced modeling techniques this study demonstrates how family/child socio-demographic elements can inform child milestone achievement. Specifically, families with fewer socio-demographic resources reported later milestone attainment. Developmental science theories highlight how family/systems can directly influence child development and this study provides a clear link between family resources and child developmental progress. Clinical implications for this work could include supporting the larger family system to improve child milestone achievement.

CLINICALTRIAL: We took the IRB from Marquette University Institutional Review Board on July 9, 2020, with the protocol number HR-1803022959, and titled “MOBILE-BASED CARE FOR CHILDREN WITH AUTISM SPECTRUM DISORDER USING REMOTE EXPERIENCE SAMPLING METHOD (MCARE)” for recruiting a total of 316 subjects, of which we recruited 300. (Details description of participants in Methods section).

PMID:33984830 | DOI:10.2196/29242

Eur Neuropsychopharmacol. 2021 May 10;50:64-74. doi: 10.1016/j.euroneuro.2021.04.007. Online ahead of print.

ABSTRACT

The specific role of white matter (WM) microstructure in parkinsonism among patients with schizophrenia spectrum disorders (SSD) is largely unknown. To determine whether topographical alterations of WM microstructure contribute to parkinsonism in SSD patients, we examined healthy controls (HC, n=16) and SSD patients with and without parkinsonism, as defined by Simpson-Angus Scale total score of ≥4 (SSD-P, n=33) or <4 (SSD-nonP, n=62). We used whole brain tract-based spatial statistics (TBSS), tractometry (along tract statistics using TractSeg) and graph analytics (clustering coefficient (CCO), local betweenness centrality (BC)) to provide a framework of specific WM microstructural changes underlying parkinsonism in SSD. Using these methods, post hoc analyses showed (a) decreased fractional anisotrophy (FA), as measured via tractometry, in the corpus callosum, corticospinal tract and striato-fronto-orbital tract, and (b) increased CCO, as derived by graph analytics, in the left orbitofrontal cortex (OFC) and left superior frontal gyrus (SFG), in SSD-P patients when compared to SSD-nonP patients. Increased CCO in the left OFC and SFG was associated with SAS scores. These findings indicate the prominence of OFC alterations and aberrant connectivity with fronto-parietal regions and striatum in the pathogenesis of parkinsonism in SSD. This study further supports the notion of altered “bottom-up modulation” between basal ganglia and fronto-parietal regions in the pathobiology of parkinsonism, which may reflect an interaction between movement disorder intrinsic to SSD and antipsychotic drug-induced sensorimotor dysfunction.

PMID:33984810 | DOI:10.1016/j.euroneuro.2021.04.007