Nevin Manimala

Mult Scler Relat Disord. 2022 Jan 10;59:103516. doi: 10.1016/j.msard.2022.103516. Online ahead of print.

ABSTRACT

BACKGROUND: In many clinical situations, ordinal scales afford the primary method of semi-quantifying patient outcomes. In the field of multiple sclerosis, the primary ordinal scale is the Expanded Disability Status Scale. Predominant methods of ordinal scale statistical analysis provide a p-value without effect size or rely heavily on the assumption of proportionality of odds, subjecting them to lack of power and error. The Wilcoxon-Manny-Whitney Odds is a statistical method which provides significant information such as p-value, effect size, number needed to treat, confidence intervals, and is largely assumption-free. However, its utility has not been demonstrated in the field of multiple sclerosis.

METHODS: Three clinical studies in the field of multiple sclerosis were selected which utilized ordinal scale outcomes at group or individual levels. Data from these studies was extracted using WebPlotDigitizer, and a custom Wilxocon-Mann-Whitney Odds software was applied to each dataset to re-analyze the main outcomes of the studies.

RESULTS: Re-analysis of the manuscript by Muraro et al., 2017 demonstrated that autologous stem cell transplantation for relapsing remitting multiple sclerosis resulted in a 65% chance of improving from any Expanded Disability Status Scale category, although not significant. Re-analysis of the manuscript by Songthammawat et al., 2019 demonstrated chance of improvement with intravenous methylprednisolone and concurrent plasma exchange was 185% versus 32% in intravenous methylprednisolone with add-on plasma exchange, although not significant. Re-analysis of Kister et al., 2012 demonstrated the chances of mobility or cognition scores generally favored decline at every 5-year increment of study, and although statistically significant, these were smaller effect sizes ranging from an 11% chance of improvement to a 66% chance of decline over a 5-year interval.

DISCUSSION: The Wilcoxon-Mann-Whitney Odds simplifies ordinal data analysis with its robust largely assumption-free nature. In the place of numerous statistical tests, this single test provides effect size estimate, number needed to treat, p-values, and confidence intervals. Importantly, the Wilcoxon-Mann-Whitney Odds effect size calculation is intuitively applicable to both individual and population-levels. Further, the Wilcoxon-Mann-Whitney Odds allows intuitive description of the progression of large cohorts over time, and we were able to clearly convey the odds of mobility and cognitive decline over 30 years in a large multiple sclerosis cohort. Overall, the Wilcoxon-Mann-Whitney Odds is a powerful and robust statistical test with significant promise within the field of multiple sclerosis.

PMID:35123291 | DOI:10.1016/j.msard.2022.103516

Mult Scler Relat Disord. 2022 Jan 8;59:103481. doi: 10.1016/j.msard.2021.103481. Online ahead of print.

ABSTRACT

BACKGROUND: Symptoms of anxiety, depression, and emotion dysregulation are common among individuals with MS and their support partners. Dialectical behavior therapy (DBT) – a type of cognitive behavioral intervention – may be a promising treatment for individuals affected by MS. This pilot randomized controlled trial (RCT) assessed the effects and feasibility of remotely delivered DBT skills on anxiety and depression symptoms and emotion dysregulation in individuals with MS and their support partners.

METHODS: This study featured a single-masked, two-arm, parallel group design. Twenty pairs of individuals with MS and their support partners (n = 40) were randomized to 12 weeks of DBT or facilitated peer support (FPS). Masked assessments were completed at weeks 0 (baseline), 13 (post-intervention), and 26 (follow-up).

RESULTS: At post-intervention (primary endpoint), participants randomized to DBT exhibited significantly greater reductions in anxiety and depression symptoms compared to FPS (B = 4.45, p = .04, Cohen’s d = 0.57). Secondary outcomes of emotion dysregulation and well-being favored the DBT group but did not reach statistical significance (ds = 0.51, ps = 0.07). Effects were not maintained at follow-up. Most (86%) individuals screened were eligible for the trial, and retention (70%) did not differ between study arms.

CONCLUSIONS: This pilot RCT provides encouraging evidence that DBT skills is feasible and may improve depression, anxiety, and emotion dysregulation for individuals with MS and their support partners. Future research is needed to optimize maintenance of DBT skills, investigate mechanisms for these improvements, and replicate these promising effects in a fully powered trial.

PMID:35123290 | DOI:10.1016/j.msard.2021.103481

Child Abuse Negl. 2022 Feb 2;126:105508. doi: 10.1016/j.chiabu.2022.105508. Online ahead of print.

ABSTRACT

BACKGROUND: Childhood maltreatment types can co-occur and are associated with increased substance use during adolescence and early adulthood. There is also a strong genetic basis for substance use which interacts with environmental factors (e.g., childhood maltreatment) to influence substance use phenotype.

OBJECTIVE: This research aimed to identify childhood maltreatment sub-groups based on type and chronicity, and their association with substance use change from adolescence to early adulthood, while accounting for the influence of substance use polygenic risk (i.e., genetic risk based on the combined effects of multiple genes).

PARTICIPANTS: We used a sample of unrelated European-origin Americans with genetic and childhood maltreatment data (n = 2,664) from the National Longitudinal Study of Adolescent to Adult Health.

METHODS: Latent profile analysis was used for sub-group identification and direct and interaction effects were tested for longitudinal trajectories of substance use utilizing generalized estimating equations.

RESULTS: Three sub-groups with co-occurring childhood maltreatment exposures were identified: a high sexual abuse sub-group, a high physical abuse sub-group, and a normative sub-group (with low maltreatment exposure). At high polygenic risk, the high physical abuse sub-group had faster increases in substance use over time. In comparison, the high sexual abuse sub-group had faster progression in substance use only at low and medium polygenic risk.

CONCLUSIONS: Findings provide initial evidence for biological and environmental differences among maltreatment sub-groups on trajectories of substance use.

PMID:35123282 | DOI:10.1016/j.chiabu.2022.105508

J Infect Public Health. 2022 Jan 31;15(3):297-306. doi: 10.1016/j.jiph.2022.01.015. Online ahead of print.

ABSTRACT

BACKGROUND: Understanding the transmissibility and pathogenicity of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is crucial for control policies, but evidence remains limited.

METHODS: We presented a systematic and meta-analytic summary concerning the transmissibility and pathogenicity of COVID-19.

RESULTS: A total of 105 studies were identified, with 35042 infected cases and 897912 close contacts. 48.6% (51/105) of studies on secondary transmissions were from China. We estimated a total SIR of 7.8% (95% confidence interval [CI], 6.8%-8.8%), SAR of 6.6% (95% CI, 5.7%-7.5%), and symptomatic infection ratio of 86.9% (95%CI, 83.9%-89.9%) with a disease series interval of 5.84 (95%CI, 4.92-6.94) days. Household contacts had a higher risk of both symptomatic and asymptomatic infection, and transmission was driven between index cases and second-generation cases, with little transmission occurring in second-to-later-generation cases (SIR, 12.4% vs. 3.6%). The symptomatic infection ratio was not significantly different in terms of infection time, generation, type of contact, and index cases.

CONCLUSIONS: Our results suggest a higher risk of infection among household contacts. Transmissibility decreased with generations during the intervention. Pathogenicity of SARS-CoV-2 varied among territories, but didn’t change over time. Strict isolation and medical observation measures should be implemented.

PMID:35123279 | DOI:10.1016/j.jiph.2022.01.015

Mar Pollut Bull. 2022 Feb 2;175:113351. doi: 10.1016/j.marpolbul.2022.113351. Online ahead of print.

ABSTRACT

Luoyuan Bay is a mariculture influenced water body located in southeastern China. Multi-statistical techniques were applied to 21 sampling locations in the bay to identify the sources of microplastics and other pollutants in the sediment. In microplastics detection, fragment was the most abundant shape (~36%), and rayon was the dominant polymer (~59%). The size of more than 48% of total microplastics observed was less than 200 μm. The study showed that the upper part of Luoyuan Bay was dominated by microplastic pollution, while the lower part of the bay was dominated by persistent organic pollutants (PAHs, OCPs). Mariculture is one of the main sources of pollution in Luoyuan Bay. Apart from mariculture, there were additional sources such as industry, land reclamation, port, and so on; industry and land reclamation were the leading sources of microplastics, while port, industry, and mariculture were the primary sources of PAHs and OCPs.

PMID:35123274 | DOI:10.1016/j.marpolbul.2022.113351

Forensic Sci Int. 2022 Jan 29;332:111196. doi: 10.1016/j.forsciint.2022.111196. Online ahead of print.

ABSTRACT

OBJECTIVES: Due to taphonomic processes such as burial, fire, or animal activity, bones are often found incomplete, which can pose problematic for establishing the biological profile of the deceased using anthropological methods. The aim of this study is to test the feasibility of using statistical shape modeling (SSM) to reconstruct full femora from simulated partial femora and determine the accuracy of the reconstruction. Moreover, we assess the accuracy of sex estimation and the degree of stature error added based on the reconstructed femur using different anthropological methods.

METHODS: A total of 42 (28 female, 14 female) 3D models of left femora extracted from computed tomography (CT) scans were used. We performed a leave-one-out cross-validation (LOOCV) where 41 bones were used to build the SSM and one bone was used for testing. This bone was cut in 1 cm steps proximally, distally and from both ends up to 10 cm, reconstructed using SSM, and tested using the methods established by Stewart and Purkait (2005), Trotter and Gleser (1952), as well as a method based on SSM. with landmarks being automatically identified.

RESULTS: The error induced by reconstructing the femur to the length measurements was low, which translated into useful stature estimations (single sided cuts up to 10 cm: 0.4-1.1%, double sided<2% for cuts shorter than 6 cm). Using Purkaits method for sex estimation on reconstructed bones looked promising as well (single sided: 90.5% when compared to applying Purkaits method on the original bone, double sided 78.6% (10 cm cut) to 97.6% (1-3 cm cuts)) Using SSM for sex classification looked promising as well (single sided cut: 81-85.7%, double sided cut: 59.5-85.3%) CONCLUSION: SSM can be used to reconstruct fragmented femora. These reconstructions can be used for sex and stature estimations, at the cost of lower accuracy. Using SSM might give investigators an additional tool to gain information about the biological profile of a deceased in cases where the fragmentation of a femur does not allow for using other anthropological methods.

PMID:35123259 | DOI:10.1016/j.forsciint.2022.111196

Oral Oncol. 2022 Feb 2;126:105750. doi: 10.1016/j.oraloncology.2022.105750. Online ahead of print.

ABSTRACT

OBJECTIVES: While the NCCN guidelines maintain that T4b oral cavity squamous cell carcinoma (OCSCC) should undergo either non-surgical treatments or clinical trials, promising outcomes of T4b OCSCC having surgical excision have been reported. We analyzed and compared the clinical outcomes of Taiwanese patients with pT4a and pT4b OCSCC who had undergone surgical treatment.

METHODS: From 2011 to 2017, a total of 4031 and 355 patients with first primary pT4a and pT4b OCSCC were identified. A propensity score (PS)-matched analysis of patients (n = 351 each) for pT4a and pT4b tumors was also performed.

RESULTS: The 5-year disease-specific and overall survival (DSS/OS) rates were more favorable in patients with pT4a than in those with pT4b OCSCC (64%/55%, p < 0.0001; 55%/43%, p < 0.0001, respectively). Compared with pT4a, those with pT4b tumors had a higher burden of the following risk factors: buccal/retromolar/hard palate subsite, male sex, depth ≥ 10 mm, and positive margins. Before PS matching, multivariable analyses revealed that pT4b tumors (versus pT4a) were an adverse prognosticator for both 5-year DSS and OS (hazard ratios: 1.32 and 1.39, respectively). However, in the PS-matched cohort, no significant differences in 5-year DSS and OS rates were observed between pT4a and pT4b OCSCC (57%/56%, p = 0.4024; 48%/44%, p = 0.1807, respectively) CONCLUSIONS: No significant outcome differences were evident between pT4b and pT4a OCSCC after PS matching. The most plausible hypothesis for the observed survival difference between T4a and T4b tumors is that it was driven by positive margins. We suggest that T4b OCSCC should undergo initial surgical excision if adequate resection is possible.

PMID:35123256 | DOI:10.1016/j.oraloncology.2022.105750

Epilepsy Behav. 2022 Feb 2;128:108572. doi: 10.1016/j.yebeh.2022.108572. Online ahead of print.

ABSTRACT

AIM: The purpose of this study was to identify the stigma and multidimensional perceived social support levels of patients with epilepsy, as well as the factors affecting them.

METHOD: The sample of the study consisted of 115 patients with epilepsy followed up in a university hospital in eastern Turkey. The data of the study were collected using the descriptive information form, the Jacoby Stigma Scale, and the Multidimensional Scale of Perceived Social Support. Data analysis was performed using t-test, one-way analysis of variance (ANOVA), and Pearson correlation coefficient.

RESULTS: The rate of exposure to stigma of the patients in the study was 62.4%. Those under 30 years of age, single, with low economic status, and living with their parents and siblings had higher stigma scale mean scores than the other groups (p = 0.001, p < 0.001, p = 0.001, p = 0.019, respectively). Multidimensional Scale of Perceived Social Support total scores were higher in women and married people (p = 0.020, p = 0.01, respectively). A statistically significant negative moderate correlation was found between the patients’ Stigma scale mean values and Multidimensional Perceived Social Support Scale mean values (r = -0.568. p < 0.01).

CONCLUSION: According to the study’s findings, stigma is prevalent among patients with epilepsy. Increasing social awareness in order to augment social support in patients with epilepsy and providing the patient with positive coping strategies may be effective in reducing stigma in patients with epilepsy.

PMID:35123241 | DOI:10.1016/j.yebeh.2022.108572

Seizure. 2022 Jan 29;96:46-58. doi: 10.1016/j.seizure.2022.01.014. Online ahead of print.

ABSTRACT

BACKGROUND: Compared to healthy controls, adults with epilepsy have a disrupted sleep architecture. Changes in sleep macrostructure may be associated with the refractoriness of epilepsy. However, there is no consensus regarding the changes in sleep architecture in patients with epilepsy. This meta-analysis aimed to elucidate the differences in sleep architecture between patients with epilepsy and healthy controls.

METHODS: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The PubMed, Embase, and Cochrane Central databases were searched (until May 2021) for studies comparing polysomnographic sleep macrostructures between patients with epilepsy and healthy controls. A meta-analysis was performed using a random-effects model. The percentage of rapid eye movement (REM) sleep, slow-wave sleep (SWS), and sleep efficiency (SE) were compared between patients with epilepsy and healthy controls.

RESULTS: Overall, 24 studies involving 789 patients with epilepsy and 599 healthy controls fulfilled the eligibility criteria. Compared to healthy controls, patients with focal epilepsy had decreased REM sleep and SE. Patients with generalised epilepsy had increased SWS and decreased SE. Subgroup analyses focussed on the potential effect of seizure control on sleep architecture. The results revealed that both antiseizure medication (ASM)-untreated and treated patients had decreased SE. ASM treatment may restore REM sleep in patients with generalised epilepsy but not in patients with focal epilepsy.

CONCLUSIONS: This meta-analysis revealed statistically significant differences in the sleep macrostructure between patients with epilepsy and healthy controls. There were significant differences in the sleep macrostructure between ASM-untreated patients and healthy controls, which may be an intrinsic change attributable to epilepsy.

PMID:35123233 | DOI:10.1016/j.seizure.2022.01.014

Vet Med Sci. 2022 Feb 5. doi: 10.1002/vms3.752. Online ahead of print.

ABSTRACT

OBJECTIVE: Gross, histopathological, and immunohistochemical characteristics of uveal melanocytic neoplasms in dogs and cats were investigated.

SAMPLES: Thirty-two enucleated globes with uveal melanocytic neoplasms, 27 from dogs and 5 from cats, were examined.

PROCEDURES: Morphological characteristics of uveal melanocytic neoplasms in dogs and cats were evaluated with anti-PNL2, anti-Melan-A, anti-Ki-67, anti-caspase-3, and anti-BAP1 immunomarkers. Statistical analysis was performed to compare canine melanocytomas and melanomas.

RESULTS: The 32 uveal neoplasms were classified as melanocytomas (19/27 in dogs) or melanomas (8/27 in dogs, 5/5 in cats). Most tumours (84%) were located in the anterior uvea. Neoplastic cells were classified as epithelioid, spindle-shaped, mixed, or special type (balloon and signet ring cells). The percentage of cells with melanin, melanin concentration within cells, anisocytosis and anisokaryosis, mitotic count, lymphocytic inflammation, necrosis, vascular invasion, and glaucoma were also characterized. Anisocytosis, percentage of neoplastic cells with melanin, mitotic count, and indices (proliferation and apoptotic) varied significantly between canine uveal melanomas and melanocytomas; in general, melanomas had greater cell variability, were less pigmented, and had a higher mitotic count. The melanocytic origin of the neoplasms was confirmed by positive anti-PNL2 immunolabelling (29/32) and positive anti-Melan-A immunolabelling (3/32). In canine uveal melanomas, anisocytosis and anisokaryosis correlated with less pigmentation and minimal pigmentation correlated with a high percentage of immunolabelling for caspase-3.

CONCLUSIONS: Uveal melanocytomas were more common in dogs, and uveal melanomas were more frequent in cats. Anisocytosis, percentage of neoplastic cells with melanin, and mitotic count are important histologic characteristics of malignancy to evaluate in uveal melanocytic neoplasms. The proliferation and apoptotic indices are relevant when comparing malignant tumours with benign tumours.

PMID:35122675 | DOI:10.1002/vms3.752