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Nevin Manimala Statistics

Stalling or oiling the engines of diagnosis? Shifting perspectives on the DSM and categorical diagnosis in psychiatry

Sociol Health Illn. 2023 Jun 17. doi: 10.1111/1467-9566.13682. Online ahead of print.

ABSTRACT

Diagnosis in psychiatry and its precursors has long attracted debate and dissent. Attempts to discipline professional praxis are associated especially with the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM). In this article, I explore how social actors with the institutional power to contribute in important ways to shaping psychiatric contexts construct the problems with and purposes of the DSM and of diagnosis in psychiatry. I suggest that despite common assumptions that influential psychiatrists and related stakeholders uncritically adopt the DSM and other tools of categorical diagnosis, their relationship with these is rather more nuanced, ambivalent, and even fraught. However, I will also show that critiques can themselves be folded into particular styles of psychiatric thought in ways that do little to impact wider concerns about biomedicalisation and pharmaceuticalisation-and might even further accelerate these processes. Moreover, since professional critiques of the DSM often underscore its ubiquity and entrenchment, when positioned against implicit or explicit justifications of the ongoing use of this text they might inadvertently contribute to a ‘discourse of inevitability’-acting to ‘oil’ rather than ‘stall’ what Annemarie Jutel terms the ‘engines of diagnosis’.

PMID:37329240 | DOI:10.1111/1467-9566.13682

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Nevin Manimala Statistics

Effect of PRDX6 gene polymorphism on susceptibility to chronic obstructive pulmonary disease in the Chinese Han population

Clin Respir J. 2023 Jun 17. doi: 10.1111/crj.13648. Online ahead of print.

ABSTRACT

BACKGROUND: To explore the relationship of peroxiredoxin6 (PRDX6) tag-single nucleotide polymorphisms (SNPs) with susceptibility to chronic obstructive pulmonary disease (COPD) in the Chinese Han population.

METHODS: A total of 502 patients with COPD and 481 healthy controls from nine hospitals in China were enrolled in this study. The PRDX6 tag-SNPs were identified by linkage disequilibrium (LD) analysis in 30 healthy controls. The associations between identified tag-SNPs and COPD risk were further evaluated.

RESULTS: Four PRDX6 tag-SNPs, including rs7314, rs34619706, rs33951697, and rs4382766, were identified in 30 healthy controls. Moreover, in the allele model, there was no statistical difference in locus in PRDX6 between patients with COPD and healthy controls (P > 0.05). However, in the recessive model, rs33951697 locus in PRDX6 gene carrier with T/T had an increased risk of COPD (odds ratio [OR] = 2.59, 95% CI = 1.06-6.33, P = 0.028). Furthermore, in the relevance analysis between genetic polymorphisms and smoking behavior and lung function indexes, we found that the number of smoked cigarettes per day and FEV1/FVC differed among different genotypes of PRDX6, rs4382766, and rs7314 (P < 0.05).

CONCLUSION: PRDX6 gene polymorphism with smoking status may contribute to the etiology of COPD in the Chinese Han population.

PMID:37329238 | DOI:10.1111/crj.13648

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Nevin Manimala Statistics

Clinical and metabolomic characterization of Brivanib-Induced hypertension in metastatic colorectal cancer

Cancer Med. 2023 Jun 17. doi: 10.1002/cam4.6248. Online ahead of print.

ABSTRACT

BACKGROUND: Trials of tyrosine kinase inhibitors (TKI) have not demonstrated dramatic benefits in advanced colorectal cancer (CRC), and this may be a function of poor patient selection. TKI-induced hypertension is reportedly a surrogate marker for treatment benefit for some tumor types. Our objective was to determine whether hypertension was associated with benefit in the context of CRC treatment, and also to gain insight on the pathogenesis of TKI-induced hypertension by monitoring associated changes in the circulating metabolome.

PATIENTS AND METHODS: Clinical data were acquired from clinical trial patients with metastatic CRC randomized to cetuximab ± the TKI brivanib (N = 750). Outcomes were evaluated as a function of treatment-induced hypertension. For metabolomic studies, plasma samples were taken at baseline, as well as at 1, 4, and 12 weeks after treatment initiation. Samples were submitted to gas chromatography-mass spectrometry to identify treatment-related metabolomic changes associated with TKI-induced hypertension, compared to pre-treatment baseline. A model based on changes in metabolite concentrations was generated using orthogonal partial least squares discriminant analysis (OPLS-DA).

RESULTS: In the brivanib treated group, 95 patients had treatment-related hypertension within 12 weeks of initiating treatment. TKI-induced hypertension was not associated with a significantly higher response rate, nor was it associated with improved progression-free or overall survival. In metabolomic studies, 386 metabolites were identified. There were 29 metabolites that changed with treatment and distinguished patients with and without TKI-induced hypertension. The OPLS-DA model for brivanib-induced hypertension was significant and robust (R2 Y score = 0.89, Q2 Y score = 0.70, CV-ANOVA = 2.01 e-7). Notable metabolomic features previously reported in pre-eclampsia and associated with vasoconstriction were found.

CONCLUSION: TKI-induced hypertension was not associated with clinical benefit in metastatic CRC. We have identified changes in the metabolome that are associated with the development of worsening brivanib-induced hypertension that may be useful in future efforts of characterizing this toxicity.

PMID:37329221 | DOI:10.1002/cam4.6248

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Nevin Manimala Statistics

Two-Compartment Perfusion MR IVIM Model to Investigate Normal and Pathological Placental Tissue

J Magn Reson Imaging. 2023 Jun 17. doi: 10.1002/jmri.28858. Online ahead of print.

ABSTRACT

BACKGROUND: Perfusion and diffusion coexist in the placenta and can be altered by pathologies. The two-perfusion model, where f1 and, f2 are the perfusion-fraction of the fastest and slowest perfusion compartment, respectively, and D is the diffusion coefficient, may help differentiate between normal and impaired placentas.

PURPOSE: Investigate the potential of the two-perfusion IVIM model in differentiating between normal and abnormal placentas.

STUDY-TYPE: Retrospective, case-control.

POPULATION: 43 normal pregnancy, 9 fetal-growth-restriction (FGR), 6 small-for-gestational-age (SGA), 4 accreta, 1 increta and 2 percreta placentas.

FIELD STRENGTH/SEQUENCE: Diffusion-weighted-echo planar imaging sequence at 1.5 T.

ASSESSMENT: Voxel-wise signal-correction and fitting-controls were used to avoid overfitting obtaining that two-perfusion model fitted the observed data better than the IVIM model (Akaike weight: 0.94). The two-perfusion parametric-maps were quantified from ROIs in the fetal and maternal placenta and in the accretion zone of accreta placentas. The diffusion coefficient D was evaluated using a b ≥ 200 sec/mm2 -mono-exponential decay fit. IVIM metrics were quantified to fix f1 + f2 = fIVIM .

STATISTICAL-TESTS: ANOVA with Dunn-Sidák’s post-hoc correction and Cohen’s d test were used to compare parameters between groups. Spearman’s coefficient was evaluated to study the correlation between variables. A P-value<0.05 indicated a statistically significant difference.

RESULTS: There was a significant difference in f1 between FGR and SGA, and significant differences in f2 and fIVIM between normal and FGR. The percreta + increta group showed the highest f1 values (Cohen’s d = -2.66). The f2 between normal and percreta + increta groups showed Cohen’s d = 1.12. Conversely, fIVIM had a small effective size (Cohen’s d = 0.32). In the accretion zone, a significant correlation was found between f2 and GA (ρ = 0.90) whereas a significant negative correlation was found between fIVIM and D (ρ = -0.37 in fetal and ρ = -0.56 in maternal side) and f2 and D (ρ = -0.38 in fetal and ρ = -0.51 in maternal side) in normal placentas.

CONCLUSION: The two-perfusion model provides complementary information to IVIM parameters that may be useful in identifying placenta impairment.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 1.

PMID:37329218 | DOI:10.1002/jmri.28858

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Nevin Manimala Statistics

The histamine system and cognitive function: An in vivo H3 receptor PET imaging study in healthy volunteers and patients with schizophrenia

J Psychopharmacol. 2023 Jun 16:2698811231177287. doi: 10.1177/02698811231177287. Online ahead of print.

ABSTRACT

BACKGROUND: The histamine-3 receptor (H3R) is an auto- and heteroreceptor that inhibits the release of histamine and other neurotransmitters. Post-mortem evidence has found altered H3R expression in patients with psychotic disorders, which may underlie cognitive impairment associated with schizophrenia (CIAS).

AIMS: We used positron emission tomography (PET) imaging to compare brain uptake of an H3R selective tracer between patients with schizophrenia and matched controls (healthy individuals). Regions of interest included the dorsolateral prefrontal cortex (DLPFC) and striatum. We explored correlations between tracer uptake and symptoms, including cognitive domains.

METHODS: A total of 12 patients and 12 matched controls were recruited to the study and were assessed with psychiatric and cognitive rating scales. They received a PET scan using the H3R-specific radioligand [11C]MK-8278 to determine H3R availability.

RESULTS: There was no statistically significant difference in tracer uptake between patients and controls in the DLPFC (t19 = 0.79, p = 0.44) or striatum (t21 = 1.18, p = 0.25). An exploratory analysis found evidence for lower volume of distribution in the left cuneus (pFWE-corrected = 0.01). DLPFC tracer uptake was strongly correlated with cognition in controls (trail making test (TMT) A: r = 0.77, p = 0.006; TMT B: rho = 0.74, p = 0.01), but not in patients (TMT A: r = -0.18, p = 0.62; TMT B: rho = -0.06, p = 0.81).

CONCLUSIONS: These findings indicate H3R in the DLPFC might play a role in executive function and this is disrupted in schizophrenia in the absence of major alterations in H3R availability as assessed using a selective radiotracer for H3R. This provides further evidence for the role of H3R in CIAS.

PMID:37329185 | DOI:10.1177/02698811231177287

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Nevin Manimala Statistics

Effects of a lymphedema prevention program based on the theory of knowledge-attitude-practice on postoperative breast cancer patients: A randomized clinical trial

Cancer Med. 2023 Jun 17. doi: 10.1002/cam4.6171. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer-related lymphedema (BCRL) is one of the common postoperative complications that severely affects the functions of the arm and quality of life. Since lymphedema is difficult to treat and prone to recurrence, early prevention of lymphedema is crucial.

METHODS: Patient diagnosed with breast cancer (N = 108) were randomized to the intervention (n = 52) or control group (n = 56). In the intervention group, patients were provided the lymphedema prevention program based on the theory of knowledge-attitude-practice during the perioperative period and the first three chemotherapy sessions (mainly includes health education, seminars, knowledge manuals, sports guidance, peer education, and WeChat group).The limb volume, handgrip strength, arm function, and quality of life were measured in all patients at the baseline, 9 weeks (T1), and 18 weeks (T2) after surgery.

RESULTS: The incidence of lymphedema in the Intervention group was numerically lower than in the control group after implementing the lymphedema prevention program, but the difference was not statistically significant (T1: 1.9% vs. 3.8%, p = 1.000; T2: 3.6% vs. 7.1%, p = 0.744). However, compared with the control group, the intervention group showed there was less deterioration in handgrip strength (T1 [t = -2.512, p < 0.05] and T2 [t = -2.538, p < 0.05]), improved postoperative upper limb dysfunction (T1 [t = 3.087, p < 0.05] and T2 [t = 5.399, p < 0.05]) and less deterioration in quality of life (T1 [p < 0.05] and T2 [p < 0.05]).

CONCLUSION: Although the investigated lymphedema prevention program improved arm function and quality of life, it did not reduce the incidence of lymphedema in postoperative breast cancer patients.

PMID:37329176 | DOI:10.1002/cam4.6171

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Nevin Manimala Statistics

14th Annual University of Pennsylvania Conference on statistical issues in clinical trials/subgroup analysis in clinical trials: Opportunities and challenges (morning panel discussion)

Clin Trials. 2023 Jun 16:17407745231175078. doi: 10.1177/17407745231175078. Online ahead of print.

NO ABSTRACT

PMID:37329159 | DOI:10.1177/17407745231175078

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Nevin Manimala Statistics

Rookery through rehabilitation: Microbial community assembly in newborn harbour seals after maternal separation

Environ Microbiol. 2023 Jun 16. doi: 10.1111/1462-2920.16444. Online ahead of print.

ABSTRACT

Microbial community assembly remains largely unexplored in marine mammals, despite its potential importance for conservation and management. Here, neonatal microbiota assembly was studied in harbour seals (Phoca vitulina richardii) at a rehabilitation facility soon after maternal separation, through weaning, to the time of release back to their native environment. We found that the gingival and rectal communities of rehabilitated harbour seals were distinct from the microbiotas of formula and pool water, and became increasingly diverse and dissimilar over time, ultimately resembling the gingival and rectal communities of local wild harbour seals. Harbour seal microbiota assembly was compared to that of human infants, revealing the rapid emergence of host specificity and evidence of phylosymbiosis even though these harbour seals had been raised by humans. Early life prophylactic antibiotics were associated with changes in the composition of the harbour seal gingival and rectal communities and surprisingly, with transient increases in alpha diversity, perhaps because of microbiota sharing during close cohabitation with other harbour seals. Antibiotic-associated effects dissipated over time. These results suggest that while early life maternal contact may provide seeding for microbial assembly, co-housing of conspecifics during rehabilitation may help neonatal mammals achieve a healthy host-specific microbiota with features of resilience.

PMID:37329141 | DOI:10.1111/1462-2920.16444

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Nevin Manimala Statistics

Highly Active Middle School Athletes Demonstrate Poor Motor Skill Proficiency

Sports Health. 2023 Jun 16:19417381231178822. doi: 10.1177/19417381231178822. Online ahead of print.

ABSTRACT

BACKGROUND: Fundamental movement skills (FMS) are critical components to lifelong participation in sports and physical activity. With the rise in early sports specialization, mastery of motor skills may be limited in youth athletes. The purpose of this study was to assess FMS proficiency in highly active middle school athletes and determine whether proficiency differed between specialization levels and sex.

HYPOTHESIS: (1) Most athletes would fail to achieve proficiency in all domains of the Test of Gross Motor Development (TGMD-2), (2) highly specialized athletes would demonstrate lower proficiency in all domains of the TGMD-2, and (3) male athletes would demonstrate higher proficiency than female athletes.

STUDY DESIGN: Cross-sectional.

LEVEL OF EVIDENCE: Level 4.

METHODS: A total of 91 athletes were recruited (44 male, 12.6 ± 0.9 years). Activity level was quantified using the Hospital for Special Surgery (HSS) Pediatric Functional Activity Brief Scale (Pedi-FABS), specialization level was determined using the Jayanthi Specialization Scale, and the TGMD-2 was used to assess FMS proficiency. Descriptive statistics were used to describe gross motor, locomotor, and object control percentile rank. A 1-way analysis of variance (ANOVA) was used to assess differences in percentile rank between low, moderate, and high specialization groups and independent samples t tests were used to compare sexes (α < 0.05).

RESULTS: Mean Pedi-FABS score was 23.6 ± 4.9. In total, 24.2%, 38.5%, and 37.4% of athletes classified as low, moderate, and highly specialized, respectively. Mean percentile ranks were 56.2%, 64.7%, and 62.6% for locomotor, object control, and gross motor domains, respectively. No athlete achieved a percentile rank >99% in any domain of the TGMD-2, and there was no significant difference between specialization groups or sex.

CONCLUSION: Despite high activity levels, no athlete demonstrated proficiency in any domain of the TGMD-2, and there was no difference in proficiency between specialization levels or by sex.

CLINICAL RELEVANCE: Sport participation, regardless of level, does not ensure adequate mastery of FMS.

PMID:37329118 | DOI:10.1177/19417381231178822

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Nevin Manimala Statistics

Drug-Coated Balloon vs. Drug-Eluting Stent in Acute Myocardial Infarction: A Systematic Review and Updated Meta-Analysis

Anatol J Cardiol. 2023 Jun 15. doi: 10.14744/AnatolJCardiol.2023.2953. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to systematically review the evidence of drug-coated balloon used in the treatment of acute myocardial infarction and compared with using drug-eluting stent in terms of clinical and angiographic outcomes for a relatively long follow-up period.

METHODS: Electronic databases including PubMed, Embase, and the Cochrane Library were used to search for the information of each study. A total of 8 studies involving 1310 patients were included in this meta-analysis.

RESULTS: During a median follow-up duration of 12 months (range 3-24 months), there were no statistical differences between the drug-coated balloon and drug-eluting stent group in terms of a major adverse cardiovascular event (odds ratio = 1.07; P =.75; 95% CI: 0.72-1.57), all-cause death (odds ratio = 1.01; P =.98; 95% CI = 0.56-1.82), cardiac death (odds ratio = 0.85, P =.65; 95% CI = 0.42-1.72), target lesion revascularization (odds ratio = 1.72; P =.09; 95% CI: 0.93-3.19), recurrent myocardial infarction (odds ratio = 0.89, P =.76; 95% CI: 0.44-1.83), and thrombotic event (odds ratio = 1.10; P =.90; 95% CI: 0.24-5.02). Drug-coated balloon was not linked with risk of late lumen loss compared with drug-eluting stent (mean difference = -0.06 mm; P =.42; 95% CI: -0.22-0.09 mm). However, there was a higher incidence of target vessel revascularization noted in the drug-coated balloon group compared with the drug-eluting stent group (odds ratio = 1.88; P =.02; 95% CI: 1.10-3.22). The subgroup analysis stratified by different study types and ethnicities showed there were no significant differences between the 2 groups.

CONCLUSIONS: Using drug-coated balloon might serve as a potential alternative strategy for patients with acute myocardial infarction because of the similar clinical and angiographic outcomes compared with using drug-eluting stent; nevertheless, the issue of target vessel revascularization should be more focused on. Larger and more representative studies are needed in the future.

PMID:37329115 | DOI:10.14744/AnatolJCardiol.2023.2953