Tag: statistics

EJNMMI Res. 2023 Jan 23;13(1):5. doi: 10.1186/s13550-023-00953-y.

ABSTRACT

BACKGROUND: To quantify the relationship between [18F]FDG uptake of the primary tumour measured by PET-imaging with immunohistochemical (IHC) expression of ER, PR, HER2, Ki-67, and clinical subtypes based on these markers in breast cancer patients.

METHODS: PubMed and Embase were searched for studies that compared SUV_max between breast cancer patients negative and positive for IHC expression of ER, PR, HER2, Ki-67, and clinical subtypes based on these markers. Two reviewers independently screened the studies and extracted the data. Standardized mean differences (SMD) and 95% confidence intervals (CIs) were estimated by using DerSimonian-Laird random-effects models. P values less than or equal to 5% indicated statistically significant results.

RESULTS: Fifty studies were included in the final analysis. SUV_max is significantly higher in ER-negative (31 studies, SMD 0.66, 0.56-0.77, P < 0.0001), PR-negative (30 studies, SMD 0.56; 0.40-0.71, P < 0.0001), HER2-positive (32 studies, SMD – 0.29, – 0.49 to – 0.10, P = 0.0043) or Ki-67-positive (19 studies, SMD – 0.77; – 0.93 to – 0.61, P < 0.0001) primary tumours compared to their counterparts. The majority of clinical subtypes were either luminal A (LA), luminal B (LB), HER2-positive or triple negative breast cancer (TNBC). LA is associated with significantly lower SUV_max compared to LB (11 studies, SMD – 0.49, – 0.68 to – 0.31, P = 0.0001), HER2-positive (15 studies, SMD – 0.91, – 1.21 to – 0.61, P < 0.0001) and TNBC (17 studies, SMD – 1.21, – 1.57 to – 0.85, P < 0.0001); and LB showed significantly lower uptake compared to TNBC (10 studies, SMD – 0.77, – 1.05 to – 0.49, P = 0.0002). Differences in SUV_max between LB and HER2-positive (9 studies, SMD – 0.32, – 0.88 to 0.24, P = 0.2244), and HER2-positive and TNBC (17 studies, SMD – 0.29, – 0.61 to 0.02, P = 0.0667) are not significant.

CONCLUSION: Primary tumour SUV_max is significantly higher in ER-negative, PR-negative, HER2-positive and Ki-67-positive breast cancer patients. Luminal tumours have the lowest and TNBC tumours the highest SUV_max. HER2 overexpression has an intermediate effect.

PMID:36689007 | DOI:10.1186/s13550-023-00953-y

Int J Gynaecol Obstet. 2023 Jan 23. doi: 10.1002/ijgo.14690. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the effect of the long-acting gonadotropin-releasing hormone agonist (GnRHa) long protocol on in vitro fertilization (IVF) outcomes of patients with endometriosis (EMs).

METHODS: This retrospective cohort study was carried out from July 1st 2016 to June 30th 2021. 798 patients with EMs who underwent first IVF were enrolled. The patients were classified by the ovarian stimulation protocols. The clinical outcomes of IVF were compared in each group.

RESULTS: These EMs patients who received the long-acting GnRHa long protocol had significantly higher clinical pregnancy rate (72.00%, 60.70% and 50.90%, respectively; P=0.047 and 0.010) and implantation rate (51.0%, 44.6%, and 38.7%, respectively; P=0.006 and <0.001) compared with short-acting GnRHa long protocol and GnRH antagonist protocol. Live birth rate was also significantly higher than GnRH antagonist protocol (60.10% and 40.0% P=0.032), but not statistically difference compared with short-acting GnRHa (60.10% and 53.80%, P=0.443). In addition, they also had significantly higher duration of stimulation, total dose of gonadotrophin (Gn) and the number of high quality embryo transferred than other groups (P<0.001).

CONCLUSIONS: Long-acting GnRHa long protocol could improve IVF outcomes of patients with EMs compared with short-acting GnRHa long protocol and GnRH antagonist protocol.

PMID:36688363 | DOI:10.1002/ijgo.14690

Health Promot Pract. 2023 Jan 23:15248399221151175. doi: 10.1177/15248399221151175. Online ahead of print.

ABSTRACT

Our Grassroots Maternal and Child Health (MCH) Initiative works to build the capacity of individuals and organizations in zip codes with persistently high infant mortality rates to bring about systems change that will improve maternal and child health (MCH) outcomes. Foundational to the Initiative is the training and mentoring of local women to become Grassroots MCH Leaders. We greatly honor that these women possess community expertise, essential to the Initiative’s success. Our training equips them with strategies they can use to bring about changes in social, economic, political, and/or cultural systems that underlie poor birth outcomes. One impactful strategy they learn is the use of critical narrative intervention (CNI). This approach, grounded in the crafting and sharing of stories, complements statistical, behavioral, and medical approaches to improve MCH outcomes. This article describes the impact of CNI within the Grassroots MCH Initiative. Drawing from 14 Grassroots MCH Leaders’ narratives, we present five significant maternal traumas and influential supports in their surrounding contexts. We explore the leaders’ reflections on the impact of story development and dissemination. Our findings reveal that situating CNI within the context of a grassroots initiative provides opportunities for leaders to use their stories to advocate for systems change. Personal MCH narratives provide a powerful and respectful approach to public health promotion, as they highlight important systems-level failures that need to be addressed to sustainability improve MCH outcomes.

PMID:36688357 | DOI:10.1177/15248399221151175

J Am Heart Assoc. 2023 Jan 23:e028222. doi: 10.1161/JAHA.122.028222. Online ahead of print.

ABSTRACT

Background Stroke incidence, care, and survival show continuous improvements in Sweden, including no or decreasing disparities between men and women. In this study, we aimed to estimate and compare the risk of stroke recurrence in men and women over time, accounting for the competing risk of death. Methods and Results We included adult patients with first-time stroke (ischemic or intracerebral hemorrhage) registered in Riksstroke (the Swedish Stroke Register), 2012 to 2020, and followed until December 2020. Stroke recurrences included new events registered in Riksstroke from 28 days after stroke. To account for the competing risk of death, we used the cumulative incidence function to estimate crude incidences, and multivariable Cox regression to estimate cause-specific hazard ratios (HRs) adjusting for differences in patients’ risk factor profiles. The study included 72 148 (53.5%) men and 62 689 (46.5%) women. We observed 10 925 stroke recurrences and 81 811 deaths following the initial 28 days after the first stroke. The cumulative incidence of stroke recurrence was 3.7% (95% CI, 3.6-3.8) after 1 year, 7.0 (95% CI, 6.8-7.1) after 3 years, and 9.1% (95% CI, 8.9-9.3) after 5 years. The incidence decreased substantially during the study period (HR, 2019-2020 versus 2012, 0.824 [95% CI, 0.759-0.894]). Overall, men had a lower risk of stroke recurrence. After adjustments for differences in patient characteristics, men had a slightly higher risk of recurrence (of any type) after an ischemic stroke (HR, 1.090 [95% CI, 1.045-1.138]) and a lower risk after hemorrhagic stroke (HR, 0.880 [95% CI, 0.781-0.991]) compared with women. Conclusions The risk of stroke recurrence has decreased in both men and women. Women’s higher age and other differences in risk factors partly explain their higher risk of stroke recurrence compared with men.

PMID:36688356 | DOI:10.1161/JAHA.122.028222

Expert Rev Gastroenterol Hepatol. 2023 Jan 23:1-9. doi: 10.1080/17474124.2023.2165489. Online ahead of print.

ABSTRACT

BACKGROUND: NASH-related liver transplants are increasing because of the obesity epidemic, but the influence of T2DM on various levels of BMI among NASH recipients is unclear.

RESEARCH DESIGN AND METHODS: We analyzed data retrieved from SRTR on 4,515 patients. We divided patients by BMI into five groups: normal weight; overweight; class 1 obesity; class 2 obesity; and class 3 obesity. Statistical analysis was done.

RESULTS: Patients in the NASH group with T2DM had a lower patient and graft survival than patients without T2DM (5-year patient and graft survival: 77.5% vs. 79.8%; P = 0.001 and 76.4% vs. 78.2%; P = 0.002, respectively). Multivariate Cox proportional regression showed an independent association between T2DM and decreased patient and graft survival (HR, 1.170; P = 0.015 and HR, 1.133; P = 0.048, respectively). In the lean and the class 3 obesity NASH groups, patients with T2DM had lower patient and graft survival than the patients without T2DM. In the class 3 obesity NASH group, T2DM was independently associated with decreased patient survival (HR, 1.581; P = 0.027).

CONCLUSION: Our research reveals that the focus of the post-transplantation treatment should be different for different BMI patients.

PMID:36688344 | DOI:10.1080/17474124.2023.2165489

J Environ Sci Health B. 2023 Jan 23:1-7. doi: 10.1080/03601234.2023.2169099. Online ahead of print.

ABSTRACT

Endosulfan, an organochlorine pesticide, has been understudied in the literature on thyroid cancer. The aim of this ecological study was to assess the correlation between endosulfan exposure and thyroid cancer incidence rates (IRs) in the United States (US). Age-adjusted thyroid cancer IRs per 100,000 people per state for the years 1999 to 2019 were obtained from the Center for Disease Control and Prevention (CDC). To assess the state-level use of endosulfan, data were obtained from the US Geological Survey (USGS). Endosulfan usage estimates (kilograms/acres cropland; quintiles) and thyroid cancer IRs were mapped together. The correlation between age-adjusted thyroid cancer IRs and statewide endosulfan use was calculated using the Spearman correlation. Overall endosulfan usage in the US trended downwards between 1992 and 2007 (T = -0.77; P < 0.001), while thyroid cancer IR trended upwards between 1999 and 2019 (T = 0.69; P < 0.001). There was a statistically significant correlation between 1992 endosulfan use and 2012 (r = 0.32; P = 0.03) and 2014 (r = 0.32; P = 0.03) thyroid cancer IRs. Although restrictions on endosulfan use seem effective, the potential impact of endosulfan exposure remains due to the persistent, semi-volatile, bioaccumulative, and biomagnifying properties of endosulfan metabolites in particular, indicating the need for future thyroid research of highly exposed populations.

PMID:36688310 | DOI:10.1080/03601234.2023.2169099

Integr Environ Assess Manag. 2023 Jan 23. doi: 10.1002/ieam.4744. Online ahead of print.

ABSTRACT

The necessary normalization of contaminant concentrations, in order to be able to compare contaminant content in sediments with different sediment properties, is currently not standardized within environmental monitoring and assessment programs. Therefore, this study investigates an alternative normalization strategy for hydrophobic organic contaminants (HOCs) by removing the coarse and chemically inert sediment fraction using an improved, half automated wet-sieving method. We compare the results to commonly used TOC normalization (2.5 % TOC, OSPAR). Simultaneously, the study provides a comprehensive overview of HOC concentrations in sediment fines (< 63 µm) for the German Exclusive Economic Zone and therefore gathers information about the more bioavailable and mobile part of the sediment that particularly accumulates HOCs due to its high surface area. We analyzed bulk sediment samples and their corresponding fine grain fractions from 25 stations in the German EEZ for 41 HOCs including PAHs, PCBs, and organochlorine pesticides. The results indicate that the wet-sieving procedure is capable of physically normalizing the concentrations of the investigated HOCs and is useful for the comparison of concentrations in different sediment types. The wet-sieving procedure is more time consuming than the normalization to the TOC content. However, it offers the possibility of lowering the detection limits (LOD) through the analytical sample preparation procedure used, as sieving concentrates the contaminants. Therefore, a higher number of results > LOD were detected in sediment fines leading to more informative data sets. In contrast to the commonly used normalization to 2.5 % TOC, the statistical analyses carried out (principal component analysis with subsequent cluster analysis) additionally indicate that physical normalization allows a better differentiation of sampling sites by contaminant sources and geographic location rather than their sediment characteristics. This article is protected by copyright. All rights reserved. Integr Environ Assess Manag 2023;00:0-0. © 2023 SETAC.

PMID:36688303 | DOI:10.1002/ieam.4744

Ann Pharmacother. 2023 Jan 23:10600280221149409. doi: 10.1177/10600280221149409. Online ahead of print.

ABSTRACT

BACKGROUND: Recent evidence suggests tenecteplase at an intravenous dose of 0.25 mg/kg is as safe and efficacious as intravenous alteplase standard dose and demonstrates a more favorable pharmacokinetic profile for treatment of acute ischemic stroke.

OBJECTIVE: The purpose was to compare the safety and efficacy of alteplase versus tenecteplase for the treatment of acute ischemic stroke at a large community hospital health system following conversion in the preferred formulary thrombolytic.

METHODS: Prior to converting, medication safety and operationalization analyses were conducted. A multicenter, retrospective medical record review was performed for patients who received alteplase 6 months prior to formulary thrombolytic conversion and for tenecteplase 6 months post-conversion for the treatment of acute ischemic stroke. Primary outcomes included the rate of symptomatic intracranial and extracranial hemorrhage complications. Secondary outcomes included door-to-needle time, reduction in National Institute Health Stroke Scale at 24 hours and at discharge, order-to-administration time, and thrombolytic errors. The rates of hemorrhage were compared using binomial regression.

RESULTS: Of the 287 patients reviewed, 115 received alteplase and 172 received tenecteplase. Symptomatic intracranial hemorrhagic complications occurred in 1 patient (1%) who received alteplase compared with 3 patients (2%) who received tenecteplase (P = 0.9). There was no statistical difference in rates of symptomatic intracranial or extracranial hemorrhagic complications.

CONCLUSION AND RELEVANCE: Conversion from alteplase to tenecteplase can be safely and effectively achieved at a large community hospital health system with differing levels of stroke certification. There were also additional cost savings and practical advantages including workflow benefits.

PMID:36688289 | DOI:10.1177/10600280221149409

Laryngoscope. 2023 Jan 23. doi: 10.1002/lary.30581. Online ahead of print.

ABSTRACT

OBJECTIVE: The treatment of nasal foreign bodies involves safe and reliable removal. Few reports have investigated the relationship between equipment and the incidence of complications.

METHODS: This retrospective study included 300 patients with nasal foreign bodies (average: 3.28 years, interquartile range: 2-4 years). Patients’ background, characteristics of nasal foreign body, equipment to remove the nasal foreign body, and complications were obtained from medical records. Statistical analysis was performed using Pearson’s chi-square test for associated factors and the incidence of epistaxis among the complications.

RESULTS: Nasal foreign bodies were found and removed in 256 patients. Forceps, hooks, suction, modified paper clips, and cotton swabs were mainly used to remove the nasal foreign bodies. Epistaxis due to the removal procedure was observed in 26 patients. The occurrence of epistaxis differed depending on the equipment (p = 0.077) and was less frequent in suction and paper clips than in forceps (p < 0.05 and p = 0.077). Epistaxis was not observed when a cotton swab was used. Aspiration and septal perforation were not observed. A statistical relationship was not detected between the hardness of foreign bodies and the occurrence of epistaxis (p = 0.251). The incidence of epistaxis was higher in cases nasal foreign bodies remained for 1 day and over than in cases foreign bodies were removed within 1 day (p < 0.05).

CONCLUSIONS: This study revealed that suction, modified paper clips, and cotton swabs could be beneficial options for minimizing complications in the removal of nasal foreign bodies.

LEVEL OF EVIDENCE: Level 4 Laryngoscope, 2023.

PMID:36688270 | DOI:10.1002/lary.30581

Iran J Med Sci. 2023 Jan;48(1):49-56. doi: 10.30476/ijms.2022.91422.2260.

ABSTRACT

BACKGROUND: Primary spontaneous pneumothorax (PSP) is a spontaneous pneumothorax without underlying lung disease. The main goals of this study were to compare the outcomes of video-assisted thoracoscopic surgery (VATS) and open thoracotomy in patients with PSP.

METHODS: The current study is a retrospective cohort study of patients who were admitted to the emergency department or general surgery ward at Dr. Masih Daneshvari Hospital (Tehran, Iran) with the diagnosis of PSP and underwent surgery by open or VATS approach from 2006 to 2012. The groups were compared in terms of the length of operation, the length of hospitalization, recurrence, and postoperative complications. Data were analyzed using SPSS version 18.0, and Student’s t test, analysis of variance (ANOVA), Chi square, and Fisher’s exact test were employed. P values less than 0.05 were considered statistically significant.

RESULTS: PSP was diagnosed in 90 patients who underwent surgery. Open thoracotomy and VATS procedures were performed in 65 (72.2%) and 25 (27.8%) patients, respectively. VATS was converted to open in seven cases (7.7%). Recurrent pneumothorax was the most common surgical indication for PSP. There was no significant difference between the two groups in terms of mean age, sex, smoking, side of the involved lung, previous pneumothorax history, mean length of hospitalization for recurrence, post-operation bleeding, and failure of lung expansion. However, the length of surgery (P=0.011) and air leakage (P=0.048) significantly differed between the two groups.

CONCLUSION: When compared to open thoracotomy, VATS could be the primary treatment option in the surgical treatment of PSP due to the shorter length of surgery and decreased complications such as air leakage.

PMID:36688202 | PMC:PMC9843463 | DOI:10.30476/ijms.2022.91422.2260