Tag: statistics

Clin Transl Oncol. 2022 Nov 14. doi: 10.1007/s12094-022-03007-2. Online ahead of print.

ABSTRACT

BACKGROUND: Triple-positive breast cancer (TPBC) is a tumor that simultaneously expresses estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2). Luminal A-like TPBC is a special subtype with a favorable prognosis but benefits less from HER2-targeted therapy. However, little is known about how to identify luminal A-like TPBCs. Therefore, our study aims to explore a clinically feasible method to identify luminal A-like TPBCs using immunohistochemical (IHC) markers.

METHODS: Our cohort enrolled consecutive 190 patients with early-stage TPBCs diagnosed, treated and followed up in our hospital between 2013 and 2019. Patients whose IHC staining displayed ≥ 50% in both ER and PR scores and B-cell lymphoma 2 (BCL2) positivity were classified as cohort A (n = 64), and the rest were enrolled in cohort B (n = 126). Kaplan-Meier plotter and log-rank test were used to compare the survival difference between cohort A and cohort B and the efficacy of trastuzumab therapy in the two cohorts.

RESULTS: The disease-free survival (DFS) of patients in cohort A was significantly better than in cohort B (p = 0.031). In cohort A, there was no statistically significant difference in DFS between patients treated with trastuzumab and those without trastuzumab (p = 0.663). While in cohort B, patients treated with trastuzumab had significantly better DFS than those without trastuzumab (p = 0.032). Multivariate survival analysis showed that cohort A was associated with better DFS(95%CI 1.046-11.776, p = 0.042).

CONCLUSION: TPBCs consist of heterogeneous subtypes. Detecting the expression of ER, PR and BCL2 via IHC can help identify luminal A-like TPBCs. This study will enable individualized treatment of TPBCs.

PMID:36376700 | DOI:10.1007/s12094-022-03007-2

Environ Sci Pollut Res Int. 2022 Nov 14. doi: 10.1007/s11356-022-24167-2. Online ahead of print.

ABSTRACT

Glyphosate-based herbicides can be harmful to the environment and human health. Especially in developing countries, these herbicides are often used indiscriminately in agricultural and urban areas. Here, we optimized a simple and efficient flow injection-based spectrophotometric method to monitor environmentally relevant glyphosate concentrations in surface waters. The method was then used to assess the environmental mobility of glyphosate in Southeast Brazil by monitoring surface runoff from experimental agricultural soil plots that received glyphosate applications in 2015. Further, water samples from low-order streams were collected in five agricultural, urban, and natural areas, as well as from the 5th-order Rio das Mortes during the rainy season. Finally, 20 drinking water sources were sampled in urban, rural, and agricultural areas. Runoff from reference plots without glyphosate application showed concentrations below the method’s detection limit of 0.49 mg.L^-1, whereas runoff from plots with standard glyphosate application had concentrations between 1.24 and 6.1 mg.L^-1. Similarly, concentrations in natural stream water were below the detection limit, whereas agricultural streams had concentrations of up to 3.7 mg.L^-1 (average: 0.97 mg.L^-1). In an agricultural stream monitored weekly, concentration peaks were observed after glyphosate applications by farmers, and concentrations were correlated to stream discharge. Urban streams had concentrations of up to 5.8 mg.L^-1 (average: 2.6 mg.L^-1), but samples from the catchment’s major river were mostly below detection limits, illustrating the dilution of urban and agricultural runoff in high-order rivers. In the sampled drinking water resources, glyphosate pollution occurred mainly in the rainy season, with detectable concentrations between 0.5 and 8.7 mg.L^-1 in 80% of the sampled drinking water sources. In conclusion, our results suggest considerable environmental mobility of glyphosate in the studied Southeast Brazilian catchment. Substantial pollution, well above national and international limits, was detected in surface runoff, stream water, and drinking water resources.

PMID:36376647 | DOI:10.1007/s11356-022-24167-2

J Gen Intern Med. 2022 Nov 14. doi: 10.1007/s11606-022-07872-z. Online ahead of print.

ABSTRACT

BACKGROUND: Health information exchanges (HIEs) have proliferated over the last decade, but a gap remains in our understanding of their benefits to patients and the healthcare system. In this systematic review, we provide an updated report on what is known regarding the impacts of HIE on clinical, health care utilization, and cost outcomes in the adult inpatient setting.

METHODS: We searched Pubmed, Web of Science, Embase, Cochrane, and Ebsco databases for citations published between January 2015 and August 2021. Eligible studies were English-language experimental or observational studies. We assessed risk of bias via the National Heart Lung and Blood Institute’s Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

RESULTS: We identified 11 eligible studies-1 quasi-experimental and 10 observational. Five studies examined readmission rates and 3 found benefits from HIE. Three studies examined mortality with 2 finding benefits from the availability of HIE. Eight studies examined utilization and cost outcomes with 2 finding benefits from HIE, 1 finding poorer outcomes with HIE, and the others finding no impact.

CONCLUSIONS: Evidence for the impacts of HIE remains largely observational with little direct measure of HIE use during clinical care, making causality difficult to assess. The highly variable outcomes examined by these studies limit meaningful synthesis. The strength of evidence is low that HIE reduces unplanned readmissions and mortality and there is insufficient evidence for the impact of HIE on cost or utilization. The increased number of studies specific to inpatient settings that examine objective outcomes with more rigorous statistical methods is a promising development since prior reviews.

TRIAL REGISTRATION: PROSPERO 2021 CRD42021274049 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021274049 AMENDMENTS TO PROTOCOL: Initially planned use of the Newcastle-Ottawa quality assessment scale was substituted for the National Heart Lung and Blood Institute’s Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies as it was better suited to evaluate the primarily retrospective observational cohort studies identified in the review.

PMID:36376635 | DOI:10.1007/s11606-022-07872-z

J Gen Intern Med. 2022 Nov 14. doi: 10.1007/s11606-022-07399-3. Online ahead of print.

ABSTRACT

BACKGROUND: Acute coronary syndrome (ACS) and opioid use are both major causes of morbidity and mortality globally. Although epidemiological studies point to increased risk of ACS in opioid users, in-hospital management and outcomes are unknown for this population when presenting with ACS. We sought to determine whether there are differences for in-hospital outcomes and management of ACS for those with and without opioid-related diagnoses (ORD).

METHODS AND RESULTS: From the National Inpatient Sample database, we extracted patients hospitalized between 2012 and 2016 for ACS. The primary independent variable was ORD by International Classification of Diseases, 9^th and 10^th Revision, codes. The primary outcome was in-hospital mortality; secondary outcomes were cardiac arrest, receipt of angiogram, and percutaneous coronary intervention (PCI). Statistical comparisons were performed using χ² test and Student’s t test. Multivariable logistic regression was performed to determine the independent association between ORD and outcomes of interest. Among the estimated 5.8 million admissions for ACS, the proportion of patients with ORD increased over the study period (p for trend < 0.01). Compared to patients without ORD presenting with ACS, patients with ORD were younger with fewer cardiovascular risk factors. Yet, in-hospital mortality was higher in patients with ORD presenting with ACS (AOR 1.36, 95% CI 1.26-1.48). Patients with ORD were more likely to experience in-hospital cardiac arrest (AOR 1.42, 95% CI 1.23-1.63) and less likely to undergo angiogram (AOR 0.42, 95% CI 0.38-0.45) or PCI (AOR 0.30, 95% CI 0.28-0.32).

CONCLUSION: Despite evidence of increased risk of mortality and cardiac arrest, patients with ORD admitted for ACS are less likely to receive ACS management.

PMID:36376632 | DOI:10.1007/s11606-022-07399-3

Nat Protoc. 2022 Nov 14. doi: 10.1038/s41596-022-00746-y. Online ahead of print.

ABSTRACT

Circadian clocks drive cyclic variations in many aspects of physiology, but some daily variations are evoked by periodic changes in the environment or sleep-wake state and associated behaviors, such as changes in posture, light levels, fasting or eating, rest or activity and social interactions; thus, it is often important to quantify the relative contributions of these factors. Yet, circadian rhythms and these evoked effects cannot be separated under typical 24-h day conditions, because circadian phase and the length of time awake or asleep co-vary. Nathaniel Kleitman’s forced desynchrony (FD) protocol was designed to assess endogenous circadian rhythmicity and to separate circadian from evoked components of daily rhythms in multiple parameters. Under FD protocol conditions, light intensity is kept low to minimize its impact on the circadian pacemaker, and participants have sleep-wake state and associated behaviors scheduled to an imposed non-24-h cycle. The period of this imposed cycle, Τ, is chosen so that the circadian pacemaker cannot entrain to it and therefore continues to oscillate at its intrinsic period (τ, ~24.15 h), ensuring circadian components are separated from evoked components of daily rhythms. Here we provide detailed instructions and troubleshooting techniques on how to design, implement and analyze the data from an FD protocol. We provide two procedures: one with general guidance for designing an FD study and another with more precise instructions for replicating one of our previous FD studies. We discuss estimating circadian parameters and quantifying the separate contributions of circadian rhythmicity and the sleep-wake cycle, including statistical analysis procedures and an R package for conducting the non-orthogonal spectral analysis method that enables an accurate estimation of period, amplitude and phase.

PMID:36376588 | DOI:10.1038/s41596-022-00746-y

J Expo Sci Environ Epidemiol. 2022 Nov 14. doi: 10.1038/s41370-022-00498-7. Online ahead of print.

ABSTRACT

BACKGROUND: Sanitary sewage overflows (SSOs) release raw sewage, which may contaminate the drinking water supply. Boil water advisories (BWAs) are issued during low or negative pressure events, alerting customers to potential contamination in the drinking water distribution system.

OBJECTIVE: We evaluated the associations between SSOs and BWAs and diagnoses of gastrointestinal (GI) illness in Columbia, South Carolina, and neighboring communities, 2013-2017.

METHODS: A symmetric bi-directional case-crossover study design was used to assess the role of SSOs and BWAs on Emergency Room and Urgent Care visits with a primary diagnosis of GI illness. Cases were considered exposed if an SSO or BWA occurred 0-4 days, 5-9 days, or 10-14 days prior to the diagnosis, within the same residential zip code. Effect modification was explored via stratification on participant-level factors (e.g., sex, race, age) and season (January-March versus April-December).

RESULTS: There were 830 SSOs, 423 BWAs, and 25,969 cases of GI illness. Highest numbers of SSOs, BWAs and GI cases were observed in a zip code where >80% of residents identified as Black or African-American. SSOs were associated with a 13% increase in the odds of a diagnosis for GI illness during the 0-4 day hazard period, compared to control periods (Odds Ratio: 1.13, 95% Confidence Interval: 1.09, 1.18), while no associations were observed during the other hazard periods. BWAs were not associated with increased or decreased odds of GI illness during all three hazard periods. However, in stratified analyses BWAs issued between January-March were associated with higher odds of GI illness, compared to advisories issued between April-December, in all three hazard periods.

SIGNIFICANCE: SSOs (all months) and BWAs (January-March) were associated with increased odds of a diagnosis of GI illness. Future research should examine sewage contamination of the drinking water distribution system, and mechanisms of sewage intrusion from SSOs.

IMPACT: Sewage contains pathogens, which cause gastrointestinal (GI) illness. In Columbia, South Carolina, USA, between 2013-2017, there were 830 sanitary sewage overflows (SSOs). There were also 423 boil water advisories, which were issued during negative pressure events. Using case-crossover design, SSOs (all months) and boil water advisories (January-March) were associated with increased odds of Emergency Room and Urgent Care diagnoses of GI illness, potentially due to contamination of the drinking water distribution system. Lastly, we identified a community where >80% of residents identified as Black or African-American, which experienced a disproportionate burden of sewage exposure, compared to the rest of Columbia.

PMID:36376586 | DOI:10.1038/s41370-022-00498-7

Dig Dis Sci. 2022 Nov 14. doi: 10.1007/s10620-022-07745-9. Online ahead of print.

ABSTRACT

OBJECTIVES: Argon plasma coagulation (APC) of gastric inlet patches of the cervical esophagus (GIP) has been shown to relieve the globus sensation. This study aimed to investigate the long-term effects of APC therapy on a variety of laryngopharyngeal symptoms.

METHODS: Patients with laryngopharyngeal symptoms who had undergone endoscopic GIP eradication via APC therapy were eligible for a retrospective observational cohort study. Symptom relief was assessed by a five-grade scale during a structured interview. Statistical analysis included ANOVA, the chi-squared and t-test.

RESULTS: A total of 45 patients (61.0 (52.0; 69.0) years, 26 (57.8%) female) were included after a follow-up time of 85.0 (55.3; 111.0) months. Symptoms included dysphagia (56.0%), dysphonia (51.0%), hoarseness (76.0%), the necessity of throat clearing (73.0%), globus sensation (56.0%) and heartburn (71.0%). Complete GIP eradication was achieved after one session in 25 (55.6%), repetitive sessions were needed in the remaining cases. Fourteen patients (31.1%) reported a very strong, 11 (24.4%) a strong and 8 patients (17.8%) an intermediate improvement; five patients did not benefit. The most apparent improvement was seen regarding hoarseness (from 2.6 ± 1.7 to 1.2 ± 1.3), the necessity of throat clearing (from 2.6 ± 1.7 to 1.1 ± 1.3), globus sensation (from 2.0 ± 1.9 to 0.9 ± 1.3) and heartburn (from 2.5 ± 1.8 to 1.4 ± 1.6). Adverse events included post-endoscopic pain (n = 6, 13.3%) and purulent pharyngitis (n = 2, 4.4%).

CONCLUSIONS: The APC therapy of GIP is safe and leads to long-term relief of laryngopharyngeal symptoms in carefully selected patients.

PMID:36376579 | DOI:10.1007/s10620-022-07745-9

Ir J Med Sci. 2022 Nov 15. doi: 10.1007/s11845-022-03223-3. Online ahead of print.

ABSTRACT

PURPOSE/AIM: The Five Times Sit-to-Stand Test (FTSST) is a method that evaluates lower extremity muscle strength and balance level. The aim of this study is to test the validity and reliability of the FTSST in patients with non-specific chronic low back pain (NSCLBP) whose lower extremity muscle strength and balance levels are adversely affected.

METHODS: The first outcome measure of the study was the FTSST, which was conducted by two different researchers. Secondary outcome measures are Biodex Balance System (BBS), Quadriceps Muscle Strength Test, Oswestry Disability Index (ODI), and Visual Analogue Scale (VAS). Intraclass Correlation Coefficient (ICC) was used for the validity and reliability of the FTSST, which was made by two different researchers, and Pearson’s Correlation Analysis was used to determine its relationship with other measurements.

RESULTS: Inter-rater and test-retest reliability for the FTSST were excellent (Intraclass Correlation Coefficient = 0.99). A statistically significant correlation was found between all secondary outcome measures (BBS, quadriceps muscle strength, ODI, VAS) and FTSST (p < 0.05).

CONCLUSION: In line with the findings of our study, we think that FTSST is a simple, easy, and reproducible method for evaluating lower extremity muscle strength, balance level, functional status, and pain in patients with NSCLBP.

PMID:36376556 | DOI:10.1007/s11845-022-03223-3

Ir J Med Sci. 2022 Nov 15. doi: 10.1007/s11845-022-03226-0. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to determine how an early occupational therapy (OT) intervention affected hospital length of stay (LOS) in a sample of patients with a moderate to severe traumatic brain injury (TBI).

METHODS: This quasi-experimental study was conducted with 2018-2020 data from a rehabilitation center at the King Saud Medical City in Riyadh, Kingdom of Saudi Arabia. The sample of 29 TBI patients included 15 experimental (prospective) group participants who received an early OT intervention and 14 control group (retrospective) participants who did not receive the intervention. The intervention provided patients with daily OT therapy based on their needs and was divided into two phases: the intensive care unit (ICU) phase and the general ward phase. The following measures were used: Glasgow Coma Scale score at admission (both groups), hospital LOS (from admission until discharge; both groups), and functional independence measures (FIM) at admission and discharge (experimental group).

RESULTS: Experimental group patients had a much shorter LOS (average 61.53 days) compared with the control group (mean 108.86 days). Additionally, the experimental group had a statistically significant increase in FIM scores from admission to discharge.

CONCLUSIONS: These results suggest that providing early OT interventions to patients with moderate and severe TBIs can help decrease their LOS, which can contribute to reduced treatment costs.

PMID:36376555 | DOI:10.1007/s11845-022-03226-0

Sci Rep. 2022 Nov 14;12(1):19513. doi: 10.1038/s41598-022-24009-8.

ABSTRACT

Childhood obesity remains one of the most important issues in global health, which is implicated in many chronic diseases. Converging evidence suggests that a higher body mass index during childhood (CBMI) is significantly associated with increased coronary artery disease (CAD) susceptibility in adulthood, which may partly arise from the shared genetic determination. Despite genome-wide association studies (GWASs) have successfully identified some loci associated with CBMI and CAD individually, the genetic overlap and common biological mechanism between them remains largely unexplored. Here, relying on the results from the two large-scale GWASs (n = 35,668 for CBMI and n = 547,261 for CAD), linkage disequilibrium score regression (LDSC) was used to estimate the genetic correlation of CBMI and CAD in the first step. Then, we applied different pleiotropy-informed methods including conditional false discovery rate ([Formula: see text]) and genetic analysis incorporating pleiotropy and annotation (GPA) to detect potentially common loci for childhood obesity and CAD. By integrating the genetic information from the existing GWASs summary statistics, we found a significant positive genetic correlation ([Formula: see text] = 0.127, p = 2E-4) and strong pleiotropic enrichment between CBMI and CAD (LRT = 79.352, p = 5.2E-19). Importantly, 28 loci were simultaneously discovered to be associated with CBMI, and 13 of them were identified as potentially pleiotropic loci by [Formula: see text] and GPA. Those corresponding pleiotropic genes were enriched in trait-associated gene ontology (GO) terms “amino sugar catabolic process”, “regulation of fat cell differentiation” and “synaptic transmission”. Overall, the findings of the pleiotropic loci will help to further elucidate the common molecular mechanisms underlying the association of childhood obesity and CAD, and provide a theoretical direction for early disease prevention and potential therapeutic targets.

PMID:36376549 | DOI:10.1038/s41598-022-24009-8