Tag: statistics

Discov Med. 2024 Mar;36(182):591-597. doi: 10.24976/Discov.Med.202436182.55.

ABSTRACT

BACKGROUND: The continuous advancement in ultrasound technology has given rise to Acoustic Radiation Force Impulse (ARFI) elastography, which boasts non-invasiveness, ease of operation, rapid inspection, and high accuracy. It has been successfully employed in detecting tissue hardness across various diseases. This study aims to investigate the application of acoustic radiation force pulse imaging technology in evaluating the efficacy of calf intermuscular vein thrombosis.

METHODS: This study is retrospective in nature, involving a total of 120 patients diagnosed with calf intermuscular venous thrombosis (MCVT) who were admitted to our hospital. These patients were selected retrospectively as the subjects for our research. They were subsequently divided into two groups: the control group and the observation group. The control group received standard nursing care and simple pressure therapy, while the observation group underwent anticoagulant drug treatment. The shear wave elastic hardness of both groups was measured, with the recording of ultrasonic elasticity scores and the average elastic modulus value (E-mean, in kPa). Furthermore, a comparison was made between the two groups regarding thrombus disappearance time, blood flow patency, and the clinical treatment effect.

RESULTS: At the 1, 3, and 6-month marks of the treatment period, the ultrasonic elasticity scores in the observation group were consistently higher compared to those in the control group. Additionally, the shear wave elastic hardness in the observation group was consistently lower than that in the control group, and these differences were found to be statistically significant (p < 0.05). The total effective rates for the control and observation groups were 83.33% and 95.00%, respectively. Notably, the clinical total effective rate in the observation group was significantly higher than that in the control group, and this difference was statistically significant (p < 0.05). The thrombus disappearance time in the observation group was significantly shorter than that in the control group, and the blood flow rate was significantly higher than in the control group, with both differences being statistically significant (p < 0.05).

CONCLUSION: ARFI plays a crucial role in assessing the efficacy of MCVT by effectively revealing the hardness and location of the patient’s thrombus tissue. This technology aids doctors in gaining a more precise understanding of the deep vein thrombosis condition. Notably, ARFI is characterized by high safety levels and exhibits positive effects due to its painless and non-invasive nature.

PMID:38531799 | DOI:10.24976/Discov.Med.202436182.55

Asian J Surg. 2024 Mar 25:S1015-9584(24)00525-6. doi: 10.1016/j.asjsur.2024.03.091. Online ahead of print.

ABSTRACT

BACKGROUND: Degenerative meniscal tear (DMT) is common in the elderly population. However, there has been controversy over the treatment of DMT regarding whether to adopt arthroscopic partial meniscectomy (APM) or exercise therapy (ET). In order to compare the long-term outcomes between the two treatment methods, we conducted a meta-analysis of randomized controlled trials (RCTs) with long-term follow-up.

METHODS: PubMed, Cochrane Library, Embase, and Web of Science were last searched on 16 April 2023 for studies on DMT that compared the clinical outcomes between APM and ET. The subjective outcomes of the comparison include the Knee Injury and Osteoarthritis Outcome Score (KOOS), which consists of five sub-scales: pain, symptoms, activities of daily living (ADL), sport and recreation (Sport/recreation), and quality of life (QOL). The objective outcome includes knee osteoarthritis progression.

RESULTS: We identified 6 potentially eligible trials, including 1078 participants, from the literature search. ET showed a lower risk of knee osteoarthritis progression than APM (RR, 1·27; 95%CI 1·05 to 1·53). There were no statistically significant differences in the KOOS-pain, KOOS-symptoms, KOOS-ADL, KOOS-Sport/recreation, and KOOS-QOL between the two treatment methods.

CONCLUSION: For the treatment of DMT, ET showed a lower risk of knee osteoarthritis progression than APM. ET and APM had comparable effects on subjective outcomes including pain management and knee function. Therefore, it is not recommended to use APM but rather recommended to use ET for treating APM.

PMID:38531745 | DOI:10.1016/j.asjsur.2024.03.091

Int J Drug Policy. 2024 Mar 25:104387. doi: 10.1016/j.drugpo.2024.104387. Online ahead of print.

ABSTRACT

BACKGROUND: Characterizing acute and chronic hepatitis C virus (HCV) infection and HIV/HCV co-infection among persons who inject drugs (PWID) can inform elimination efforts.

METHODS: During 2018 National HIV Behavioral Surveillance in 10 U.S. metropolitan statistical areas (MSAs), PWID were recruited using respondent-driven sampling and offered a survey, HIV testing, and HCV antibody and RNA testing. We examined prevalence and associated characteristics of HCV infection and HIV/HCV co-infection. Associations were assessed using log-linked Poisson regression models with robust standard errors accounting for clustering by recruitment chain and adjusting for MSA and network size.

RESULTS: Overall, 44.2% had current HCV infection (RNA detected), with 3.9% classified as acute infection (HCV antibody non-reactive/RNA detected) and 40.3% as chronic (HCV antibody reactive/RNA detected). Four percent had HIV/HCV co-infection. Current HCV infection was significantly higher among PWID who were male, White, injected >1 time/day, shared syringes in past year, and shared injection equipment in past year. PWID who were transgender, injecting >5 years, and most often injected speedball (heroin and cocaine together) or stimulants alone were more likely to have HIV/HCV co-infection. Among PWID who never previously had HCV infection, 9.9% had acute HCV infection. Among PWID who started injecting ≤5 years ago, 41.5% had already acquired HCV infection.

CONCLUSIONS: Acute and chronic HCV infections were substantial among a sample of PWID in 10 U.S. MSAs. Accessibility to HCV RNA testing, promoting safer practices, and intervening early with harm reduction programs for recent injection initiates will be critical to disease elimination efforts for PWID.

PMID:38531730 | DOI:10.1016/j.drugpo.2024.104387

Cardiovasc Revasc Med. 2024 Mar 9:S1553-8389(24)00073-3. doi: 10.1016/j.carrev.2024.02.020. Online ahead of print.

ABSTRACT

BACKGROUND: The risk of coronary artery disease is exaggerated in patients with autoimmune diseases (AID). A higher risk of complications has been reported during and after percutaneous coronary intervention (PCI) in these patients. We aimed to analyze the in-hospital outcomes and trends of patients with AID, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and inflammatory bowel disease (IBD) undergoing PCI.

METHOD: We identified all PCI procedures using the National In-patient Sample database from 2016 to 2020. Stratified them into cohorts with RA, SLE and IBD and compared them to cohorts without AID. The Chi-square test and multivariate logistic regression were used for analysis. A p-value <0.005 was considered statistically significant.

RESULT: We identified 2,367,475 patients who underwent PCI. Of these, 1.6 %, 0.5 %, and 0.4 % had RA, IBD and SLE respectively. The odds of mortality were lower among patients with IBD (aOR: 0.56; CI 0.38-0.81, p = 0.002) but patients with RA had higher odds of having composite major complications [(MC) including cerebrovascular accident (CVA), cardiac arrest, acute heart failure (AHF), ventricular arrhythmia (VA), major bleeding, and acute kidney injury (AKI)] (aOR: 0.90; CI 0.83-0.98, p = 0.013). Our SLE cohort had higher rates of CVA (p = 0.017) and AKI (p = 0.002). Our cohort with IBD had lower rates of cardiac arrest but had longer hospital length of stay (4.9 days vs 3.9 days) and they incurred higher hospital charges compared to cohort without IBD.

CONCLUSION: This study depicts the immediate adverse outcomes observed in patients with AID undergoing PCI. In contrast to those without AID, our cohorts with RA exhibited worse outcomes, as indicated by the higher odds of major complications. IBD is associated with lower risks of in-hospital adverse outcomes but with higher resource utilization.

PMID:38531708 | DOI:10.1016/j.carrev.2024.02.020

Br J Dermatol. 2024 Mar 26:ljae138. doi: 10.1093/bjd/ljae138. Online ahead of print.

ABSTRACT

BACKGROUND: Interleukin (IL)-13 is a key driver of inflammation and barrier dysfunction in atopic dermatitis (AD). While there is robust evidence that tralokinumab, a monoclonal antibody neutralizing IL-13, reduces inflammation and clinical disease activity, less is known about its effects on barrier function.

OBJECTIVES: To characterize effects of tralokinumab treatment on skin barrier function.

METHODS: Transepidermal water loss (TEWL), stratum corneum hydration (SCH), natural moisturizing factor (NMF) content, histopathological characteristics, biomarker expression and microbiome composition were evaluated in lesional, non-lesional, and sodium lauryl sulfate (SLS)-irritated skin of 16 AD patients over the course of 16 weeks of tralokinumab treatment.

RESULTS: All clinical severity scores decreased significantly over time. At week 16, mean TEWL in target lesions decreased by 32.66% (p = 0.01), and SCH increased by 58.44% (p = 0.004), along with histological reduction in spongiosis (p = 0.003), keratin 16 expression and epidermal thickness (p = 0.001). In parallel, there was a significant decrease in several barrier dysfunction-associated and pro-inflammatory proteins such as fibronectin (p = 0.006), CCL17/TARC (p = 0.025) and IL-8 (p = 0.014), with significant changes already at week 8. Total bacterial load and Staphylococcus aureus abundance were significantly reduced from week 2.

CONCLUSION: Tralokinumab treatment improves skin physiology, epidermal pathology, and dysbiosis, further highlighting the pleiotropic role of IL-13 in AD pathogenesis.

PMID:38531691 | DOI:10.1093/bjd/ljae138

Respir Care. 2024 Mar 26:respcare.11455. doi: 10.4187/respcare.11455. Online ahead of print.

ABSTRACT

BACKGROUND: The goals of this study were to develop a model that predicts the risk of 30-d all-cause readmission in hospitalized Medicaid patients diagnosed with COPD and to create a predictive model in a retrospective study of a population cohort.

METHODS: We analyzed 2016-2019 Medicaid claims data from 7 United States states. A COPD admission was one in which either the admission diagnosis or the first or second clinical (discharge) diagnosis bore an International Classification of Diseases, Tenth Revision code for COPD. A readmission was an admission for any condition (not necessarily COPD) that occurred within 30 d of a COPD discharge. We estimated a mixed-effects logistic model to predict 30-d readmission from patient demographic data, comorbidities, past health care utilization, and features of the index hospitalization. We evaluated model fit graphically and measured predictive accuracy by the area under the receiver operating characteristic (ROC) curve.

RESULTS: Among 12,283 COPD hospitalizations contributed by 9,437 subjects, 2,534 (20.6%) were 30-d readmissions. The final model included demographics, comorbidities, claims history, admission and discharge variables, length of stay, and seasons of admission and discharge. The observed versus predicted plot showed reasonable fit, and the estimated area under the ROC curve of 0.702 was robust in sensitivity analyses.

CONCLUSIONS: Our model identified with acceptable accuracy hospitalized Medicaid patients with a diagnosis of COPD who are at high risk of readmission. One can use the model to develop post-discharge management interventions for reducing readmissions, for adjusting comparisons of readmission rates between sites/providers or over time, and to guide a patient-centered approach to patient care.

PMID:38531636 | DOI:10.4187/respcare.11455

Bipolar Disord. 2024 Mar 26. doi: 10.1111/bdi.13426. Online ahead of print.

ABSTRACT

INTRODUCTION: Owing to the heterogenic picture of bipolar disorder, it takes approximately 8.8 years to reach a correct diagnosis. Early recognition and early intervention might not only increase quality of life, but also increase life expectancy as a whole in individuals with bipolar disorder. Therefore, we hypothesize that implementing machine learning techniques can be used to support the diagnostic process of bipolar disorder and minimize misdiagnosis rates.

MATERIALS AND METHODS: To test this hypothesis, a de-identified data set of only demographic information and the results of cognitive tests of 196 patients with bipolar disorder and 145 healthy controls was used to train and compare five different machine learning algorithms.

RESULTS: The best performing algorithm was logistic regression, with a macro-average F1-score of 0.69 [95% CI 0.66-0.73]. After further optimization, a model with an improved macro-average F1-score of 0.75, a micro-average F1-score of 0.77, and an AUROC of 0.84 was built. Furthermore, the individual amount of contribution per variable on the classification was assessed, which revealed that body mass index, results of the Stroop test, and the d2-R test alone allow for a classification of bipolar disorder with equal performance.

CONCLUSION: Using these data for clinical application results in an acceptable performance, but has not yet reached a state where it can sufficiently augment a diagnosis made by an experienced clinician. Therefore, further research should focus on identifying variables with the highest amount of contribution to a model’s classification.

PMID:38531635 | DOI:10.1111/bdi.13426

Acta Anaesthesiol Scand. 2024 Mar 26. doi: 10.1111/aas.14405. Online ahead of print.

ABSTRACT

BACKGROUND: This study focuses on biomarkers in infants after open heart surgery, and examines the association of high-sensitive troponin T (hs-cTnT), interleukin-6 (IL-6), and interleukin-8 (IL-8) with postoperative acute kidney injury (AKI), ventilatory support time and need of vasoactive drugs.

METHODS: Secondary exploratory study from a double-blinded clinical randomized trial (Mile-1) on 70 infants undergoing open heart surgery with cardiopulmonary bypass (CPB). In this sub-study, the entire study population was examined without considering the study drugs. The biomarkers’ peak concentration (highest concentration at 2 or 6 h post-CPB) were used for statistical analyses.

RESULTS: Peak IL-8, hs-cTnT, and IL-6 occurred at 2 h post-CPB for 96%, 79%, and 63% of the patients, respectively. The odds ratio of developing AKI2-3 for IL-6 > 293 pg/mL was 23.4 (95% CI 5.3;104.0), for IL-8 > 100 pg/mL it was 11.5 (3.0;44.2), and for hs-cTnT >5597 pg/mL it was 6.1 (1.5; 24.5). In more than two third of the patients with the highest peak concentrations of IL-8, IL-6, and hs-cTnT, there was a need for ventilatory support for >24 h and use of vasoactive drugs at 24 h post-CPB, while in less than one third of the patients with the lowest peak concentrations of IL-8 and hs-cTnT such requirements were observed.

CONCLUSIONS: The peak biomarker concentrations and CPB-time strongly predicted AKI2-3, with IL-6 and IL-8 emerging as strongest predictors. Furthermore, our findings suggest that measuring hs-cTnT and IL-8 just 2 h post-CPB-weaning may assist in identifying infants suitable for early extubation and highlight those at risk of prolonged ventilation.

PMID:38531618 | DOI:10.1111/aas.14405

BMJ Open. 2024 Mar 25;14(3):e082927. doi: 10.1136/bmjopen-2023-082927.

ABSTRACT

INTRODUCTION: The non-intoxicating plant-derived cannabinoid, cannabidiol (CBD), has demonstrated therapeutic potential in a number of clinical conditions. Most successful clinical trials have used relatively high (≥300 mg) oral doses of CBD. Relatively few studies have investigated the efficacy of lower (<300 mg) oral doses, typical of those available in over-the-counter CBD products.

METHODS: We present a protocol for a randomised, double-blind, placebo-controlled, parallel-group clinical trial investigating the effects of a low oral dose (150 mg) of CBD on acute psychosocial stress, situational anxiety, motion sickness and cybersickness in healthy individuals. Participants (n=74) will receive 150 mg of CBD or a matched placebo 90 min before completing three virtual reality (VR) challenges (tasks) designed to induce transient stress and motion sickness: (a) a 15 min ‘Public Speaking’ task; (b) a 5 min ‘Walk the Plank’ task (above a sheer drop); and (c) a 5 min ‘Rollercoaster Ride’ task. The primary outcomes will be self-reported stress and nausea measured on 100 mm Visual Analogue Scales. Secondary outcomes will include salivary cortisol concentrations, skin conductance, heart rate and vomiting episodes (if any). Statistical analyses will test the hypothesis that CBD reduces nausea and attenuates subjective, endocrine and physiological responses to stress compared with placebo. This study will indicate whether low-dose oral CBD has positive effects in reducing acute psychosocial stress, situational anxiety, motion sickness and cybersickness.

ETHICS AND DISSEMINATION: The University of Sydney Human Research Ethics Committee has granted approval (2023/307, version 1.6, 16 February 2024). Study findings will be disseminated in a peer-reviewed journal and at academic conferences.

TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12623000872639).

PMID:38531572 | DOI:10.1136/bmjopen-2023-082927

BMJ Open. 2024 Mar 25;14(3):e081022. doi: 10.1136/bmjopen-2023-081022.

ABSTRACT

INTRODUCTION: Non-pharmacological interventions play a crucial role in the management of non-specific chronic low back pain (NSCLBP). One prime example is Tuina, a traditional Chinese manual therapy that incorporates pressing, kneading and rubbing techniques to alleviate physical discomfort and enhance overall well-being. It serves as a widely used technique in China and other East Asian countries. However, the effectiveness and safety of Tuina for managing NSCLBP have not been substantiated through rigorous clinical research. We sought to carry out a randomised controlled trial with an open-label design, blinded assessors and parallel arms to assess the effectiveness and safety of Tuina as a treatment for NSCLBP. The trial aims to provide high-quality evidence regarding the efficacy and safety of Tuina in improving outcomes for patients with NSCLBP.

METHODS AND ANALYSIS: A total of 150 patients aged 18-60 years with NSCLBP will be recruited. Participants will be randomly assigned to one of the two groups. Both groups will receive standard health education. In addition, the treatment group will receive Tuina therapy, while the control group will participate in core stability exercises. Each group will undergo a total of 18 interventions over 6 weeks, with the interventions administered three times per week. The primary outcome measure is the patient’s pain intensity, assessed using the Numerical Rating Scale, at week 6 following randomisation. Secondary outcomes encompass disability (measured by the Roland-Morris Disability Questionnaire), quality of life (assessed using the EuroQoL-5 dimensions questionnaire), adverse emotions (evaluated with the Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia and Depression Anxiety Stress Scale), biomechanical outcomes, socioeconomic indicators (medication use, healthcare utilisation and absenteeism), patient satisfaction, treatment adherence and other relevant factors.The statistical analysis will follow the intention-to-treat principle. Two-way repeated measures analysis of variance will be used to compare the clinical data across different time points within both groups.

ETHICS AND DISSEMINATION: The study protocol has received approval from the Ethics Committee of Shuguang Hospital, Shanghai University of Traditional Chinese Medicine (2023-1366-133-01). All study participants will be required to give written informed consent. The findings of the study will be submitted to a peer-reviewed journal for publication and presented at scientific conferences. Additionally, the participants will receive copies of the results.

TRIAL REGISTRATION NUMBER: ChiCTR2300076257.

PMID:38531569 | DOI:10.1136/bmjopen-2023-081022