Tag: statistics

JAMA Surg. 2024 Feb 21. doi: 10.1001/jamasurg.2023.7985. Online ahead of print.

ABSTRACT

IMPORTANCE: Surgical site infections frequently occur after open abdominal surgery. Intraoperative wound irrigation as a preventive measure is a common practice worldwide, although evidence supporting this practice is lacking.

OBJECTIVE: To evaluate the preventive effect of intraoperative wound irrigation with polyhexanide solution.

DESIGN, SETTING, AND PARTICIPANTS: The Intraoperative Wound Irrigation to Prevent Surgical Site Infection After Laparotomy (IOWISI) trial was a multicenter, 3-armed, randomized clinical trial. Patients and outcome assessors were blinded to the intervention. The clinical trial was conducted in 12 university and general hospitals in Germany from September 2017 to December 2021 with 30-day follow-up. Adult patients undergoing laparotomy were eligible for inclusion. The main exclusion criteria were clean laparoscopic procedures and the inability to provide consent. Of 11 700 screened, 689 were included and 557 completed the trial; 689 were included in the intention-to-treat and safety analysis.

INTERVENTIONS: Randomization was performed online (3:3:1 allocation) to polyhexanide 0.04%, saline, or no irrigation (control) of the operative wound before closure.

MAIN OUTCOME AND MEASURES: The primary end point was surgical site infection within 30 postoperative days according to the US Centers for Disease Control and Prevention definition.

RESULTS: Among the 689 patients included, 402 were male and 287 were female. The median (range) age was 65.9 (18.5-94.9) years. Participants were randomized to either wound irrigation with polyhexanide (n = 292), saline (n = 295), or no irrigation (n = 102). The procedures were classified as clean contaminated in 92 cases (8%). The surgical site infection incidence was 11.8% overall (81 of 689), 10.6% in the polyhexanide arm (31 of 292), 12.5% in the saline arm (37 of 295), and 12.8% in the no irrigation arm (13 of 102). Irrigation with polyhexanide was not statistically superior to no irrigation or saline irrigation (hazard ratio [HR], 1.23; 95% CI, 0.64-2.36 vs HR, 1.19; 95% CI, 0.74-1.94; P = .47). The incidence of serious adverse events did not differ among the 3 groups.

CONCLUSIONS AND RELEVANCE: In this study, intraoperative wound irrigation with polyhexanide solution did not reduce surgical site infection incidence in clean-contaminated open abdominal surgical procedures compared to saline or no irrigation. More clinical trials are warranted to evaluate the potential benefit in contaminated and septic procedures, including the emergency setting.

TRIAL REGISTRATION: drks.de Identifier: DRKS00012251.

PMID:38381428 | DOI:10.1001/jamasurg.2023.7985

J Vis. 2024 Feb 1;24(2):5. doi: 10.1167/jov.24.2.5.

ABSTRACT

Our perception does not depend exclusively on the immediate sensory input. It is also influenced by our internal predictions derived from prior observations and the temporal regularities of the environment, which can result in choice history biases. However, it is unclear how this flexible use of prior information to predict the future influences perceptual decisions. Prior information may bias decisions independently of the current sensory input, or it may modulate the weight of current sensory input based on its consistency with the expectation. To address this question, we used a visual decision-making task and manipulated the transitional probabilities between successive noisy grating stimuli. Using a reverse correlation analysis, we evaluated the contribution of stimulus-independent decision bias and stimulus-dependent sensitivity modulations to choice history biases. We found that both effects coexist, whereby there was increased bias to respond in line with the predicted orientation alongside modulations in perceptual sensitivity to favor perceptual information consistent with the prediction, akin to selective attention. Furthermore, at the individual differences level, we investigated the relationship between autistic-like traits and the adaptation of choice history biases to the sequential statistics of the environment. Over two studies, we found no convincing evidence of reduced adaptation to sequential regularities in individuals with high autistic-like traits. In sum, we present robust evidence for both perceptual confirmation bias and decision bias supporting adaptation to sequential regularities in the environment.

PMID:38381426 | DOI:10.1167/jov.24.2.5

Ophthalmologie. 2024 Feb 21. doi: 10.1007/s00347-024-01988-9. Online ahead of print.

ABSTRACT

Retinal optical coherence tomography (OCT) biomarkers have the potential to serve as early, noninvasive, and cost-effective markers for identifying individuals at risk for cognitive impairments and neurodegenerative diseases. They may also aid in monitoring disease progression and evaluating the effectiveness of interventions targeting cognitive decline. The association between retinal OCT biomarkers and cognitive performance has been demonstrated in several studies, and their importance in cognitive assessment is increasingly being recognized. Machine learning (ML) is a branch of artificial intelligence (AI) with an exponential number of applications in the medical field, particularly its deep learning (DL) subset, which is widely used for the analysis of medical images. These techniques efficiently deal with novel biomarkers when their outcome for the applications of interest is unclear, e.g., for diagnosis, prognosis prediction, disease staging, or any other relevance to clinical practice. However, using AI-based tools for medical purposes must be approached with caution, despite the many efforts to address the black-box nature of such approaches, especially due to the general underperformance in datasets other than those used for their development. Retinal OCT biomarkers are promising as potential indicators for decline in cognitive function. The underlying mechanisms are currently being explored to gain deeper insights into this relationship linking retinal health and cognitive function. Insights from neurovascular coupling and retinal microvascular changes play an important role. Further research is needed to establish the validity and utility of retinal OCT biomarkers as early indicators of cognitive decline and neurodegenerative diseases in routine clinical practice. Retinal OCT biomarkers could then provide a new avenue for early detection, monitoring and intervention in cognitive impairment with the potential to improve patient care and outcomes.

PMID:38381373 | DOI:10.1007/s00347-024-01988-9

J Clin Monit Comput. 2024 Feb 21. doi: 10.1007/s10877-024-01133-6. Online ahead of print.

ABSTRACT

Perfusion Computed Tomography (PCT) is an alternative tool to assess cerebral hemodynamics during trauma. As acute traumatic subdural hematomas (ASH) is a severe primary injury associated with poor outcomes, the aim of this study was to evaluate the cerebral hemodynamics in this context. Five adult patients with moderate and severe traumatic brain injury (TBI) and ASH were included. All individuals were indicated for surgical evacuation. Before and after surgery, PCT was performed and cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were evaluated. These parameters were associated with the outcome at 6 months post-trauma with the extended Glasgow Outcome Scale (GOSE). Mean age of population was 46 years (SD: 8.1). Mean post-resuscitation Glasgow coma scale (GCS) was 10 (SD: 3.4). Mean preoperative midline brain shift was 10.1 mm (SD: 1.8). Preoperative CBF and MTT were 23.9 ml/100 g/min (SD: 6.1) and 7.3 s (1.3) respectively. After surgery, CBF increase to 30.7 ml/100 g/min (SD: 5.1), and MTT decrease to 5.8s (SD:1.0), however, both changes don’t achieve statistically significance (p = 0.06). Additionally, CBV increase after surgery, from 2.34 (SD: 0.67) to 2.63 ml/100 g (SD: 1.10), (p = 0.31). Spearman correlation test of postoperative and preoperative CBF ratio with outcome at 6 months was 0.94 (p = 0.054). One patient died with the highest preoperative MTT (9.97 s) and CBV (4.51 ml/100 g). CBF seems to increase after surgery, especially when evaluated together with the MTT values. It is suggested that the improvement in postoperative brain hemodynamics correlates to favorable outcome.

PMID:38381360 | DOI:10.1007/s10877-024-01133-6

Methods Mol Biol. 2024;2765:23-46. doi: 10.1007/978-1-0716-3678-7_2.

ABSTRACT

Circular RNAs (circRNAs) are types of RNA molecules that have been discovered relatively recently and have been found to be widely expressed in eukaryotic cells. Unlike canonical linear RNA molecules, circRNAs form a covalently closed continuous loop structure without a 5′ or 3′ end. They are generated by a process called back-splicing, in which a downstream splice donor site is joined to an upstream splice acceptor site. CircRNAs have been found to play important roles in various biological processes, including gene regulation, alternative splicing, and protein translation. They can act as sponges for microRNAs or RNA-binding proteins and can also encode peptides or proteins. Additionally, circRNAs have been implicated in several diseases, including cancer, neurological disorders, and cardiovascular diseases.This protocol provides all necessary steps to detect and analyze circRNAs in silico from RNA sequencing data using the circtools circRNA analytics software suite. The protocol starts from raw sequencing data with circRNA detection via back-splice events and includes statistical testing of circRNAs as well as primer design for follow-up wet lab experiments.

PMID:38381332 | DOI:10.1007/978-1-0716-3678-7_2

Genes Genomics. 2024 Feb 21. doi: 10.1007/s13258-024-01503-z. Online ahead of print.

ABSTRACT

BACKGROUND: High temperature stress is an important abiotic factor, which affects tuberization and ultimately causes heavy yield reduction in potato.

OBJECTIVES: Identification and characterization of genes associated with tuberization under high temperature stress is essential for future management through biotechnology.

METHODOLOGY: Two contrasting potato varieties Kufri Anand (profuse tuber-bearing) versus Kufri Frysona (very less/scanty tuber-bearing, control) were cultivated in aeroponics under high temperature stress, and transcriptomes were analyzed.

RESULTS: Potato cv. Kufri Anand was found superior over control (Kufri Frysona) for tuber yield and its component traits along with root morphology under aeroponics. Transcriptomes of tuber and leaf tissues were analyzed. Statistically significant (p < 0.05) differentially expressed genes (DEGs) were categorised into up-regulated (> 2 log₂ fold change, FC) and down-regulated (< -2 log2 FC) genes. DEGs were annotated by gene ontology and KEGG pathways. A few selected up-regulated genes of both tissues were identified, and phylogeny tree and motif analysis were analysed based on 36 peptide sequences representing 15 selected DEGs in this study. Further, gene expression markers were developed and validated by real time qPCR analysis for the identification of high temperature tolerant genotypes.

CONCLUSION: A few key genes associated in tuberization under high temperature conditions were heat shock proteins (e.g. 18.5 kDa class I heat shock protein), sugar metabolism (e.g. glucosyltransferase), transcription factor (e.g. WRKY), and phytohormones (e.g. auxin-induced beta-glucosidase). Our study provides an overview of key genes involved in tuberization under high temperature stress in potato cv. Kufri Anand under aeroponics.

PMID:38381322 | DOI:10.1007/s13258-024-01503-z

Environ Sci Pollut Res Int. 2024 Feb 21. doi: 10.1007/s11356-024-32129-z. Online ahead of print.

ABSTRACT

This paper aims to create a new probability distribution and conducts statistical analysis on air quality dataset from Kathmandu. Using this innovative distribution, we have studied the ground reality of air quality conditions of Kathmandu, Nepal. In our research, we have developed a new probability distribution known as the New Extended Kumaraswamy Exponential Distribution by introducing an additional shape parameter to the Extended Kumaraswamy Exponential (EKwE) Distribution. Statistical characteristics such as cumulative distribution function, probability density function, hazard function, reversed hazard function, skewness, kurtosis, survival function, and hazard rate function are studied. The suggested model is non-normal and positively skewed with increasing and inverted bathtub-shaped hazard rate curves. To assess the model’s suitability, we utilized a real dataset comprising air quality data from Kathmandu, Nepal, during the year 2021. Study shows that the air quality data exhibit an increasing failure rate, but the P_2.5, P₁₀, and total suspended particle concentrations exhibited its lowest levels during the monsoon season and its highest levels during the winter season. Parameters of the model are estimated by using the least square estimation (LSE), maximum likelihood estimation (MLE), and Cramér-von Mises (CVM) approach for P₁₀ at Ratnapark Station, Kathmandu. To assess the model’s validity, P-P plots and Q-Q plots are employed. Model comparisons are carried out using Akaike Information Criterion (AIC), Corrected Akaike Information Criterion (CAIC), Bayesian Information Criterion (BIC), and Hannan-Quinn Information Criterion (HQIC). Furthermore, the goodness of fit of the proposed model is evaluated using test statistics such as Anderson-Darling (A²) test, Cramér-von Mises (CVM) test, and the Kolmogorov-Smirnov (KS) test along with their respective p-values. From the findings, we have found that the air quality status of Kathmandu, Nepal, was found to be poor. Proposed distribution provides a better fit with greater flexibility for forecasting air quality data and conducting reliability data analyses. Dataset is analyzed and visualized using R programming.

PMID:38381289 | DOI:10.1007/s11356-024-32129-z

Int Urol Nephrol. 2024 Feb 21. doi: 10.1007/s11255-024-03958-1. Online ahead of print.

ABSTRACT

BACKGROUND: Hyperuricemia, hyperglycemia, hypertension, hyperlipidemia, and hyperhomocysteinemia are all established risk factors for chronic kidney disease (CKD), and their interplay could exacerbate CKD progression. This study aims to evaluate the potential mediation effects of hyperglycemia, hypertension, hyperlipidemia, and hyperhomocysteinemia on the association between hyperuricemia (HUA) and chronic kidney disease (CKD).

METHODS: We collected electronic medical record data from 2055 participants who underwent physical examinations at the Affiliated Hospital of Qingdao University. The data were utilized to investigate the mediating effect of various factors including systolic blood pressure (SBP), diastolic blood pressure (DBP), homocysteine (HCY), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), blood glucose (Glu), and hemoglobin A1c (HbA1c) on the relationship between HUA and CKD.

RESULTS: Upon adjusting for confounding variables, mediation analysis indicated that only HCY acted as a mediator in the HUA-CKD relationship (p value < 0.05), exhibiting a statistically significant mediation effect of 7.04%. However, after adjustment for multiple testing, none of these variables were statistically significant.

CONCLUSIONS: Considering the observed associations between hyperuricemia, hyperglycemia, hypertension, hyperlipidemia, and CKD, none of the factors of interest remained statistically significant after adjusting for multiple testing as potential mediators of hyperuricemia on CKD.

PMID:38381286 | DOI:10.1007/s11255-024-03958-1

Drugs Real World Outcomes. 2024 Feb 21. doi: 10.1007/s40801-023-00407-w. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with chronic thromboembolic pulmonary hypertension (CTEPH) in countries with limited resources have, to date, been poorly represented in registries.

OBJECTIVE: This work assesses the epidemiology, diagnosis, hemodynamic and functional parameters, and treatment of CTEPH in Russia, Kazakhstan, Turkey, Lebanon, and Saudi Arabia.

METHODS: A prospective, cohort, phase IV, observational registry with 3-year follow-up (n = 212) in patients aged ≥ 18 years diagnosed with CTEPH was created. Clinical, hemodynamic, and functional parameters were obtained at an initial visit, follow-up visits, and a final visit at the end of 3 years’ observation or end of follow-up. Data were recorded on electronic case report forms. Parameters evaluated included 6-minute walking distance (6MWD), use of pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), pulmonary hypertension (PH)-targeted therapy, and survival. All statistical analyses were exploratory and descriptive, and were performed in the overall population.

RESULTS: The most common symptoms were typical of those expected for CTEPH. Almost 90% of patients underwent right heart catheterization at diagnosis or initial study visit. In total, 66 patients (31%) underwent PEA before the initial visit; 95 patients (45%) were considered operable, 115 (54%) were inoperable, and two (1%) had no operability data. Only 26 patients (12%) had been assessed for BPA at their initial visit. PH-targeted therapy was documented at diagnosis for 77 patients (36%), most commonly a phosphodiesterase type 5 inhibitor (23%). Use of PH-targeted therapy increased to 142 patients (67%) at the initial visit, remaining similar after 3 years. Use of riociguat increased from 6% of patients at diagnosis to 38% at 3 years. Between baseline and end of observation, results for patients with paired data showed an increase in 6MWD. Survival at the end of observation was 88%.

CONCLUSIONS: These data highlight the current diagnosis and management of CTEPH in the participating countries. They show that early CTEPH diagnosis remains challenging, and use of off-label PH-targeted therapy is common.

CLINICALTRIALS: gov: NCT02637050; registered December 2015.

PMID:38381283 | DOI:10.1007/s40801-023-00407-w

Mol Cell Biochem. 2024 Feb 21. doi: 10.1007/s11010-024-04942-0. Online ahead of print.

ABSTRACT

The recognition of microthrombi in the heart microcirculation has recently emerged from studies in COVID-19 decedents. The present study investigated the ultrastructure of coronary microthrombi in heart failure (HF) due to cardiomyopathies that are unrelated to COVID-19 infection. In addition, we have investigated the role of von Willebrand factor (VWF) and PECAM-1 in microthrombus formation. We used electron microscopy to investigate the occurrence of microthrombi in patients with HF due to dilated (DCM, n = 7), inflammatory (MYO, n = 6) and ischemic (ICM, n = 7) cardiomyopathy and 4 control patients. VWF and PECAM-1 was studied by quantitative immunohistochemistry and Western blot. In comparison to control, the number of microthrombi was increased 7-9 times in HF. This was associated with a 3.5-fold increase in the number of Weibel-Palade bodies (WPb) in DCM and MYO compared to control. A fivefold increase in WPb in ICM was significantly different from control, DCM and MYO. In Western blot, VWF was increased twofold in DCM and MYO, and more than threefold in ICM. The difference between ICM and DCM and MYO was statistically significant. These results were confirmed by quantitative immunohistochemistry. Compared to control, PECAM-1 was by approximatively threefold increased in all groups of patients. This is the first study to demonstrate the occurrence of microthrombi in the failing human heart. The occurrence of microthrombi is associated with increased expression of VWF and the number of WPb, being more pronounced in ICM. These changes are likely not compensated by increases in PECAM-1 expression.

PMID:38381272 | DOI:10.1007/s11010-024-04942-0