Tag: statistics

J Cancer Res Ther. 2023 Dec 15. doi: 10.4103/jcrt.jcrt_7_23. Online ahead of print.

ABSTRACT

BACKGROUND: Esophageal cancer (EC) is an extremely aggressive tumor with one of the highest geographic, ethnic, and gender variations. Various factors including tobacco consumption, unhealthy diet, and socioeconomic status have been implicated in the etiology of EC. Despite the advent of modern treatments, the prognosis of EC is dismal. This study has been undertaken to review the clinical and pathologic profiles, treatment approach, and survival pattern in patients with EC in a tertiary care hospital in northeast India.

MATERIALS AND METHODS: A retrospective descriptive study was done with 179 EC patients presented to our department between January 2013 and December 2020. Statistical analysis was done by using IBM Statistical Package for the Social Sciences version 21. P- value <0.05 was considered significant.

RESULTS: The majority of the patients presented in the sixth decade of life from rural areas with male to female ratio of 3.7:1. Dysphagia was the most common presenting feature. High incidence of tobacco and alcohol use was found. Mid-esophagus is the most common site and squamous cell carcinoma is the most common type. Fifty-two (29.1%) and 71 (39.6%) patients presented in stages III and IV, respectively. Twenty-four (13.4%) patients presented with metastatic disease, the lung being the most common site. Patients were treated with surgery, chemotherapy, radiotherapy, or combination of any of these. Overall median survival for the EC patients was 6 months. Patients treated with concurrent chemoradiation had better survival.

CONCLUSION: EC is a serious malignancy with a dismal prognosis due to the advanced stage at presentation. Larger clinical trials using new therapeutic strategies are the need of the hour.

PMID:38102907 | DOI:10.4103/jcrt.jcrt_7_23

J Cancer Res Ther. 2023 Dec 15. doi: 10.4103/jcrt.jcrt_2377_22. Online ahead of print.

ABSTRACT

BACKGROUND: Reports suggested that hormone replacement therapy decreased the incidence of squamous cell carcinoma (SCC) of the oral cavity.

AIM: The aim of this study was to analyze and quantify the serum 17β-estradiol (E2) level by chemiluminescence immunoassay in four groups, Group I (control group with no habit of tobacco and areca), Group II (control group with a habit of tobacco and areca), Group III (potentially malignant disorder-leukoplakia), and Group IV (oral squamous cell carcinoma (OSCC)). It was the first study to evaluate E2 in four study groups with and without the habit of tobacco.

METHOD: The serum analysis was carried out in Cobas e411 analyzer by electrochemiluminescence immunoassay analysis.

RESULTS: As per the Kruskal–Wallis test, statistically significant rise in estradiol levels in Group IV as in comparison to Group III as compared with Groups II and I.

CONCLUSION: This study proved that irrespective of the gender bias, the female sex hormone, estradiol levels were significantly raised in OSCC patients. This study suggests that E2 may play a vital role in determining the patient prognosis in OSCC with tobacco habit. The confounding results of this preliminary study opened up new advents emphasizing the role of E2 in OSCC. The role of E2 in estrogen receptor regulation can also be a subject of study for targeted therapies in improving the patient’s prognosis.

PMID:38102904 | DOI:10.4103/jcrt.jcrt_2377_22

J Environ Manage. 2023 Dec 14;351:119764. doi: 10.1016/j.jenvman.2023.119764. Online ahead of print.

ABSTRACT

Indoor air, especially with suspended particulate matter (PM), can be a carrier of airborne infectious pathogens. Without sufficient ventilation, airborne infectious diseases can be transmitted from one person to another. Indoor air quality (IAQ) significantly impacts people’s daily lives as people spend 90% of their time indoors. An industrial-grade air cleaner prototype (filtration + ultraviolet light) was previously upgraded to clean indoor air to improve IAQ on two metrics: particulate matter (PM) and viable airborne bacteria. Previous experiments were conducted to test its removal efficiency on PM and airborne bacteria between the inlet and treated air. However, the longer-term improvement on IAQ would be more informative. Therefore, this research focused on quantifying longer-term improvement in a testing environment (poultry facility) loaded with high and variable PM and airborne bacteria concentrations. A 25-day experiment was conducted to treat indoor air using an air cleaner prototype with intermittent ON and OFF days in which PM and viable airborne bacteria were measured to quantify the treatment effect. The results showed an average of 55% reduction of total suspended particulate (TSP) concentration between OFF days (110 μg/m³) and ON days (49 μg/m³). An average of 47% reduction of total airborne viable bacteria concentrations was achieved between OFF days (∼3200 CFU/m³) and ON days (∼2000 CFU/m³). A cross-validation (CV) model was established to predict PM concentrations with five input variables, including the status of the air cleaner, time (h), ambient temperature, indoor relative humidity, and day of the week to help simulate the air-cleaning effect of this prototype. The model can approximately predict the air quality trend, and future improvements may be made to improve its accuracy.

PMID:38100867 | DOI:10.1016/j.jenvman.2023.119764

J Environ Manage. 2023 Dec 14;351:119807. doi: 10.1016/j.jenvman.2023.119807. Online ahead of print.

ABSTRACT

Accurate prediction of the dissolved oxygen level (DOL) is important for enhancing environmental conditions and facilitating water resource management. However, the irregularity and volatility inherent in DOL pose significant challenges to achieving precise forecasts. A single model usually suffers from low prediction accuracy, narrow application range, and difficult data acquisition. This study proposes a new weighted model that avoids these problems, which could increase the prediction accuracy of the DOL. The weighting constructs of the proposed model (PWM) included eight neural networks and one statistical method and utilized Young’s double-slit experimental optimizer as an intelligent weighting tool. To evaluate the effectiveness of PWM, simulations were conducted using real-world data acquired from the Tualatin River Basin in Oregon, United States. Empirical findings unequivocally demonstrated that PWM outperforms both the statistical model and the individual machine learning models, and has the lowest mean absolute percentage error among all the weighted models. Based on two real datasets, the PWM can averagely obtain the mean absolute percentage errors of 1.0216%, 1.4630%, and 1.7087% for one-, two-, and three-step predictions, respectively. This study shows that the PWM can effectively integrate the distinctive merits of deep learning methods, neural networks, and statistical models, thereby increasing forecasting accuracy and providing indispensable technical support for the sustainable development of regional water environments.

PMID:38100864 | DOI:10.1016/j.jenvman.2023.119807

J Environ Manage. 2023 Dec 14;351:119782. doi: 10.1016/j.jenvman.2023.119782. Online ahead of print.

ABSTRACT

Climate change has intensified the effects of habitat fragmentation in many ecosystems, particularly exacerbated in riparian habitats. Therefore, there is an urgent need to identify keystone connectivity spots to ensure long-term conservation and sustainable management of riparian systems as they play a crucial role for landscape connectivity. This paper aims to identify critical areas for connectivity under two contrasting climate change scenarios (RCP 4.5 and RCP 8.5 models) for the years 2030, 2050 and 2100 and to group these critical areas by similar connectivity in keystone spots for sustainable management. A set of analyses comprising climate analysis, drainage network analysis, configuration of potential riparian habitats, riparian habitat connectivity, data clustering, and statistical analysis within a Spanish river basin (NW Spain) were applied. The node and link connectivity would be reduced under the two climate change scenarios (≈2.5 % and 4.4 % reduction, respectively), intensifying riparian habitat fragmentation. Furthermore, 51 different clusters (critical areas) were obtained and classified in five classes (keystone spots) with similar connectivity across the different scenarios of climate change. Each keystone spot obtained by hierarchical classification was associated with one or more climate scenarios. One of these keystone spots was especially susceptible to the worst climate change scenario. Key riparian connectivity spots will be crucial for the management and restoration of highly threatened riparian systems and to ensure long-term biodiversity conservation.

PMID:38100859 | DOI:10.1016/j.jenvman.2023.119782

J Acquir Immune Defic Syndr. 2023 Dec 14. doi: 10.1097/QAI.0000000000003362. Online ahead of print.

ABSTRACT

BACKGROUND: This study examined the relationships among adiposity, handgrip, physical function, inflammation (i.e., senescence-associated secretory phenotype [SASP] chemokines as biomarkers of aging and frailty), and sex hormones in aging people with HIV (PWH).

METHODS: This cross-sectional exploratory study included 150 PWH aged ≥40 years (67.3% of participants were males). Our measures included: 1) body mass index (BMI) and waist circumference as measures of adiposity; 2) handgrip as a measure of muscle strength; 3) Short Physical Performance Battery as a measure of physical function; 4) interleukin-6, tumor necrosis factor alpha receptor II (TNFRII), high sensitivity C-reactive protein (hsCRP), C-X-C motif chemokine 10 (CXCL10), and C-X3-C motif chemokine ligand 1 aka fractalkine as SASP chemokines; and 5) free testosterone, estradiol, sex hormone binding globulin, and dehydroepiandrosterone (DHEA) as sex hormones. Quantile regression analyses were used to identify relationships among inflammatory markers and hormones with age, adiposity, handgrip, and physical function.

RESULTS: 74% (n=111) of participants were classified as overweight or obese and 53.3% (n=80) presented with abdominal obesity. After controlling for age and sex, BMI was positively associated with estradiol (β=0.043, p<0.01), and waist circumference was positively associated with hsCRP (β=2.151, p<0.01). After controlling for sex, age was positively associated with CXCL10 (β=0.024, p=0.03) and TNFRII (β=2.205, p=0.01). After controlling for age and sex, SPPB was negatively associated with DHEA (β=-0.004, p=0.01); no statistically significant associations were observed for handgrip.

CONCLUSION: Adiposity levels and aging were associated with inflammation (i.e., CXCL10, TNFRII, and hsCRP) among PWH aged 40 years and older.

PMID:38100820 | DOI:10.1097/QAI.0000000000003362

Anesth Analg. 2024 Jan 1;138(1):123-133. doi: 10.1213/ANE.0000000000006734. Epub 2023 Dec 15.

ABSTRACT

BACKGROUND: Guidelines for the evaluation and grading of diastolic dysfunction are available for transthoracic echocardiography (TTE). Transesophageal echocardiography (TEE) is used for this purpose intraoperatively but the level of agreement between these 2 imaging modalities for grading diastolic dysfunction is unknown. We assessed agreement between awake preoperative TTE and intraoperative TEE for grading diastolic dysfunction.

METHODS: In 98 patients undergoing cardiac surgery, key Doppler measurements were obtained using TTE and TEE at the following time points: TTE before anesthesia induction (TTEawake), TTE following anesthesia induction (TTEanesth), and TEE following anesthesia induction (TEEanesth). The primary endpoint was grade of diastolic dysfunction categorized by a simplified algorithm, and measured by TTEawake and TEEanesth, for which the weighted κ statistic assessed observed agreement beyond chance. Secondary endpoints were peak early diastolic lateral mitral annular tissue velocity (e’lat) and the ratio of peak early diastolic mitral inflow velocity (E) to e’lat (E/e’lat), measured by TTEawake and TEEanesth, were compared using Bland-Altman limits of agreement.

RESULTS: Disagreement in grading diastolic dysfunction by ≥1 grade occurred in 43 (54%) of 79 patients and by ≥2 grades in 8 (10%) patients with paired measurements for analysis, yielding a weighted κ of 0.35 (95% confidence interval [CI], 0.19-0.51) for the observed level of agreement beyond chance. Bland-Altman analysis of paired data for e’lat and E/e’lat demonstrated a mean difference (95% CI) of 0.51 (-0.06 to 1.09) and 0.70 (0.07-1.34), respectively, for measurements made by TTEawake compared to TEEanesth. The percentage (95% CI) of paired measurements for e’lat and E/e’lat that lay outside the [-2, +2] study-specified boundary of acceptable agreement was 36% (27%-48%) and 39% (29%-51%), respectively. Results were generally robust to sensitivity analyses, including comparing measurements between TTEawake and TTEanesth, between TTEanesth and TEEanesth, and after regrading diastolic dysfunction by the American Society of Echocardiography (ASE)/European Association of CardioVascular Imaging (EACVI) algorithm.

CONCLUSIONS: There was poor agreement between TTEawake and TEEanesth for grading diastolic dysfunction by a simplified algorithm, with disagreement by ≥1 grade in 54% and by ≥2 grades in 10% of the evaluable cohort. Future studies, including comparing the prognostic utility of TTEawake and TEEanesth for clinically important adverse outcomes that may be a consequence of diastolic dysfunction, are needed to understand whether this disagreement reflects random variability in Doppler variables, misclassification by the changed technique and physiological conditions of intraoperative TEE, or the accurate detection of a clinically relevant change in diastolic dysfunction.

PMID:38100804 | DOI:10.1213/ANE.0000000000006734

Sex Transm Dis. 2023 Dec 13. doi: 10.1097/OLQ.0000000000001909. Online ahead of print.

ABSTRACT

BACKGROUND: The United States has seen a significant rise in syphilis over the past twenty years with a disparate impact on American Indian communities. We conducted a thorough review of the local epidemiology that guided an innovative response to curb the epidemic.

METHODS: We analyzed syphilis data from a hospital in rural Arizona that serves an American Indian population of over 18,000. Testing data was extracted from 2017-2023 with detailed chart reviews of all reactive results since January 2022. Descriptive and comparative statistics were computed using parametric and non-parametric methods where appropriate.

RESULTS: Among 5,888 tested persons, 555 (9.4%) had reactive results and 277 (4.7%) represented new infections. Among new cases, 151 (54.5%) were female and 55 (19.9%) were reinfections. The annualized incidence rate was 10.0 cases per 1000 persons with peak annualized incidence among women ages 30-34 years of 22.6 infections per 1000 persons. During the observation period and after the implementation of programmatic changes in June 2022, there were statistically significant reductions in median time to treatment (-80%), test positivity (-70%), infections (-60%) and no congenital syphilis cases during the observation period.

CONCLUSIONS: We observed significantly elevated syphilis rates in AI/AN persons compared to the general population. Strategic implementation of new policies and practices led to a measurable and meaningful improvement in several epidemic variables and our experience may serve as a model to other communities.

PMID:38100793 | DOI:10.1097/OLQ.0000000000001909

J Neurosurg Spine. 2023 Dec 15:1-8. doi: 10.3171/2023.10.SPINE23806. Online ahead of print.

ABSTRACT

OBJECTIVE: Since its introduction, electrocautery has served as a valuable surgical tool, enabling precise tissue cutting and effective hemostasis in spine surgery. While there have been numerous efforts to elucidate the possible hazardous effects of surgical smoke in various surgical fields, there has been very little discussion in the context of spine surgery. The objective of this study was to measure and conduct a quantitative analysis of the particulate matter (PM) of different sizes and of formaldehyde (HCHO) generated by smoke during spine surgeries.

METHODS: This study included a consecutive series of patients who underwent 1- or 2-level lumbar spinal fusion surgery between June and November 2021. Particle counts were measured using a particle counter, specifically focusing on six different sizes of PM (0.3, 0.5, 1, 2.5, 5, and 10 µm). Additionally, measurements were taken for HCHO in parts per million (ppm). Monopolar cautery was used in the surgical setting. Systematic measurements were conducted at specific time points during the surgical procedures to assess the levels of PM and HCHO. Furthermore, the efficacy of surgical smoke suction was evaluated by comparing the PM levels with and without adjacent placement of suction.

RESULTS: This study involved 35 patients, with measurements of both PM and HCHO taken in 27 cases. The remaining 8 cases had measurements only for PM. In this study, statistically significant quantitative changes in various PM sizes were observed when electrocautery was used during spine surgery (12.3 ± 1.7 vs 1975.7 ± 422.8, 3.4 ± 0.5 vs 250.1 ± 45.7, and 1.9 ± 0.2 vs 78.1 ± 13.3, respectively, for 2.5-, 5-, and 10-µm PM; p < 0.05). The level of HCHO was also significantly higher (0.085 ± 0.006 vs 0.131 ± 0.014 ppm, p < 0.05) with electrocautery use. Utilization of adjacent suction of surgical smoke during electrocautery demonstrated a statistically significant reduction in PM levels.

CONCLUSIONS: The findings of this study highlight the potential surgical smoke-related hazards that spine surgeons may be exposed to in the operating room. Implementing simple interventions, such as utilizing nearby suction, can effectively minimize the amount of toxic surgical smoke and mitigate these risks.

PMID:38100756 | DOI:10.3171/2023.10.SPINE23806

J Neurosurg Pediatr. 2023 Dec 15:1-12. doi: 10.3171/2023.10.PEDS23174. Online ahead of print.

ABSTRACT

OBJECTIVE: Abdominal CSF pseudocysts are an uncommon but challenging complication of ventriculoperitoneal shunts. Pseudocysts consist of a loculated intraperitoneal compartment that inadequately absorbs CSF and may be infected or sterile at diagnosis. The treatment goal is to clear infection if present, reduce inflammation, and reestablish long-term function in an absorptive (intraperitoneal) space. This aim of this paper was to study the efficacy of primary laparoscopic repositioning of the distal shunt catheter for treatment of sterile abdominal CSF pseudocysts.

METHODS: All patients treated for abdominal CSF pseudocysts at Dallas Children’s Health from 1991 to 2021 were retrospectively reviewed. Patient history and pseudocyst characteristics were analyzed, with a primary outcome of pseudocyst recurrence at 1 year.

RESULTS: Of 92 primary pseudocysts, 5 initial treatment strategies (groups) were used depending on culture status, clinical history, and surgeon preference: 1) shunt explant/external ventricular drain (EVD) placement (23/92), 2) distal tubing externalization (13/92), 3) laparoscopic repositioning (35/92), 4) open repositioning (4/92), and 5) other methods such as pseudocyst drainage or direct revision to another terminus (17/92). Seventy pseudocysts underwent shunt reimplantation in the peritoneal space. The 1-year peritoneal shunt survival for groups 1 and 2 combined was 90%, and 62% for group 3. In group 3, 1-year survival was better for those with normal systemic inflammatory markers (100%) than for those with high markers (47%) (p = 0.042). In a univariate Cox proportional hazards model, the risk of pseudocyst recurrence was increased if the most recent abdominal procedure was a nonshunt abdominal surgery (p = 0.012), and it approached statistical significance with male sex (p = 0.054) and elevated inflammatory markers (p = 0.056. Multivariate Cox analysis suggested increased recurrence risk with male sex (p = 0.05) and elevated inflammatory markers (p = 0.06), although the statistical significance threshold was not reached. The length of hospital stay was shorter for laparoscopic repositioning (6 days) than for explantation/EVD placement (21 days) (p < 0.0001). Ultimately, 62% of patients had a peritoneal terminus at the last follow-up, 33% (n = 30) had an extraperitoneal terminus (19 pleura, 8 right heart, and 3 gallbladder), and 5 patients were shunt free.

CONCLUSIONS: Some sterile pseudocysts with normal systemic inflammatory markers can be effectively treated with laparoscopic repositioning, resulting in a significantly shorter hospitalization and modestly higher recurrence rate than shunt explantation.

PMID:38100755 | DOI:10.3171/2023.10.PEDS23174