Tag: statistics

Zhonghua Er Ke Za Zhi. 2023 Nov 2;61(11):989-994. doi: 10.3760/cma.j.cn112140-20230809-00094.

ABSTRACT

Objective: To explore the clinical and imaging features of acute encephalopathy with biphasic seizures and late reduced diffusion(AESD) in children. Methods: For the case series study, 21 children with AESD from Peking University First Hospital, Provincial Children’s Hospital Affiliated to Anhui Medical University, Children‘s Hospital of Fudan University, and Shanxi Children’s Hospital who were diagnosed and treated from October 2021 to July 2023 were selected. Clinical data were collected to summarize their clinical information, imaging, and laboratory tests, as well as treatment and prognostic characteristics. Descriptive statistical analysis was applicated. Results: Of the 21 cases with AESD, 11 were males and 10 were females, with the age of onset of 2 years and 6 months (1 year and 7 months, 3 years and 6 months). Of the 21 cases, 18 were typical cases with biphasic seizures. All typical cases had early seizures within 24 hours before or after fever onset. Among them, 16 cases had generalized seizures, 2 cases had focal seizures, and 7 cases reached the status epilepticus. Of the 21 cases, 3 atypical cases had late seizures in biphasic only. The late seizures in the 21 cases occurred on days 3 to 9. The types of late seizures included focal seizures in 12 cases, generalized seizures in 6 cases, and both focal and generalized seizures in 3 cases. Diffusion-weighted imaging (DWI) test on days 3 to 11 showed reduced diffusion of subcortical white matter which was named “bright tree sign” in all cases. The diffuse cerebral atrophy predominantly presented in the front-parietal-temporal lobes was found in 19 cases between day 12 and 3 months after the onset of the disease. Among 21 cases, 20 had been misdiagnosed as autoimmune encephalitis, central nervous system infection, febrile convulsions, posterior reversible encephalopathy syndrome, acute disseminated encephalomyelitis, and hemiconvulsion-hemiplegia-epilepsy syndrome. All the cases received high-dose gammaglobulin and methylprednisolone pulse therapy with poor therapeutic effect. By July 2023, 18 cases were under follow-up. Among them, 17 cases were left with varying degrees of neurologic sequelae, including 11 cases with post-encephalopathic epilepsy; 1 recovered completely. Conclusions: AESD is characterized by biphasic seizures clinically and “bright tree sign” on DWI images. Symptomatic and supportive treatments are recommended. The immunotherapy is ineffective. The prognosis of AESD is poor, with a high incidence of neurological sequelae and a low mortality.

PMID:37899338 | DOI:10.3760/cma.j.cn112140-20230809-00094

Zhonghua Er Ke Za Zhi. 2023 Nov 2;61(11):983-988. doi: 10.3760/cma.j.cn112140-20230731-00057.

ABSTRACT

Objective: To analyze the efficacy and safety of the sodium channel blockers (SCB) antiseizure medication in the treatment of focal epilepsy in infants under 6 months of age. Methods: This was a case series study. Infants with focal epilepsy with onset within 6 months of age and treated with SCB attending the Department of Neurology of Beijing Children’s Hospital from June 2016 to April 2022 were collected. The clinical data, auxiliary examinations, SCB application, efficacy, adverse reactions, and prognosis were analyzed retrospectively. Patients were grouped according to type of seizure and epileptic syndrome, age of onset and etiology. Chi square test and Fisher exact test were used to analyze the differences between groups statistically. Results: A total of 118 infants were enrolled, 65 males and 53 females, with an age of epilepsy onset of 56 (4, 114) days. Developmental and epileptic encephalopathy was diagnosed in 60 infants, 39 had self-limited neonatal and (or) infantile epilepsy, and 19 had non-syndromic focal epilepsy. Application of SCB: 106 used oxcarbazepine, 2 used lacosamide, 9 switched from oxcarbazepine to lacosamide or a combination of 2 SCB, and 1 used oxcarbazepine, lacosamide, and lamotrigine successively; oxcarbazepine was the first choice in 46 cases. The age at which SCB was applied was 103 (53, 144) days. The children were followed up for 6 months to 6 years. SCB was effective in 89 cases (75.4%), including 70 cases (59.3%) who achieved seizure freedom. The seizure-free rate was higher in the focal epilepsy only group than in the group with other seizure types (64.4% (65/101) vs. 4/17, χ²=9.99, P<0.05). The responder and seizure-free rates were all higher in the group with the onset age of >3-6 months than the group >1-3 months (84.4% (38/45) vs. 62.5% (20/32), 73.3% (33/45) vs. 46.9% (15/32), χ²=4.85 and 5.58, both P<0.05). With the exception of variants in the PRRT2 gene, those with variants in sodium or potassium channels had higher responder and seizure-free rates than those with variants in other genes(86.2% (25/29) vs. 45.5% (10/22), 62.1% (18/29) vs. 22.7% (5/22), χ²=9.65 and 7.82,both P<0.05). The most common adverse event was transient hyponatremia, which happened in 66 cases (55.9%). There were 9 cases of rash, which subsided in 6 cases after discontinuing oxcarbazepine and switching to lacosamide, and 7 cases of electrocardiogram abnormalities, which improved after withdrawing oxcarbazepine and changing to lacosamide in 1 case. Conclusion: SCB are effective and tolerable in the treatment of focal epilepsy in infants under 6 months of age, with better efficacy in patients with genetic variants of the sodium or potassium channel, focal seizures only, and seizure onset >3-6 months of age.

PMID:37899337 | DOI:10.3760/cma.j.cn112140-20230731-00057

Korean J Ophthalmol. 2023 Oct 25. doi: 10.3341/kjo.2023.0092. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate repeatability and agreemeny of chord mu between Scheimpflug tomography (Pentacam HR, Oculus Optikgeräte GmbH, Wetzlar, Germany) and swept-source optical coherence tomography-based optical biometer (IOLMaster 700, Carl Zeiss Meditec AG, Jena, Germany).

METHOD: In this retrospective study, 63 eyes of 33 patients were included. Chord mu, X, and Y Cartesian distances between the corneal vertex and the pupil center (Px and Py), and the pupil diameter were compared using two instruments. Repeatability was evaluated using intraclass correlation coefficient (ICC), coefficient of variation (CoV), and within-subject standard deviation (Sw). Inter-device agreement was evaluated using paired t-tests and Bland-Altman plots.

RESULTS: Although Sw values for all parameters were similar between the two devices, CoV values of chord mu and pupil diameter were lower, and ICC values of those parameters were higher, in the IOLMaster 700 than in the Pentacam HR. Chord mu and pupil diameter values were higher in IOLMaster 700 than Pentacam HR (p < 0.01). The width of the 95% limit of agreement was wide for all parameters.

CONCLUSION: IOLMaster 700 showed better repeatability than Pentacam HR in chord mu, Px, Py, and pupil diameter values. Because there were statistically significant differences and a low level of agreement in chord mu and pupil diameter values between the two devices, they cannot be used interchangeably.

PMID:37899279 | DOI:10.3341/kjo.2023.0092

Int J Epidemiol. 2023 Oct 28:dyad150. doi: 10.1093/ije/dyad150. Online ahead of print.

ABSTRACT

BACKGROUND: When estimating the effect of time-varying exposures on longer-term outcomes, the assumption of conditional exchangeability or no uncontrolled confounding extends beyond baseline confounding to include time-varying confounding. We illustrate the structures and magnitude of uncontrolled time-varying confounding in exposure effect estimates obtained from g-computation when sequential conditional exchangeability is violated.

METHODS: We used directed acyclic graphs (DAGs) to depict time-varying uncontrolled confounding. We performed simulations and used g-computation to quantify the effects of each time-varying exposure for each DAG type. Models adjusting all time-varying confounders were considered the true (bias-adjusted) estimate. The exclusion of time-varying uncontrolled confounders represented the biased effect estimate and an unmet ‘no uncontrolled confounding’ assumption. True and biased estimates were compared across DAGs, with different magnitudes of uncontrolled confounding.

RESULTS: Time-varying uncontrolled confounding can present in several scenarios, including relationships into subsequently measured exposure(s), outcome, unmeasured confounder(s) and other measured confounder(s). In simulations, effect estimates obtained from g-computation were more biased in DAGs when the uncontrolled confounders were directly related to the outcome. Complex DAGs that included relationships between uncontrolled confounders and other variables and relationships where exposures caused uncontrolled confounders at the next time point resulted in the most biased effect estimates. In these complex DAGs, excluding uncontrolled confounders affected the multiple effect estimates.

CONCLUSIONS: Time-varying uncontrolled confounding has the potential to substantially impact observed effect estimates. Given the importance of longitudinal studies in advising public health, the impact of time-varying uncontrolled confounding warrants more recognition and evaluation using quantitative bias analysis.

PMID:37898996 | DOI:10.1093/ije/dyad150

Arch Environ Contam Toxicol. 2023 Oct 29. doi: 10.1007/s00244-023-01035-9. Online ahead of print.

ABSTRACT

In 2018, the dietary exposure bioaccumulation fish test of the Organization for Economic Co-operation and Development Test Guideline No. 305 was introduced into Japan’s Chemical Substances Control Law. The Japanese government has adopted a single definitive testing criterion for the absence of high bioaccumulation: the growth-corrected kinetic dietary magnification factor (BMF_Kg) must be less than 0.007. The aim of this study was to decrease regulatory restrictions in order to increase newly developed chemical substances and their subsequent approval of their manufacture and import, i.e., the present study was motivated by concerns over the criterion being too restrictive, rather than scientific concerns, such as uncertainty in criterion. We used statistical post-processing to assess the possibility of expanding the criteria for not being highly bioaccumulative. Based on our results, we proposed the criterion that the test substance should be considered not highly bioaccumulative if the following two conditions are met: (1) The ratio of the maximum to the minimum measured 5% lipid-standardized biomagnification factor at the end of the uptake phase (BMF_5%, n = 5) for the test substance and reference substance should be less than 3.0, and (2) For the measured BMF_5% of the test substance (n = 5), the probability that the next (the sixth) BMF_5% is below 0.0334 should exceed 95% based on statistical post-processing. It is worth noting that the BMF_5% values should only be applied for non-ionizable lipid soluble compounds. Application of our suggested approach to Japan implies that the criterion for chemical substances that are not highly bioaccumulative in the dietary exposure bioaccumulation fish test would be increased from 0.007 to 0.0149.

PMID:37898995 | DOI:10.1007/s00244-023-01035-9

J Anesth. 2023 Oct 29. doi: 10.1007/s00540-023-03273-6. Online ahead of print.

ABSTRACT

PURPOSE: There are few reports regarding the association between the neutrophil-lymphocyte ratio (NLR), uric acid, and the development of postoperative delirium (POD) in patients who are undergoing spine surgeries. We investigated the associations between the NLR, uric acid as a natural antioxidant, and POD in elderly patients undergoing degenerative spine surgery.

PATIENTS AND METHODS: This was a single-center, observational, and retrospective study conducted in Japan. We enrolled 410 patients who underwent degenerative spine surgery. POD was diagnosed after the surgeries by psychiatrists, based on the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). We performed a multivariable logistic regression analysis to clarify whether the NLR and uric acid values were associated with the development of POD in the patients.

RESULTS: 129 of the 410 patients were excluded from the analysis. Of the 281 patients (137 females, 144 males), 32 patients (11.4%) were diagnosed with POD. The multivariable logistic regression analysis revealed that the preoperative uric acid level (adjusted odds ratio [aOR]: 0.67, 95% confidence interval [CI]: 0.49-0.90, p = 0.008) and age (aOR: 1.09, 95% CI: 1.02-1.16, p = 0.008) were significantly associated with POD. The preoperative NLR (aOR: 0.82, 95% CI: 0.60-1.13, p = 0.227) and antihyperuricemic medication (aOR: 0.97, 95% CI: 0.24-3.82, p = 0.959) were not significantly associated with POD.

CONCLUSION: Our results demonstrated that in elderly patients undergoing degenerative spine surgery, the preoperative NLR was not significantly associated with POD, but a lower preoperative uric acid value was an independent risk factor for developing POD. Uric acid could have a neuroprotective impact on POD in patients with degenerative spine diseases.

PMID:37898990 | DOI:10.1007/s00540-023-03273-6

J Med Imaging Radiat Oncol. 2023 Oct 29. doi: 10.1111/1754-9485.13592. Online ahead of print.

ABSTRACT

INTRODUCTION: Malignant pleural mesothelioma is difficult to prognosticate. F18-Fluorodeoxyglucose positron emission tomography (FDG PET) shows promise for response assessment but is confounded by talc pleurodesis. F18-Fluorothymidine (FLT) PET is an alternative tracer specific for proliferation. We compared the prognostic value of FDG and FLT PET and determined the influence of talc pleurodesis on these parameters.

METHODS: Overall, 29 prospectively recruited patients had FLT PET, FDG PET and CT-scans performed prior to and post one chemotherapy cycle; 10 had prior talc pleurodesis. Patients were followed for overall survival. CT response was assessed using mRECIST. Radiomic features were extracted using the MiM software platform. Changes in maximum SUV (SUVmax), mean SUV (SUVmean), FDG total lesion glycolysis (TLG), FLT total lesion proliferation (TLP) and metabolic tumour volume (MTV) after one chemotherapy cycle.

RESULTS: Cox univariate analysis demonstrated FDG PET radiomics were confounded by talc pleurodesis, and that percentage change in FLT MTV was predictive of overall survival. Cox multivariate analysis showed a 10% increase in FLT tumour volume corresponded with 9.5% worsened odds for overall survival (P = 0.028, HR = 1.095, 95% CI [1.010, 1.187]). No other variables were significant on multivariate analysis.

CONCLUSION: This is the first prospective study showing the statistical significance of FLT PET tumour volumes for measuring mesothelioma treatment response. FLT may be better than FDG for monitoring mesothelioma treatment response, which could help optimise mesothelioma treatment regimes.

PMID:37898984 | DOI:10.1111/1754-9485.13592

Int J Health Plann Manage. 2023 Oct 29. doi: 10.1002/hpm.3721. Online ahead of print.

ABSTRACT

OBJECTIVES: The COVID-19 pandemic has stretched Bangladesh government’s capability for disaster engagement. As normalcy is interrupted, people’s confidence in the government in ending the crisis needs evaluation, especially considering the past vaccination successes in Bangladesh and growing worldwide vaccine hesitancy amidst the COVID-19 misinfodemic. This study assessed the level of public life disruption due to the pandemic at the micro-level and how much impact it had on people’s trust in the government’s capacity for successful national immunisation.

METHODS: Given the infectious nature of the pandemic, the study conducted an online survey of 2291 respondents, distributed proportionally across sex and income groups. We conducted bivariate analyses and fitted generalised linear models to assess disruption to respondents’ lives, and their trust in the government’s immunisation ability, which were measured using multiple parameters.

RESULTS: Nearly 50% of the respondents reported multifaceted disputations in their daily lives, with 90% suffering financially. Trust in the government was very low at the time of the survey as only 11.3% of respondents had faith that the government could successfully conduct a mass vaccination campaign. Rural residents and non-earning members of families found their lives to be less disrupted. Comparatively higher income families and highly educated individuals had lesser confidence in the government’s inoculation capabilities.

CONCLUSIONS: For the vaccine campaign to be successful, effective risk communication and timely display of data-driven decision-making efforts targeting the groups who are more sceptical of immunisation campaigns could be of significance to the Bangladesh government.

PMID:37898969 | DOI:10.1002/hpm.3721

Int Urol Nephrol. 2023 Oct 29. doi: 10.1007/s11255-023-03843-3. Online ahead of print.

ABSTRACT

OBJECTIVE: This review aimed to assess the utility of urinary N-acetyl-β-D-glucosaminidase (uNAG) as a prognostic biomarker for nephropathy in patients with type 2 diabetes mellitus.

METHODS: The search for relevant studies was conducted across multiple databases, including PubMed (Medline), EMBASE, LILACS, CENTRAL, IBECS, and gray literature. We employed a random effects model to calculate the standardized mean difference and 95% confidence interval. Furthermore, we assessed heterogeneity using Cochrane’s Q test and Higgins’ I2 statistics.

RESULTS: This review included a total of 16 articles involving 1669 patients, with 13 being case-control studies and three being cohorts. The meta-analysis conducted across all studies revealed significant heterogeneity. However, subgroup analysis of four studies indicated that an increase in uNAG among normoalbuminuric patients was associated with the development of macroalbuminuria (DMP = – 1.47; 95% CI = – 1.98 to 0.95; p < 0.00001; I² = 45%). Conversely, it did not demonstrate effectiveness in predicting the development of microalbuminuria (DMP = 0.26; 95% CI = – 0.08 to 0.60; p = 0.13; I² = 17%).

CONCLUSIONS: Elevated uNAG levels in normoalbuminuric patients may indicate an increased risk for the development of macroalbuminuria, but not microalbuminuria. However, the high heterogeneity observed among the studies highlights the necessity for further research to validate these findings.

PMID:37898960 | DOI:10.1007/s11255-023-03843-3

Wiad Lek. 2023;76(9):2103-2111. doi: 10.36740/WLek202309129.

ABSTRACT

OBJECTIVE: The aim: The article examines the peculiarities of the Ukrainian state policy in the field of digitalization, reveals the social challenges caused by this phenom¬enon, and outlines the ways to overcome them.

PATIENTS AND METHODS: Materials and Methods: The data collection was carried out using PubMed, Scopus, Google Scholar databases. Research papers were identified according to the search terms: “digitalization”, “digital transformations”, “Internet”, “digital services”, “smart city”, “smart urbanization”, “inclusion”, “social exclusion”, “community mental health”, “volunteering”, “social partnership”. The authors analyzed international and domestic official strategies, programs, and messages along with statistical data and social surveys conducted by foreign and Ukrainian institutions, public organizations, and analytical centers. The authors used the interdisciplinary approach along with the principles of objectivity, tolerance, and impartiality, and general scientific methods, such as induction, deduction, generalization, etc.

CONCLUSION: Conclusion: The rapid spread of digital technologies is associated with the growth of social cohesion, inclusion, solidarity, and the development of a healthy harmonious society that will provide all the conditions for a decent life for a human being and the comprehensive development of his/her abilities and talents. These hopes are not groundless, because digitalization is accompanied by a number of structural shifts in economics and public administration, which contribute to overcoming subjectivity in making management decisions and increasing the level of “intellectualization” of the environment. In addition, digitalization is becoming a significant driver of the sustainable growth in labor productivity, employment levels, personal and social well-being; and the spread of digital technologies provides an opportunity to overcome various social challenges. As the Ukrainian experience reveals, despite a number of positive shifts, digitalization can also give rise to destructive social trends, among which the digital gaps caused by the uneven access to digital technologies and services occupy a special place. People in the city outskirts, small towns, and especially in the remote rural areas often have extremely limited access to the Internet that significantly reduces their social opportunities. These problems became more acute after the full-scale invasion of the russian federation into Ukraine. The occupation of the part of Ukraine, hostilities, and missile attacks damaged the energy sector blocking telecommunication networks, which led to the social exclusion of a significant part of the population in some Ukrainian regions. The harsh living conditions during the war, the social exclusion as a result of the occupation, as well as the destruction of energy infrastructure and civilian objects fueled the activities of the Ministry of Digital Transformation of Ukraine. The proposed services and transformations provided social opportunities for a part of the population, while remaining unable to overcome social exclusion generated by the digital, social, or other gap. Volunteers and social activists usually help to bridge the gap and maintain mental health of the community, which has been suffering from the horrors of the war for more than a year. Their activities and public position lay the ground for the establishment of social partnership aimed at the harmonious development of every individual and the community as a whole.

PMID:37898951 | DOI:10.36740/WLek202309129