Categories
Nevin Manimala Statistics

Vitamin B12 and Folate as Risk Factors for Retinal Vein Occlusion: A Meta-Analysis

Klin Monbl Augenheilkd. 2021 May 17. doi: 10.1055/a-1473-5897. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the association between serum vitamin B12/folate and retinal vein occlusion (RVO).

METHODS: A comprehensive search of the PubMed database was performed, which identified 271 abstracts to be screened. Ten studies met our inclusion criteria and a meta-analysis of these comparative case-control studies was performed on the mean ± standard deviation serum vitamin B12 and folate levels, without language restrictions. Nine studies with 720 patients with RVO and 613 controls were included in the meta-analysis for vitamin B12, and 10 studies with 784 patients with RVO and 677 controls in the meta-analysis for folate.

RESULTS: There was no statistically significant difference between patients with RVO and controls in serum vitamin B12 levels (mean difference: – 40.25 pg/mL, p = 0.28), either central RVO (mean difference: – 18.24 pg/mL, p = 0.71) or branch RVO (mean difference: – 23.56 pg/mL, p = 0.48). On the contrary, the plasma folate level was significantly lower in RVO patients than in controls (mean difference: – 1.34 ng/mL, p = 0.001), as well as in patients with CRVO compared to controls (mean difference: – 1.48 ng/mL, p = 0.006), but not in BRVO patients (mean difference: – 0.72 ng/mL, p = 0.11).

CONCLUSIONS: RVO is associated with low serum folate levels, but not with serum vitamin B12 levels.

PMID:34000749 | DOI:10.1055/a-1473-5897

Categories
Nevin Manimala Statistics

The Oxygen Saturation in the Retinal Vessels of Patients with Diabetes Mellitus – The Search for Determinants

Klin Monbl Augenheilkd. 2021 May 17. doi: 10.1055/a-1384-0737. Online ahead of print.

ABSTRACT

INTRODUCTION: Oxygen saturation in retinal vessels can be non-invasively measured by a new method. It is known that oxygen extraction is lowered in diabetic retinopathy. In the cross-sectional study presented here, it has been investigated whether diabetes-specific changes and typical accompanying diseases could influence the measurements in oximetry.

METHODS: During a time span of seven months, 237 diabetics were included who came to our clinic for an intravitreal injection, who met the inclusion criteria, who showed no exclusion criteria and gave written consent. 203 eyes of 203 patients were evaluated. The oxygen saturation (SO2) was measured in digitally stored fundus images taken with a fundus camera (Zeiss 450 FF). In its illumination beam, a filter was inserted with two transmission maxima at 584 nm and 610 nm (bandwidth 10 nm). With the program “Oximetry” (Imedos Systems, Jena, Germany), the venous and the arterial SO2 were measured. The values were stored in a spreadsheet. Diabetes related data, clinical parameters and accompanying diseases were documented in the predefined scheme.

RESULTS: In the whole patient sample, the venous oxygen saturation (vSO2) was 69 ± 12%, the arterial saturation (aSO2) 99 ± 5% and the arteriovenous difference 31 ± 9%. A statistically significant association could not be found between the measurement values of oximetry and age, duration of diabetes and HbA1c (Kruskal-Wallis ANOVA: p > 0.05). The differences in oximetry values between units of analysis (UOA) e.g. hypertension and non units of analysis (NOA) were analysed. Descriptive testing showed significant differences in vSO2% in the following units of analysis: allergies n = 47: UOA vs. NUOA: 64 vs. 69 (t test: p < 0.02); sartan therapy n = 46: UOA vs. NUOA: 64 vs. 70 (p = 0.003); state after intravitreal injections n = 144: 68 vs. 71 (p = 0.02). Oxygen extraction from the retinal capillaries was improved in patients who had injections with VEGF inhibitors. An improvement in oxygen extraction is also seen in patients with allergies and hypertension in comparison to those without these units of analysis.

CONCLUSION: The clinically observed improvement in the retinal state situation after intravitreal injections with VEGF inhibitors may be seen in association with the improved oxygen extraction. It seems reasonable to study whether a switch to sartans in the therapy of hypertension may improve retinal function.

PMID:34000750 | DOI:10.1055/a-1384-0737

Categories
Nevin Manimala Statistics

Influence of Mitomycin C on the Therapeutic Success of Stand-Alone Xen45 Gel Stents and Its Combination with Cataract Surgery in Open-Angle Glaucoma Patients

Klin Monbl Augenheilkd. 2021 May 17. doi: 10.1055/a-1384-1020. Online ahead of print.

ABSTRACT

PURPOSE: Minimally invasive glaucoma surgery (MIGS), like Xen45 gel stents, is known as effective therapy in lowering intraocular pressure (IOP); however, fibrotic reactions are a common problem in postoperative management. It was the aim of this study to investigate the therapeutic success of Xen45 gel stents as a stand-alone technique (Xen) and combined with cataract surgery (XenPhaco), and with antimetabolites (mitomycin C, MMC) in open-angle glaucoma patients.

METHODS: Retrospective analysis was performed of 199 eyes of 177 glaucoma patients of the Department of Ophthalmology, University of Erlangen Nürnberg, and from the Erlangen Glaucoma Registry (NCT00494923; ISSN 2191-5008, CS-2011) who underwent implantation of a Xen45 gel stent. Therapeutic success was defined as IOP reduction of ≥ 20% on the same or less anti-glaucomatous medication after 12 months compared to preoperative and without any additional glaucoma-related surgery (except bleb needling). IOP reduction, reduction in local anti-glaucomatous eye drops, and intra- and postoperative complications were monitored.

RESULTS: Stand-alone Xen45 gel stent: therapeutic success was reached in 39% (-MMC) and 55% (+MMC). Failure rate was 61% (-MMC) and 45% (+MMC). XenPhaco: therapeutic success was achieved in 57% (-MMC) and 46% (+MMC). Failure rate was 43% (-MMC) and 54% (+MMC). Data were not different for group and subgroup analyses (p > 0.05).

CONCLUSIONS: The use of MMC seemed to increase the therapeutic success rate after stand-alone Xen45 gel stent implantation and combined with cataract surgery, yet statistical significant was not reached.

PMID:34000747 | DOI:10.1055/a-1384-1020

Categories
Nevin Manimala Statistics

Reflection on modern methods: good practices for applied statistical learning in epidemiology

Int J Epidemiol. 2021 May 17;50(2):685-693. doi: 10.1093/ije/dyaa259.

ABSTRACT

Statistical learning includes methods that extract knowledge from complex data. Statistical learning methods beyond generalized linear models, such as shrinkage methods or kernel smoothing methods, are being increasingly implemented in public health research and epidemiology because they can perform better in instances with complex or high-dimensional data-settings in which traditional statistical methods fail. These novel methods, however, often include random sampling which may induce variability in results. Best practices in data science can help to ensure robustness. As a case study, we included four statistical learning models that have been applied previously to analyze the relationship between environmental mixtures and health outcomes. We ran each model across 100 initializing values for random number generation, or ‘seeds’, and assessed variability in resulting estimation and inference. All methods exhibited some seed-dependent variability in results. The degree of variability differed across methods and exposure of interest. Any statistical learning method reliant on a random seed will exhibit some degree of seed sensitivity. We recommend that researchers repeat their analysis with various seeds as a sensitivity analysis when implementing these methods to enhance interpretability and robustness of results.

PMID:34000733 | DOI:10.1093/ije/dyaa259

Categories
Nevin Manimala Statistics

Impact of Pre- and Intraoperative Factors on Endothelial Cell Density in the Early and Late Stage after Penetrating Keratoplasty

Klin Monbl Augenheilkd. 2021 May 17. doi: 10.1055/a-1333-2723. Online ahead of print.

ABSTRACT

AIM: This retrospective investigated the impact of donor age, recipient age, donor endothelial cell density, vis-à-tergo, and additional intraoperative lens exchange (triple-procedure) on overall early and late phase postoperative endothelial cell density (ECD) following penetrating keratoplasty (PKP) in various diagnosis groups.

PATIENTS AND METHODS: In 590 cases with diagnosed keratoconus (KC), Fuchs dystrophy (FD) and herpes simplex virus infection (HSV) who underwent PKP or triple surgery, the ECD in cells/mm2 was analysed, both preoperatively, with all-sutures-in (early postoperative stage), and after last suture removal. The factors were tested by Mann-Whitney U-test, correlation analysis and linear regression analysis.

OUTCOME: Correlation analysis demonstrated a weak negative correlation between the patient’s ECD and donor age (early postoperative stage: r = – 0.25, p < 0.001; after last suture removal: r = – 0.16; p = 0.003). Regression analysis revealed that donor age did not impact postoperative patient ECD. There was a weak negative correlation between postoperative ECD and recipient age (early postoperative stage: r = – 0.31, p < 0.001; after last suture removal: r = – 0.34, p < 0.001). Regression analysis confirmed the negative impact of recipient age on patient ECD (early postoperative stage: β = – 13.2, p = 0.001; after last suture removal: β = – 4.6, p < 0.001). Correlation analysis determined a weak positive correlation between postoperative ECD and donor endothelial cell density (early postoperative stage: r = 0.37, p < 0.001; after last suture removal: r = 0.32, p < 0.001). Regression analysis also determined that donor endothelial cell density had a positive impact on postoperative ECD following last suture removal (β = 0.4, p < 0.001). Vis-à-tergo and additional lens exchange (triple procedure) had no significant effect on postoperative ECD (p > 0.05). This was also confirmed by the results of the regression analysis after last suture removal.

CONCLUSION: Recipient age and donor endothelial cell density have a significant impact on postoperative ECD following PKP. Not all of the statistical tests proved donor age to be a significant influencing factor. Vis-à-tergo and additional lens exchange (triple procedure) had no significant effect on postoperative ECD following PKP.

PMID:34000746 | DOI:10.1055/a-1333-2723

Categories
Nevin Manimala Statistics

Using structural equation modeling to predict Indian people’s attitudes and intentions towards COVID-19 vaccination

Diabetes Metab Syndr. 2021 May 8;15(3):1017-1022. doi: 10.1016/j.dsx.2021.05.006. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: Understanding people’s attitudes towards Covid-19 vaccination is crucial to the successful implementation of a vaccination program. Hence this research study seeks to identify critical factors influencing Indian people’s attitudes and intentions to take up Covid-19 vaccinations.

METHODS: An online questionnaire was administered to a sample (n = 254) drawn from Indian population, to assess the impact of perceived benefits, risk perceptions, social media exposure, social norms, and trust associated with Covid-19 vaccines on people’s attitudes towards Covid-19 vaccines and their intentions to take up the Covid-19 vaccinations.

RESULTS: The findings showed that the perceived benefits, social norms, and trust correlated significantly with people’s attitudes towards Covid-19 vaccinations. In contrast, risk perceptions and social media exposure showed an insignificant influence on people’s attitudes towards Covid-19 vaccinations. Social norms, trust, and people’s attitudes towards the Covid-19 vaccinations are significantly correlated with their intentions to take up Covid-19 vaccinations. On the contrary, social media exposure was found to have an insignificant influence on people’s intentions to take up Covid-19 vaccinations.

CONCLUSION: Participants’ intentions to take up Covid-19 vaccinations was influenced mainly by their attitudes and perceptions of Covid-19 vaccines in general, which strongly confirms the importance of various dimensions (perceived benefits, trust, social norms) of Covid-19 vaccines in cultivating Covid-19 vaccination acceptance among participants’.

PMID:34000711 | DOI:10.1016/j.dsx.2021.05.006

Categories
Nevin Manimala Statistics

The Role of Nasal Endoscopy in Allergic Rhinitis and House Dust Mite Sublingual Immunotherapy

Int Arch Allergy Immunol. 2021 May 17:1-7. doi: 10.1159/000513810. Online ahead of print.

ABSTRACT

INTRODUCTION: While there exists considerable evidence for efficacy of sublingual immunotherapy (SLIT), its impact on the improvement of nasal signs in allergic rhinitis (AR) patients remains quite unclear. In this study, the endoscopic examination and the modified Lund-Kennedy (MLK) scoring system were performed to describe and evaluate the therapeutic effect of SLIT.

METHODS: A total of 105 patients with AR induced by house dust mites were enrolled and treated with standardized Dermatophagoides farinae (D. farinae) drops for 1 year. The total nasal symptoms score (TNSS), total medication score (TMS), visual analog scale (VAS), and MLK scores were assessed at baseline and 6 and 12 months. The MLK score was also compared for its correlation with TNSS, TMS, and VAS.

RESULTS: The TNSS, TMS, and VAS scores statistically decreased after SLIT compared to baseline (all p < 0.05). After 12 months of treatment, the rates of well-controlled, partial controlled, and uncontrolled AR patients were 42, 49.5, and 8.5%, respectively. The nasal endoscopy findings showed significant improvement in nasal signs, which mainly included color change of turbinate mucosa, reduction of nasal secretions, and improvement of nasal edema. A significant decrease was observed in MLK scores, and there was a positive correlation between MLK and VAS scores.

CONCLUSIONS: In addition to commonly utilized subjective assessments (TMS, TNSS, and VAS), our results of endoscopic examination and the MLK scores consistently confirmed that SLIT is an effective therapeutic modality for AR patients. The MLK scores might be considered as an auxiliary tool to evaluate efficacy of SLIT in clinical practice and outcomes research.

PMID:34000723 | DOI:10.1159/000513810

Categories
Nevin Manimala Statistics

Clinical Outcomes of 2nd- and 3rd-Line Regorafenib for Advanced Hepatocellular Carcinoma

Oncology. 2021 May 17:1-8. doi: 10.1159/000515280. Online ahead of print.

ABSTRACT

INTRODUCTION: This study compared clinical outcomes of 2nd- and 3rd-line regorafenib in patients with unresectable hepatocellular carcinoma.

METHODS: In this retrospective cohort study, 48 patients were treated with regorafenib for unresectable hepatocellular carcinoma. Thirty-five and 13 patients were initiated on 2nd- and 3rd-line therapy, respectively. We assessed the responses to and safety of the therapy.

RESULTS: There were no statistically significant differences in clinical characteristics at the start of 2nd- or 3rd-line regorafenib therapy. The overall response rate of 2nd- and 3rd-line regorafenib was 20 and 8%, respectively. The disease control rate was 57 and 54%, respectively. Median overall survival (mOS) from the start of 2nd-line regorafenib was 17.5 months. mOS from the start of 3rd-line regorafenib was not obtained. Median progression-free survival of 2nd- and 3rd-line regorafenib was 4.9 and 2.3 months, respectively. mOS from 1st-line therapy with tyrosine kinase inhibitor plus sorafenib-regorafenib-lenvatinib was 29.5 months; that with lenvatinib-sorafenib-regorafenib was not obtained. Patients on 3rd-line therapy tended to have better Child-Pugh scores and tumor factors at the start of 1st-line therapy than other patients.

CONCLUSION: Patients on 2nd- and 3rd-line regorafenib showed favorable responses. Good Child-Pugh scores and tumor factors may be associated with a better response rate and OS.

PMID:34000725 | DOI:10.1159/000515280

Categories
Nevin Manimala Statistics

Sensory contribution to vocal emotion deficit in patients with cerebellar stroke

Neuroimage Clin. 2021 May 3;31:102690. doi: 10.1016/j.nicl.2021.102690. Online ahead of print.

ABSTRACT

In recent years, there has been increasing evidence of cerebellar involvement in emotion processing. Difficulties in the recognition of emotion from voices (i.e., emotional prosody) have been observed following cerebellar stroke. However, the interplay between sensory and higher-order cognitive dysfunction in these deficits, as well as possible hemispheric specialization for emotional prosody processing, has yet to be elucidated. We investigated the emotional prosody recognition performances of patients with right versus left cerebellar lesions, as well as of matched controls, entering the acoustic features of the stimuli in our statistical model. We also explored the cerebellar lesion-behavior relationship, using voxel-based lesion-symptom mapping. Results revealed impairment of vocal emotion recognition in both patient subgroups, particularly for neutral or negative prosody, with a higher number of misattributions in patients with right-hemispheric stroke. Voxel-based lesion-symptom mapping showed that some emotional misattributions correlated with lesions in the right Lobules VIIb and VIII and right Crus I and II. Furthermore, a significant proportion of the variance in this misattribution was explained by acoustic features such as pitch, loudness, and spectral aspects. These results point to bilateral posterior cerebellar involvement in both the sensory and cognitive processing of emotions.

PMID:34000647 | DOI:10.1016/j.nicl.2021.102690

Categories
Nevin Manimala Statistics

Distinct clinical and genetic mutation characteristics in sporadic and Lynch syndrome-associated endometrial cancer in a Chinese population

Cancer Epidemiol. 2021 May 14;73:101934. doi: 10.1016/j.canep.2021.101934. Online ahead of print.

ABSTRACT

BACKGROUND: The diagnosis of Lynch syndrome-associated endometrial cancer patients is significant for early warning of their relatives. The purpose of this study was to provide diagnostic indicators of Lynch syndrome-associated endometrial cancer by screening the differential clinical and genetic characteristics.

METHODS: Clinical information and hysterectomy specimens were collected from 377 eligible patients with endometrial cancer. The MLH1 methylation level was detected by an EZ DNA Methylation-Gold Kit. According to the above experimental results, the patients were then divided into sporadic endometrial cancer and suspected Lynch syndrome-associated endometrial cancer groups. A total of 62 samples were randomly selected for whole-exome sequencing. IBM SPSS Statistics 21 was used to compare the clinical data between the sporadic and suspected Lynch syndrome-associated endometrial cancer groups, and the relationship between the specific high-frequency-mutation genes and the clinical data.

RESULTS: According to the results of MMR immunohistochemistry and MLH1 methylation, the sporadic endometrial cancer group included 361 patients and the suspected Lynch syndrome-associated endometrial cancer group included 16 patients in this study. In the clinical analysis, the average age of the suspected Lynch syndrome-associated endometrial cancer patients was 45.50 ± 11.50 years, which was significantly younger than the 51.17 ± 10.03 years of the sporadic endometrial cancer patients (P = 0.028). The average BMI of the suspected Lynch syndrome-associated endometrial cancer patients was 23.43 kg/m2 (CI: 20, 30), which was lower than the 26.50 kg/m2 of the sporadic endometrial cancer patients (P = 0.028). Combined with the WES data, MASP2, NADK and RNF223 were identified as three specific mutation sites related to age, FIGO stage and histology.

CONCLUSIONS: Compared with the suspected endometrial cancer patients, the Lynch syndrome-associated endometrial cancer patients were younger and less obese. Mutations in MASP2, NADK and RNF223 might be regarded as genetic endometrial cancer features related to clinical characteristics.

PMID:34000661 | DOI:10.1016/j.canep.2021.101934