Tag: statistics

Stroke. 2023 Jan 9. doi: 10.1161/STROKEAHA.122.041302. Online ahead of print.

ABSTRACT

BACKGROUND: Noncontrast computed tomography hypodensities are a validated predictor of hematoma expansion (HE) in intracerebral hemorrhage and a possible alternative to the computed tomography angiography (CTA) spot sign but their added value to available prediction models remains unclear. We investigated whether the inclusion of hypodensities improves prediction of HE and compared their added value over the spot sign.

METHODS: Retrospective analysis of patients admitted for primary spontaneous intracerebral hemorrhage at the following 8 university hospitals in Boston, US (1994-2015, prospective), Hamilton, Canada (2010-2016, retrospective), Berlin, Germany (2014-2019, retrospective), Chongqing, China (2011-2015, retrospective), Pavia, Italy (2017-2019, prospective), Ferrara, Italy (2010-2019, retrospective), Brescia, Italy (2020-2021, retrospective), and Bologna, Italy (2015-2019, retrospective). Predictors of HE (hematoma growth >6 mL and/or >33% from baseline to follow-up imaging) were explored with logistic regression. We compared the discrimination of a simple prediction model for HE based on 4 predictors (antitplatelet and anticoagulant treatment, baseline intracerebral hemorrhage volume, and onset-to-imaging time) before and after the inclusion of noncontrast computed tomography hypodensities, using receiver operating characteristic curve and De Long test for area under the curve comparison.

RESULTS: A total of 2465 subjects were included, of whom 664 (26.9%) had HE and 1085 (44.0%) had hypodensities. Hypodensities were independently associated with HE after adjustment for confounders in logistic regression (odds ratio, 3.11 [95% CI, 2.55-3.80]; P<0.001). The inclusion of noncontrast computed tomography hypodensities improved the discrimination of the 4 predictors model (area under the curve, 0.67 [95% CI, 0.64-0.69] versus 0.71 [95% CI, 0.69-0.74]; P=0.025). In the subgroup of patients with a CTA available (n=895, 36.3%), the added value of hypodensities remained statistically significant (area under the curve, 0.68 [95% CI, 0.64-0.73] versus 0.74 [95% CI, 0.70-0.78]; P=0.041) whereas the addition of the CTA spot sign did not provide significant discrimination improvement (area under the curve, 0.74 [95% CI, 0.70-0.78]).

CONCLUSIONS: Noncontrast computed tomography hypodensities provided a significant added value in the prediction of HE and appear a valuable alternative to the CTA spot sign. Our findings might inform future studies and suggest the possibility to stratify the risk of HE with good discrimination without CTA.

PMID:36621819 | DOI:10.1161/STROKEAHA.122.041302

Cancer Med. 2023 Jan 9. doi: 10.1002/cam4.5592. Online ahead of print.

ABSTRACT

BACKGROUND: To our knowledge, the different situations of identifying second primary malignant tumors (SPMTs) in lymphoma patients with synchronous solid tumors remain to be comprehensively investigated.

METHODS: We retrospectively collected information pertaining to lymphoma patients with synchronous solid tumors (diagnosed within 6 months) at Peking University Cancer Hospital & Institute between 2009 and 2019. The non-parametric Aalen-Johansen estimator was applied to calculate cumulative incidence function in the competing risk model. Furthermore, propensity score-matched analysis was performed to compare survival differences in lymphoma patients with or without synchronous solid tumors.

RESULTS: Thirty-eight patients were enrolled. There were three situations of identifying SPMTs. First, in 15 patients (39.5%), SPMTs were identified before the initiation of any treatment. Among them, priority was given to anti-lymphoma treatment in case of only three patients. Second, in 17 patients (44.7%), SPMTs were unexpectedly detected on surgical specimen assessment; of them, 13 received anti-lymphoma treatment after surgery. Third, in six patients (15.8%), SPMTs were identified after the outset of treatment for the primary tumor; in this population, three of four patients with lymphoma switched toward the treatment plan for SPMTs. The 5-year overall survival was 58.7%. The cumulative incidence function within 5 years was 26.6% for lymphoma and 14.7% for other solid tumors. The early identification of SPMTs was associated with better outcomes (p = 0.048). After balancing the baseline characteristics, no differences in survival were observed between lymphoma patients with and without synchronous solid tumors (p = 0.664).

CONCLUSIONS: This is the first study to present the different situations of identifying SPMTs in lymphoma patients with synchronous solid tumors. In only <50% patients, SPMTs were identifiable at baseline. SPMT identification at different situations may make it difficult to choose the optimal therapeutic option, which may consequently impact patient survival.

PMID:36621802 | DOI:10.1002/cam4.5592

Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2022 Dec;44(6):1028-1032. doi: 10.3881/j.issn.1000-503X.14918.

ABSTRACT

Objective To validate the performance of the model for predicting the risk of intraoperative hypothermia.Methods This observational prospective study enrolled the adult patients who were of American Society of Anesthesiologists Ⅰ-Ⅲ and underwent elective surgery with general anesthesia in Peking Union Medical College Hospital,Beijing Hospital,and Xuanwu Hospital of Capital Medical University from October 2019 to August 2021.The risk prediction model of intraoperative hypothermia was used to calculate the predictors score of each patient.The body temperature of each patient was monitored throughout the perioperative period,and perioperative temperature management were entirely at the discretion of the anesthesiologists.The area under the receiver operating characteristic curve(AUC),Hosmer-Lemeshow goodness-of-fit test,and Brier score were employed to evaluate the prediction performance of the model.Results Of the 472 participants included in this study,141(29.9%)developed intraoperative hypothermia and 124(26.3%)received intraoperative active warming.For predicting intraoperative hypothermia in the overall cohort,the model demonstrated good discrimination capacity with an AUC of 0.729(95% CI=0.680-0.777),adequate calibration(Hosmer-Lemeshow χ²=3.143,P=0.925),and good overall performance(Brier score of 0.34).For the patients with passive warming only,the model showed good discrimination(AUC=0.756;95% CI=0.704-0.808),good calibration(Hosmer-Lemeshow χ²=7.457,P=0.488),and the Brier score of 0.29.For the patients with active warming,the model presented the AUC of 0.747(95% CI=0.632-0.863),Hosmer-Lemeshow χ² of 4.754(P=0.783)and the Brier score of 0.47.Furthermore,we stratified the risk scores as low,moderate and high risk groups,in which the incidence of intraoperative hypothermia was 14.4%(95% CI=9.6%-19.1%),36.7%(95% CI=29.9%-43.5%),and 58.2%(95% CI=46.1%-70.3%),respectively.The differences between the three groups were statistically significant(χ²=54.112,P<0.001).Conclusion The intraoperative hypothermia prediction model demonstrates good overall differentiation capacity and has good prediction performance for the patients with or without active warming.

PMID:36621793 | DOI:10.3881/j.issn.1000-503X.14918

Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2022 Dec;44(6):996-1003. doi: 10.3881/j.issn.1000-503X.15058.

ABSTRACT

Objective To understand the status quo and analyze the influencing factors of new hepatitis B virus(HBV) infection in Anzhou district,Mianyang city,Sichuan province,so as to provide a scientific basis for the formulation of hepatitis B prevention and control measures.Methods This study enrolled 71 418 residents of Anzhou District,Mianyang City,who participated in the physical examination of “Mianyang Comprehensive Prevention and Control Demonstration Study of Major Infectious Diseases” in 2013 and were tested negative for the hepatitis B surface antigen.The residents were followed for 5 years and underwent serological test again in 2018.The new infection rate of HBV was calculated and the influencing factors were analyzed by multivariate Logistic regression analysis.Results In 2018,the new infection rate of HBV among 71 418 residents in Anzhou district was 1.61%.The new infection rate varied with the differences in gender,age,occupation,marital status,smoking status,drinking frequency,place of residence,family history of hepatitis B,and history of hepatitis B vaccination(P<0.001).Multivariate Logistic regression results showed that male(OR=1.29,95%CI=1.12-1.48,P<0.001),farmer(OR=2.01,95%CI=1.39-2.90,P<0.001),and family history of hepatitis B(OR=1.97,95%CI=1.44-2.70,P<0.001)were the independent risk factors for new HBV infection(P<0.001).Conclusions The new infection rate of HBV is high in Anzhou district of Mianyang city.Males,farmers,and those with family history of hepatitis B are high-risk groups of HBV infection.

PMID:36621789 | DOI:10.3881/j.issn.1000-503X.15058

Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2022 Dec;44(6):950-960. doi: 10.3881/j.issn.1000-503X.14779.

ABSTRACT

Objective To investigate the expression regulation of autophagy-related genes(ATG)and the mechanism of autophagy in rheumatoid arthritis(RA).Methods The differentially expressed genes(DEG)of RA were identified from GSE55235 and GSE55457,on the basis of which the differentially expressed autophagy-related genes(DE-ATG)were selected from the Human Autophagy Database.STRING 11.0 and GeneMANIA were used to establish protein-protein interaction networks.Further,the transcription factor-gene-miRNA co-expression network was established via NetworkAnalyst and Cytoscape.Finally,receiver operating characteristic(ROC)curve and DrugBank were employed to evaluate the efficacy of the predicted biomarkers and the performance of drugs targeting DE-ATG.GraphPad Prism 8.2.1 and R 4.0.3 were used for statistical analysis and graphics.Results A total of 485 DEG were enriched in signaling pathways such as T cell activation,hormone regulation,osteoclast differentiation,RA,and chemokines.Eleven DE-ATG regulated the expression of RUNX1,TP53,SOX2,and hsa-mir-155-5p in synovial tissues of RA patients and were involved in the response to environmental factors such as 2,3,7,8-tetrachlorodibenzodioxin and silicon dioxide.The ROC curve analysis identified the DE-ATG with good sensitivity and specificity,such as MYC,MAPK8,CDKN1A,and TNFSF10,which can be used to distinguish certain phenotypes and serve as novel biomarkers for RA.Conclusions In RA,down-regulated DE-ATG expression may promote apoptosis and lysis of chondrocytes.The identified novel biomarkers provides new ideas and methods for diagnosing and treating RA.The establishment of transcription factor-miRNA-gene co-expression network provides direct evidence for dissecting synovial inflammation and articular cartilage destruction.

PMID:36621784 | DOI:10.3881/j.issn.1000-503X.14779

Chest. 2023 Jan 5:S0012-3692(23)00015-6. doi: 10.1016/j.chest.2022.12.037. Online ahead of print.

ABSTRACT

BACKGROUND: Robotic-assisted lobectomy (RAL) is increasingly employed as an alternative to video-assisted lobectomy (VAL) for resectable non-small-cell lung cancer (NSCLC). However, there is little evidence for any difference in the postoperative health-related quality of life (HRQoL) between these two approaches.

RESEARCH QUESTION: Is robotic-assisted lobectomy (RAL) superior to video-assisted lobectomy (VAL) in improving quality of life in patients with resectable non-small-cell lung cancer (NSCLC)?

STUDY DESIGN AND METHODS: We performed a single-center, open-label randomized clinical trial from May 2017 to May 2020 with 320 patients undergoing RAL or VAL for resectable NSCLC enrolled (RVlob trial, NCT03134534). Postoperative pain was evaluated with the visual analogue score (VAS) or numeric rating score (NRS) on postoperative day 1 and at weeks 4, 24, and 48. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30), EORTC Quality of Life Questionnaire in Lung Cancer (QLQ-LC13), and the European Quality of Life 5 Dimensions (EQ-5D) questionnaire were also administered at weeks 4, 24 and 48 after surgery.

RESULTS: 157 patients underwent RAL and 163 had VAL. The mean pain score of patients after RAL was statistically lower at week 4 (2.097 ± 0.111 vs 2.431 ± 0.108, p=0.032). QLQ-C30 and QLQ-LC13 summary scores (p>0.05) were similar for both RAL and VAL during the first 48 weeks of follow-up. HRQoL score assessed with the EQ-5D questionnaire was also comparable between the two groups (p＞0.05) during the whole study period.

INTERPRETATION: Both RAL and VAL showed satisfactory and comparable HRQoL and postoperative pain up to 48 weeks after surgery, despite some minor statistical differences at week 4.

CLINICAL TRIAL REGISTRATION: NCT03134534 (http://www.

CLINICALTRIALS: gov).

PMID:36621757 | DOI:10.1016/j.chest.2022.12.037

Int J Infect Dis. 2023 Jan 5:S1201-9712(22)00673-7. doi: 10.1016/j.ijid.2022.12.030. Online ahead of print.

ABSTRACT

OBJECTIVES: Investigate risk factors for SARS-CoV-2 infections in schools students and staff.

METHODS: In the 2020/2021 schoolyear, we administered PCR, antibody tests and questionnaires to a sample of primary and secondary schools students and staff, with data linkage to COVID-19 surveillance. We fitted logistic regression models to identify factors associated with infection.

RESULTS: We included 6799 students and 5090 staff in the autumn and 11952 students and 4569 staff in the spring/summer terms. Infections in students in autumn 2020 were related to the percentage of students eligible for free school meals. We found no statistical association between infection risk in primary and secondary schools and reported contact patterns between students and staff in either time period in our study. Using public transports was associated with increased risk in the autumn in students (aOR=1.72 (95%CI 1.31 to 2.25) and staff. One or more infections in the same household during either period was the strongest risk factor for infection in students, and more so among staff.

INTERPRETATION: Deprivation, community and household factors were more strongly associated with infection than contacts patterns at school; this suggests the additional school-based mitigation measures in England’s in 2020/21 likely helped reduce transmission risk in schools.

PMID:36621754 | DOI:10.1016/j.ijid.2022.12.030

Int J Infect Dis. 2023 Jan 5:S1201-9712(23)00001-2. doi: 10.1016/j.ijid.2023.01.001. Online ahead of print.

ABSTRACT

OBJECTIVE: Bloodstream infections (BSIs) caused by ESBL-producing Enterobacteriaceae (ESBL-PE) has become a global public health threat, and beta-lactam/beta-lactamase inhibitor combinations (BLBLIs) are considered as one reliable carbapenem-sparing antibiotic. But it’s still controversial whether BLBLIs is truly non-inferior to carbapenems. Therefore, we conducted this meta-analysis to compare efficacy of BLBLIs with carbapenems for ESBL-PE BSIs.

METHODS: A systematic search of PubMed, Cochrane Library and Embase was conducted until December 2021 to enroll studies comparing BLBLIs with carbapenems for ESBL-PE BSIs. Subgroups analysis was performed based on the choice of therapy (empirical, definitive, and mixed therapy). The protocol was registrated in PROSPERO (#CRD42022316011).

RESULTS: 2,786 patients from one randomized clinical trial (RCT) and 25 cohorts were included. There was no statistically difference between BLBLIs and carbapenems groups in therapeutical response (OR=1.19, P=0.45) and mortality (OR=1.06, P=0.68). Furthermore, although statistical difference was also not found in subgroup analysis, BLBLIs performed better in definitive therapy than empirical therapy when compared with carbapenems, with a numerically higher therapeutical response (OR=1.42 vs 0.89) and a mildly lower mortality (OR=0.85 vs 1.14).

CONCLUSIONS: BLBLIs was non-inferior to carbapenems for ESBL-PE BSIs, especially in definitive therapy. BLBLIs may be a valid alternative to spare the use of carbapenems.

PMID:36621752 | DOI:10.1016/j.ijid.2023.01.001

Clin Gastroenterol Hepatol. 2023 Jan 5:S1542-3565(23)00004-6. doi: 10.1016/j.cgh.2022.12.026. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Multitarget stool DNA (mt-sDNA) testing is a stool-based screening test for colorectal cancer (CRC). In a single instance of testing, the pivotal FDA-approval study (NCT01397747) found that 16% of mt-sDNA tests were positive, and the positive predictive value (PPV) for CRC or advanced precursor lesions (APL) was 27.3%. We aimed to examine real-world longitudinal performance by determining the test positive rate and PPV of mt-sDNA on the 2^nd round of testing.

METHODS: Colonoscopy and pathology reports were retrospectively reviewed for patients with a negative mt-sDNA on the 1^st round of screening and a positive mt-sDNA on the 2^nd round. Test-positivity rate and PPV for CRC, APL, and any colorectal neoplasia (CRN) were calculated for the 2^nd mt-sDNA and compared to baseline PPVs from a previously published cohort of patients from our institution who tested positive on the 1^st round of screening.

RESULTS: 2,758 patients completed a 2^nd test at a median of 3.2 years after the 1^st test. Of these, 422 (15%) had a positive 2^nd mt-sDNA. The PPV was 0.25% for CRC, 24% for APL, and 67% for any CRN. There was no significant difference in PPV on the 2^nd mt-sDNA test compared to the 1^st round (24% vs 28% for APL, P=0.12).

CONCLUSIONS: Mt-sDNA test positive rate and PPV were similar between 1^st and 2^nd rounds of screening. These observations confirm the utility of a second round of mt-sDNA screening and may inform estimates of mt-sDNA effectiveness for CRC screening.

PMID:36621751 | DOI:10.1016/j.cgh.2022.12.026

Environ Pollut. 2023 Jan 5:121021. doi: 10.1016/j.envpol.2023.121021. Online ahead of print.

ABSTRACT

China fully implemented the new emission standards in 2016 to further reduce the emissions of air pollutants from the municipal solid waste (MSW) incineration industry; however, the implementation effect of the new standards remains unknown. This study developed the first nationwide air pollutant emission inventory of MSW incineration plants in China based on the measured concentration data from China’s continuous emissions monitoring systems (CEMS) network, and activity level data from the China Urban Construction Statistical Yearbook, to evaluate the effectiveness of implementing the new emission standards and estimate the future reduction potentials. Our results demonstrated that the overall standard-reaching proportions of particulate matter (PM), sulfur dioxide (SO₂), nitrogen oxide (NO_X), hydrogen chloride (HCl) and carbon monoxide (CO) were 98.8%, 99.3%, 99.4%, 99.4% and 97.6%, respectively, by comparing with the corresponding concentration limits of new emission standards. The total emissions of PM, SO₂, NO_X, HCl and CO from 412 MSW incineration plants in 2019 were 1.9, 6.2, 50.8, 4.3 and 6.6 kt yr^-1, respectively, which is 33.6-75.8% lower than those in 2015, mainly due to the sharp decrease in emission factors. Pollutant emission hotspots were mainly concentrated in eastern and central and southern regions with large populations and well-developed economies. The analysis of future scenario results shows that despite the continuous increase of MSW incineration amount in the future, if the government strengthens pollutant emission standards and comprehensively implements waste sorting, total emissions and emission factors of air pollutants could be further reduced by 25.8-72.7% and 59.8-81.2%, respectively, by 2050. These findings provide helpful insights into future policymaking and technology selection for China and other countries seeking to reduce pollutant emissions from the MSW incineration industry.

PMID:36621718 | DOI:10.1016/j.envpol.2023.121021