Tag: statistics

Nutr Metab Cardiovasc Dis. 2023 Mar 4:S0939-4753(23)00086-8. doi: 10.1016/j.numecd.2023.03.001. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Abdominal adiposity indices have stronger associations with cardiometabolic risk factors compared to anthropometric measures but are rarely used in large scale studies due to the cost and efficiency. The aim of this study is to establish sex and race/ethnicity specific reference equations using anthropometric measures.

METHODS AND RESULTS: A secondary data analysis (n = 6589) of healthy adults was conducted using data from National Health and Nutrition Examination Survey 2011-2018. Variables included in the analyses were anthropometric measures (height; weight; waist circumference, WC) and abdominal adiposity indices (android percent fat; android to gynoid ratio, A/G ratio; visceral adipose tissue area, VATA; visceral to subcutaneous adipose area ratio, VSR). Multivariable prediction models were developed using quantile regression. Bland-Altman was used for external validation of prediction models. Reference equations to estimate android percent fat, A/G ratio, VATA and VSR from anthropometric measurements were developed using a randomly selected subsample of 4613. These reference equations for four abdominal adiposity indices were then cross-validated in the remaining subsample of 1976. The measured and predicted android percent fat, A/G ratio, VATA and VSR were not statistically different (p > 0.05) except for the A/G ratio in Asian males and VSR in White females. The results of Bland-Altman further revealed that ≥93% of predicted abdominal adiposity indices fell within the limits of agreement (±1.96 standard deviation).

CONCLUSION: The sex and race/ethnicity specific reference equations for abdominal adiposity indices established using anthropometrics in the present study have strong predictive ability in US healthy adults.

PMID:36958968 | DOI:10.1016/j.numecd.2023.03.001

Nutr Metab Cardiovasc Dis. 2023 Mar 2:S0939-4753(23)00085-6. doi: 10.1016/j.numecd.2023.02.025. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Serum uric acid (SUA) is involved in the development of cardiovascular disease (CVD). However, information on the dose-response relationship between SUA and CVD is limited in the Chinese population. This study aimed to investigate the potential nonlinear dose-response association of SUA with CVD risk in a Chinese population and to explore the effect of sex on these associations.

METHODS AND RESULTS: Cross-sectional data, from 6252 Chinese adults aged 30-74 years who participated in the China Health and Nutrition Survey 2009, were stratified by SUA deciles. The 10-year risk of CVD was determined using the Framingham risk score. A restricted cubic spline (RCS) was incorporated into the logistic models to assess the nonlinear relationship between SUA and CVD. Among the participants, 65%, 20%, and 15% had low, moderate, and high 10-year CVD risks, respectively. Compared with the reference SUA strata of 225 to <249 μmol/L, CVD risk was significantly increased at SUA ≥294 μmol/L, with adjusted ORs ranging from 2.39 (1.33-4.33) to 4.25 (2.37-7.65). An increasingly higher nonsignificant CVD risk was found at SUA <225 μmol/L and showed a nonlinear U-shaped association. In the fitted RCS model, an approximate U-shaped association between SUA and CVD risk scores was found in women, but this significant nonlinear relationship was not found in men.

CONCLUSION: This study showed that both lower and higher SUA levels were associated with a higher 10-year CVD risk among Chinese adults, forming a U-shaped relationship, and this pattern was particularly pronounced for women.

PMID:36958966 | DOI:10.1016/j.numecd.2023.02.025

Cancer Control. 2023 Jan-Dec;30:10732748231165878. doi: 10.1177/10732748231165878.

ABSTRACT

PURPOSE: To identify prognostic factors of survival and recurrence in advanced ovarian cancer patients undergoing radical surgery and HIPEC.

METHODS: In a single Department of Surgical Oncology, Peritoneal Surface Malignancy Program, and over a 16-year period, from a total of 274 epithelial ovarian cancer patients, retrospectively, we identified 152 patients undergoing complete (CC-0) or near-complete (CC-1) cytoreduction, including at least one colonic resection, and HIPEC.

RESULTS: Mean age of patients was 58.8 years and CC-0 was possible in 72.4%. Rates of in-hospital mortality and major morbidity were 2.6% and 15.7%. Only 122 (80.3%) patients completed Adjuvant Systemic Chemotherapy (ASCH). Rates of metastatic Total Lymph Nodes (TLN), Para-Aortic and Pelvic Lymph Nodes (PAPLN) and Large Bowel Lymph Nodes (LBLN) were 58.7%, 58.5%, and 51.3%, respectively. Median, 5- and 10-year survival rates were 39 months, 43%, and 36.2%, respectively. The recurrence rate was 35.5%. On univariate analysis, CC-1, high Peritoneal Cancer Index (PCI), in-hospital morbidity, and no adjuvant chemotherapy were adverse factors for survival and recurrence. On multivariate analysis, negative survival indicators were the advanced age of patients, extensive peritoneal dissemination, low total number of TLN and no systemic PAPLN. Metastatic LBLN and segmental resection of the small bowel (SIR) were associated with a high risk for recurrence.

CONCLUSION: CC-O is feasible in most advanced ovarian cancer patients and HIPEC may confer a survival benefit. Radical bowel resection, with its entire mesocolon, may be necessary, as its lymph nodes often harbor metastases influencing disease recurrence and survival. The role of metastatic bowel lymph nodes has to be taken into account when assessing the impact of systemic lymphadenectomy in this group of patients.

PMID:36958947 | DOI:10.1177/10732748231165878

J Osteopath Med. 2023 Mar 24. doi: 10.1515/jom-2022-0141. Online ahead of print.

ABSTRACT

CONTEXT: Cardiac rehabilitation (CR) and intensive cardiac rehabilitation (ICR) are secondary prevention interventions for cardiovascular disease (CVD) with a class 1a indication yet suboptimal utilization. To date, there are only three approved ICR programs. Alternative programing should be explored to increase enrollment and adherence in these interventions.

OBJECTIVES: This study aims to evaluate the effectiveness of the Strong Hearts program in cardiovascular patients following a major cardiovascular event.

METHODS: One hundred ninety-seven (n = 197) participants were enrolled in this prospective, nonrandomized study. Patients were eligible for participation if they were referred by a physician after a major cardiovascular event, defined as any of the following: (1) acute myocardial infarction (MI) within the preceding 12 months; (2) current stable or unstable angina pectoris; (3) heart valve procedure; (4) percutaneous intervention of any kind; (5) heart transplant; (6) coronary artery bypass grafting (CABG); or (7) congestive heart failure (CHF) with reduced or preserved ejection fraction. Participants were asked to attend program visits four times per week for 9 weeks. Visits consisted of individualized exercise and intensive healthy lifestyle education. Paired t tests were utilized to compare pre- and postprogram outcome measures.

RESULTS: One hundred twenty-eight (n = 128) participants completed the program within the 9-week time frame and their outcome measures were included in the data analysis. Among this, 35.2% participants were female and 64.8% were male. The mean age was 65 (range, 19-88). Qualifying diagnoses were percutaneous coronary intervention (PCI; 60, 46.9%), CABG (33, 25.8%), angina (24, 18.8%), valve procedures (8, 6.2%), and CHF (3, 2.3%). After implementation of the intervention, statistically significant decreases in weight (P < .001), body mass index (BMI, P < .001), waist circumference (P < .001), triglycerides (P = .01), systolic blood pressure (SBP, P <.001), diastolic blood pressure (DBP, P = .002), total fat mass (P < .001), Dartmouth Quality of Life Index P < .001), and cardiac depression scores (P = .044) were detected. In other instances, there were statistically significant increases across time for the clinical parameters of high-density lipoprotein (HDL, P = .02), Vitamin D (P = .001), metabolic equivalents (METS, P < .001), Duke activity scores (P < .001), and Rate Your Plate nutrition scores (P < .001). There were no significant changes across time for total cholesterol (P = .17), low-density lipoprotein (LDL, P = .21), A1c (P = .27), or dual-energy X-ray absorptiometry (DXA) total lean mass (P = .86).

CONCLUSIONS: The 9-week structured program resulted in significant cardiovascular benefit to patients with CVD by reducing cardiac risk factors, increasing exercise capacity, and improving quality of life.

PMID:36958944 | DOI:10.1515/jom-2022-0141

Cancer Epidemiol Biomarkers Prev. 2023 Mar 23:EPI-22-1157. doi: 10.1158/1055-9965.EPI-22-1157. Online ahead of print.

ABSTRACT

BACKGROUND: Prostate cancer (PC) affects African American men disproportionately compared to men of other racial/ethnic groups. To identify biological bases for this health disparity, we sought to create a state-wide biobank of African American PC survivors in Florida.

METHODS: African American men diagnosed with PC between 2013-2017 and living in Florida at diagnosis were identified through the State of Florida’s cancer registry. Individuals were approached via mail and telephone, assessed for eligibility, and asked for informed consent. Chi-square and t-tests were conducted to identify differences between eligible and reachable individuals (i.e., had valid contact information) vs. consented participants.

RESULTS: Of the 5,960 eligible and reachable individuals, 3,904 were eligible and contacted at least once, and 578 consented (overall consent rate=10% [578/5,960]; adjusted consent rate=15% [578/3,904]). Statistically significant (ps<.05) but small differences in demographic and clinical variables were observed. Consented participants were less likely to be older than 64 (35% vs. 41%) and less likely to have received radiotherapy (36% vs. 41%) and hormone therapy (16% vs. 21%), but more likely to have regional PC (13% vs. 11%) and have undergone surgery (44% vs. 39%). Consented participants did not differ from reachable individuals on other demographic and clinical factors (ps>.05).

CONCLUSIONS: Recruiting African American PC survivors to biobanking research through a cancer registry is feasible. However, the consent rate was low, and existing challenges limit consent and participation.

IMPACT: Strategies for overcoming barriers to informed consent and increasing participation in biospecimen research are needed to address cancer disparities.

PMID:36958853 | DOI:10.1158/1055-9965.EPI-22-1157

AJNR Am J Neuroradiol. 2023 Mar 23. doi: 10.3174/ajnr.A7826. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Infarct evolution after endovascular treatment varies widely among patients with stroke and may be affected by baseline characteristics and procedural outcomes. Moreover, IV alteplase and endovascular treatment may influence the relationship of these factors to infarct evolution. We aimed to assess whether the infarct evolution between baseline and follow-up imaging was different for patients who received IVT and EVT versus EVT alone.

MATERIALS AND METHODS: We included patients from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN)-NO IV trial with baseline CTP and follow-up imaging. Follow-up infarct volume was segmented on 24-hour or 1-week follow-up DWI or NCCT. Infarct evolution was defined as the follow-up lesion volume: CTP core volume. Substantial infarct growth was defined as an increase in follow-up infarct volume of >10 mL. We assessed whether infarct evolution was different for patients with IV alteplase and endovascular treatment versus endovascular treatment alone and evaluated the association of baseline characteristics and procedural outcomes with infarct evolution using multivariable regression.

RESULTS: From 228 patients with CTP results available, 145 patients had follow-up imaging and were included in our analysis. For patients with IV alteplase and endovascular treatment versus endovascular treatment alone, the baseline median CTP core volume was 17 (interquartile range = 4-35) mL versus 11 (interquartile range = 6-24) mL. The median follow-up infarct volume was 13 (interquartile range, 4-48) mL versus 17 (interquartile range = 4-50) mL. Collateral status and occlusion location were negatively associated with substantial infarct growth in patients with and without IV alteplase before endovascular treatment.

CONCLUSIONS: No statistically significant difference in infarct evolution was found in directly admitted patients who received IV alteplase and endovascular treatment within 4.5 hours of symptom onset versus patients who underwent endovascular treatment alone. Collateral status and occlusion location may be useful predictors of infarct evolution prognosis in patients eligible for IV alteplase who underwent endovascular treatment.

PMID:36958803 | DOI:10.3174/ajnr.A7826

AJNR Am J Neuroradiol. 2023 Mar 23. doi: 10.3174/ajnr.A7831. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Mechanical thrombectomy appears to be a promising option for distal medium-vessel occlusions, for which intravenous thrombolysis is effective but may be insufficient when used alone. This study aimed to determine the optimal technique for these distal mechanical thrombectomies using the human placenta model.

MATERIALS AND METHODS: Twenty-four procedures were performed, allowing comparison of direct aspiration (n = 12) versus the combined technique (n = 12). Two positions of the aspiration catheter were tested for each of these techniques: in direct contact with the clot and at a distance from it (5-10 mm). Two types of clots were tested: red blood cell-rich clots and fibrin-rich clots. First-pass recanalization and induced arterial collapse and traction were assessed.

RESULTS: The first-pass recanalization was less frequent for direct aspiration than for the combined technique, without reaching statistical significance (41.7% versus 75.0%, P = .098). Full collapse (P < .001) and extended arterial traction (P = .001) were significantly less frequent for direct aspiration. For direct aspiration with the aspiration catheter not in direct contact with the clot, there was not a single first-pass recanalization and there was systematic arterial collapse, resulting in a no-flow in the aspiration syringe.

CONCLUSIONS: The combined technique appears to be more harmful, and although direct aspiration has a lower rate of first-pass recanalization, it seems appropriate to try direct aspiration as a first-line procedure. However, if the aspiration catheter cannot reach the clot, it is not useful or even risky to try aspiration alone. These results need to be confirmed by clinical studies.

PMID:36958799 | DOI:10.3174/ajnr.A7831

AJNR Am J Neuroradiol. 2023 Mar 23. doi: 10.3174/ajnr.A7823. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: The previous studies described phenotype-associated imaging findings in amyotrophic lateral sclerosis (ALS) with a prior categorization of patients based on clinical characteristics. We investigated the natural segregation of patients through a radiologic cluster-based approach without a priori patient categorization using 3 well-known prognostic MR imaging biomarkers in ALS, namely bilateral precentral and paracentral gyrus cortical thickness and medulla oblongata volume. We aimed to identify clinical/prognostic features that are cluster-associated.

MATERIALS AND METHODS: Bilateral precentral and paracentral gyri and medulla oblongata volume were calculated using FreeSurfer in 90 patients with amyotrophic lateral sclerosis and 25 healthy controls. A 2-step cluster analysis was performed using precentral and paracentral gyri (averaged pair-wise) and medulla oblongata volume.

RESULTS: We identified 3 radiologic clusters: 28 (31%) patients belonged to “cluster-1”; 51 (57%), to “cluster 2”; and 11 (12%), to “cluster 3.” Patients in cluster 1 showed statistically significant cortical thinning of the analyzed cortical areas and lower medulla oblongata volume compared with subjects in cluster 2 and cluster 3, respectively. Patients in cluster 3 exhibited significant cortical thinning of both paracentral and precentral gyri versus those in cluster 2, and this latter cluster showed lower medulla oblongata volume than cluster 3. Patients in cluster 1 were characterized by older age, higher female prevalence, greater disease severity, higher progression rate, and lower survival compared with patients in clusters 2 and 3.

CONCLUSIONS: Patients with amyotrophic lateral sclerosis spontaneously segregate according to age and sex-specific patterns of neurodegeneration. Some patients with amyotrophic lateral sclerosis showed an early higher impairment of cortical motor neurons with relative sparing of bulbar motor neurons (cluster 3), while others expressed an opposite pattern (cluster 2). Moreover, 31% of patients showed an early simultaneous impairment of cortical and bulbar motor neurons (cluster 1), and they were characterized by higher disease severity and lower survival.

PMID:36958798 | DOI:10.3174/ajnr.A7823

BMJ Open Qual. 2023 Mar;12(1):e002128. doi: 10.1136/bmjoq-2022-002128.

ABSTRACT

BACKGROUND: Over-ordering of daily laboratory tests adversely affects patient care through hospital-acquired anaemia, patient discomfort, burden on front-line staff and unnecessary downstream testing. This remains a prevalent issue despite the 2013 Choosing Wisely recommendation to minimise unnecessary daily labs. We conducted a systematic review of the literature to identify interventions targeting unnecessary laboratory testing.

METHODS: We systematically searched MEDLINE, EMBASE, Cochrane Central and SCOPUS databases to identify interventions focused on reducing daily complete blood count, complete metabolic panel and basic metabolic panel labs. We defined interventions as ‘effective’ if a statistically significant reduction was attained and ‘highly effective’ if a reduction of ≥25% was attained.

RESULTS: The search yielded 5646 studies with 41 articles that met inclusion criteria. We grouped interventions into one or more categories: audit and feedback, cost display, education, electronic medical record (EMR) change, and policy change. Most interventions lasted less than a year and used a multipronged approach. All five strategies were effective in most studies with EMR change being the most commonly used independent strategy. EMR change and policy change were the strategies most frequently reported as effective. EMR change was the strategy most frequently reported as highly effective.

CONCLUSION: Our analysis identified five categories of interventions targeting daily laboratory testing. All categories were effective in most studies, with EMR change being most frequently highly effective.

PROSPERO REGISTRATION NUMBER: CRD42021254076.

PMID:36958791 | DOI:10.1136/bmjoq-2022-002128

Emerg Infect Dis. 2023 Apr;29(4):742-750. doi: 10.3201/eid2904.221022.

ABSTRACT

Human populations that hunt, butcher, and sell bushmeat (bushmeat activities) are at increased risk for zoonotic pathogen spillover. Despite associations with global epidemics of severe illnesses, such as Ebola and mpox, quantitative assessments of bushmeat activities are lacking. However, such assessments could help prioritize pandemic prevention and preparedness efforts. We used geospatial models that combined published data on bushmeat activities and ecologic and demographic drivers to map the distribution of bushmeat activities in rural regions globally. The resulting map had high predictive capacity for bushmeat activities (true skill statistic = 0.94). The model showed that mammal species richness and deforestation were principal drivers of the geographic distribution of bushmeat activities and that countries in West and Central Africa had the highest proportion of land area associated with bushmeat activities. These findings could help prioritize future surveillance of bushmeat activities and forecast emerging zoonoses at a global scale.

PMID:36957996 | DOI:10.3201/eid2904.221022