Tag: statistics

Cancer Biol Med. 2023 Mar 24;20(3):j.issn.2095-3941.2022.0513. doi: 10.20892/j.issn.2095-3941.2022.0513.

ABSTRACT

OBJECTIVE: Neoadjuvant therapy (NAT) has been widely implemented as an essential treatment to improve therapeutic efficacy in patients with locally-advanced cancer to reduce tumor burden and prolong survival, particularly for human epidermal growth receptor 2-positive and triple-negative breast cancer. The role of peripheral immune components in predicting therapeutic responses has received limited attention. Herein we determined the relationship between dynamic changes in peripheral immune indices and therapeutic responses during NAT administration.

METHODS: Peripheral immune index data were collected from 134 patients before and after NAT. Logistic regression and machine learning algorithms were applied to the feature selection and model construction processes, respectively.

RESULTS: Peripheral immune status with a greater number of CD3⁺ T cells before and after NAT, and a greater number of CD8⁺ T cells, fewer CD4⁺ T cells, and fewer NK cells after NAT was significantly related to a pathological complete response (P < 0.05). The post-NAT NK cell-to-pre-NAT NK cell ratio was negatively correlated with the response to NAT (HR = 0.13, P = 0.008). Based on the results of logistic regression, 14 reliable features (P < 0.05) were selected to construct the machine learning model. The random forest model exhibited the best power to predict efficacy of NAT among 10 machine learning model approaches (AUC = 0.733).

CONCLUSIONS: Statistically significant relationships between several specific immune indices and the efficacy of NAT were revealed. A random forest model based on dynamic changes in peripheral immune indices showed robust performance in predicting NAT efficacy.

PMID:36971132 | DOI:10.20892/j.issn.2095-3941.2022.0513

Vet Surg. 2023 Mar 27. doi: 10.1111/vsu.13953. Online ahead of print.

ABSTRACT

OBJECTIVE: To describe and compare the pattern of fluid dispersal and retrieval in a novel instillation therapy system.

STUDY DESIGN: In vitro experimental study.

METHODS: A 10 cm² square model was constructed using plastic sheeting secured to plexiglass, with a wound infusion catheter and Jackson-Pratt (JP) active suction drain positioned in 4 configurations: parallel, perpendicular, diagonal, and opposite. Fluid was instilled using the wound infusion catheter, allowed to dwell for 10 min, and retrieved using the JP drain. Two surface area calculations were made using imaging software: coloration with diluted methylene blue (MB) on photos, and filling with diluted contrast on fluoroscopic images. Fluid retrieval was recorded. Statistical analysis was performed using a mixed-effects linear model (p < .05).

RESULTS: Configuration influenced fluid dispersion within the model (p = .0001); the diagonal configuration had the greatest surface area coverage (mean ± SD; 94.5 ± 2.4%) and the parallel configuration had the lowest surface area coverage (60.2 ± 2.9%). A dwell period increased fluid dispersal by an average of 4.0 ± 0.8% (p < .0001). Fluid retrieval exceeded 16.7 ± 1.5 mL (83.5 ± 7.5% volume instilled) for all configurations and was 0.5 ± 0.1 mL (2.5 ± 0.5% volume instilled) greater for MB than contrast agent (p < .0001).

CONCLUSION: Perpendicular or diagonal configurations and low-viscosity fluid maximized fluid dispersion and retrieval.

CLINICAL SIGNIFICANCE: Wound instillation therapy involves delivering lavage fluid or medications to a closed wound space. This is feasible using a wound-infusion catheter and active suction drain. Configuration should be considered to optimize fluid dispersal and retrieval when planning instillation therapy.

PMID:36971099 | DOI:10.1111/vsu.13953

Sci Diabetes Self Manag Care. 2023 Mar 27:26350106231163516. doi: 10.1177/26350106231163516. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of the study was to examine the relationship between satisfaction of Medicare coverage for out-of-pocket costs and problems paying medical bills among Medicare beneficiaries with type 2 diabetes.

METHODS: The 2019 Medicare Current Beneficiary Survey Public Use File, a nationally representative sample of Medicare beneficiaries aged ≥65 years with type 2 diabetes, was analyzed (n = 2178). A survey-weighted multivariable logit regression model was conducted to examine the association between satisfaction of Medicare coverage for out-of-pocket costs and problems paying medical bills, adjusted for sociodemographics and comorbidities.

RESULTS: Among study beneficiaries, 12.6% reported problems paying medical bills. Among those with and without problems paying medical bills, 59.5% and 12.8%, respectively, were dissatisfied with out-of-pocket costs. In the multivariable analysis, beneficiaries who were dissatisfied with out-of-pocket costs were more likely to report problems paying medical bills than those who were satisfied. Younger beneficiaries, beneficiaries with lower incomes, those with functional limitations, and those with multiple comorbidities were more likely to report problems paying medical bills.

CONCLUSIONS: Despite having health care coverage, more than one-tenth of Medicare beneficiaries with type 2 diabetes reported problems paying medical bills, which raises concerns about delaying or forgoing needed medical care due to unaffordability. Screenings and targeted interventions that identify and reduce financial hardships associated with out-of-pocket costs should be prioritized.

PMID:36971086 | DOI:10.1177/26350106231163516

J Asthma. 2023 Mar 27:1-18. doi: 10.1080/02770903.2023.2196689. Online ahead of print.

ABSTRACT

Objective: The nitric-oxide pathway plays a crucial role in the pathogeneses of asthma and NOS3-encoded endothelial nitric oxide synthase is one of the main components of the pathway. Variants of NOS3 are known to contribute to asthma development and pathophysiology. Methods: We investigated the association of NOS3-c.894G/T (rs1799983) with asthma risk and severity by studying frequencies of its genotypes and alleles in 555 asthmatics (93 intermittent, 240 mild, 158 moderate, and 64 severe asthma cases) and 351 control participants using the PCR-FRLP method, logistic regression analysis and generalized ordered logit estimates. Results: GT genotype (OR_adj:1.39; CI:1.04-1.85; P = 0.026), dominant model GT + TT (OR_adj:1.41; CI:1.07-1.87; P = 0.015), and T allele (OR_adj:1.32; CI:1.05-1.67; P = 0.018) was associated with increased ORs in asthmatics. Also, the frequency of GT + TT (OR_adj:1.55; CI:1.01-2.38; P = 0.044) was significantly higher in males. Furthermore, GT genotype (OR_adj:1.39; CI:1.04-1.85; P = 0.024), GT + TT (OR_adj:1.42; CI:1.07-1.87; P = 0.014), and T allele (OR_adj:1.32; CI:1.05-1.66; P = 0.018) in total population and GT + TT (OR_adj:1.56; CI:1.02-2.37; P = 0.04) in males were significantly associated with increased risk of severe, moderate, mild, intermittent asthma vs. controls. Also, GT genotype (OR_adj:1.39; CI:1.02-1.91; P = 0.039) was significantly more frequent in severe, moderate grades vs. lower severity grades in the total population. Frequencies of GT genotype (OR_adj:1.77; CI:1.05-3.00; P = 0.032) and GT + TT (OR_adj:1.74; CI:1.04-2.90; P = 0.036) in total population and GT genotype (OR_adj:2.40; CI:1.16-4.97; P = 0.018) and GT + TT (OR_adj:2.30; CI:1.12-4.74; P = 0.023) in male subpopulation were significantly higher in severe cases compared to lower grades. Conclusions: NOS3-c.894G/T may be associated with asthma risk and its severer grades, with greater effects in men.

PMID:36971059 | DOI:10.1080/02770903.2023.2196689

Med J Aust. 2023 Mar 27. doi: 10.5694/mja2.51903. Online ahead of print.

ABSTRACT

OBJECTIVE: To simulate the impact on population mental health indicators of allowing people to book some Medicare-subsidised sessions with psychologists and other mental health care professionals without a referral (direct access), and of increasing the annual growth rate in specialist mental health care capacity (consultations).

DESIGN: System dynamics model, calibrated using historical time series data from the Australian Bureau of Statistics, HealthStats NSW, the Australian Institute of Health and Welfare, and the Australian Early Development Census. Parameter values that could not be derived from these sources were estimated by constrained optimisation.

SETTING: New South Wales, 1 September 2021 – 1 September 2028.

MAIN OUTCOME MEASURES: Projected mental health-related emergency department presentations, hospitalisations following self-harm, and deaths by suicide, both overall and for people aged 15-24 years.

RESULTS: Direct access (for 10-50% of people requiring specialist mental health care) would lead to increases in the numbers of mental health-related emergency department presentations (0.33-1.68% of baseline), hospitalisations with self-harm (0.16-0.77%), and deaths by suicide (0.19-0.90%), as waiting times for consultations would increase, leading to disengagement and consequently to increases in adverse outcomes. Increasing the annual rate of growth of mental health service capacity (two- to fivefold) would reduce the frequency of all three outcomes; combining direct access to a proportion of services with increased growth in capacity achieved substantially greater gains than an increase in service capacity alone. A fivefold increase in the annual service growth rate would increase capacity by 71.6% by the end of 2028, compared with current projections; combined with direct access to 50% of mental health consultations, 26 616 emergency department presentations (3.6%), 1199 hospitalisations following self-harm (1.9%), and 158 deaths by suicide (2.1%) could be averted.

CONCLUSION: The optimal combination of increased service capacity growth (fivefold) and direct access (50% of consultations) would have double the impact over seven years of accelerated capacity growth alone. Our model highlights the risks of implementing individual reforms without knowledge of their overall system effect.

PMID:36971040 | DOI:10.5694/mja2.51903

Ultrasound Obstet Gynecol. 2023 Mar 27. doi: 10.1002/uog.26206. Online ahead of print.

ABSTRACT

OBJECTIVES: The human umbilical cord normally inserts in the central region of the placental disc. There is conflicting evidence about whether or not peripheral cord insertions (<3.0 cm from the placental edge) are associated with adverse pregnancy outcomes. The relative importance of peripheral cord insertions and pathology within the placenta in mediating adverse outcomes has not been fully established.

METHODS: Sonographic measurement of the cord insertion and detailed placental pathology was performed in 309 participants. Associations between cord insertion site, placental pathology and adverse pregnancy outcomes (preeclampsia, preterm birth, small for gestational age) were examined.

RESULTS: Ninety-three participants (30%) were identified by pathological examination to have a peripheral cord insertion site. Only 41 of the 93 peripheral cords (44%) were detected by prenatal ultrasound. Peripherally inserted cords were associated with diagnostic placental pathology (p<0.0001), most commonly with maternal vascular malperfusion, within which 85% had an adverse pregnancy outcome. In cases of isolated peripheral cords, without placental pathology, the incidence of adverse outcomes was not statistically different compared to those with central cord insertions and no placental pathology (31% vs. 18%, p=0.3). A peripheral cord with an abnormal umbilical artery pulsatility index (UA PI) corresponded to an adverse outcome in 96% of the cases compared to 29% when the UA PI was normal.

CONCLUSIONS: This study demonstrates that peripheral cord insertion often is part of the spectrum of findings of maternal vascular malperfusion disease and is associated with adverse pregnancy outcomes. However, adverse outcomes were uncommon when there was an isolated peripheral cord insertion and no placental pathology. Therefore additional sonographic and biochemical features of maternal vascular malperfusion should be sought when a peripheral cord is observed. This article is protected by copyright. All rights reserved.

PMID:36971026 | DOI:10.1002/uog.26206

Transfusion. 2023 Mar 27. doi: 10.1111/trf.17327. Online ahead of print.

ABSTRACT

OBJECTIVE: The safety of Low Titer Group O Whole Blood (LTOWB) transfusion has not been well-studied in small children.

METHODS: This is a single-center retrospective cohort study of pediatric recipients of RhD- LTOWB (June 2016-October 2022) who weigh less than 20 kilograms. Biochemical markers of hemolysis (lactate dehydrogenase, total bilirubin, haptoglobin, and reticulocyte count) and renal function (creatinine and potassium) were recorded on the day of LTOWB transfusion and post-transfusion days 1 and 2. Group O and non-Group O recipients were compared.

RESULTS: Twenty-one children were included. Their median (IQR) weight was 12 kg (12-18) with minimum 2.8 kg, and median (IQR) age was 3 years (1.75-5.00) with minimum 0.08 years (29 days old). The most common indication for transfusion was trauma (17/21; 81%). The median (IQR) volume of LTOWB transfused was 30 mL/kg (20-42). There were 9 non-group O and 12 group O recipients. There were no statistically significant differences in the median concentrations of any of the biochemical markers of hemolysis or the renal function markers between the non-group O and the group O recipients at any of the three time points (p>0.05 for all comparisons). There were also no statistically significant differences in demographic parameters or clinical outcomes including 28-day mortality, length of stay, ventilator days, and venous thromboembolism between the groups. No transfusion reactions were reported in either group.

CONCLUSION: These data suggest LTOWB use is safe in children weighing less than 20 kg. Further multi-centre studies and larger cohorts are needed to confirm these results.

PMID:36971012 | DOI:10.1111/trf.17327

Scand J Gastroenterol. 2023 Mar 27:1-8. doi: 10.1080/00365521.2023.2194009. Online ahead of print.

ABSTRACT

BACKGROUND: Response evaluation after induction therapy with ustekinumab (UST) in Crohn’s disease (CD) is important for decisions on maintenance therapy. We aimed to assess the potential of fecal calprotectin (FC) levels to predict endoscopic response at week 16.

METHODS: CD patients with FC >100 µg/g and endoscopic active disease (SES-CD> 2, Rutgeerts’ score ≥ i2) at initiation of UST therapy were enrolled. FC was determined at weeks 0, 2, 4, 8 and 16 and patients underwent a colonoscopy at week 16. The primary outcome was an endoscopic response at week 16 (SES-CD score ≥50% decrease or a decrease of ≥1 points in Rutgeerts’ score). The optimal cut-off levels of FC and change in FC to predict endoscopic response were determined using ROC statistics.

RESULTS: 59 CD patients were included. Endoscopic response was observed in 21/59 (36%) patients. The diagnostic accuracy for FC levels at week 8 to predict endoscopic response at week 16 showed a predictive value of 0.71. A decrease in FC levels ≥500 µg/g between baseline at week 8 indicates endoscopic response (PPV = 89%), whereas absence of any decrease indicates endoscopic non-response after induction (NPV = 81%).

CONCLUSIONS: Continuation of UST therapy without endoscopic response evaluation may be considered in patients with a decrease in FC levels of ≥500 µg/g at week 8. The decision on continuation of UST therapy or therapy optimization needs reconsideration in patients without a decrease of FC level. In all other patients, endoscopic response evaluation of induction therapy remains essential for therapeutic decisions.

PMID:36970968 | DOI:10.1080/00365521.2023.2194009

Technol Health Care. 2023 Mar 23. doi: 10.3233/THC-220664. Online ahead of print.

ABSTRACT

BACKGROUND: Gastric cancer (GC) is the fifth most common cancer worldwide and the third leading cause of cancer death. Due to the low rate of early diagnosis, most patients are already in the advanced stage and lose the chance of radical surgery.

OBJECTIVE: To investigate the clinical value of computed tomography (CT) spectral imaging in preoperative evaluation of pathological types of gastric cancer patients.

METHODS: 121 patients with gastric cancer were selected. CT energy spectrum imaging was performed on the patients. The water and iodine concentration of the lesion were measured, and the standardized iodine concentration ratio was calculated. The iodine concentration, iodine concentration ratio and water concentration level of different pathological types were analyzed and compared.

RESULTS: The iodine concentration and iodine concentration ratio of gastric mucinous carcinoma patients in venous phase and parenchymal phase were lower than those of gastric non-mucinous carcinoma patients, and the differences were statistically significant (P< 0.05). The iodine concentration and iodine concentration ratio of patients with mucinous adenocarcinoma in venous phase and parenchymal phase were lower than those of patients with choriocarcinoma, and the differences were statistically significant (P< 0.05). The iodine concentration and iodine concentration ratio of middle and high differentiated adenocarcinoma patients in venous phase and parenchymal phase were lower than those of low differentiated adenocarcinoma patients, and the differences were statistically significant (P< 0.05). However, there was no significant difference in water concentration levels among venous, arterial, and parenchymal phases in all pathological types of gastric cancer patients (P> 0.05).

CONCLUSION: CT spectral imaging plays an important role in the preoperative evaluation of patients with gastric cancer. The pathological types of gastric cancer are different, and the iodine concentration will change accordingly. CT spectral imaging can effectively evaluate the pathological types of gastric cancer and has high clinical application value.

PMID:36970925 | DOI:10.3233/THC-220664

Technol Health Care. 2023 Mar 23. doi: 10.3233/THC-220600. Online ahead of print.

ABSTRACT

BACKGROUND: With the development of modern technology, the use of software-based applications in the field of health has become increasingly widespread. For this reason, computer-assisted personal registration forms have been developed using software programs.

OBJECTIVE: The aim of this study was to compare surface contamination during the filling of orthodontic anamnesis-consent forms, traditionally on paper and digitally on a tablet equipped with a software application, measured in confined spaces using the 3M Clean-Trace Luminometer device.

METHODS: In order for the participants to complete the orthodontic anamnesis-consent forms, two separate identical cabins with standard flat surfaces were prepared. In the first cabin, the participants conventionally completed these forms on paper (conventional group), while in the second cabin, the other group used a tablet equipped with a software program for this purpose (digital group). After the form completion process, surface pollution of the predetermined areas was measured in both cabins using a 3M Clean-Trace Luminometer device.

RESULTS: Surface contamination was found to be statistically significantly higher in all measurement areas in the conventional group than in the digital group. Despite a statistically significant difference between the two groups in relation to the measurements performed using the pens (conventional or electronic), this was not as strong as those found for the remaining surfaces.

CONCLUSION: The completion of orthodontic anamnesis-consent forms over tablets significantly reduced surface contamination in the close environment. This study reflects the importance of digitization – which has become beneficial in many fields – in reducing the spread of infections.

PMID:36970922 | DOI:10.3233/THC-220600