Tag: statistics

J Magn Reson Imaging. 2023 May;57(5):1533-1540. doi: 10.1002/jmri.28403. Epub 2022 Aug 16.

ABSTRACT

BACKGROUND: Automated segmentation of the placenta by MRI in early pregnancy may help predict normal and aberrant placenta function, which could improve the efficiency of placental assessment and the prediction of pregnancy outcomes. An automated segmentation method that works at one gestational age may not transfer effectively to other gestational ages.

PURPOSE: To evaluate a spatial attentive deep learning method (SADL) for automated placental segmentation on longitudinal placental MRI scans.

STUDY TYPE: Prospective, single-center.

SUBJECTS: A total of 154 pregnant women who underwent MRI scans at both 14-18 weeks of gestation and at 19-24 weeks of gestation, divided into training (N = 108), validation (N = 15), and independent testing datasets (N = 31).

FIELD STRENGTH/SEQUENCE: A 3 T, T2-weighted half Fourier single-shot turbo spin-echo (T2-HASTE) sequence.

ASSESSMENT: The reference standard of placental segmentation was manual delineation on T2-HASTE by a third-year neonatology clinical fellow (B.L.) under the supervision of an experienced maternal-fetal medicine specialist (C.J. with 20 years of experience) and an MRI scientist (K.S. with 19 years of experience).

STATISTICAL TESTS: The three-dimensional Dice similarity coefficient (DSC) was used to measure the automated segmentation performance compared to the manual placental segmentation. A paired t-test was used to compare the DSCs between SADL and U-Net methods. A Bland-Altman plot was used to analyze the agreement between manual and automated placental volume measurements. A P value < 0.05 was considered statistically significant.

RESULTS: In the testing dataset, SADL achieved average DSCs of 0.83 ± 0.06 and 0.84 ± 0.05 in the first and second MRI, which were significantly higher than those achieved by U-Net (0.77 ± 0.08 and 0.76 ± 0.10, respectively). A total of 6 out of 62 MRI scans (9.6%) had volume measurement differences between the SADL-based automated and manual volume measurements that were out of 95% limits of agreement.

DATA CONCLUSIONS: SADL can automatically detect and segment the placenta with high performance in MRI at two different gestational ages.

LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY STAGE: 2.

PMID:37021577 | DOI:10.1002/jmri.28403

Haematologica. 2023 Apr 6. doi: 10.3324/haematol.2023.282733. Online ahead of print.

ABSTRACT

Not available.

PMID:37021537 | DOI:10.3324/haematol.2023.282733

Thorac Cancer. 2023 Apr 6. doi: 10.1111/1759-7714.14882. Online ahead of print.

ABSTRACT

OBJECTIVE: Advanced lung cancers carrying Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation remain a group that lacks effective treatments. Receptor activator of nuclear factor-κB ligand (RANKL) has been demonstrated to drive malignant phenotypes in lung cancer; however, its role in KRAS-mutant (mt) lung adenocarcinoma (LUAD) is not yet fully elucidated.

MATERIALS AND METHODS: The data used to explore expression and prognosis were obtained from The Cancer Genome Atlas, Genotype-Tissue Expression databases, and from our hospital. The proliferation, invasion, and migration capacities of KRAS-mt LUAD cells were evaluated. The prediction model was established via Lasso regression method.

RESULTS: RANKL is strongly expressed in advanced KRAS-mt LUAD, and significantly distinct association exists between high RANKL expression and poor survival. The enriched expression of RANKL in advanced KRAS-mt LUAD was confirmed by specimens from our hospital. Further, although not statistically significant, our clinical cohort (n = 57) revealed a longer median progression-free survival in advanced KRAS-mt LUAD patients treated with RANKL inhibitor than those without (300 vs. 133 days, p = 0.210), but not in KRAS-wt ones (208 vs. 250 days, p = 0.334). Decrease of KRAS-mt LUAD cells’ capacity for proliferation, invasion, and migration was observed when RANKL was knocked down. Enrichment analysis suggested distinct roles of RANKL between KRAS-mt and KRAS-wt LUAD, with adhesion-related pathways and molecules significantly downregulated in the KRAS-mt RANKL-high tumors. Finally, a model for predicting overall survival of KRAS-wt LUAD was established according to four related key genes (BCAM, ICAM5, ITGA3, and LAMA3), which had good performance in prediction concordance.

CONCLUSIONS: RANKL acts as an unfavorable prognostic biomarker for patients with advanced KRAS-mt LUAD. Inhibition of RANKL may be a feasible strategy for this subset of patients.

PMID:37021520 | DOI:10.1111/1759-7714.14882

J Chemother. 2023 Apr 6:1-9. doi: 10.1080/1120009X.2023.2196916. Online ahead of print.

ABSTRACT

This study aims to evaluate the clinical pharmacist’s contribution impact on the appropriate use of colistin. Our study was conducted prospectively in patients in the Internal Diseases Intensive Care Unit of Gazi University Medical Faculty Hospital for eight months. The first four months of the study were with the observation group, while the next four months were with the intervention group. The study determined how the active participation of clinical pharmacists had affected the appropriateness of colistin use. The results showed that the appropriate use of colistin was higher in the intervention group than in the observational group; furthermore, incidence of nephrotoxicity was lower. The difference between both groups was statistically significant (p < 0.001, p < 0.05), respectively. This study showed that the clinical pharmacist’s active intervention by following the patients increased the frequency and percentage of the appropriate use of colistin. This decreased the incidence of nephrotoxicity, colistin’s most important side effect.

PMID:37021512 | DOI:10.1080/1120009X.2023.2196916

Allergy Asthma Immunol Res. 2023 Mar;15(2):262-270. doi: 10.4168/aair.2023.15.2.262.

ABSTRACT

Various therapeutic approaches, including supplemental nutritional support, have been tried for the treatment of atopic dermatitis (AD). Previous studies have reported the role of vitamin D in the treatment of AD with inconsistent results. The aim of this study was to evaluate the effectiveness of vitamin D in the treatment of AD, with considerations on the heterogeneities of AD. Randomized controlled trials (RCTs) on the efficacy of vitamin D supplementation for AD treatment, published before June 30, 2021 were identified in the PubMed, EMBASE, MEDLINE, and Cochrane Library databases. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation system. This meta-analysis included 5 RCTs with 304 cases of AD. We found that vitamin D supplementation did not decrease AD severity, even when AD was classified as severe vs non-severe. However, vitamin D supplementation was found to be effective in the treatment of AD in RCTs that included both children and adults, but not in those that included only children. Geographic location was associated with a significant difference in the therapeutic effect of vitamin D supplementation. Moreover, vitamin D supplementation of > 2,000 IU/day decreased AD severity, but supplementation ≤ 2,000 IU/day did not. Vitamin D supplementation, in general, was not effective for the treatment of AD. However, vitamin D supplementation might provide a therapeutic effect depending on the geographic location and dose of supplementation. The results of the present meta-analysis suggest that vitamin D supplementation might be targeted for patients with AD who may benefit from vitamin D supplementation.

PMID:37021510 | DOI:10.4168/aair.2023.15.2.262

Stat Methods Med Res. 2023 Apr 6:9622802231167437. doi: 10.1177/09622802231167437. Online ahead of print.

ABSTRACT

Response-adaptive randomization allows the probabilities of allocating patients to treatments in a clinical trial to change based on the previously observed response data, in order to achieve different experimental goals. One concern over the use of such designs in practice, particularly from a regulatory viewpoint, is controlling the type I error rate. To address this, Robertson and Wason (Biometrics, 2019) proposed methodology that guarantees familywise error rate control for a large class of response-adaptive designs by re-weighting the usual $z$-test statistic. In this article, we propose an improvement of their method that is conceptually simpler, in the context where patients are allocated to the experimental treatment arms in a trial in blocks (i.e. groups) using response-adaptive randomization. We show the modified method guarantees that there will never be negative weights for the contribution of each block of data to the adjusted test statistics, and can also provide a substantial power advantage in practice.

PMID:37021480 | DOI:10.1177/09622802231167437

Clin Rehabil. 2023 Apr 6:2692155231166220. doi: 10.1177/02692155231166220. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate whether combination of corticosteroid subdeltoid injections and physiotherapy was more effective than either treatment alone in chronic subacromial bursitis.

DESIGN: Prospective, three-arm randomised controlled trial.

SETTING: Rehabilitation department of an academic hospital.

SUBJECTS: Patients with chronic subacromial bursitis.

INTERVENTIONS: Patients were divided into corticosteroid injection (N = 36), physiotherapy (N = 40) and combined (N = 35) groups. Two corticosteroid subdeltoid injections in corticosteroid group, 8-week physical therapy emphasising on therapeutic exercise in physiotherapy group, and combined both treatments in combined group.

MAIN OUTCOME MEASURES: The primary outcome measures were pain visual analogue scale and Shoulder Pain and Disability Index at 8 weeks after finishing treatment. The secondary outcome measures were active range of motion, Shoulder Disability Questionnaire, Western Ontario Rotator Cuff Index, patient’s evaluation of treatment effect, and symptom recurrence.

RESULTS: Group comparison showed significant statistical difference in shoulder flexion (P < 0.003) and patient’s evaluation of treatment effect (P < 0.001). The time and group interactions comparison revealed significant statistical differences in pain score (P < 0.024), external rotation (P < 0.044) and patient’s evaluation of treatment effect (P < 0.001). The above statistics were in favour of the corticosteroid and combined groups rather than physiotherapy group. The percentage of recurrence was 36.1, 7.5 and 17.1 in the corticosteroid, physiotherapy and combined groups, respectively (P < 0.001).

CONCLUSION: Corticosteroid subdeltoid injection, or combined with physiotherapy, was superior to physiotherapy alone, but the recurrence rate was least in the physiotherapy group.

PMID:37021475 | DOI:10.1177/02692155231166220

CNS Neurol Disord Drug Targets. 2023 Apr 4. doi: 10.2174/1871527322666230404114911. Online ahead of print.

ABSTRACT

BACKGROUND: Autism Spectrum Disorder (ASD) is a common child neurodevelopmental disorder, whose pathogenesis is not completely understood. Until now, there is no proven treatment for the core symptoms of ASD. However, some evidence indicates a crucial link between this disorder and GABAergic signals which are altered in ASD. Bumetanide is a diuretic that reduces chloride, shifts gamma-amino-butyric acid (GABA) from excitation to inhibition, and may play a significant role in the treatment of ASD.

OBJECTIVE: The objective of this study is to assess the safety and efficacy of bumetanide as a treatment for ASD.

METHODS: Eighty children, aged 3-12 years, with ASD diagnosed by Childhood Autism Rating Scale (CARS), ⩾30 were included in this double-blind, randomized, and controlled study. Group 1 received Bumetanide, Group 2 received a placebo for 6 months. Follow-up by CARS rating scale was performed before and after 1, 3, and 6 months of treatment.

RESULTS: The use of bumetanide in group 1 improved the core symptoms of ASD in a shorter time with minimal and tolerable adverse effects. There was a statistically significant decrease in CARS and most of its fifteen items in group 1 versus group 2 after 6 months of treatment (p-value <0.001).

CONCLUSION: Bumetanide has an important role in the treatment of core symptoms of ASD.

PMID:37021422 | DOI:10.2174/1871527322666230404114911

Nutr Health. 2023 Apr 6:2601060231166036. doi: 10.1177/02601060231166036. Online ahead of print.

ABSTRACT

AIM: To evaluate the association between sociodemographic factors and screen exposure during meals with the consumption of dietary markers in children treated at a university hospital in Rio de Janeiro.

METHODS: Cross-sectional study with children of both sexes between 2 and 9 years of age. Food consumption and screen exposure were assessed using specific forms. The socio-demographic data evaluated were age, maternal education, household composition, receipt of government benefits, and household food and nutrition security. The statistical analysis included simple and multivariate logistic regression with a confidence interval of 95%.

RESULTS: Among the 129 children evaluated, most of them were of preschool age (57.4%), 71.3% received some type of government benefit, and 69.8% ate meals in front of screens. Among the markers of a healthy diet, beans (86.0%) and fresh fruits (69.8%) were the most consumed, while among the markers of an unhealthy diet, the most common components were sweetened beverages (61.7%) and cookies, candies, or other sweets (54.7%). There was a higher consumption of sweetened beverages among the children whose families received a government benefit (OR 2.63; 95% CI: 1.13-6.13) and who were exposed to a screen during meals (2.27; 95% CI: 1.01-5, 14).

CONCLUSION: This study showed that in view of the high frequency of consumption of unhealthy foods and screen exposure during meals, it is imperative that food and nutrition education actions are taken to promote an adequate and healthy food environment in childhood.

PMID:37021415 | DOI:10.1177/02601060231166036

J Gerontol A Biol Sci Med Sci. 2023 Apr 6:glad099. doi: 10.1093/gerona/glad099. Online ahead of print.

ABSTRACT

BACKGROUND: Almost 60% of adults with amnestic mild cognitive impairment (aMCI) have obstructive sleep apnea (OSA). Treatment with continuous positive airway pressure (CPAP) may delay cognitive decline, but CPAP adherence is often suboptimal. In this study we report predictors of CPAP adherence in older adults with aMCI who have increased odds of progressing to dementia, particularly due to Alzheimer’s disease.

METHODS: The data are from Memories 2, “Changing the Trajectory of Mild Cognitive Impairment with CPAP Treatment of Obstructive Sleep Apnea”. Participants had moderate to severe OSA, were CPAP naïve, and received a telehealth CPAP adherence intervention. Linear and logistic regression models examined predictors.

RESULTS: The 174 participants (mean age 67.08 years, 80 Female, 38 Black persons) had a mean apnea-hypopnea index of 34.78, and 73.6% were adherent, defined as an average of ≥ 4 hours of CPAP use per night. Only 18 (47.4%) Black persons were CPAP adherent. In linear models, White race, moderate OSA, and participation in the tailored CPAP adherence intervention were significantly associated with higher CPAP use at 3 months. In logistic models, White persons had 9.94 times the odds of adhering to CPAP compared to Black persons. Age, sex, ethnicity, education, body mass index, nighttime sleep duration, daytime sleepiness, and cognitive status were not significant predictors.

CONCLUSIONS: Older patients with aMCI have high CPAP adherence, suggesting that age and cognitive impairment should not be a barrier to prescribing CPAP. Research is needed to improve adherence in Black patients, perhaps through culturally tailored interventions.

PMID:37021413 | DOI:10.1093/gerona/glad099