Tag: statistics

Ann Stat. 2022 Oct;50(5):2793-2815. doi: 10.1214/22-aos2210. Epub 2022 Oct 27.

ABSTRACT

Multiple biomarkers are often combined to improve disease diagnosis. The uniformly optimal combination, i.e., with respect to all reasonable performance metrics, unfortunately requires excessive distributional modeling, to which the estimation can be sensitive. An alternative strategy is rather to pursue local optimality with respect to a specific performance metric. Nevertheless, existing methods may not target clinical utility of the intended medical test, which usually needs to operate above a certain sensitivity or specificity level, or do not have their statistical properties well studied and understood. In this article, we develop and investigate a linear combination method to maximize the clinical utility empirically for such a constrained classification. The combination coefficient is shown to have cube root asymptotics. The convergence rate and limiting distribution of the predictive performance are subsequently established, exhibiting robustness of the method in comparison with others. An algorithm with sound statistical justification is devised for efficient and high-quality computation. Simulations corroborate the theoretical results, and demonstrate good statistical and computational performance. Illustration with a clinical study on aggressive prostate cancer detection is provided.

PMID:36341282 | PMC:PMC9635489 | DOI:10.1214/22-aos2210

Front Med (Lausanne). 2022 Oct 20;9:994308. doi: 10.3389/fmed.2022.994308. eCollection 2022.

ABSTRACT

OBJECTIVE: This study aimed to identify trajectories of radiographic progression of the spine over time and use them, along with associated clinical factors, to develop a prediction model for patients with ankylosing spondylitis (AS).

METHODS: Data from the medical records of patients diagnosed with AS in a single center were extracted between 2001 and 2018. Modified Stoke Ankylosing Spondylitis Spinal Scores (mSASSS) were estimated from cervical and lumbar radiographs. Group-based trajectory modeling classified patients into trajectory subgroups using longitudinal mSASSS data. In multivariate analysis, significant clinical factors associated with trajectories were selected and used to develop a decision tree for prediction of radiographic progression. The most appropriate group for each patient was then predicted using decision tree analysis.

RESULTS: We identified three trajectory classes: class 1 had a uniformly increasing slope of mSASSS, class 2 showed sustained low mSASSS, and class 3 showed little change in the slope of mSASSS but highest mSASSS from time of diagnosis to after progression. In multivariate analysis for predictive factors, female sex, younger age at diagnosis, lack of eye involvement, presence of peripheral joint involvement, and low baseline erythrocyte sedimentation rate (log) were significantly associated with class 2. Class 3 was significantly associated with male sex, older age at diagnosis, presence of ocular involvement, and lack of peripheral joint involvement when compared with class 1. Six clinical factors from multivariate analysis were used for the decision tree for classifying patients into three trajectories of radiographic progression.

CONCLUSION: We identified three patterns of radiographic progression over time and developed a decision tree based on clinical factors to classify patients according to their trajectories of radiographic progression. Clinically, this model holds promise for predicting prognosis in patients with AS.

PMID:36341272 | PMC:PMC9631932 | DOI:10.3389/fmed.2022.994308

Front Med (Lausanne). 2022 Oct 19;9:1042101. doi: 10.3389/fmed.2022.1042101. eCollection 2022.

ABSTRACT

PURPOSE: To compare stereopsis and visual acuity (VA) between bilateral implantation of trifocal intraocular lenses (IOL) and blended implantation of an extended depth of focus (EDOF) IOL with a bifocal IOL.

METHODS: This is a non-randomized, prospective comparative study included 74 eyes of 37 patients who underwent phacoemulsification and bilateral implantation of AT LISA tri 839MP IOL (bilateral group; 21 patients) or blended implantation of Tecnis Symfony ZXR00 and Tecnis ZLB00 IOL (blended group; 16 patients). The primary outcomes were stereoacuity and binocular VA. The secondary outcomes were visual defocus curve, quality of life, and patient satisfaction. Follow-up was performed 3 months after the surgery.

RESULTS: The mean near stereoacuity was 49.76 ± 22.67 and 120.63 ± 90.94 seconds of arc (arcsec) in the bilateral and blended groups, respectively (P < 0.001). Near stereoacuity was positively correlated with VA difference of two eyes (r = 0.896, P < 0.001). The mean binocular uncorrected visual acuity at 40 cm, 80 cm, 5 m, and corrected distance visual acuity at 5 m of the bilateral and blended groups was not statistically significant different. The bilateral group had better VA at a vergence from -2.5 to -4.0 D. Both groups obtained high quality of life and patient satisfaction scores.

CONCLUSION: The bilateral and blended groups achieved good binocular VA, quality of life, and high patient satisfaction. However, the near stereoacuity of the blended group was worse.

PMID:36341263 | PMC:PMC9629615 | DOI:10.3389/fmed.2022.1042101

Front Med (Lausanne). 2022 Oct 20;9:1028171. doi: 10.3389/fmed.2022.1028171. eCollection 2022.

ABSTRACT

OBJECTIVE: To explore the clinical efficacy and adverse reactions of Jiawei Maxing Shigan Tang (JMST; a modified decoction of ephedra, apricot kernel, gypsum, and licorice) combined with western medicine in the symptomatic treatment of COVID-19.

METHODS: In this study, we retrospectively collected the basic data of 48 patients with COVID-19 who were discharged from our hospital between January 20 and February 28, 2020. Besides, the blood routines, biochemical indexes, nucleic acid detection results, clinical symptoms, lung imaging improvements, adverse reactions, and other clinical data of these patients before and after treatment were recorded. Finally, we drew comparisons between the outcomes and adverse reactions of patients in the combined treatment group (therapeutic regimen recommended by authoritative guidelines and supplemented by JMST) and the conventional treatment group (therapeutic regimen recommended by authoritative guidelines).

RESULTS: There were no significant differences in age, gender, clinical classification, and underlying medical conditions between the combined treatment group (28 cases) and the conventional treatment group (20 cases). However, the combined treatment group presented superior results to the conventional treatment group in several key areas. For instance, patients produced negative nasal/throat swab-based nucleic acid detection results in a shorter time, clinical symptoms were more effectively alleviated, and the absorption time of lung exudation was shorter (P < 0.05). Furthermore, the combined treatment group had a shorter length of stay (LOS) and faster lymphocyte recovery duration than the conventional treatment group, although the differences were not statistically significant. Moreover, there were no significant differences concerning gastrointestinal reaction, hepatic injury, renal impairment, myocardial injury, and other adverse reactions between the two groups.

CONCLUSION: The results of this study indicate that JMST combined with the recommended therapeutic regimen enhances the recovery of COVID-19 patients without increasing the risk of adverse reactions. Therefore, this therapy promotes positive outcomes for COVID-19 patients.

PMID:36341261 | PMC:PMC9632655 | DOI:10.3389/fmed.2022.1028171

Diabetes Metab Syndr Obes. 2022 Oct 29;15:3329-3337. doi: 10.2147/DMSO.S383234. eCollection 2022.

ABSTRACT

PURPOSE: Angiopoietin-Like3 is a protein that plays an important role in regulating plasma triglyceride concentrations by inhibiting the enzyme lipoprotein lipase. Lipid metabolism and glucose metabolism are closely related and interact with each other. ANGPTL3 may also be a factor involved in blood glucose regulation through an increase in free fatty acids generated from enhanced lipolysis in adipose tissue leading to insulin resistance. This study aimed to investigate plasma ANGPTL3 concentrations and their correlation with lipid and glucose metabolic markers in newly diagnosed type 2 Diabetes Mellitus patients.

SUBJECT AND METHODS: A cross-sectional descriptive study was conducted on 98 healthy subjects (control group) and 103 patients with type 2 diabetes at the first diagnosis, without any treatment (patient group). Plasma ANGPTL3 concentration was quantified by the ELISA method. The study determines the correlation of ANGPTL3 concentration with some indicators reflecting lipid and glucose metabolism.

RESULTS: The concentration of ANGPTL3 in the newly diagnosed type 2 Diabetes Mellitus patient group was lower than in the control group, the difference was statistically significant with p < 0.05. In the patient group: there was an inverse correlation between ANGPTL3 concentration and HDL-C concentration (r = -0.37; p<0.001), and a positive correlation with triglyceride concentration (r = 0.275; p < 0.05). There was no correlation between plasma ANGPTL3 levels and anthropometric indices, total cholesterol, HDL-C, glucose, HbA1C, insulin, and HOMA-IR. In the control group: there was no correlation between ANGPTL3 and any of the indicators mentioned above.

CONCLUSION: ANGPTL3 levels in newly diagnosed type 2 diabetes mellitus patients were statistically significantly lower than in healthy subjects. Plasma ANGPTL3 was positively correlated with triglyceride levels and inversely correlated with HDL-C levels in newly diagnosed type 2 Diabetes mellitus patients.

PMID:36341228 | PMC:PMC9628699 | DOI:10.2147/DMSO.S383234

Diabetes Metab Syndr Obes. 2022 Oct 29;15:3339-3346. doi: 10.2147/DMSO.S369457. eCollection 2022.

ABSTRACT

PURPOSE: Critically ill patients with premorbid diabetes can suffer from relative hypoglycemia (RHG), falling below the normal blood glucose (BG) target. However, these events have not been well defined or studied. In the present study, we aimed to explore the incidence and clinical significance of RHG events in critically ill patients with diabetes.

PATIENTS AND METHODS: Patients with a history of diabetes who stayed in the intensive care unit (ICU) for more than three days with at least 12 BG recordings were retrospectively included in the study. A BG level > 30% below the estimated average according to patient hemoglobin A1c measured at admission was defined as a single RHG event. Outcomes were compared between patients with and those without RHG events.

RESULTS: In total, 113 patients were included in the final analysis. RHG was detected in 73 patients (64.6%). Those who experienced RHG events had a significantly higher incidence of ICU delirium. They also had a higher risk of 28-day mortality, but this was not statistically significant. However, patients with a higher frequency of RHG events did have a significantly higher risk of overall mortality (57.1% for more than four events vs 15.4% for three to four events, P=0.006 and 15.1% for one to two events, P=0.003).

CONCLUSION: In conclusion, RHG is a common finding in critically ill patients with diabetes and is associated with mortality and the occurrence of delirium.

PMID:36341226 | PMC:PMC9628698 | DOI:10.2147/DMSO.S369457

JACC Asia. 2021 Oct 26;1(3):317-329. doi: 10.1016/j.jacasi.2021.08.007. eCollection 2021 Dec.

ABSTRACT

BACKGROUND: Clinical advantages of sutureless rapid-deployment (RD) aortic valve replacement (AVR) for severe aortic valve stenosis (AS) have not been elucidated compared with surgical (SAVR) or transcatheter (TAVR) aortic valve replacement.

OBJECTIVES: This study sought to investigate comparative effectiveness and safety of RD-AVR compared with SAVR and TAVR in a prospective cohort of patients with severe AS.

METHODS: The primary outcome was a composite of death, stroke, or rehospitalization at 12 months. Propensity score matching was used to assemble a cohort of patients with similar baseline characteristics.

RESULTS: Among 1,020 eligible patients, 107 (10.5%) underwent RD-AVR, 437 (42.8%) underwent SAVR, and 476 (46.7%) underwent TAVR. In the matched cohorts of RD-AVR and SAVR (n = 107), the incidence of primary composite outcome at 12 months was similar between the 2 groups (8.0% vs 10.8%, respectively; hazard ratio [HR]: 0.74; 95% confidence interval [CI]: 0.30-1.84; P = 0.52). In the matched cohorts of RD and TAVR (n = 58), the incidence of primary composite outcome at 12 months did not statistically differ between the 2 groups (9.4% vs 16.2%, respectively; HR: 0.53; 95% CI: 0.18-1.57; P = 0.25).

CONCLUSIONS: In this propensity-matched cohort of patients who underwent AVR for severe AS, we did not detect significant differences in the rates of the primary composite of death, stroke, or rehospitalization at 12 months when comparing RD-AVR with SAVR and TAVR. Because the study was underpowered, the results should be considered as hypothesis generating highlighting the need for further research. (ASAN Medical Center Aortic Valve Replacement Registry [ASAN-AVR]; NCT03298178).

PMID:36341221 | PMC:PMC9627931 | DOI:10.1016/j.jacasi.2021.08.007

JIMD Rep. 2022 Aug 24;63(6):604-613. doi: 10.1002/jmd2.12325. eCollection 2022 Nov.

ABSTRACT

Inherited metabolic disorders (IMD) are a group of hereditary diseases wherein the impairment of a biochemical pathway is intrinsic to the pathophysiology of the disease. Estonia’s small population and nationwide digitalised healthcare system make it possible to perform an epidemiological study that covers the whole population. A study was performed in Tartu University Hospital, which is the only tertiary care unit in Estonia for diagnosing patients with IMD, to define the prevalence and live birth prevalence of IMDs and the effectiveness of new diagnostic methods on the diagnosis of IMD. During the retrospective study period from 1990 to 2017, 333 patients were diagnosed with IMD. Statistical analysis showed a significant increase in IMD diagnoses per year from 0.47 to 2.51 cases per 100 000 persons (p < 0.0001) during the study period. Live birth prevalence of IMD in Estonia was calculated to be 41.52 cases per 100 000 live births. The most frequently diagnosed IMD groups were disorders of amino acid metabolism, disorders of complex molecule degradation, mitochondrial disorders, and disorders of tetrapyrrole metabolism. Phenylketonuria was the most frequently diagnosed disorder of all IMD (21.6%). Our results correlated well with data from other developed countries and, along with high birth prevalence, add confidence in the effectiveness of our diagnostic yield. Implementation of new diagnostic methods during study period may largely account for the significant increase in the number of IMD diagnoses per year. We conclude that the implementation of new diagnostic methods continues to be important and contributes to better diagnosis of rare diseases.

PMID:36341167 | PMC:PMC9626666 | DOI:10.1002/jmd2.12325

ScientificWorldJournal. 2022 Oct 28;2022:4808065. doi: 10.1155/2022/4808065. eCollection 2022.

ABSTRACT

In this paper, we obtain the approximate value of 42.9815 arcsec/century for Mercury’s perihelion precession by solving both numerically and analytically the nonlinear ordinary differential equation derived from the geodesic equation in Einstein’s Theory of Relativity. We also compare our result with known results, and we illustrate graphically the way Mercury’s perihelion moves. The results we obtained are applicable to any body that moves around the Sun. We give predictions about the value of the Cosmological Constant. Simple algebraic formulas allow to estimate perihelion shifts with high accuracy.

PMID:36341161 | PMC:PMC9635960 | DOI:10.1155/2022/4808065

Mil Med. 2022 Nov 5:usac328. doi: 10.1093/milmed/usac328. Online ahead of print.

ABSTRACT

INTRODUCTION: There is a paucity of quantitative research regarding the effect of coronavirus 2019 (COVID-19) on Emergency Department (ED) visits in the United States, and specifically mental health-related ED visits. The small existing body of research describes an overall decline in ED visits worldwide; however, there are anecdotal reports that psychiatric complaints to the ED have increased during the pandemic. The primary objective of this study was to describe the volume of mental health ED visits at a single ED during the COVID-19 pandemic compared to previous years.

MATERIALS AND METHODS: This was a single-center, retrospective chart review of adult patients evaluated in the ED at an academic military medical facility from March to December of 2017-2020 for mental health. The electronic medical record was queried for mental health International Classification of Diseases, 10th Revision diagnosis codes. Demographic data including age, gender, disposition, diagnosis, and beneficiary status were collected, and Pearson Chi-Square was used to assess for statistical significance between years.

RESULTS: There was a total of 1,486 mental health ED visits from March to December 2020, compared to an average of 1,668 visits from March to December 2017-2019. Statistically significant (P < 0.05) differences, between 2020 and the prior 3 years combined, were identified in the categories of age, disposition, beneficiary status, and diagnosis. In 2020, there was a lower proportion of visits for patients aged ≥60 (1.2%) than in 2017-2019 (2.5%). Active-duty patients comprised a higher proportion of mental health visits in 2020 (82.4%) versus 2017-2019 (77%). Proportionately fewer patients were admitted in 2020 (25.2%) versus 2017-2019 (29.2%). Adjustment disorders made up 19.0% of visits in 2020 versus 23.2% in 2017-2019, and suicidal ideation and intentional self-inflicted injury comprised 43.3% in 2020 compared with 40.4% in 2017-2019.

CONCLUSION: There was a significant decline in ED visits for patients over the age of 60 but a significant increase in visits for active-duty patients. Fewer patients were admitted compared to previous years. There was a significant increase in patients diagnosed with suicidal ideation and intentional self-inflicted injury in 2020 compared to previous years. Alarmingly, this study shows increased rates of self-harm and suicidal ideation. Further study is needed to determine why these effects were seen and if there is a higher risk for suicide attempt or completion in these populations. These results indicate that military leadership and the military health system is failing to adequately support and protect service members and their families during these uniquely stressful times. High-level attention to this issue by military leadership is required; the readiness and safety of the nation’s fighting force is at stake.

PMID:36336793 | DOI:10.1093/milmed/usac328