Tag: statistics

Ann Nucl Med. 2022 Oct 30. doi: 10.1007/s12149-022-01797-7. Online ahead of print.

ABSTRACT

OBJECTIVE: This study was performed to evaluate the prognostic meaning of volumetric and semi-quantitative parameters measured using [18F]FDG PET/CT and somatostatin receptor (SSTR) imaging in patients with typical lung carcinoid (TC), and their relationship with proliferative index (Ki67).

METHODS: We retrospectively reviewed 67 patients (38-94 years old, mean: 69.7) with diagnosis of TC who underwent [18F]FDG PET/CT and/or SSTR scintigraphy/SPECT with [111In]DTPA-Octreotide plus contrast-enhanced CT (CECT) at staging evaluation. All patients had Ki67 measured and a follow-up (FU) of at least 1 year. SSTR density (SSTRd) was calculated as the percentage difference of tumor/non-tumor ratio at 4 and 24 h post-injection. At PET/CT, metabolic activity was measured using SUVmax and SUVratio; volumetric parameters included MTV and TLG of the primary tumor, measured using the threshold SUV41%. ROC analysis, discriminant analysis and Kaplan-Meier curves (KM) were performed.

RESULTS: 11 patients died during FU. Disease stage (localized versus advanced), SUVratio, SUVmax, Ki67, MTV and TLG were significantly higher in non-survivors than in survivors. ROC curves resulted statistically significant for Ki67, SUVratio, SUVmax, MTV and TLG. On multivariate analysis, stage of disease and TLG were significant independent predictors of overall survival (OS). In KM curves, the combination of disease stage and TLG identified four groups with significantly different outcomes (p < 0.005). Metabolic activity (SUVmax and SUVratio) was confirmed as significant independent prognostic factor for OS also in patients with advanced disease, with the best AUC using SUVmax. In patients with advanced and localized disease, SSTRd proved to be the best imaging prognostic factor for progression and for disease-free survival (DFS), respectively. In localized disease, SSTRd 31.5% identified two subgroups of patients with significant different DFS distribution and in advanced disease, a high cutoff value (58.5%) was a significant predictor of adverse prognosis.

CONCLUSION: Volumetric and semi-quantitative parameters measured using [18F]FDG PET/CT and SSTR imaging combined with Ki67 may provide a reference for prognosis evaluation of patients with TC, to better stratify risk groups with the goal of developing individualized therapeutic strategies.

PMID:36309948 | DOI:10.1007/s12149-022-01797-7

AIDS Behav. 2022 Oct 30. doi: 10.1007/s10461-022-03906-z. Online ahead of print.

ABSTRACT

In South Africa, little is known about interrelationships between syndemic problems among people with HIV (PWH). A better understanding of syndemic problems may yield important information regarding factors amenable to mitigation. We surveyed 194 PWH in Khayelitsha, outside of Cape Town, South Africa. We used network analysis to examine the frequency of 10 syndemic problems and their interrelationships. Syndemic problems among PWH in South Africa were common; 159 (82.8%) participants reported at least 2 co-occurring syndemic problems and 90 (46.9%) endorsed 4 or more. Network analysis revealed seven statistically significant associations. The most central problems were depression, substance use, and food insecurity. Three clusters of syndemics were identified: mood and violence; structural factors; and behavioral factors. Depression, substance use, and food insecurity commonly co-occur among PWH in sub-Saharan Africa and interfere with HIV outcomes. Network analysis can identify intervention targets to potentially improve HIV treatment outcomes.

PMID:36309936 | DOI:10.1007/s10461-022-03906-z

Ann Neurol. 2022 Oct 30. doi: 10.1002/ana.26541. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the effect of additional mobile stroke unit (MSU) dispatch on functional outcomes among the full spectrum of stroke patients, regardless of subtype or potential reperfusion therapies contraindications.

METHODS: We used data from the nonrandomized Berlin-based B_PROUD study (02/2017-05/2019), in which MSUs were dispatched based solely on availability, and the linked B-SPATIAL stroke registry. All patients with final stroke or transient ischemic attack (TIA) diagnosis were eligible. The intervention under study was the additional dispatch of an MSU, an emergency physician-staffed ambulance equipped to provide prehospital imaging and thrombolytic treatment, compared to conventional ambulance alone. The primary outcome was the 3-month modified Rankin Scale (mRS) score, and the co-primary outcome was a 3-tiered disability scale. We identified confounders using Directed Acyclic Graphs and obtained adjusted effect estimates using inverse probability of treatment weighting.

RESULTS: MSUs were dispatched to 1,125 patients (mean age: 74y, 46.5% female), while for 1,141 only conventional ambulances were dispatched (75y, 49.9% female). After confounding adjustment, MSU dispatch was associated with more favorable 3-month mRS scores (common odds ratio, cOR=0.82; 95%CI: 0.71-0.94). No statistically significant association was found with the co-primary outcome (cOR=0.86; 0.72-1.01) or seven-day mortality (OR=0.94; 0.59-1.48).

INTERPRETATION: When considering the entire population of stroke/TIA patients, MSU dispatch improved 3-month functional outcomes without evidence of compromised safety. Our results are relevant for decision-makers since stroke subtype and treatment eligibility are unknown at time of dispatch. This article is protected by copyright. All rights reserved.

PMID:36309933 | DOI:10.1002/ana.26541

Int J Health Plann Manage. 2022 Oct 30. doi: 10.1002/hpm.3588. Online ahead of print.

ABSTRACT

BACKGROUND: Intermittent Preventive Therapy using Sulfadoxine Pyrimethamine (IPTp-SP) is a malaria control strategy to reduce cases of malaria in pregnancy in endemic countries. However, the administration of the recommended three doses of Intermittent Preventive Therapy (IPTp) throughout the stages of pregnancy still remains low in Nigeria. Limited knowledge by health workers on the administration of the recommended doses of IPTp to pregnant women receiving antenatal care (ANC) services is partly responsible for this gap. This study applied Quality Improvement (QI) approach to improve knowledge and practice among healthcare providers with respect to the administration of IPTp-SP.

METHODS: A quasi-experimental study design was carried out to evaluate the effect of QI approach consisting of training and coaching of healthcare providers to improve the administration of IPTp during ANC services. Primary Healthcare Centre Samaru was purposively selected and 11 healthcare providers participated in the study. The total duration of the intervention was for a period of 4 weeks which comprises of four training sessions conducted over a period of 2 weeks and four coaching sessions conducted for a period of another 2 weeks. The training package involved the use of the Information, Education and Communication approach of healthcare providers on IPTp administration while the coaching package involved supervision and follow-up meetings guiding healthcare providers on the protocol of IPTp administration. Antenatal care daily register was reviewed pre-intervention, intervention and post-intervention period of the study. Data were analysed using line graphs and run charts.

RESULTS: A total of 36 ANC visit weeks were observed between 21 November 2016 and 27 July 2017. There was overestimation of first dose of IPTp (IPTp1) as 8 of the 16 Weeks in the pre-intervention period had more than 100% of eligible women administered IPTp1. There was evidence indicating the process of IPTp1 was relatively stable post-intervention as the data crosses the median line only six times that is, 7 runs. This indicates that the process of IPTp1 was within normal variation over the post-intervention period. The patterns of IPTp2+ administrations shows the levels of IPTp2+ administration were erratic. There was an upward shift showing immediate improvement of the administration of IPTp2+ post-intervention.

CONCLUSIONS: The integrated training and coaching intervention approach improved the administration of the recommended three doses of IPTp within the context of a Primary Healthcare Centre. The data quality of the ANC daily register improved post-intervention.

PMID:36309932 | DOI:10.1002/hpm.3588

Transfusion. 2022 Oct 30. doi: 10.1111/trf.17165. Online ahead of print.

ABSTRACT

BACKGROUND: Platelets are part of innate immunity and comprise the cellular portion of hemostasis. Platelets express sex hormone receptors on their plasma membrane and sex hormones can alter their function in vitro. Little is known about how age and sex may affect platelet biology; thus, we hypothesized that platelets from males and females have different metabolomic profiles, which may be altered by age and in vitro treatment with sex hormones.

METHODS: Day 1 apheresis platelets were drawn from five 18-53-year-old, premenopausal younger females (YF), five ≥54-year-old, postmenopausal, older females (OF), five 18-44-year-old younger males (YM), and four ≥45-year-old older males (OM). Platelets were normalized to a standard concentration and metabolomics analyses were completed. Unsupervised statistical analyses and hierarchical clustering with principal component analyses were completed.

RESULTS: Platelets from OM had (1) elevated mono-, di- and tri-carboxylates, (2) increased levels of free fatty acids, acyl-carnitines, and free amino acids, and (3) increased purine breakdown and deamination products. In vitro incubation with sex hormones only affected platelets from OM donors with trends towards increased ATP and other high-energy purines and decreases in L-proline and other amino acids.

CONCLUSION: Platelets from OM’s versus YF, OF, and YM have a different metabolome implying increased energy metabolism, more free fatty acids, acylcarnitines, and amino acids, and increased breakdown of purines and deamination products. However, only platelets from OM were affected by sex hormones in vitro. Platelets from OM are metabolically distinct, which may impart functional differences when transfused.

PMID:36309927 | DOI:10.1111/trf.17165

J Burn Care Res. 2022 Oct 30:irac163. doi: 10.1093/jbcr/irac163. Online ahead of print.

ABSTRACT

Chronic airway illness is a well-documented inhalation injury side effect. Many pulmonary function impairments persisted for several months after lung parenchymal injury. Thus, the purpose of this study was to investigate the effects of inspiratory muscle training on respiratory muscle strength and pulmonary function (PFT) in patients who had suffered an inhalation injury. This study included male patients with inhalation injuries aged 20-35 years. Patients were chosen at random and assigned to an exercise group, which received inspiratory muscle training and routine chest physiotherapy, including early ambulation, coughing, and deep breathing, three times weekly for 4 weeks, and the control group, which only received routine chest physiotherapy. All participants were assessed for PFT and respiratory muscle strength at enrollment and the end of the study. The statistical analysis for outcome variables between both groups revealed no significant differences before treatment (P > 0.05) of forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), maximal inspiratory pressure, and maximal expiratory pressure. According to the findings of this study, including IMT as part of a physical therapy program led to significant gains (P ˂ 0.05) in FVC and FEV1. However, after treatment, there was not a substantial difference found in either the MIP or the MEP between the groups. The exercise group performed better in terms of FVC, FEV1, MIP, and MEP after receiving treatment, according to these significant and non-significant differences.

PMID:36309913 | DOI:10.1093/jbcr/irac163

Arch Gynecol Obstet. 2022 Oct 30. doi: 10.1007/s00404-022-06826-4. Online ahead of print.

ABSTRACT

PURPOSE: The mode of delivery influences the genital image and perception, especially regarding the effects of delivery on sexual life and intercourse. The current literature has not adequately investigated the relationship between delivery and genital appearance. The aim of the study is to determine whether the mode of delivery changes the genital perception of the woman and, in doing so, influences their acceptance. The secondary aim is to analyze the impact of genital appearance on sexuality.

METHODS: A prospective survey regarding genital appearance and the impact of delivery mode on vulvar perception was conducted in patients 6 weeks after childbirth. We enrolled 365 women for evaluation, divided into three groups: spontaneous vaginal delivery (SVD 295 women 80.82%), operative vaginal delivery (OVD 36 women 9.86%) and cesarean section (CS 34 women 9.31%).

RESULTS: There was a statistically significant difference in the frequency of vulva inspection and in the perception of genital modifications among the groups (p < 0.001 and p < 0.001, respectively). The perception of overall genital modifications was significantly correlated with the frequency of inspection (p = 0.004) and the delivery mode (p = 0.0002).

CONCLUSION: Mode of delivery may influence the genital perception and appearance of genitalia without a decrease of sexual life and daily activity in childbirth.

PMID:36309906 | DOI:10.1007/s00404-022-06826-4

Orv Hetil. 2022 Oct 30;163(44):1751-1757. doi: 10.1556/650.2022.32615. Print 2022 Oct 30.

ABSTRACT

INTRODUCTION: Congenital absence of teeth is one of the most prevalent craniofacial malformation and dental disorder. Hypodontia may present with varying degrees of severity. The absence of all teeth (anodontia) is rare. Based on epidemiological studies, it is more common in the permanent dentition, then in deciduous teeth.

OBJECTIVE: The aim of the present study was to compare the dento-alveolar changes, on panoramic radiographs, between patients with hypodontia from the case group and subjects without tooth agenesis from the control group.

METHOD: Measurements were performed on panoramic radiographs. The results were compared between the patients with hypodontia and the subjects from the control group. Dento-alveolar linear and angular measurements were performed. The mean age of the 60 subjects was 14.15 ± 4.48 years, to which a control group was assigned with a mean age 13.98 ± 4.07 years. 70% of the study population were female and 30% were male.

RESULTS: We found statistically significant differences between the case group and the control group in the case of transverse measurements and unilateral linear measurements (p<0.01).

CONCLUSION: Hypodontia will affect the transversal development of mandibular dento-alveolar structures, and will cause the decrease of gonial angle. Orv Hetil. 2022; 163(44): 1751-1757.

PMID:36309889 | DOI:10.1556/650.2022.32615

Am J Hypertens. 2022 Oct 30:hpac121. doi: 10.1093/ajh/hpac121. Online ahead of print.

ABSTRACT

BACKGROUND: We investigated the association between ambulatory blood pressure (BP) and the risk of home hypertension in a normotensive population and whether considering ambulatory BP improves the 10-year prediction model for home hypertension risk, which was developed in the previous Ohasama Study.

METHODS: In this prospective study, we followed up 410 participants (83.2% women; age, 53.6 years) without home and ambulatory hypertension in the general population of Ohasama, Japan. The Cox model was used to assess the hazard ratios for home hypertension (home BP ≥135/≥85 mmHg or initiation of antihypertensive treatment) and model improvement.

RESULTS: During a mean 14.2-year follow-up, 225 home hypertension incidences occurred. The hazard ratio (95% confidence interval) for home hypertension incidence per 1-standard deviation higher (=6.76 mmHg) 24-h systolic BP was 1.59 (1.33-1.90), after adjustments for possible confounding factors, including baseline home systolic BP. Harrell’s C-statistics increased from 0.72 to 0.73 (P=0.11) when 24-h systolic BP was added to the basic 10-year home hypertension prediction model, which includes sex, age, body mass index, smoking status, office systolic BP, and baseline home systolic BP. Continuous net reclassification improvement (0.53, P<0.0001) and integrated discrimination improvement (0.028, P=0.0014) revealed improvement in the model.

CONCLUSIONS: 24-h systolic BP could be an independent predictor of future home hypertension. Home BP and 24-h BP can longitudinally influence each other in the long term.

PMID:36309880 | DOI:10.1093/ajh/hpac121

Eur Spine J. 2022 Oct 30. doi: 10.1007/s00586-022-07417-2. Online ahead of print.

ABSTRACT

PURPOSE: Paediatric intervertebral disc calcification (PIDC) is a rare disease, and its aetiology remains unknown. This study aimed to analyse the characteristics and clinical outcomes of patients with PIDC.

METHODS: After applying the exclusion and inclusion criteria, 159 children diagnosed with PIDC were analysed at our hospital between January 2010 and November 2020. Patients’ demographic and clinical data were collected, such as sex, pain, duration time, physical examination, white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and radiography, computed tomography, and magnetic resonance imaging findings. Patients were followed up for at least 6 months, and radiography or symptoms were evaluated. Fisher’s exact test or χ²-test was used for statistical analyses.

RESULTS: One hundred and fifty-nine patients were ultimately followed up with for about 12.5 ± 5.8 months. There were 103 male and 56 female, with an average age of 6.08 ± 2.62 years (2 months to 12 years). A total of 109 patients had only one PIDC, 29 patients had two PIDCs, and 21 patients had multiple PIDCs. Thirty patients were found incidentally and were asymptomatic. A total of 106 patients had neck torticollis. Sixteen patients had IDC herniations, fifteen patients had posterior longitudinal ligament calcification, two patients had anterior longitudinal ligament calcification, and 17 patients had herniation of the vertebral canal. All patients underwent conservative treatment, and none underwent surgery. All patients’ symptoms resolved after either collar fixation or neck traction.

CONCLUSION: PIDC can be treated conservatively, even when accompanied by herniation, longitudinal ligament calcification, or clinical neck symptoms.

LEVEL OF EVIDENCE: IV.

PMID:36309875 | DOI:10.1007/s00586-022-07417-2