Tag: statistics

BMC Geriatr. 2021 Mar 9;21(1):171. doi: 10.1186/s12877-021-02123-y.

ABSTRACT

BACKGROUND: Although previous studies have evaluated risk factors for the incidence of severe infection in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV), the relationship between body mass index (BMI) and severe infection in AAV has not been elucidated. We hypothesized that older adults with AAV and a low BMI would be at a higher risk of infection. We therefore investigated the association between underweight status at AAV diagnosis and subsequent occurrence of severe infection in older adults with AAV.

METHODS: This single-center retrospective cohort study included 93 consecutive older adults with microscopic polyangiitis (MPA) treated at the Aichi Medical University Hospital in Japan between 2004 and 2018. The relationships between BMI at diagnosis and subsequent first severe infection were assessed using multivariate Cox proportional hazards models. The cumulative probability of the development of the first severe infection was calculated using the Kaplan-Meier method and the log-rank test. The level of statistical significance was set at P < 0.05.

RESULTS: During the median follow-up period of 19 (6-53) months, 29 (31.2%) patients developed at least one severe infection. Older age (adjusted hazard ratio [HR] = 2.02, 95% confidence interval [CI]: 1.14-3.52, per 10 years; P = 0.016), low BMI (< 18.5 kg/m² compared with normal BMI [18.5-23.0 kg/m²], adjusted HR = 2.63, 95% CI: 1.11-6.19; P = 0.027), and use of methylprednisolone pulse therapy (adjusted HR = 2.48, 95% CI: 1.07-5.76; P = 0.034) were found to be significant predictors of severe infection.

CONCLUSIONS: Low BMI was associated with a higher risk of severe infection in older adults with MPA, suggesting that careful management may be required to prevent this complication in this vulnerable group. Further studies are needed to elucidate the optimal treatment strategy for these patients.

PMID:33750328 | DOI:10.1186/s12877-021-02123-y

BMC Neurol. 2021 Mar 9;21(1):107. doi: 10.1186/s12883-021-02143-6.

ABSTRACT

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is usually a benign, yet underdiagnosed clinical condition associated with subacute to acute neurological manifestations primarily affecting white matter. PRES is reversible when recognized promptly and treated early by removal of the insulting factor; however, can lead to irreversible and life-threatening complications such as cerebral hemorrhage, cerebellar herniation, and refractory status epilepticus.

METHODS: We utilized the National Inpatient Sample database provided by the Healthcare Cost and Utilization Project (HCUP-NIS) 2017 to investigate the demographic variables (age, sex, and race) for patients with PRES, concomitant comorbidities and conditions, inpatient complications, inpatient mortality, length of stay (LOS), and disposition.

RESULTS: A total of 635 admissions for patients aged 18 years or older with PRES were identified. The mean age was 57.2 ± 0.6 years old with most encounters for female patients (71.7%, n = 455) and white as the most prevalent race. Half the patients in our study presented with seizures (50.1%, n = 318), sixty-three patients (9.9%) presented with vision loss, and sixty-four patients (10.1%) had speech difficulty. In addition, 45.5% of patients had hypertensive crisis (n = 289). 2.2% of hospitalizations had death as the outcome (n = 14). The mean LOS was 8.2 (±0.3) days, and the mean total charges were $92,503 (±$5758). Inpatient mortality differed between males and females (1.7% vs. 2.4%) and by race (3.6% in black vs. 1.8% in white) but was ultimately determined to be not statistically significant. Most patients who present with vision disturbance have a high risk of intracranial hemorrhage. Furthermore, end-stage renal disease, atrial fibrillation, and malignancy seemed to be linked with a very high risk of mortality.

CONCLUSION: PRES, formerly known as reversible posterior leukoencephalopathy, is a neurological disorder with variable presenting symptoms. Although it is generally a reversible condition, some patients suffer significant morbidity and even mortality. To the best of our knowledge, this is the largest retrospective cohort of PRES admissions that raises clinician awareness of clinical characteristics and outcomes of this syndrome.

PMID:33750332 | DOI:10.1186/s12883-021-02143-6

BMC Gastroenterol. 2021 Mar 9;21(1):117. doi: 10.1186/s12876-021-01701-z.

ABSTRACT

BACKGROUND: A colorectal cancer screening programme (CCSP) was implemented from 2012 to 2017 in Tianjin, China. Residents with a positive faecal immunochemical test (FIT) or positive self-reported symptom questionnaire (SRSQ) were recommended to undergo colonoscopy. The objective was to investigate the potential factors associated with nonadherence to colonoscopy among a risk-increased population.

METHODS: Data were obtained from the CCSP database, and 199,522 residents with positive FIT or positive SRSQ during two screening rounds (2012-2017) were included in the analysis. Logistic regression analysis was performed to assess the association between nonadherence to colonoscopy and potential predictors.

RESULTS: A total of 152,870 (76.6%) individuals did not undergo colonoscopy after positive FIT or positive SRSQ. Residents with positive SRSQ but without positive FIT were more likely not to undergo colonoscopy (negative FIT: OR, 2.35; 95% CI, 2.29-2.41, no FIT: OR, 1.27; 95% CI, 1.24-1.31). Patients without a cancer history were less likely to undergo colonoscopy even if they received risk-increased reports based on the SRSQ.

CONCLUSION: In the CCSP, seventy-seven percent of the risk-increased population did not undergo colonoscopy. FIT should be recommended since positive FIT results are related to improved adherence to colonoscopy. Residents with negative FIT but positive SRSQ should be informed of the potential cancer risk to ensure adherence to colonoscopy.

PMID:33750307 | DOI:10.1186/s12876-021-01701-z

Quintessence Int. 2021 Mar 22;0(0):0. doi: 10.3290/j.qi.b1098315. Online ahead of print.

ABSTRACT

OBJECTIVES: The goal of the study was to determine the effects of software updates on the trueness and precision of digital impressions obtained with a variety of intraoral scanner (IOS) systems.

METHOD AND MATERIALS: Seven IOS systems were investigated. Each system was tested using two versions of software, with the second version being the latest at the time of conducting the study. Scans were performed on a custom mandibular typodont model with natural teeth that were either unrestored or restored with amalgam, composite, lithium disilicate, zirconia, and gold. Eight scans were obtained for each software version on any of the tested IOS systems. Experimental IOS scans were compared against an industry-standard master scan of the typodont obtained with an ATOS Capsule scanner proven to have a trueness of 3 µm and a precision of 2 µm. Isolation of each substrate material on the digital experimental and master scans was achieved using the Geomagic metrology software for subsequent analysis of the substrate influence on accuracy. A generalized linear mixed model was used to determine the influence of the software version on the trueness and precision of the impression scan.

RESULTS: For some IOS systems, scans made with older software versions differ in accuracy compared with those obtained with the most recent software versions. Trueness was improved for most scanners following the software update, although the Element2 IOS performance deteriorated. Software updates had lesser effects on precision and showed variable trends among different systems. Software updates also influence different substrate materials scans’ accuracy, although the results show variability among IOS systems. When comparisons were done among IOS systems updated with the latest software version, best performers for complete arch trueness were the Emerald S, Trios 3, and Primescan systems.

CONCLUSION: Software updates have a statistically significant effect on the trueness and precision of different IOS systems. These updates can have both positive and negative effects on scan accuracy, although it appears that these variations are within the clinical acceptability levels.

PMID:33749223 | DOI:10.3290/j.qi.b1098315

ESC Heart Fail. 2021 Mar 21. doi: 10.1002/ehf2.13313. Online ahead of print.

ABSTRACT

AIMS: This study aimed to determine the effects of sodium-glucose cotransporter-2 inhibitor (SGLT2i) in heart failure with reduced ejection fraction (HFrEF), compare the effect of SGLT2i with angiotensin receptor neprilysin inhibitor (ARNI), and find whether combination of SGLT2i and ARNI is better than monotherapy.

METHODS AND RESULTS: Embase, Medline, and Cochrane Central Registry of Controlled Trials were searched for randomized controlled trials evaluating SGLT2i or ARNI in HFrEF. And a total of six trials were included. SGLT2i was found to significantly reduce the risk of cardiovascular death or hospitalization for heart failure by 27% [hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.67-0.80], hospitalization for heart failure by 31% (HR 0.69, 95% CI 0.62-0.77), cardiovascular death by 16% (HR 0.84, 95% CI 0.74-0.95), and all-cause death by 16% (HR 0.84, 95% CI 0.75-0.94) in HFrEF only with a statistically higher risk of genital infection (risk ratio (RR) 2.78, 95% CI 1.46-5.29). The reduction in cardiovascular death or hospitalization for heart failure was of similar magnitude in patients with or without diabetes mellitus (HR 0.71, 95% CI 0.64-0.80 vs. HR 0.75, 95% CI 0.65-0.87) using SGLT2i. Indirect treatment comparison showed that SGLT2i and ARNI had similar effects on primary outcome (HR 0.93, 95% CI 0.82-1.06). And combination of SGLT2i and ARNI achieved a better prognosis performance (HR 0.68, 95% CI 0.53-0.89) compared with ARNI monotherapy.

CONCLUSIONS: SGLT2i could safely reduce cardiovascular death or hospitalization for heart failure in HFrEF regardless of diabetes mellitus status. SGLT2i and ARNI demonstrate similar effects, while combination of SGLT2i and ARNI results in a better cardiovascular protective effect.

PMID:33749159 | DOI:10.1002/ehf2.13313

J Clin Res Pediatr Endocrinol. 2021 Mar 22. doi: 10.4274/jcrpe.galenos.2021.2020.0305. Online ahead of print.

ABSTRACT

OBJECTIVE: Bisphenol A exposure is crucial for lactating women and exclusively breastfed infants. Bisphenol A transfers directly by breastfeeding and may cause adverse health outcomes. We conduct this study to determine maternal human milk bisphenol A level and exclusively breastfed infants’ bisphenol A exposure. We investigated the effect of exposure according to participants’ nutritional habits.

METHODS: We enrolled voluntarily, healthy postnatal, exclusively breastfeeding women (n=80) and collected hindmilk samples. Human milk-free bisphenol A concentration was analyzed using a competitive ELISA method. Free (unconjugated) BPA has been detected in human samples indicating that humans are internally exposed to estrogenically active BPA. Participants’ demographic properties, nutritional habits were questioned with an elaborated survey face-to-face by the researcher.

RESULTS: Human milk median free bisphenol A level is 0.63 µg/L. There was no statistically significant association between maternal body mass index, birth type, parity, infant birth week, infant birth weight, and human milk bisphenol A concentration. Nevertheless, we only found a statistically significant association between human milk bisphenol A level and fast-food, carbonated drinks consumption (p=0.022 and p=0.018, respectively). Exclusively breastfed infants’ bisphenol A exposure was 0.0099±0.0079 µg/kg bw/day. There was a negative moderate statistically significant correlation between infant bisphenol A exposure and infant current body weight (r= 0.327, p=0.003).

CONCLUSION: Exclusively breastfed infants bisphenol A exposure was under the tolerable bisphenol A level (4 µg/kg bw/day), and infants’ current dietary exposure level was safe.

PMID:33749218 | DOI:10.4274/jcrpe.galenos.2021.2020.0305

Quintessence Int. 2021 Mar 22;0(0):0. doi: 10.3290/j.qi.b1098307. Online ahead of print.

ABSTRACT

OBJECTIVES: To describe the step-by-step procedure of a novel surgical technique consisting of a combination of the laterally closed tunnel (LCT) and the modified coronally advanced tunnel (MCAT) (ie, LCT/MCAT), designed to treat multiple mandibular adjacent gingival recessions (MAGR) and to present the clinical outcomes obtained in 11 consecutively treated patients.

METHOD AND MATERIALS: Eleven systemically and periodontally healthy patients (7 females, mean ± SD 33.62 ± 14.6 years, min. 19 years max. 67 years) with a total of 40 adjacent mandibular RT1 (ie, Miller Class 1 and 2) gingival recessions with a minimum depth ≥ 3 mm, were consecutively treated with LCT/MCAT, in conjunction with an enamel matrix derivative (EMD) and subepithelial palatal connective tissue graft (SCTG). Treatment outcomes were assessed at baseline and at 12 months postoperatively. Prior to surgery and at 12 months postoperatively, recession depth (RD) and recession width (RW) were evaluated. The primary outcome variable was complete root coverage (CRC, ie 100% root coverage), the secondary outcome was mean root coverage (MRC).

RESULTS: Postoperative pain and discomfort were low and the healing was uneventful in all cases without any complications. At 12 months, statistically significant (P < .05) root coverage (RC) was obtained in all patients. CRC was obtained in five patients with a total of 21 recessions, while MRC measured 92.9% (ie, 3.75 mm). In seven patients (ie, 63.6%), RC amounted to > 93% while the minimum RC per patient measured 83.76%.

CONCLUSION: The results of the present case series suggest that the LCT/MCAT is a valuable technique for the treatment of mandibular RT1 MAGR.

PMID:33749221 | DOI:10.3290/j.qi.b1098307

Am J Hum Biol. 2021 Mar 21:e23591. doi: 10.1002/ajhb.23591. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of the study was to evaluate the agreement between the Fels and Greulich-Pyle methods for the assessment of skeletal age (SA) in female youth soccer players.

METHODS: The sample included 441 Portuguese players 10.08-16.73 years of age who regularly participated in organized and competitive soccer. Standardized radiographs of the left hand-wrist were obtained and analyzed by an experienced examiner. SA was estimated with the Fels and Greulich-Pyle (GP) methods. Differences between SA and chronological age (CA) were used to define skeletal maturity groups: late, average and early maturing. In addition to descriptive statistics, Cohen’s kappa and Lin concordance correlation coefficients were used to evaluate agreement between methods.

RESULTS: Intraindividual differences in SA based on the two methods varied between 0.10 to 1.47 years among age groups with larger mean differences at older ages. Agreement of maturity classifications between methods was 74% at younger ages (under-13: kappa = 0.48; under-14: kappa = 0.39; Lin CCC = 0.68) and declined with increasing CA (under-17: 19% agreement; kappa = 0.001; Lin CCC = 0.11). About 19% of the total sample was skeletally mature with the Fels method and an SA was not assigned; in contrast, no players were skeletally mature with the GP method.

CONCLUSIONS: GP SAs were systematically lower than Fels SAs among female soccer players. Intraindividual variability in SAs between methods was considerable. The findings highlight the impact of method on estimates of maturity status.

PMID:33749124 | DOI:10.1002/ajhb.23591

Hemodial Int. 2021 Mar 21. doi: 10.1111/hdi.12926. Online ahead of print.

ABSTRACT

INTRODUCTION: Job burnout is an occupational psychological syndrome with a high prevalence among nurses in China. Hemodialysis (HD) nursing work has the characteristics of high intensity, high technical content, and high risk. The aims of this study were to investigate the prevalence and level of job burnout among HD nurses in China and explore the potential factors associated with burnout among HD nurses.

METHODS: This was a cross-sectional study in 2019. Survey data were collected from 2738 HD centers in mainland China. Job burnout was measured by the Chinese version of the Maslach Burnout Inventory. The working atmosphere, interpersonal relationships with colleagues, and intention to leave were each assessed by a single question respectively. Multiple linear regression and structural equation modeling were used for the analysis.

FINDINGS: A total of 10,570 surveys were collected. A total of 1199 (11.34%) HD nurses reported a high level of emotional exhaustion, 782 (7.40%) reported a high level of depersonalization, and 6767 (64.02%) reported a low level of personal accomplishment. Job burnout in the Northeastern region of mainland China was higher than that in other regions (p < 0.05). The working atmosphere, interpersonal relationships, region, hospital level, educational level, career planning, age, and number of children were significantly associated with burnout among HD nurses (p < 0.001, adjusted R² = 0.313). The working environment, individual factors, and specialist nurse training were significantly associated with HD nurse burnout and intention to leave (comparative fit index = 0.907; goodness of fit index = 0.930; root mean square error of approximation = 0.055).

DISCUSSION: There were notable regional differences in the burnout of HD nurses. This study contributes to the knowledge of the possible relationship of job burnout and intention to leave in HD nurses. It is suggested that improving the working atmosphere or interpersonal relationships and providing more training opportunities can alleviate job burnout in HD nurses.

PMID:33749129 | DOI:10.1111/hdi.12926

Mol Ecol Resour. 2021 Mar 22. doi: 10.1111/1755-0998.13379. Online ahead of print.

ABSTRACT

Balancing selection is an important adaptive mechanism underpinning a wide range of phenotypes. Despite its relevance, the detection of recent balancing selection from genomic data is challenging as its signatures are qualitatively similar to those left by ongoing positive selection. In this study we developed and implemented two deep neural networks and tested their performance to predict loci under recent selection, either due to balancing selection or incomplete sweep, from population genomic data. Specifically, we generated forward-in time simulations to train and test an artificial neural network (ANN) and a convolutional neural network (CNN). ANN received as input multiple summary statistics calculated on the locus of interest, while CNN was applied directly on the matrix of haplotypes. We found that both architectures have high accuracy to identify loci under recent selection. CNN generally outperformed ANN to distinguish between signals of balancing selection and incomplete sweep and was 18 less affected by incorrect training data. We deployed both trained network son neutral genomic regions in European populations and demonstrated a lower false positive rate for CNN than ANN. We finally deployed CNN within the MEFV gene region and identified several common variants predicted to be under incomplete sweep in a European population. Notably, two of these variants are functional changes and could modulate susceptibility to Familial Mediterranean Fever, possibly as a consequence of past adaptation to pathogens. In conclusion, deep neural networks were able to characterise signals of selection on intermediate-frequency variants, an analysis currently inaccessible by commonly used strategies.

PMID:33749134 | DOI:10.1111/1755-0998.13379