Tag: statistics

Ann Palliat Med. 2021 Aug 31:apm-21-1650. doi: 10.21037/apm-21-1650. Online ahead of print.

ABSTRACT

BACKGROUND: Weight gain during chemotherapy for breast cancer is quite common and has a major impact on the quality of life. Post-treatment weight gain can also impact on primary endpoints such as tumor recurrence and overall survival. Parameters thought to impact weight gain include menopausal status, age and chemotherapy regimen. Using meta-regression, we studied the effect of age on weight change by menopausal status and chemotherapy regimen.

METHODS: Twenty-four studies were identified, and extracted for weight change, mean/median age, menopausal status and chemotherapy regimen. A meta-regression was performed using a random-effects model for high heterogeneity and fixed-effects inverse-variance model for low heterogeneity. Subgroup analyses by menopausal status and chemotherapy regimen were conducted. P values <0.05 were considered statistically significant.

RESULTS: There exists no relationship between weight change and age (β=0.00; P=0.987). Stratifying by menopausal status (β=0.05 and P=0.150 for premenopausal patients; β=0.09 and P=0.588 for postmenopausal patients) and chemotherapy regimens (β=-0.07 and P=0.562 for patients receiving CMF alone; β=0.08 and P=0.707 for patients receiving CMF in addition to others; β=0.02 and P=0.807 for patients not receiving CMF), there likewise was no relationship between weight change and age.

CONCLUSIONS: Management of weight gain due to chemotherapy has been focused on relatively young women who are generally at higher risk of mortality and tumor recurrence. However, our results suggest that age should not be used for differential care.

PMID:34498483 | DOI:10.21037/apm-21-1650

Environ Health Perspect. 2021 Sep;129(9):97702. doi: 10.1289/EHP9131. Epub 2021 Sep 9.

NO ABSTRACT

PMID:34498494 | DOI:10.1289/EHP9131

Ann Palliat Med. 2021 Sep 1:apm-21-1084. doi: 10.21037/apm-21-1084. Online ahead of print.

ABSTRACT

BACKGROUND: It is unclear whether the doses of opioids and the routes of administration used for postoperative analgesic management are associated with delirium. We aimed to compare the incidence of postoperative delirium (POD) between intravenous patient-controlled analgesia (IVPCA) and patientcontrolled epidural analgesia (PCEA) in patients who underwent postoperative analgesic management using opioids.

METHODS: We retrospectively investigated surgical patients (n=3,324) who received patient-controlled analgesia (PCA). Morphine was used for IVPCA, and fentanyl and ropivacaine were used for PCEA. The patients’ background characteristics, perioperative management, presence of POD, and postoperative analgesia technique after IVPCA (n=1,184) or PCEA (n=2,140) were assessed. We divided the patients into IVPCA and PCEA groups and compared the incidence of POD by propensity score matching. We used the independent t-test for comparisons between the groups, and P<0.05 as considered as statistically significant.

RESULTS: POD was noted in a total of 125 patients (3.8%); 55 patients (4.6%) with IVPCA and 70 patients (3.3%) with PCEA (P=0.046). There was no statistically significant difference in cumulative opioid usage up to postoperative day 2 (in mg) between patients with and without POD (POD 62.7±39.8 vs. non-POD 48.9±50.3, P=0.10). After propensity score matching, 1,156 patients with similar baseline characteristics were selected. POD was noted in 22 of 578 patients (3.8%) in the IVPCA group and 30 of 578 patients (5.2%) in the PCEA group, with no difference between the two groups (P=0.256). On the other hand, opioid usage was higher in the IVPCA group than in the PCEA group (P<0.001).

CONCLUSIONS: There was no difference in the incidence of POD between morphine IVPCA and fentanyl PCEA when the patient characteristics were matched using propensity score matching. POD occurs regardless of the route and dose of opioid administration.

PMID:34498474 | DOI:10.21037/apm-21-1084

Ann Palliat Med. 2021 Aug 30:apm-21-2195. doi: 10.21037/apm-21-2195. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies found that lactate dehydrogenase (LDH) levels predicted poor outcomes in hemorrhagic stroke, but the prognostic role of LDH in ischemic stroke (IS) remains unclear. The aim of this study is to investigate the association between LDH and adverse clinical outcomes in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA).

METHODS: All patients were enrolled from the Third China National Stroke Registry (CNSR-III). Adverse outcomes included all-cause death and poor functional outcomes [defined as modified Rankin Scale (mRS) score 3-6 and 2-6] at 3 months and 1 year. Multivariable Cox proportional hazards models and logistic regressions were used to evaluate the association of LDH with risk of all-cause death and poor functional outcomes, respectively.

RESULTS: Among 9,796 included patients, the median [interquartile range (IQR)] of LDH was 175.00 (151.00-205.40) U/L. After adjustment for confounding factors, patients in the highest LDH quartile had a higher risk of all-cause death [hazard ratio (HR), 2.23; 95% confidence interval (CI), 1.27-3.90], and a higher proportion of mRS score 3-6 (odds ratio (OR), 1.54; 95% CI, 1.26-1.90) and mRS score 2-6 (OR, 1.56; 95% CI, 1.32-1.84) at 3 months. We also observed a J-shaped association between LDH and risk of each outcome. Consistent results were found at 1 year.

CONCLUSIONS: Higher LDH levels are independently associated with adverse outcomes in patients with AIS or TIA.

PMID:34498480 | DOI:10.21037/apm-21-2195

Langmuir. 2021 Sep 9. doi: 10.1021/acs.langmuir.1c01576. Online ahead of print.

ABSTRACT

Understanding how sorption depends on temperature on a molecular basis has been made difficult by the coexistence of isotherm models, each assuming a different sorption mechanism and the routine application of planar, multilayer sorption models (such as Brunauer-Emmett-Teller (BET) and Guggenheim-Anderson-de Boer (GAB)) beyond their premises. Furthermore, a common observation that adsorption isotherms measured at different temperatures fall onto a single “characteristic curve” when plotted against the adsorption potential has not been given a clear explanation, due to its ambiguous foundation. Extending our recent statistical thermodynamic fluctuation theory of sorption, we have generalized the classical isosteric theory of sorption into a statistical thermodynamic fluctuation theory and clarified how sorption depends on temperature. We have shown that a characteristic curve exists when sorbate number increment contributes purely energetically to the interface, whereas the correlation between sorbate number and entropy drives the temperature dependence of an isotherm. This theory rationalizes the opposite temperature dependence of water vapor sorption on activated carbons with uniform versus broad pore size distributions and can be applied to moisture sorption on starch gels. The adsorption potential is a convenient variable for sorption in its ability to unify sorbate-sorbate fluctuation and the isosteric thermodynamics of sorption.

PMID:34498469 | DOI:10.1021/acs.langmuir.1c01576

Eur J Transl Myol. 2021 Aug 31. doi: 10.4081/ejtm.2021.9877. Online ahead of print.

ABSTRACT

In Multiple sclerosis (MS) it is important to preserve the residual physiological functions of subjects. The aim of the present study was to investigate the influence of nanotechnological device treatment combined with home-based training program (TP) on lactate level, hand grip strength and cervical mobility on MS patients. Seventeen MS patients were enrolled in the study and randomly assigned to an experimental group (EG) in which the Taopatch® nanotechnological device was applied or to a control group (CG). All the participants carried out a cervical range of motion (1) assessment and the hand grip test at baseline (T0) and after TP (T1), also investigating the lactate levels to figure out if there could be a correlation with the possible changes in the investigated parameters. The results showed no significant differences in both groups for ROM. As regards the hand grip test, EG showed a statistically significant improvement on strength for both hands, dominant (p = 0.01) and non-dominant (p = 0.04), while the CG showed an improvement only for the non-dominant hand (p = 0.001). No correlation was found between baseline lactate level and cervical ROM change. We can definitely conclude that exercise and Taopatch® can help to improve and maintain hand strength in MS subjects and also can prevent sedentary lifestyle during the COVID-19 pandemic time. These are preliminary results that need further investigations, possibly increasing sample size and lengthening time of intervention.

PMID:34498450 | DOI:10.4081/ejtm.2021.9877

Yeungnam Univ J Med. 2021 Sep 9. doi: 10.12701/yujm.2021.01123. Online ahead of print.

ABSTRACT

BACKGROUND: This study was aimed at comparing and analyzing the results of FractionLab (Varian/Mobius Medical System) with those of portal dosimetry that uses an electronic portal imaging device. Portal dosimetry is extensively used for patient-specific quality assurance (QA) in intensity-modulated radiotherapy (IMRT).

METHODS: The study includes 29 patients who underwent IMRT on a Novalis-Tx linear accelerator (Varian Medical System and BrainLAB) between June 2019 and March 2021. We analyzed the multileaf collimator (MLC) DynaLog files generated after portal dosimetry to evaluate the same condition using FractionLab. The results of the recently launched FractionLab at various gamma indices (0.1%/0.1 mm-1%/1 mm) are analyzed and compared with those of portal dosimetry (3%/3 mm).

RESULTS: The average gamma passing rates of portal dosimetry (3%/3 mm) and FractionLab are 98.1 (95.5%-100%) and 97.5% (92.3%-99.7%) at 0.6%/0.6 mm, respectively. The results of portal dosimetry (3%/3 mm) are statistically comparable with the QA results of FractionLab (0.6%/0.6 mm-0.9%/0.9 mm).

CONCLUSION: This paper presents the clinical performance of FractionLab by the comparison of the QA results of FractionLab using portal dosimetry with various gamma indexes when performing patient-specific QA in IMRT treatment. Further, the appropriate gamma index when performing patient-specific QA with FractionLab is provided.

PMID:34496467 | DOI:10.12701/yujm.2021.01123

J Clin Psychiatry. 2021 Sep 7;82(5):20m13831. doi: 10.4088/JCP.20m13831.

ABSTRACT

Objective: The DSM-5 criteria for avoidant/restrictive food intake disorder (ARFID) include ambiguities. Diagnostic criteria that allow for clinical judgment are essential for clinical practice. However, ambiguities can have major implications for treatment access and comparability and generalizability of research studies. The purpose of this study was to determine the degree to which distinct operationalizations of the diagnostic criteria for ARFID contribute to differences in the frequency of individuals who are eligible for the ARFID diagnosis.

Methods: Because criteria B, C, and D are rule-outs, we focused on criterion A, identified 19 potential operational definitions, and determined the extent to which these different methods impacted the proportion of individuals who met criteria for ARFID in a sample of children, adolescents, and young adults (n = 80; September 2016-February 2020) enrolled in an avoidant/restrictive eating study.

Results: Within each criterion, the proportion of individuals meeting diagnostic criteria differed significantly across the methodologies (all P values < .008). Using the strictest definition of each criterion, 50.0% (n = 40) of participants met criteria for ARFID. In contrast, under the most lenient definition of each criterion, the number nearly doubled, resulting in 97.5% (n = 78) meeting ARFID criteria.

Conclusions: Comparison of diagnostic definitions for ARFID among children, adolescents, and young adults confirmed a broad range of statistically distinct proportions within a single sample. Our findings support the need for additional contextual support and consensus among disciplines on operationalization in both research and clinical settings.

PMID:34496463 | DOI:10.4088/JCP.20m13831

Chronic Obstr Pulm Dis. 2021 Sep 8. doi: 10.15326/jcopdf.2021.0252. Online ahead of print.

ABSTRACT

PURPOSE: Pharmacotherapy is one cornerstone of Chronic Obstructive Pulmonary Disease (COPD) management. Published U.S. data seldom includes patient-reported COPD medication use and adherence. We add this patient perspective to the commonly reported administrative prescribing and fill data.

METHODS: This survey study used inhaler and nebulizer pictures and lists of oral COPD medication lists to query members of the COPD Foundation Patient-Powered Research Network, a national self-reported online registry. Medications used, adherence, inhaler education, cost concerns, previous exacerbations, and COPD Assessment Test scores were assessed and summarized using simple descriptive statistics and hazard ratios controlling for age, gender, and disease burden.

RESULTS: Respondents mean age was 68 years, 60% were women, >69% with the COPD Assessment Test (CAT) scores >15, and >50% reported 2 or more exacerbations in the past 12 months. Overall, >98% used one or more inhaled COPD medications, 7.6% rescue inhaler only, 17.3% bronchodilator therapy (11.1% dual), and 72.8% using corticosteroid containing therapies, including 53% triple therapy. Nebulizers were used by 59.4% and 34.8% use oral COPD medications. Reported adherence rates were high (80.1%), but 41% reported trouble paying for medications, with 20.1% reported missing medications due to cost.

CONCLUSIONS: In this population, COPD had a high burden with >50% of respondents using triple therapy, and one in eight maintenance oral corticosteroids. Self-reported adherence was high, but with significant costs concerns reported resulting in missed medications.

PMID:34496465 | DOI:10.15326/jcopdf.2021.0252

J Clin Psychiatry. 2021 Sep 7;82(5):20m13810. doi: 10.4088/JCP.20m13810.

ABSTRACT

Background: Etiologic differences between bipolar I disorder (BD-I) and bipolar II disorder (BD-II) have been challenged recently, and family epidemiologic studies may elucidate the matter. Nevertheless, it remains unclear whether BD-I and BD-II display different familial aggregation patterns within each bipolar disorder subtype and coaggregation with other psychiatric disorders.

Method: Per the Taiwan National Health Insurance Research Database (N = 23,258,175), patients with bipolar disorder were classified as having BD-I or BD-II based on the history of psychiatric hospitalization for a manic episode. During the study period (2001-2011), 184,958 first-degree relatives (FDRs) of patients with BD-I and BD-II were identified. By comparing patients with 1:4 age-, sex-, and kinship-matched samples without BD-I/BD-II probands, the relative risks (RRs) of major psychiatric disorders were estimated.

Results: FDRs of BD-I probands had a significantly higher risk of BD-I than those of BD-II probands (BD-I proband: RR = 15.80 vs BD-II proband: RR = 5.68, P < .001). The risk of BD-II was similar between FDRs of BD-I and BD-II probands (BD-I proband: RR = 6.48 vs BD-II proband: RR = 5.89, P = .1161). Familial aggregation was greater within each BD subtype than among cross-subtypes. Furthermore, FDRs of BD-I probands had an increased risk of schizophrenia (BD-I probands: RR = 5.83 vs BD-II probands: RR = 2.72, P < .001); FDRs of BD-II probands had a higher likelihood of attention-deficit/hyperactivity disorder (BD-II probands: 2.36 vs BD-I probands: 1.93, P = .0009).

Conclusions: The risk of psychiatric disorders is higher among the FDRs of patients with either BD-I or BD-II. Furthermore, the familial specificity of BD-I and BD-II assessed in this study may further the current understanding of etiologic boundaries between bipolar disorder subtypes.

PMID:34496462 | DOI:10.4088/JCP.20m13810