1
|
Ruberu TLM, Braun D, Parmigiani G, Biswas S. Meta-analysis of breast cancer risk for individuals with PALB2 pathogenic variants. Genet Epidemiol 2024. [PMID: 38654400 DOI: 10.1002/gepi.22561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 02/06/2024] [Accepted: 03/27/2024] [Indexed: 04/25/2024]
Abstract
Multigene panel testing now allows efficient testing of many cancer susceptibility genes leading to a larger number of mutation carriers being identified. They need to be counseled about their cancer risk conferred by the specific gene mutation. An important cancer susceptibility gene is PALB2. Multiple studies reported risk estimates for breast cancer (BC) conferred by pathogenic variants in PALB2. Due to the diverse modalities of reported risk estimates (age-specific risk, odds ratio, relative risk, and standardized incidence ratio) and effect sizes, a meta-analysis combining these estimates is necessary to accurately counsel patients with this mutation. However, this is not trivial due to heterogeneity of studies in terms of study design and risk measure. We utilized a recently proposed Bayesian random-effects meta-analysis method that can synthesize estimates from such heterogeneous studies. We applied this method to combine estimates from 12 studies on BC risk for carriers of pathogenic PALB2 mutations. The estimated overall (meta-analysis-based) risk of BC is 12.80% (6.11%-22.59%) by age 50 and 48.47% (36.05%-61.74%) by age 80. Pathogenic mutations in PALB2 makes women more susceptible to BC. Our risk estimates can help clinically manage patients carrying pathogenic variants in PALB2.
Collapse
Affiliation(s)
| | - Danielle Braun
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA
- Department of Data Science, Dana Farber Cancer Institute, Boston, USA
| | - Giovanni Parmigiani
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA
- Department of Data Science, Dana Farber Cancer Institute, Boston, USA
| | - Swati Biswas
- Department of Mathematical Sciences, University of Texas at Dallas, Richardson, USA
| |
Collapse
|
2
|
Lin DY, Wang J, Gu Y, Zeng D. Evaluating treatment efficacy in hospitalized COVID-19 patients, with applications to Adaptive COVID-19 Treatment Trials. Clin Trials 2024:17407745241238443. [PMID: 38618926 DOI: 10.1177/17407745241238443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND The current endpoints for therapeutic trials of hospitalized COVID-19 patients capture only part of the clinical course of a patient and have limited statistical power and robustness. METHODS We specify proportional odds models for repeated measures of clinical status, with a common odds ratio of lower severity over time. We also specify the proportional hazards model for time to each level of improvement or deterioration of clinical status, with a common hazard ratio for overall treatment benefit. We apply these methods to Adaptive COVID-19 Treatment Trials. RESULTS For remdesivir versus placebo, the common odds ratio was 1.48 (95% confidence interval (CI) = 1.23-1.79; p < 0.001), and the common hazard ratio was 1.27 (95% CI = 1.09-1.47; p = 0.002). For baricitinib plus remdesivir versus remdesivir alone, the common odds ratio was 1.32 (95% CI = 1.10-1.57; p = 0.002), and the common hazard ratio was 1.30 (95% CI = 1.13-1.49; p < 0.001). For interferon beta-1a plus remdesivir versus remdesivir alone, the common odds ratio was 0.95 (95% CI = 0.79-1.14; p = 0.56), and the common hazard ratio was 0.98 (95% CI = 0.85-1.12; p = 0.74). CONCLUSIONS The proposed methods comprehensively characterize the treatment effects on the entire clinical course of a hospitalized COVID-19 patient.
Collapse
Affiliation(s)
- Dan-Yu Lin
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jianqiao Wang
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yu Gu
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donglin Zeng
- Department of Biostatistics, The University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
3
|
Al-Hamed F, Alonso A, Vivaldi D, Smith S, Meloto CB. The Adaptive, Pain Sensitive, and Global Symptoms Clusters: Evidence from a Patient-Based Study. JDR Clin Trans Res 2024; 9:170-179. [PMID: 37114677 PMCID: PMC10943621 DOI: 10.1177/23800844231164076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVES The largest epidemiologic study conducted about painful temporomandibular disorders (pTMDs) to date identified 3 clusters of individuals with similar symptoms-adaptive, pain sensitive, and global symptoms-which hold promise as a means of personalizing pain care. Our goal was to compare the clinical and psychological characteristics that are consistent with a pTMD clinical examination among patients who are seeking care and assigned to the different clusters. METHODS This cross-sectional study used data from the medical records of patients attending Duke Innovative Pain Therapies between August 2017 and April 2021 who received a pTMD diagnosis (i.e., myalgia) and consented to have their data used for research. Data included orofacial and pain-related measures, dental features, and psychological measures. We used the Rapid OPPERA Algorithm to assign clusters to patients and multinomial regression to determine the likelihood (odds ratios [OR] and 95% confidence intervals [CI]) of being assigned to the pain sensitive or global symptoms cluster attributed to each measure. RESULTS In total, 131 patients were included in this study and assigned a cluster: adaptive (n = 54, 41.2%), pain sensitive (n = 49, 37.4%), and global symptoms (n = 28, 21.4%). The PS cluster displayed greater numbers of temporomandibular joint sites (OR, 1.29; 95% CI, 1.01 to 1.65) and masticatory (1.48; 1.19 to 1.83) and cervical (1.23; 1.09 to 1.39) muscles with pain evoked by palpation. The GS cluster displayed greater scores of pain catastrophizing (1.04; 1.01 to 1.06) and perceived stress (1.23; 1.03 to 1.46) and was more likely to report persistent pain (16.23; 1.92 to 137.1) of higher impact (1.43; 1.14 to 1.80). CONCLUSION Our findings support that care-seeking patients with pTMDs who are assigned to the GS cluster display a poorer psychological profile, even though those assigned to the PS cluster display more measures consistent with orofacial pain. Findings also establish the PS cluster as a group that does not display psychological comorbidities despite being hypersensitive. KNOWLEDGE TRANSFER STATEMENT This study informs clinicians that patients seeking care for painful temporomandibular disorders, in specific cases of myalgia, can be classified into 1 of 3 groups that display unique profiles of symptoms. Most importantly, it emphasizes the importance of examining patients with painful temporomandibular disorders in a holistic manner that includes assessing symptoms of psychological distress. Patients with greater psychological distress will likely benefit from multidisciplinary treatment strategies that may include psychological treatments.
Collapse
Affiliation(s)
- F.S. Al-Hamed
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
- The Alan Edwards Centre for Research on Pain, McGill University, Montreal, Canada
- College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| | - A.A. Alonso
- Department of Anesthesiology and Center for Translational Pain Medicine, Duke University, Durham, NC, USA
| | - D. Vivaldi
- Department of Anesthesiology and Center for Translational Pain Medicine, Duke University, Durham, NC, USA
| | - S.B. Smith
- Department of Anesthesiology and Center for Translational Pain Medicine, Duke University, Durham, NC, USA
| | - C. B. Meloto
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
- The Alan Edwards Centre for Research on Pain, McGill University, Montreal, Canada
| |
Collapse
|
4
|
Izhari MA, Hadadi MAA, Alharbi RA, Gosady ARA, Sindi AAA, Dardari DMM, Alotaibi FE, Klufah F, Albanghali MA, Alharbi TH. Association of Coagulopathy and Inflammatory Biomarkers with Severity in SARS-CoV-2-Infected Individuals of the Al-Qunfudhah Region of Saudi Arabia. Healthcare (Basel) 2024; 12:729. [PMID: 38610151 PMCID: PMC11012004 DOI: 10.3390/healthcare12070729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Identifying prognosticators/predictors of COVID-19 severity is the principal focus for early prediction and effective management of the disease in a time-bound and cost-effective manner. We aimed to evaluate COVID-19 severity-dependent alteration in inflammatory and coagulopathy biomarkers. METHODS A hospital-dependent retrospective observational study (total: n = 377; male, n = 213; and female, n = 164 participants) was undertaken. COVID-19 exposure was assessed by performing real-time PCR on nasopharyngeal (NP) swabs. Descriptive and inferential statistics were applied for both continuous and categorical variables using Rstudio-version-4.0.2. Pearson correlation and regression were executed with a cut-off of p < 0.05 for evaluating significance. Data representation by R-packages and ggplot2. RESULTS A significant variation in the mean ± SD (highly-sever (HS)/moderately severe (MS)) of CRP (HS/MS: 102.4 ± 22.9/21.3 ± 6.9, p-value < 0.001), D-dimer (HS/MS: 661.1 ± 80.6/348.7 ± 42.9, p-value < 0.001), and ferritin (HS/MS: 875.8 ± 126.8/593.4 ± 67.3, p-value < 0.001) were observed. Thrombocytopenia, high PT, and PTT exhibited an association with the HS individuals (p < 0.001). CRP was correlated with neutrophil (r = 0.77), ferritin (r = 0.74), and WBC (r = 0.8). D-dimer correlated with platelets (r = -0.82), PT (r = 0.22), and PTT (r = 0.37). The adjusted odds ratios (Ad-OR) of CRP, ferritin, D-dimer, platelet, PT, and PTT for HS compared to MS were 1.30 (95% CI -1.137, 1.50; p < 0.001), 1.048 (95% CI -1.03, 1.066; p < 0.001), 1.3 (95% CI -1.24, 1.49, p > 0.05), -0.813 (95% CI -0.734, 0.899, p < 0.001), 1.347 (95% CI -1.15, 1.57, p < 0.001), and 1.234 (95% CI -1.16, 1.314, p < 0.001), respectively. CONCLUSION SARS-CoV-2 caused alterations in vital laboratory parameters and raised ferritin, CRP, and D-dimer presented an association with disease severity at a significant level.
Collapse
Affiliation(s)
- Mohammad Asrar Izhari
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha 65528, Saudi Arabia
| | - Mansoor A. A. Hadadi
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha 65528, Saudi Arabia
- Laboratory Department, Qunfudhah Hospital, Al-Qunfudhah 28887, Saudi Arabia
| | - Raed A. Alharbi
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha 65528, Saudi Arabia
| | - Ahmed R. A. Gosady
- Laboratory Department, Baish General Hospital, Jazan 87597, Saudi Arabia
| | | | | | - Foton E. Alotaibi
- Department of Genetic Counseling, Al-Faisal University, Riyadh 11533, Saudi Arabia
| | - Faisal Klufah
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha 65528, Saudi Arabia
| | - Mohammad A Albanghali
- Department of Public Health, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha 65528, Saudi Arabia
| | - Tahani H Alharbi
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha 65528, Saudi Arabia
| |
Collapse
|
5
|
Kader MA, Sainudeen S, Khan AAG, Arora S, Ronsivalle V, Marrapodi MM, Cicciù M, Minervini G. Prevalence of obstructive sleep apnoea syndrome in oncological patients: A systematic review and meta-analysis. J Oral Rehabil 2024. [PMID: 38528326 DOI: 10.1111/joor.13681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/27/2024] [Accepted: 03/02/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Obstructive sleep apnoea syndrome (OSAS) has garnered increasing attention in recent years due to its potential association with cancer. This systematic review and meta-analysis aimed to assess the prevalence of OSAS in cancer patients through a comprehensive analysis of existing literature. METHODS This systematic review and meta-analysis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, aimed to evaluate the prevalence of OSAS in cancer patients. A comprehensive search of electronic databases was performed to identify relevant studies published up to September 2021. Eligible studies reporting on the prevalence of OSAS in cancer patients, encompassing various study designs, were included in the analysis. Pooled estimates of the odds ratios (OR) with 95% confidence intervals (CIs) were calculated using a random effects model. Heterogeneity among the studies was assessed using the I2 statistic. RESULTS Seventeen studies fulfilled the inclusion criteria and were subsequently included in the review. The prevalence of OSAS in cancer patients was estimated to have an overall OR of 0.80 (95% CI: 0.75-0.85). In comparison with non-cancer patients, cancer patients had a statistically significant greater risk of OSAS, as indicated by the total estimated RR for the prevalence of OSAS in cancer patients, which was 0.89 (95% CI: 0.86-0.92). Nonetheless, there was a significant amount of heterogeneity (I2 = 96%) among the studies. CONCLUSION The overall data analysed in this review indicates that patients with cancer had far reduced likelihood of developing OSAS than individuals without cancer. However, the significant variation across the included studies highlights the need for additional investigation to fully clarify the complex association between OSAS and cancer incidence. These results emphasise how critical it is to identify OSAS as a possible comorbidity in cancer patients, one that should be taken into account for clinical management and ongoing research.
Collapse
Affiliation(s)
- Mohammed Abdul Kader
- Department of Restorative Dental Science, College of Dentistry, King Khalid University Abha, Abha, Saudi Arabia
| | - Shan Sainudeen
- Department of Restorative Dental Science, College of Dentistry, King Khalid University Abha, Abha, Saudi Arabia
| | - Abdul Ahad Ghaffar Khan
- Department of Oral and Maxillofacial Surgery, King Khalid University College of Dentistry, Abha, Saudi Arabia
| | - Suraj Arora
- Department of Restorative Dental Science, College of Dentistry, King Khalid University Abha, Abha, Saudi Arabia
| | - Vincenzo Ronsivalle
- Department of General Surgery and Medical-Surgical Specialties, School of Dentistry, University of Catania, Catania, Italy
| | - Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, Largo Madonna delle Grazie 1, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Cicciù
- Department of General Surgery and Medical-Surgical Specialties, School of Dentistry, University of Catania, Catania, Italy
| | - Giuseppe Minervini
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, India
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
| |
Collapse
|
6
|
Zhang Y, Lv T, Nguyen TN, Wu S, Li Z, Bai X, Chen D, Zhao C, Lin W, Chen S, Sui Y. Intravenous Alteplase Versus Best Medical Therapy for Patients With Minor Stroke: A Systematic Review and Meta-Analysis. Stroke 2024. [PMID: 38465591 DOI: 10.1161/strokeaha.123.045495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/29/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND The efficacy of thrombolysis (IVT) in minor stroke (National Institutes of Health Stroke Scale score, 0-5) remains inconclusive. The aim of this study is to compare the effectiveness and safety of IVT with best medical therapy (BMT) by means of a systematic review and meta-analysis of randomized controlled trials and observational studies. METHODS We searched the PubMed, Embase, Cochrane Library, and Web of Science databases to obtain articles related to IVT in minor stroke from inception until August 10, 2023. The primary outcome was an excellent functional outcome, defined as a modified Rankin Scale score of 0 or 1 at 90 days. The associations were calculated for the overall and preformulated subgroups by using the odds ratios (ORs). This study was registered with PROSPERO (CRD42023445856). RESULTS A total of 20 high-quality studies, comprised of 13 397 patients with acute minor ischemic stroke, were included. There were no significant differences observed in the modified Rankin Scale scores of 0 to 1 (OR, 1.10 [95% CI, 0.89-1.37]) and 0 to 2 (OR, 1.16 [95% CI, 0.95-1.43]), mortality rates (OR, 0.67 [95% CI, 0.39-1.15]), recurrent stroke (OR, 0.89 [95% CI, 0.57-1.38]), and recurrent ischemic stroke (OR, 1.09 [95% CI, 0.68-1.73]) between the IVT and BMT group. There were differences between the IVT group and the BMT group in terms of early neurological deterioration (OR, 1.81 [95% CI, 1.17-2.80]), symptomatic intracranial hemorrhage (OR, 7.48 [95% CI, 3.55-15.76]), and hemorrhagic transformation (OR, 4.73 [95% CI, 2.40-9.34]). Comparison of modified Rankin Scale score of 0 to 1 remained unchanged in subgroup patients with nondisabling deficits or compared with those using antiplatelets. CONCLUSIONS These findings indicate that IVT does not yield significant improvement in the functional prognosis of patients with acute minor ischemic stroke. Additionally, it is associated with an increased risk of symptomatic intracranial hemorrhage when compared with the BMT. Moreover, IVT may not have superiority over BMT in patients with nondisabling deficits or those using antiplatelets.
Collapse
Affiliation(s)
- Yang Zhang
- School of Public Health, China Medical University, Shenyang, China (Y.Z., X.B., D.C., Y.S.)
| | - Tian Lv
- Department of Neurology, Zhuji Affliated Hospital of WenZhou University, China (T.L.)
| | - Thanh N Nguyen
- Department of Neurology and Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine (T.N.N.)
| | - Simiao Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (S.W.)
| | - Zhi Li
- Department of Medical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, China. (Z.L.)
| | - Xue Bai
- School of Public Health, China Medical University, Shenyang, China (Y.Z., X.B., D.C., Y.S.)
| | - Dan Chen
- School of Public Health, China Medical University, Shenyang, China (Y.Z., X.B., D.C., Y.S.)
| | - Chuansheng Zhao
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, China. (C.Z., Y.S.)
| | - Wanyi Lin
- Department of Neurology, Qingtian County Hospital, Lishui, China (W.L.)
| | - Shiqin Chen
- Department of Neurology, Second People's Hospital of Yuhuan, China (S.C.)
| | - Yi Sui
- School of Public Health, China Medical University, Shenyang, China (Y.Z., X.B., D.C., Y.S.)
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, China. (C.Z., Y.S.)
- Department of Neurology and Neurointervention, Shenyang First People's Hospital, Shenyang Medical College Affiliated Brain Hospital, China (Y.S.)
| |
Collapse
|
7
|
Cao S, Jung SH. Estimation of the odds ratio from multi-stage randomized trials. Pharm Stat 2024. [PMID: 38462496 DOI: 10.1002/pst.2378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 12/15/2023] [Accepted: 02/21/2024] [Indexed: 03/12/2024]
Abstract
A multi-stage design for a randomized trial is to allow early termination of the study when the experimental arm is found to have low or high efficacy compared to the control during the study. In such a trial, an early stopping rule results in bias in the maximum likelihood estimator of the treatment effect. We consider multi-stage randomized trials on a dichotomous outcome, such as treatment response, and investigate the estimation of the odds ratio. Typically, randomized phase II cancer clinical trials have two-stage designs with small sample sizes, which makes the estimation of odds ratio more challenging. In this paper, we evaluate several existing estimation methods of odds ratio and propose bias-corrected estimators for randomized multi-stage trials, including randomized phase II cancer clinical trials. Through numerical studies, the proposed estimators are shown to have a smaller bias and a smaller mean squared error overall.
Collapse
Affiliation(s)
- Shiwei Cao
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Sin-Ho Jung
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| |
Collapse
|
8
|
Kumwichar P, Poonsiri C, Botwright S, Sirichumroonwit N, Loharjun B, Thawillarp S, Cheewaruangroj N, Chokchaisiripakdee A, Teerawattananon Y, Chongsuvivatwong V. Durability of the Effectiveness of Heterologous COVID-19 Vaccine Regimens in Thailand: Retrospective Cohort Study Using National Registration Data. JMIR Public Health Surveill 2024; 10:e48255. [PMID: 38441923 PMCID: PMC10951833 DOI: 10.2196/48255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/31/2023] [Accepted: 02/08/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The durability of heterologous COVID-19 vaccine effectiveness (VE) has been primarily studied in high-income countries, while evaluation of heterologous vaccine policies in low- and middle-income countries remains limited. OBJECTIVE We aimed to evaluate the duration during which the VE of heterologous COVID-19 vaccine regimens in mitigating serious outcomes, specifically severe COVID-19 and death following hospitalization with COVID-19, remains over 50%. METHODS We formed a dynamic cohort by linking records of Thai citizens aged ≥18 years from citizen vital, COVID-19 vaccine, and COVID-19 cases registry databases between May 2021 and July 2022. Encrypted citizen identification numbers were used to merge the data between the databases. This study focuses on 8 common heterologous vaccine sequences: CoronaVac/ChAdOx1, ChAdOx1/BNT162b2, CoronaVac/CoronaVac/ChAdOx1, CoronaVac/ChAdOx1/ChAdOx1, CoronaVac/ChAdOx1/BNT162b2, BBIBP-CorV/BBIBP-CorV/BNT162b2, ChAdOx1/ChAdOx1/BNT162b2, and ChAdOx1/ChAdOx1/mRNA-1273. Nonimmunized individuals were considered for comparisons. The cohort was stratified according to the vaccination status, age, sex, province location, month of vaccination, and outcome. Data analysis employed logistic regression to determine the VE, accounting for potential confounders and durability over time, with data observed over a follow-up period of 7 months. RESULTS This study includes 52,580,841 individuals, with approximately 17,907,215 and 17,190,975 receiving 2- and 3-dose common heterologous vaccines (not mutually exclusive), respectively. The 2-dose heterologous vaccinations offered approximately 50% VE against severe COVID-19 and death following hospitalization with COVID-19 for 2 months; however, the protection significantly declined over time. The 3-dose heterologous vaccinations sustained over 50% VE against both outcomes for at least 8 months, as determined by logistic regression with durability time-interaction modeling. The vaccine sequence consisting of CoronaVac/CoronaVac/ChAdOx1 demonstrated >80% VE against both outcomes, with no evidence of VE waning. The final monthly measured VE of CoronaVac/CoronaVac/ChAdOx1 against severe COVID-19 and death following hospitalization at 7 months after the last dose was 82% (95% CI 80.3%-84%) and 86.3% (95% CI 83.6%-84%), respectively. CONCLUSIONS In Thailand, within a 7-month observation period, the 2-dose regimens could not maintain a 50% VE against severe and fatal COVID-19 for over 2 months, but all of the 3-dose regimens did. The CoronaVac/CoronaVac/ChAdOx1 regimen showed the best protective effect against severe and fatal COVID-19. The estimated durability of 50% VE for at least 8 months across all 3-dose heterologous COVID-19 vaccine regimens supports the adoption of heterologous prime-boost vaccination strategies, with a primary series of inactivated virus vaccine and boosting with either a viral vector or an mRNA vaccine, to prevent similar pandemics in low- and middle-income countries.
Collapse
Affiliation(s)
- Ponlagrit Kumwichar
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chittawan Poonsiri
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Siobhan Botwright
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Natchalaikorn Sirichumroonwit
- Department of Medical Services, Institute of Medical Research and Technology Assessment, Ministry of Public Health, Nonthaburi, Thailand
| | - Bootsakorn Loharjun
- Department of Medical Services, Institute of Medical Research and Technology Assessment, Ministry of Public Health, Nonthaburi, Thailand
| | | | | | | | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | | |
Collapse
|
9
|
van Niftrik CHB, Sebök M, Germans MR, Halter M, Pokorny T, Stumpo V, Bellomo J, Piccirelli M, Pangalu A, Katan M, Wegener S, Tymianski M, Kulcsár Z, Luft AR, Fisher JA, Mikulis DJ, Regli L, Fierstra J. Increased Risk of Recurrent Stroke in Symptomatic Large Vessel Disease With Impaired BOLD Cerebrovascular Reactivity. Stroke 2024; 55:613-621. [PMID: 38328926 DOI: 10.1161/strokeaha.123.044259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/11/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Impaired cerebrovascular reactivity (CVR) has been correlated with recurrent ischemic stroke. However, for clinical purposes, most CVR techniques are rather complex, time-consuming, and lack validation for quantitative measurements. The recent adaptation of a standardized hypercapnic stimulus in combination with a blood-oxygenation-level-dependent (BOLD) magnetic resonance imaging signal as a surrogate for cerebral blood flow offers a potential universally comparable CVR assessment. We investigated the association between impaired BOLD-CVR and risk for recurrent ischemic events. METHODS We conducted a retrospective analysis of patients with symptomatic cerebrovascular large vessel disease who had undergone a prospective hypercapnic-challenged BOLD-CVR protocol at a single tertiary stroke referral center between June 2014 and April 2020. These patients were followed up for recurrent acute ischemic events for up to 3 years. BOLD-CVR (%BOLD signal change per mm Hg CO2) was calculated on a voxel-by-voxel basis. Impaired BOLD-CVR of the affected (ipsilateral to the vascular pathology) hemisphere was defined as an average BOLD-CVR, falling 2 SD below the mean BOLD-CVR of the right hemisphere in a healthy age-matched reference cohort (n=20). Using a multivariate Cox proportional hazards model, the association between impaired BOLD-CVR and ischemic stroke recurrence was assessed and Kaplan-Meier survival curves to visualize the acute ischemic stroke event rate. RESULTS Of 130 eligible patients, 28 experienced recurrent strokes (median, 85 days, interquartile range, 5-166 days). Risk factors associated with an increased recurrent stroke rate included impaired BOLD-CVR, a history of atrial fibrillation, and heart insufficiency. After adjusting for sex, age group, and atrial fibrillation, impaired BOLD-CVR exhibited a hazard ratio of 10.73 (95% CI, 4.14-27.81; P<0.001) for recurrent ischemic stroke. CONCLUSIONS Among patients with symptomatic cerebrovascular large vessel disease, those exhibiting impaired BOLD-CVR in the affected hemisphere had a 10.7-fold higher risk of recurrent ischemic stroke events compared with individuals with nonimpaired BOLD-CVR.
Collapse
Affiliation(s)
- Christiaan H B van Niftrik
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Martina Sebök
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Menno R Germans
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Matthias Halter
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Thomas Pokorny
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (T.P., M.K., S.W., A.R.L.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Vittorio Stumpo
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Jacopo Bellomo
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Marco Piccirelli
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (M.P., A.P., Z.K.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Athina Pangalu
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (M.P., A.P., Z.K.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Mira Katan
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (T.P., M.K., S.W., A.R.L.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Susanne Wegener
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (T.P., M.K., S.W., A.R.L.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Michael Tymianski
- Division of Neurosurgery, Toronto Western Hospital (M.T., J.F.), University of Toronto, ON, Canada
| | - Zsolt Kulcsár
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (M.P., A.P., Z.K.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Andreas R Luft
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (T.P., M.K., S.W., A.R.L.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Joseph A Fisher
- Institute of Medical Science (J.A.F.), University of Toronto, ON, Canada
- Department of Anesthesia and Pain Management (J.A.F.), University Health Network, Toronto, ON, Canada
| | - David J Mikulis
- Joint Department of Medical Imaging and Functional Neuroimaging Laboratory (D.J.M.), University Health Network, Toronto, ON, Canada
| | - Luca Regli
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Division of Neurosurgery, Toronto Western Hospital (M.T., J.F.), University of Toronto, ON, Canada
| |
Collapse
|
10
|
Smith JL, Tcheandjieu C, Dikilitas O, Iyer K, Miyazawa K, Hilliard A, Lynch J, Rotter JI, Chen YDI, Sheu WHH, Chang KM, Kanoni S, Tsao P, Ito K, Kosel M, Clarke SL, Schaid DJ, Assimes TL, Kullo IJ. Multi-Ancestry Polygenic Risk Score for Coronary Heart Disease Based on an Ancestrally Diverse Genome-Wide Association Study and Population-Specific Optimization. Circ Genom Precis Med 2024:e004272. [PMID: 38380516 DOI: 10.1161/circgen.123.004272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Predictive performance of polygenic risk scores (PRS) varies across populations. To facilitate equitable clinical use, we developed PRS for coronary heart disease (CHD; PRSCHD) for 5 genetic ancestry groups. METHODS We derived ancestry-specific and multi-ancestry PRSCHD based on pruning and thresholding and continuous shrinkage priors (polygenic risk score for CHD developed using ancestry-based continuous shrinkage methods) applied to summary statistics from the largest multi-ancestry genome-wide association study meta-analysis for CHD to date, including 1.1 million participants from 5 major genetic ancestry groups. Following training and optimization in the Million Veteran Program, we evaluated the best-performing PRSCHD in 176 988 individuals across 9 diverse cohorts. RESULTS Multi-ancestry polygenic risk score for CHD developed using pruning and thresholding methods and polygenic risk score for CHD developed using ancestry-based continuous shrinkage methods outperformed ancestry-specific Polygenic risk score for CHD developed using pruning and thresholding methods and polygenic risk score for CHD developed using ancestry-based continuous shrinkage methods across a range of tuning values. Two best-performing multi-ancestry PRSCHD (ie, polygenic risk score for CHD developed using pruning and thresholding methods optimized using a multi-ancestry population and polygenic risk score for CHD developed using ancestry-based continuous shrinkage methods optimized using a multi-ancestry population) and 1 ancestry-specific (PRSCSxEUR) were taken forward for validation. Polygenic risk score for CHD developed using pruning and thresholding methods (PT) optimized using a multi-ancestry population demonstrated the strongest association with CHD in individuals of South Asian genetic ancestry and European genetic ancestry (odds ratio per 1 SD [95% CI, 2.75 [2.41-3.14], 1.65 [1.59-1.72]), followed by East Asian genetic ancestry (1.56 [1.50-1.61]), Hispanic/Latino genetic ancestry (1.38 [1.24-1.54]), and African genetic ancestry (1.16 [1.11-1.21]). Polygenic risk score for CHD developed using ancestry-based continuous shrinkage methods optimized using a multi-ancestry population showed the strongest associations in South Asian genetic ancestry (2.67 [2.38-3.00]) and European genetic ancestry (1.65 [1.59-1.71]), lower in East Asian genetic ancestry (1.59 [1.54-1.64]), Hispanic/Latino genetic ancestry (1.51 [1.35-1.69]), and the lowest in African genetic ancestry (1.20 [1.15-1.26]). CONCLUSIONS The use of summary statistics from a large multi-ancestry genome-wide meta-analysis improved the performance of PRSCHD in most ancestry groups compared with single-ancestry methods. Despite the use of one of the largest and most diverse sets of training and validation cohorts to date, improvement of predictive performance was limited in African genetic ancestry. This highlights the need for larger Genome-wide association study datasets of underrepresented populations to enhance the performance of PRSCHD.
Collapse
Affiliation(s)
- Johanna L Smith
- Department of Cardiovascular Medicine (J.L.S., O.D., I.J.K.)
| | - Catherine Tcheandjieu
- Department of Epidemiology and Biostatistics, University of California San Francisco (C.T.)
- VA Palo Alto Health Care System (C.T., A.H., P.T., S.L.C.)
| | - Ozan Dikilitas
- Department of Cardiovascular Medicine (J.L.S., O.D., I.J.K.)
| | - Kruthika Iyer
- Stanford University School of Medicine, Palo Alto, CA (K. Iyer, A.H.)
| | - Kazuo Miyazawa
- Riken Center for Integrative Medical Sciences, Yokohama City, Japan (K.M., K. Ito)
| | - Austin Hilliard
- Gladstone Institute of Data Science and Biotechnology, Gladstone Institute, San Francisco VA Palo Alto Health Care System (A.H., P.T., S.L.C.)
- VA Palo Alto Health Care System (C.T., A.H., P.T., S.L.C.)
- Stanford University School of Medicine, Palo Alto, CA (K. Iyer, A.H.)
| | | | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, Department of Pediatrics, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA (J.I.R., Y.-D.I.C.)
| | - Yii-Der Ida Chen
- Institute for Translational Genomics and Population Sciences, Department of Pediatrics, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA (J.I.R., Y.-D.I.C.)
| | - Wayne Huey-Herng Sheu
- Institute of Molecular and Genomic Medicine, National Health Research Institute (W.H.-H.S.)
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital. Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan (W.H.-H.S.)
| | - Kyong-Mi Chang
- Corporal Michael J Crescenz VA Medical Center, Philadelphia, PA (K.-M.C.)
| | - Stavroula Kanoni
- Queen Mary University of London, Cambridge, United Kingdom (S.K.)
| | - Phil Tsao
- Gladstone Institute of Data Science and Biotechnology, Gladstone Institute, San Francisco VA Palo Alto Health Care System (A.H., P.T., S.L.C.)
- VA Palo Alto Health Care System (C.T., A.H., P.T., S.L.C.)
- Stanford University, Stanford (P.T., S.L.C., T.L.A.)
| | - Kaoru Ito
- Riken Center for Integrative Medical Sciences, Yokohama City, Japan (K.M., K. Ito)
| | - Matthew Kosel
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN (M.K., D.J.S.)
| | - Shoa L Clarke
- Gladstone Institute of Data Science and Biotechnology, Gladstone Institute, San Francisco VA Palo Alto Health Care System (A.H., P.T., S.L.C.)
- VA Palo Alto Health Care System (C.T., A.H., P.T., S.L.C.)
- Stanford University, Stanford (P.T., S.L.C., T.L.A.)
| | - Daniel J Schaid
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN (M.K., D.J.S.)
| | | | | |
Collapse
|
11
|
Zhang Z, Jackson SL, Steele EM, Hayes DK, Yang Q. Relationship Between Ultra-Processed and Minimally Processed Food Intake and Cardiovascular Health Among US Women of Reproductive Age. J Womens Health (Larchmt) 2024. [PMID: 38386796 DOI: 10.1089/jwh.2023.0739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Objectives: Ultra-processed food (UPF) intake is associated with worse cardiovascular health (CVH), but associations between unprocessed/minimally processed foods (MPFs) and CVH are limited, especially among women of reproductive age (WRA). Materials and Methods: For 5,773 WRA (20-44 years) in National Health and Nutrition Examination Survey (NHANES) 2007-2018, we identified UPFs and MPFs using the Nova classification and based on 24-hour dietary recalls. We calculated usual percentages of calories from UPFs and MPFs using the National Cancer Institute's usual intake method. Seven CVH metrics were scored, and CVH levels were grouped by tertile. We used multivariable linear and multinomial logistic regression to assess associations between UPFs and MPFs and CVH. Results: The average usual percentage of calories from UPFs and MPFs was 57.2% and 29.3%, respectively. There was a graded, positive association between higher UPF intake and higher odds of poor CVH: adjusted odds ratios (aORs) for the lowest versus highest CVH were 1.74 (95% confidence interval: 1.51-2.01), 2.67 (2.07-3.44) and 4.66 (3.13-6.97), respectively, comparing quartile 2 (Q2)-Q4 to the lowest quartile (Q1) of UPF intake. Higher MPF intake was associated with lower odds of poor CVH: aORs for the lowest CVH were 0.61 (0.54-0.69), 0.39 (0.31-0.50), and 0.21 (0.14-0.31). Patterns of association remained consistent across subgroups and in sensitivity analyses. Conclusions: Higher UPF intake was associated with worse CVH, while higher MPF intake was associated with better CVH among WRA in the United States. Our analyses highlight an opportunity for WRA to improve nutrition and their CVH.
Collapse
Affiliation(s)
- Zefeng Zhang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Euridice Martinez Steele
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Donald K Hayes
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Quanhe Yang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
12
|
Martín Andrés A, Gayá Moreno F, Álvarez Hernández M, Herranz Tejedor I. Miettinen and Nurminen score statistics revisited. J Biopharm Stat 2024:1-14. [PMID: 38335320 DOI: 10.1080/10543406.2024.2311242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/24/2024] [Indexed: 02/12/2024]
Abstract
It is commonly necessary to perform inferences on the difference, ratio, and odds ratio of two proportions p1 and p2 based on two independent samples. For this purpose, the most common asymptotic statistics are based on the score statistics (S-type statistics). As these do not correct the bias of the estimator of the product pi (1-pi), Miettinen and Nurminen proposed the MN-type statistics, which consist of multiplying the statistics S by (N-1)/N, where N is the sum of the two sample sizes. This paper demonstrates that the factor (N-1)/N is only correct in the case of the test of equality of two proportions, providing the estimation of the correct factor (AU-type statistics) and the minimum value of the same (AUM-type statistics). Moreover, this paper assesses the performance of the four-type statistics mentioned (S, MN, AU and AUM) in one and two-tailed tests, and for each of the three parameters cited (d, R and OR). We found that the AUM-type statistics are the best, followed by the MN type (whose performance was most similar to that of AU-type). Finally, this paper also provides the correct factors when the data are from a multinomial distribution, with the novelty that the MN and AU statistics are similar in the case of the test for the odds ratio.
Collapse
|
13
|
Kurakazu M, Kurakazu M, Kiyoshima C, Shigekawa K, Hirakawa T, Yoshikawa K, Ito T, Urushiyama D, Miyata K, Yotsumoto F. Clinical Prediction of Retained Products of Conception: Combining Obstetric History and Ultrasound for Improved Accuracy in Severe Postpartum Hemorrhage. Cureus 2024; 16:e53651. [PMID: 38449994 PMCID: PMC10917468 DOI: 10.7759/cureus.53651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/08/2024] Open
Abstract
Background The current challenge is how to improve the management of postpartum hemorrhage (PPH) to reduce the maternal mortality rate further. This study aimed to investigate whether a combined specific obstetric history and ultrasonographic findings can improve the predictive accuracy of retained products of conception (RPOC) with severe PPH. Methods This retrospective study included 56 patients who were diagnosed with RPOC. We extracted the following clinical data: obstetric history of second-trimester miscarriage, the time at which there was clinical suspicion of RPOC after the previous pregnancy (TIME), grayscale ultrasonographic finding (RPOC long-axis length [SIZE]), and color Doppler ultrasonographic finding based on the Gutenberg classification (RPOC hypervascularity). In this study, we defined cases requiring blood transfusion therapy or transcatheter arterial embolization as severe PPH. The patients were divided into two groups according to the presence or absence of severe PPH. The predictors of severe PPH were evaluated using logistic regression models. Model A comprised a combination of second-trimester miscarriage and TIME, Model B comprised a combination of Model A and long-axis SIZE, and Model C comprised a combination of Model B and RPOC hypervascularity. Results The multivariable analysis showed that long-axis SIZE was the only significant predictor of severe PPH (odds ratio [OR], 10.38; 95% confidence interval [CI], 2.06-63.86) independent of second-trimester miscarriage, TIME, and RPOC hypervascularity. The c-statistic was higher in Model C (OR, 0.863; 95% CI, 0.731-0.936) than in Model A (OR, 0.723; 95% CI, 0.551-0.847) and Model B (OR, 0.834; 95% CI, 0.677-0.923). Conclusion Combining a specific obstetric history (second-trimester miscarriage and TIME) and ultrasonographic findings (long-axis SIZE and RPOC hypervascularity) improves the predictive accuracy of RPOC with severe PPH. This prediction model may be a useful clinical screening tool for RPOC with severe PPH.
Collapse
Affiliation(s)
- Mariko Kurakazu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Masamitsu Kurakazu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Chihiro Kiyoshima
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Koichiro Shigekawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Toyofumi Hirakawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Kenichi Yoshikawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Tomohiro Ito
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Daichi Urushiyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Kohei Miyata
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Fusanori Yotsumoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| |
Collapse
|
14
|
Žiūkaitė L, Weijdijk LPM, Tang J, Slot DE, van der Weijden GAF. Edentulism among diabetic patients compared to non-diabetic controls: A systematic review and meta-analysis. Int J Dent Hyg 2024; 22:3-14. [PMID: 37890036 DOI: 10.1111/idh.12762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 06/08/2023] [Accepted: 09/06/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE The purpose of this paper is to systematically and critically appraise the available scientific evidence concerning the prevalence of edentulism among diabetic patients compared to non-diabetic people. METHODS MEDLINE-PubMed and Cochrane-CENTRAL databases were comprehensively searched up to April 2023 to identify appropriate studies. The inclusion criteria were observational studies conducted in human subjects ≥18 years of age with the primary aim of investigating the prevalence of edentulism among diabetic patients. Based on the extracted data, a meta-analysis was performed. Recommendations based on the body of evidence were formulated using the GRADE approach. RESULTS Independent screening of 2085 unique titles and abstracts revealed seven publications that met the eligibility criteria. Study size ranged from 293 to 15,943 participants. Data from all seven studies were suitable for meta-analysis. Overall, 8.3% of the studied population was edentulous. The weighted mean prevalence of edentulism among diabetic and non-diabetics was 14.0% and 7.1%, respectively. The overall odds ratio for diabetic patients to be edentulous as compared to non-diabetics was 2.39 (95% CI [1.73, 3.28], p < 0.00001). CONCLUSION There appears to be moderate certainty that the risk of being edentulous for diabetic patients compared to non-diabetic people is significant, but the odds ratio is estimated to be small.
Collapse
Affiliation(s)
- Laura Žiūkaitė
- Department of Periodontology Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lotte P M Weijdijk
- Department of Periodontology Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgey, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Univsersiteit Amsterdam, Amsterdam, The Netherlands
| | - Jennifer Tang
- Department of Periodontology Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dagmar Else Slot
- Department of Periodontology Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - G A Fridus van der Weijden
- Department of Periodontology Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
15
|
Hwang J, Park S. Korean Nationwide Exploration of Sarcopenia Prevalence and Risk Factors in Late Middle-Aged Women. Healthcare (Basel) 2024; 12:362. [PMID: 38338247 PMCID: PMC10855089 DOI: 10.3390/healthcare12030362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
This study examined specific clinical risk factors for age-related loss of skeletal muscle mass in late middle-aged women with sarcopenia. This Korean nationwide cross-sectional study analyzed data from 2814 community-dwelling women aged from 50 to 64 years old and screened them for sarcopenia. This study examined various risk factors such as age; height; weight; body mass index; waist circumference; skeletal muscle mass index; systolic and diastolic blood pressure; smoking and drinking habits; fasting glucose levels; triglyceride; and cholesterol levels. Complex sampling analysis was used for the data set. Prevalence of sarcopenia with a weighted prevalence of 13.43% (95% confidence interval: 2.15-15.78). The risk factors for sarcopenia were height, body mass index, waist circumference, skeletal muscle mass index, systolic blood pressure, diastolic blood pressure, triglyceride level, and total cholesterol level (p < 0.05). Weight, fasting glucose level, drinking status, and smoking status were not significant (p > 0.05). These results are expected to contribute to the existing literature on sarcopenia and identify potential risk factors associated with the development of sarcopenia in late middle-aged females. By acknowledging prevalence and recognized risk factors, healthcare professionals may augment their proficiency in recognizing and discerning potential instances of sarcopenia in female patients.
Collapse
Affiliation(s)
- Jongseok Hwang
- Institute of Human Ecology, Yeungnam University, Gyeongsan-si 38541, Republic of Korea;
| | - Soonjee Park
- Department of Clothing and Fashion, Yeungnam University, Gyeongsan-si 38541, Republic of Korea
| |
Collapse
|
16
|
Cordoba-Caballero J, Perkins JR, García-Criado F, Gallego D, Navarro-Sánchez A, Moreno-Estellés M, Garcés C, Bonet F, Romá-Mateo C, Toro R, Perez B, Sanz P, Kohl M, Rojano E, Seoane P, Ranea JAG. Exploring miRNA-target gene pair detection in disease with coRmiT. Brief Bioinform 2024; 25:bbae060. [PMID: 38436559 PMCID: PMC10939301 DOI: 10.1093/bib/bbae060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/14/2023] [Accepted: 01/10/2024] [Indexed: 03/05/2024] Open
Abstract
A wide range of approaches can be used to detect micro RNA (miRNA)-target gene pairs (mTPs) from expression data, differing in the ways the gene and miRNA expression profiles are calculated, combined and correlated. However, there is no clear consensus on which is the best approach across all datasets. Here, we have implemented multiple strategies and applied them to three distinct rare disease datasets that comprise smallRNA-Seq and RNA-Seq data obtained from the same samples, obtaining mTPs related to the disease pathology. All datasets were preprocessed using a standardized, freely available computational workflow, DEG_workflow. This workflow includes coRmiT, a method to compare multiple strategies for mTP detection. We used it to investigate the overlap of the detected mTPs with predicted and validated mTPs from 11 different databases. Results show that there is no clear best strategy for mTP detection applicable to all situations. We therefore propose the integration of the results of the different strategies by selecting the one with the highest odds ratio for each miRNA, as the optimal way to integrate the results. We applied this selection-integration method to the datasets and showed it to be robust to changes in the predicted and validated mTP databases. Our findings have important implications for miRNA analysis. coRmiT is implemented as part of the ExpHunterSuite Bioconductor package available from https://bioconductor.org/packages/ExpHunterSuite.
Collapse
Affiliation(s)
- Jose Cordoba-Caballero
- Departamento de Biología Molecular y Bioquímica, Facultad de Ciencias, Universidad de Málaga, Bulevar Louis Pasteur, 31, Málaga, 29010, Spain
- Research Unit, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Puerta del Mar University Hospital, Cádiz, Spain
| | - James R Perkins
- Departamento de Biología Molecular y Bioquímica, Facultad de Ciencias, Universidad de Málaga, Bulevar Louis Pasteur, 31, Málaga, 29010, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Plataforma BIONAND), C/ Severo Ochoa, 35, Parque Tecnológico de Andalucía (PTA), Campanillas, Málaga, 29590, Spain
| | - Federico García-Criado
- Departamento de Biología Molecular y Bioquímica, Facultad de Ciencias, Universidad de Málaga, Bulevar Louis Pasteur, 31, Málaga, 29010, Spain
| | - Diana Gallego
- CIBER de Enfermedades Raras (CIBERER), Avda. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, Madrid, 28029, Spain
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular-SO UAM-CSIC, Universidad Autónoma de Madrid, Campus de Cantoblanco, Madrid, Spain
- Instituto de Investigación Sanitaria IdiPaZ, Madrid, Spain
| | - Alicia Navarro-Sánchez
- CIBER de Enfermedades Raras (CIBERER), Avda. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, Madrid, 28029, Spain
- Departament de Fisiologia, Facultat de Medicina i Odontologia, Universitat de València, Av. Blasco Ibáñez 15, 46010, València, Spain
| | - Mireia Moreno-Estellés
- CIBER de Enfermedades Raras (CIBERER), Avda. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, Madrid, 28029, Spain
- Consejo Superior de Investigaciones Científicas, Instituto de Biomedicina de Valencia, Jaime Roig 11, 46010, Valencia, Spain
| | - Concepción Garcés
- CIBER de Enfermedades Raras (CIBERER), Avda. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, Madrid, 28029, Spain
- Departament de Fisiologia, Facultat de Medicina i Odontologia, Universitat de València, Av. Blasco Ibáñez 15, 46010, València, Spain
| | - Fernando Bonet
- Research Unit, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Puerta del Mar University Hospital, Cádiz, Spain
- Medicine Department, School of Medicine, University of Cádiz, Cádiz, Spain
| | - Carlos Romá-Mateo
- CIBER de Enfermedades Raras (CIBERER), Avda. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, Madrid, 28029, Spain
- Departament de Fisiologia, Facultat de Medicina i Odontologia, Universitat de València, Av. Blasco Ibáñez 15, 46010, València, Spain
- Incliva Biomedical Research Institute, 46010, València, Spain
| | - Rocio Toro
- Research Unit, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Puerta del Mar University Hospital, Cádiz, Spain
- Medicine Department, School of Medicine, University of Cádiz, Cádiz, Spain
| | - Belén Perez
- CIBER de Enfermedades Raras (CIBERER), Avda. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, Madrid, 28029, Spain
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular-SO UAM-CSIC, Universidad Autónoma de Madrid, Campus de Cantoblanco, Madrid, Spain
- Instituto de Investigación Sanitaria IdiPaZ, Madrid, Spain
| | - Pascual Sanz
- CIBER de Enfermedades Raras (CIBERER), Avda. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, Madrid, 28029, Spain
- Consejo Superior de Investigaciones Científicas, Instituto de Biomedicina de Valencia, Jaime Roig 11, 46010, Valencia, Spain
| | - Matthias Kohl
- Faculty of Medical and Life Sciences, Furtwangen University, Germany
| | - Elena Rojano
- Departamento de Biología Molecular y Bioquímica, Facultad de Ciencias, Universidad de Málaga, Bulevar Louis Pasteur, 31, Málaga, 29010, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Plataforma BIONAND), C/ Severo Ochoa, 35, Parque Tecnológico de Andalucía (PTA), Campanillas, Málaga, 29590, Spain
| | - Pedro Seoane
- Departamento de Biología Molecular y Bioquímica, Facultad de Ciencias, Universidad de Málaga, Bulevar Louis Pasteur, 31, Málaga, 29010, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Plataforma BIONAND), C/ Severo Ochoa, 35, Parque Tecnológico de Andalucía (PTA), Campanillas, Málaga, 29590, Spain
- CIBER de Enfermedades Raras (CIBERER), Avda. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, Madrid, 28029, Spain
| | - Juan A G Ranea
- Departamento de Biología Molecular y Bioquímica, Facultad de Ciencias, Universidad de Málaga, Bulevar Louis Pasteur, 31, Málaga, 29010, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Plataforma BIONAND), C/ Severo Ochoa, 35, Parque Tecnológico de Andalucía (PTA), Campanillas, Málaga, 29590, Spain
- CIBER de Enfermedades Raras (CIBERER), Avda. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, Madrid, 28029, Spain
- Instituto Nacional de Bioinformática (INB/ELIXIR-ES), Instituto de Salud Carlos III (ISCIII), C/ Sinesio Delgado, 4, Madrid, 28029, Spain
| |
Collapse
|
17
|
Lech MA, Warpechowski M, Wojszel A, Rentflejsz J, Świętek M, Wojszel ZB. Vitamin D Status among Patients Admitted to a Geriatric Ward-Are Recommendations for Preventing Its Deficiency Effective Enough? Nutrients 2024; 16:193. [PMID: 38257086 PMCID: PMC10819869 DOI: 10.3390/nu16020193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/01/2024] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Despite a decade of available recommendations aimed at preventing vitamin D (VD) deficiency in Poland, the efficacy of these measures among community-dwelling older individuals remains inconsistent. The PolSenior2 study provided valuable insights into VD status among community-dwelling older individuals in Poland. However, it is important to note that this research did not include the elderly living in care institutions. Therefore, our study concentrates on evaluating VD status in older patients admitted to a geriatrics ward to indirectly assess their adherence to existing recommendations and preventive actions in this particular setting (whether they translate into health-promoting behaviors (i.e., taking vitamin D supplements) and whether the recommended, optimal 25(OH)D concentration values are achieved). This approach offers a comprehensive understanding of VD status in a previously understudied population. We aimed to evaluate VD status in patients aged 70 and above within the geriatrics ward, exploring its association with age, sex, BMI, and the use of VD supplements. The study involved the measurement of serum VD concentration in 240 individuals. Of these participants, 177 (73.8%) were women, and 193 (80.4%) were over 75 years old. The median 25(OH)D concentration was found to be 22.95 (IQR, 13.7-33.0) ng/mL. Notably, profound deficiency (<10 ng/mL) was noted in 15% of the participants, while 67.5% exhibited VD inadequacy (<30 ng/mL). It is worth mentioning that only 18.3% of individuals took VD supplements preadmission. Insufficiency was more prevalent in nonsupplemented individuals (70.9% vs. 52.3%, p = 0.02) and those with a BMI ≥30 kg/m2 (76.2% vs. 59.2%, p = 0.007). The logistic regression model demonstrated that obese patients had over two times higher odds of VD inadequacy (OR = 2.21, p = 0.0074), as did nonsupplemented individuals (OR = 2.23, p = 0.0187). The high prevalence of VD deficiency and inadequacy in geriatric ward admissions emphasizes the urgent need for targeted interventions and enhanced education for older adults, caregivers, and physicians to improve adherence to preventive supplementation practices.
Collapse
Affiliation(s)
- Maksymilian Adam Lech
- Interdisciplinary Student Scientific Society, Department of Geriatrics, Medical University of Bialystok, 15-471 Bialystok, Poland; (M.A.L.); (M.W.); (A.W.)
| | - Marcin Warpechowski
- Interdisciplinary Student Scientific Society, Department of Geriatrics, Medical University of Bialystok, 15-471 Bialystok, Poland; (M.A.L.); (M.W.); (A.W.)
| | - Aleksandra Wojszel
- Interdisciplinary Student Scientific Society, Department of Geriatrics, Medical University of Bialystok, 15-471 Bialystok, Poland; (M.A.L.); (M.W.); (A.W.)
| | - Justyna Rentflejsz
- Doctoral School, Medical University of Bialystok, 15-089 Bialystok, Poland;
- Department of Geriatrics, Medical University of Bialystok, 15-471 Bialystok, Poland
- Department of Geriatrics and Internal Medicine, Hospital of the Ministry of Interior in Bialystok, 15-471 Bialystok, Poland;
| | - Marta Świętek
- Department of Geriatrics and Internal Medicine, Hospital of the Ministry of Interior in Bialystok, 15-471 Bialystok, Poland;
| | - Zyta Beata Wojszel
- Department of Geriatrics, Medical University of Bialystok, 15-471 Bialystok, Poland
- Department of Geriatrics and Internal Medicine, Hospital of the Ministry of Interior in Bialystok, 15-471 Bialystok, Poland;
| |
Collapse
|
18
|
Qin Y, Pan L. Prebiotics and sepsis in infants: An updated systematic review and meta-analysis. ADV CLIN EXP MED 2024; 33:0-0. [PMID: 38180329 DOI: 10.17219/acem/174307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/31/2023] [Accepted: 10/19/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Sepsis is a critical situation, and its treatment and reduction are important clinical issues. Antibiotics are a routine treatment option, but their adverse effects are a concern in pediatric patients, especially infants. Prebiotics might be an alternative option. OBJECTIVES The aim of this study was to provide an updated systemic review and meta-analysis of randomized controlled trials (RCTs) on the use of prebiotics for sepsis in infants, which could assist clinicians in deciding whether to use this treatment. METHODS The study included RCTs related to prebiotics and sepsis in infants. A random effects model and the odds ratio (OR) were applied to estimate the effect of prebiotic use and the incidence of sepsis in infants. The analysis included 16 studies with a total of 6,438 infants. The primary outcome was the OR of sepsis for infants who received prebiotics. RESULTS The results of the meta-analysis demonstrated that the pooled OR of sepsis was significantly lower for infants who used prebiotics. However, the results indicated a medium level of heterogeneity. CONCLUSION The results showed that the use of prebiotics might be associated with a reduction of sepsis in infants. The standardized application of this treatment might be an intriguing topic for future clinical research.
Collapse
Affiliation(s)
- Yuejia Qin
- Anesthesiology Department, Tumor Hospital Affiliated to Guangxi Medical University, Nanning, China
- Intensive Care Unit, Liuzhou People's Hospital Affiliated to Guangxi Medical University, China
- Guangxi Clinical Research Center for Anesthesiology (GK AD22035214), Nanning, China
- Guangxi Health Commission Key Laboratory of Basic Science and Prevention of Perioperative Organ Disfunction, Nanning, China
| | - Linhui Pan
- Anesthesiology Department, Tumor Hospital Affiliated to Guangxi Medical University, Nanning, China
- Guangxi Clinical Research Center for Anesthesiology (GK AD22035214), Nanning, China
- Guangxi Health Commission Key Laboratory of Basic Science and Prevention of Perioperative Organ Disfunction, Nanning, China
| |
Collapse
|
19
|
Venugopal R, Das AV, Takkar B, Narayanan R. Clinical Profile, Demographic Distribution and Risk Factors of Parafoveal Telangiectasia: An Electronic Medical Record-Driven Big Data Analytics from a Multitier Eye Care Network. Semin Ophthalmol 2024; 39:102-108. [PMID: 37610827 DOI: 10.1080/08820538.2023.2249536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To describe the demographics and clinical profile of parafoveal telangiectasia (PFT) and compare risk factors for diabetic retinopathy (DR) among PFT and non-PFT patients. METHODS This cross-sectional hospital-based study included 2,834,616 new patients presenting to a multi-tier ophthalmology hospital network in India between August 2010 and June 2021. Patients with a clinical diagnosis of PFT in at least one eye were included as cases. The data were collected using an electronic medical record system. RESULTS Overall, 2,310 (0.081%) patients were diagnosed with PFT. Most of the patients were female (62.42%) with (odds ratio [OR] = 2.08), and had bilateral (84.85%) affliction. The most common age group at presentation was during the sixth decade of life with 825 (35.71%) patients. The overall prevalence was higher in patients from an upper socio economic status (0.242%) presenting from the metropolitan geography (0.113%; OR = 2.37). Systemic history of diabetes mellitus (DM) with a mean duration of 122.03 ± 95.59 months was seen in 849 (36.75%) and hypertension in 609 (26.36%) patients. Of the 4,270 eyes, 2,441 (57.17%) eyes had a visual impairment of mild or no visual impairment (<20/70) followed by moderate visual impairment (>20/70-20/200) in 1022 (23.93%) eyes. The risk of sight threatening diabetic retinopathy (STDR) among PFT patients was higher (OR = 1.43) compared to non-PFT cohort. Choroidal neovascular membrane (CNVM) was observed in 481 (11.26%) eyes. CONCLUSION PFT is more common in females and is predominantly bilateral. PFT is more common in upper socio economic status and majority of the eyes had mild or moderate visual impairment. Diabetes and Hypertension are associated risk factors in PFT.
Collapse
Affiliation(s)
- Ragukumar Venugopal
- Department of eyeSmart EMR & AEye, L V Prasad Eye Institute, Hyderabad, India
- Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, India
| | - Anthony Vipin Das
- Department of eyeSmart EMR & AEye, L V Prasad Eye Institute, Hyderabad, India
- Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, India
| | - Brijesh Takkar
- Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, India
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Raja Narayanan
- Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, India
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, India
| |
Collapse
|
20
|
Doretti M, Genbäck M, Stanghellini E. Mediation analysis with case-control sampling: Identification and estimation in the presence of a binary mediator. Biom J 2024; 66:e2300089. [PMID: 38285401 DOI: 10.1002/bimj.202300089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/08/2023] [Accepted: 11/11/2023] [Indexed: 01/30/2024]
Abstract
With reference to a stratified case-control (CC) procedure based on a binary variable of primary interest, we derive the expression of the distortion induced by the sampling design on the parameters of the logistic model of a secondary variable. This is particularly relevant when performing mediation analysis (possibly in a causal framework) with stratified case-control (SCC) data in settings where both the outcome and the mediator are binary. Despite being designed for parametric identification, our strategy is general and can be used also in a nonparametric context. With reference to parametric estimation, we derive the maximum likelihood (ML) estimator and the M-estimator of the joint outcome-mediator parameter vector. We then conduct a simulation study focusing on the main causal mediation quantities (i.e., natural effects) and comparing M- and ML estimation to existing methods, based on weighting. As an illustrative example, we reanalyze a German CC data set in order to investigate whether the effect of reduced immunocompetency on listeriosis onset is mediated by the intake of gastric acid suppressors.
Collapse
Affiliation(s)
- Marco Doretti
- Department of Statistics, Computer Science, and Applications, University of Florence, Florence, Italy
| | - Minna Genbäck
- Department of Statistics, USBE, Umeå University, Umeå, Sweden
| | - Elena Stanghellini
- Department of Statistics, USBE, Umeå University, Umeå, Sweden
- Department of Economics, University of Perugia, Perugia, Italy
| |
Collapse
|
21
|
Roy S, Adhya S, Rana S. Estimation of odds ratio from group testing data with misclassified exposure. Biom J 2024; 66:e2200254. [PMID: 38285402 DOI: 10.1002/bimj.202200254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 08/21/2023] [Accepted: 09/17/2023] [Indexed: 01/30/2024]
Abstract
For low prevalence disease, we consider estimation of the odds ratio for two specified groups of individuals using group testing data. Broadly the two groups may be classified as "the exposed" and "the unexposed." Often in observational studies, the exposure status is not correctly recorded. In addition, diagnostic tests are rarely completely accurate. The proposed model accounts for imperfect sensitivity and specificity of diagnostic tests along with the misclassification in the exposure status. For model identifiability, we make use of internal validation data, where a subsample of reasonably small size is selected from the original sample by simple random sampling without replacement. Pseudo-maximum likelihood method is employed for the estimation of the model parameters. The performance of group testing methodology is compared with individual testing for different parametric configurations. A limited data study related to COVID-19 prevalence is performed to illustrate the methodology.
Collapse
Affiliation(s)
- Surupa Roy
- Department of Statistics, St Xavier's College (Autonomous), Kolkata, West Bengal, India
| | - Sumanta Adhya
- Department of Statistics, West Bengal State University, Kolkata, West Bengal, India
| | - Subrata Rana
- Department of Statistics, Krishnagar Government College, Kolkata, West Bengal, India
| |
Collapse
|
22
|
Gencer B, Doğan Ö, Biçimoğlu A. Bilateral Involvement in Developmental Dislocation of the Hip: Analysis of 561 Patients Operated on Using the Limited Posteromedial Approach. Children (Basel) 2023; 11:37. [PMID: 38255351 PMCID: PMC10813854 DOI: 10.3390/children11010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
Our objective was to scrutinize the risk factors related to bilateral involvement in the developmental dysplasia of the hip (DDH) and to inspect the impact of bilaterality on the enduring results of the DDH. All patients, aged between 6 and 18 months, who underwent surgery using the limited posteromedial approach (734 hips from 561 patients), were included in this study. The number of births, birth type, history of consanguineous marriage, family history, and swaddling were analyzed. Physical examination and complaints of the patients were evaluated, and direct radiographs were examined in terms of the redislocation, avascular necrosis, and residual acetabular dysplasia. Among the 561 patients, bilateral DDH was observed in 173 patients (30.8%). The use of swaddling was found to be statistically significant between groups (p = 0.012). The use of swaddling for more than one month was associated with a higher odds ratio for bilaterality (p = 0.001, OR = 1.56, 95% CI: 1.2-2.0). Furthermore, bilaterality was associated with a higher risk for redislocation in DDH (p = 0.001, OR = 4.25, 95% CI: 1.6-11.2). The study concludes that swaddling for over a month is strongly linked with the bilateral involvement in DDH. It is important to note that bilaterality plays a crucial role in the development of redislocation after open reduction in DDH.
Collapse
Affiliation(s)
- Batuhan Gencer
- Department of Orthopaedics and Traumatology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, 34785 Istanbul, Turkey
| | - Özgür Doğan
- Department of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, 06800 Ankara, Turkey; (Ö.D.); (A.B.)
| | - Ali Biçimoğlu
- Department of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, 06800 Ankara, Turkey; (Ö.D.); (A.B.)
| |
Collapse
|
23
|
Shen Y, Liu H, Meng X, Gao A, Liu Y, Ma W, Liang H, Hu F. The causal effects between gut microbiota and hemorrhagic stroke: a bidirectional two-sample Mendelian randomization study. Front Microbiol 2023; 14:1290909. [PMID: 38188561 PMCID: PMC10770845 DOI: 10.3389/fmicb.2023.1290909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/30/2023] [Indexed: 01/09/2024] Open
Abstract
Background Recent studies have suggested that the composition of gut microbiota (GM) may change after intracerebral hemorrhage. However, the causal inference of GM and hemorrhagic stroke is unknown. Mendelian Randomization (MR) is an effective research method that removes confounding factors and investigates the causal relationship between exposure and outcome. This study intends to explore the causal relationship between GM and hemorrhagic stroke with the help of MR. Methods Univariable and multivariable MR analyses were performed using summary statistics of the GM (n = 18,340) in the MiBioGen consortium vs. the FinnGen consortium R9 summary statistics (intracerebral hemorrhage, subarachnoid hemorrhage, and nontraumatic intracranial hemorrhage). Causal associations between gut microbiota and hemorrhagic stroke were analyzed using inverse variance weighted, MR-Egger regression, weighted median, weighted mode, simple mode, and MR-PRESSO. Cochran's Q statistic, MR-Egger regression, and leave-one-out analysis were used to test for multiplicity and heterogeneity of instrumental variables. Separate reverse MR analyses were performed for microbiota found to be causally associated with hemorrhagic stroke in the forward MR analysis. Also, multivariate MR analyses were conducted after incorporating common confounders. Results Based on the results of univariable and multivariate MR analyses, Actinobacteria (phylum) (OR, 0.80; 95%CI, 0.66-0.97; p = 0.025) had a protective effect against hemorrhagic stroke, while Rikenellaceae RC9 gut group (genus) (OR, 0.81; 95%CI, 0.67-0.99; p = 0.039) had a potential protective effect. Furthermore, Dorea (genus) (OR, 1.77; 95%CI, 1.27-2.46; p = 0.001), Eisenbergiella (genus) (OR, 1.24; 95%CI, 1.05-1.48; p = 0.013) and Lachnospiraceae UCG008 (genus) (OR, 1.28; 95%CI, 1.01-1.62; p = 0.041) acted as potential risk factors for hemorrhagic stroke. The abundance of Dorea (genus) (β, 0.05; 95%CI, 0.002 ~ 0.101; p = 0.041) may increase, and that of Eisenbergiella (genus) (β, -0.072; 95%CI, -0.137 ~ -0.007; p = 0.030) decreased after hemorrhagic stroke according to the results of reverse MR analysis. No significant pleiotropy or heterogeneity was detected in any of the MR analyses. Conclusion There is a significant causal relationship between GM and hemorrhagic stroke. The prevention, monitoring, and treatment of hemorrhagic stroke through GM represent a promising avenue and contribute to a deeper understanding of the mechanisms underlying hemorrhagic stroke.
Collapse
Affiliation(s)
- Yingjie Shen
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hao Liu
- Clinical Laboratory of Molecular Biology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiangyi Meng
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Aili Gao
- School of Life Science, Northeast Agricultural University, Harbin, China
| | - Yansong Liu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei Ma
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongsheng Liang
- NHC Key Laboratory of Cell Transplantation, Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Fulan Hu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen, China
| |
Collapse
|
24
|
Tedesco CC, Bonfiglio C, Notarnicola M, Rendina M, Castellaneta A, Di Leo A, Giannelli G, Fontana L. High Extra Virgin Olive Oil Consumption Is Linked to a Lower Prevalence of NAFLD with a Prominent Effect in Obese Subjects: Results from the MICOL Study. Nutrients 2023; 15:4673. [PMID: 37960329 PMCID: PMC10647576 DOI: 10.3390/nu15214673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/27/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
Extra virgin olive oil (EVOO) has healthy benefits for noncommunicable diseases (NCDs). However, limited evidence is available about the effects of liver disease and non-alcoholic fatty liver disease (NAFLD). We evaluate whether dose-increased consumption of EVOO is associated with a lower prevalence of NAFLD and if these effects vary based on body weight. The study included 2436 subjects with a 33% NAFLD prevalence. Daily EVOO was categorized into tertiles: low (0-24 g/day), moderate (25-37 g/day), and high consumption (>37 g/day). Subjects were also classified by body mass index (BMI) as normo-weight (18.5-24.9), overweight (25-29.9), and obese (≥30). Logistic regression analysis was applied to calculate odds ratios (ORs) for NAFLD, considering a 20-gram increment in EVOO intake and accounting for EVOO categories combined with BMI classes. The ORs were 0.83 (0.74;0.93) C.I. p = 0.0018 for continuous EVOO, 0.89 (0.69;1.15) C.I. p = 0.37, and 0.73 (0.55;0.97) C.I. p = 0.03 for moderate and high consumption, respectively, when compared to low consumption. Overall, the percent relative risk reductions (RRR) for NAFLD from low to high EVOO consumption were 18% (16.4%;19.2%) C.I. and 26% (25%;27.4%) C.I. in overweight and obese subjects. High EVOO consumption is associated with a reduced risk of NAFLD. This effect is amplified in overweight subjects and even more in obese subjects.
Collapse
Affiliation(s)
- Calogero Claudio. Tedesco
- Data Science Unit, National Institute of Gastroenterology, IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy
| | - Caterina Bonfiglio
- Laboratory of Epidemiology and Statistics, National Institute of Gastroenterology, IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy;
| | - Maria Notarnicola
- Laboratory of Nutritional Biochemistry, National Institute of Gastroenterology, IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy;
| | - Maria Rendina
- Gastroenterology and Digestive Endoscopy, University Hospital, Policlinico of Bari, 70100 Bari, Italy;
| | - Antonino Castellaneta
- Gastroenterology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70100 Bari, Italy; (A.C.); (A.D.L.)
| | - Alfredo Di Leo
- Gastroenterology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70100 Bari, Italy; (A.C.); (A.D.L.)
| | - Gianluigi Giannelli
- Scientific Direction, National Institute of Gastroenterology, IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy;
| | - Luigi Fontana
- Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW 2006, Australia
| |
Collapse
|
25
|
Leppälä K. Sensitivity Analysis on Odds Ratios. Am J Epidemiol 2023; 192:1882-1886. [PMID: 37312597 PMCID: PMC10631298 DOI: 10.1093/aje/kwad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/15/2023] Open
Abstract
The classical Cornfield inequalities state that if a third confounding variable is fully responsible for an observed association between the exposure and the outcome variables, then the association between both the exposure and the confounder, and the confounder and the outcome, must be at least as strong as the association between the exposure and the outcome, as measured by the risk ratio. The work of Ding and VanderWeele on assumption-free sensitivity analysis sharpens this bound to a bivariate function of the 2 risk ratios involving the confounder. Analogous results are nonexistent for the odds ratio, even though the conversion from odds ratios to risk ratios can sometimes be problematic. We present a version of the classical Cornfield inequalities for the odds ratio. The proof is based on the mediant inequality, dating back to ancient Alexandria. We also develop several sharp bivariate bounds of the observed association, where the 2 variables are either risk ratios or odds ratios involving the confounder.
Collapse
Affiliation(s)
- Kalle Leppälä
- Correspondence to Dr. Kalle Leppälä, Organismal and Evolutionary Biology Research Programme, Viikinkaari 1 P.O. Box 65, University of Helsinki, FI-00014 Helsinki, Finland (e-mail: )
| |
Collapse
|
26
|
Pushpa, Magotra A, Kamaldeep, Sindhu V, Chaudhary P. Impact of temporal variations and risk factors associated with udder inflammation in Hardhenu cattle (Bos taurus × Bos indicus). Reprod Domest Anim 2023; 58:1612-1621. [PMID: 37800186 DOI: 10.1111/rda.14478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023]
Abstract
This study aimed to explore the occurrence and risk factors associated with clinical mastitis within the Hardhenu cattle herd over a span of 14 years (2008-2021). A comprehensive analysis of 1515 lactation records was conducted to ascertain the incidence of clinical mastitis. The investigation determined an overall incidence rate of 26.80% in the studied population. A significant relationship between the year and clinical mastitis incidence was established through Chi-square analysis (p < .05). Temporal variations in clinical mastitis odds were apparent, with the highest odds (ranging from 0.91 to 1.00) observed during the initial years of 2008-2009 and 2009-2010. Logistic regression revealed that odds values for clinical mastitis incidence were highest in 2008-2009 (1.00), succeeded by 2009-2010 (0.91), 2012-2013 (0.88), 2018-2019 (0.67) and reaching the lowest in 2021-2022 (0.35). Subsequent rankings included 2010-2011 (0.39), 2014-2015 (0.43) and 2019-2020 (0.45). Parity was found to be significantly associated with clinical mastitis occurrence. When compared to Parity 3, both Parity 1 (odds ratio: 1.516, 95% confidence interval: 0.881-2.612) and Parity 2 (odds ratio: 2.626, 95% confidence interval: 1.568-4.398) exhibited higher odds values for clinical mastitis incidence. While the period of calving did not exert a significant influence on clinical mastitis incidence, a heightened occurrence was observed during the rainy season within the targeted population. These findings offer valuable insights into the patterns of incidence, temporal fluctuations, and non-genetic determinants impacting clinical mastitis within the Hardhenu cattle. The implications of this study can facilitate the development of targeted strategies and management protocols aimed at enhancing udder health and overall productivity in dairy cattle.
Collapse
Affiliation(s)
- Pushpa
- Department of Animal Genetics and Breeding, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, India
| | - Ankit Magotra
- Department of Animal Genetics and Breeding, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, India
| | - Kamaldeep
- Department of Animal Genetics and Breeding, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, India
| | - Vikas Sindhu
- Department of Animal Nutrition, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, India
| | - Pradeep Chaudhary
- Department of Animal Genetics and Breeding, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, India
| |
Collapse
|
27
|
Behrndtz A, Blauenfeldt RA, Johnsen SP, Valentin JB, Gude MF, Al-Jazi MA, von Weitzel-Mudersbach P, Modrau B, Damgaard D, Hougaard KD, Hjort N, Diedrichsen T, Poulsen M, Schmitz ML, Fisher M, Andersen G, Simonsen CZ. Transport Strategy in Patients With Suspected Acute Large Vessel Occlusion Stroke: TRIAGE-STROKE, a Randomized Clinical Trial. Stroke 2023; 54:2714-2723. [PMID: 37800374 PMCID: PMC10589426 DOI: 10.1161/strokeaha.123.043875] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND When patients with acute ischemic stroke present with suspected large vessel occlusion in the catchment area of a primary stroke center (PSC), the benefit of direct transport to a comprehensive stroke center (CSC) has been suggested. Equipoise remains between transport strategies and the best transport strategy is not well established. METHODS We conducted a national investigator-driven, multicenter, randomized, assessor-blinded clinical trial. Patients eligible for intravenous thrombolysis (IVT) who were suspected for large vessel occlusion were randomized 1:1 to admission to the nearest PSC (prioritizing IVT) or direct CSC admission (prioritizing endovascular therapy). The primary outcome was functional improvement at day 90 for all patients with acute ischemic stroke, measured as shift towards a lower score on the modified Rankin Scale score. RESULTS From September 2018 to May 2022, we enrolled 171 patients of whom 104 had acute ischemic stroke. The trial was halted before full recruitment. Baseline characteristics were well balanced. Primary analysis of shift in modified Rankin Scale (ordinal logistic regression) revealed an odds ratio for functional improvement at day 90 of 1.42 (95% CI, 0.72-2.82, P=0.31). Onset to groin time for patients with large vessel occlusion was 35 minutes (P=0.007) shorter when patients were transported to a CSC first, whereas onset to needle (IVT) was 30 minutes (P=0.012) shorter when patients were transported to PSC first. IVT was administered in 67% of patients in the PSC group versus 78% in the CSC group and EVT was performed in 53% versus 63% of the patients, respectively. CONCLUSIONS This trial investigated the benefit of bypassing PSC. We included only IVT-eligible patients presenting <4 hours from onset and with suspected large vessel occlusion. Lack of power prevented the results from showing effect on functional outcome for patients going directly to CSC. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03542188.
Collapse
Affiliation(s)
- Anne Behrndtz
- Department of Neurology (A.B., R.A.B., D.D., K.D.H., N.H., T.D., M.P., M.L.S., G.A., C.Z.S.), Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark (A.B., R.A.B., C.Z.S.)
| | - Rolf A. Blauenfeldt
- Department of Neurology (A.B., R.A.B., D.D., K.D.H., N.H., T.D., M.P., M.L.S., G.A., C.Z.S.), Aarhus University Hospital, Denmark
- Department of Neurology (B.M.), Aarhus University Hospital, Denmark
| | - Søren P. Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital (S.P.J., J.B.V.)
| | - Jan B. Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital (S.P.J., J.B.V.)
| | - Martin F. Gude
- Prehospital Emergency Medical Services, Central Denmark Region (M.F.G.), Goedstrup Hospital
| | | | | | - Boris Modrau
- Department of Neurology (B.M.), Aarhus University Hospital, Denmark
| | - Dorte Damgaard
- Department of Neurology (A.B., R.A.B., D.D., K.D.H., N.H., T.D., M.P., M.L.S., G.A., C.Z.S.), Aarhus University Hospital, Denmark
| | - Kristina Dupont Hougaard
- Department of Neurology (A.B., R.A.B., D.D., K.D.H., N.H., T.D., M.P., M.L.S., G.A., C.Z.S.), Aarhus University Hospital, Denmark
| | - Niels Hjort
- Department of Neurology (A.B., R.A.B., D.D., K.D.H., N.H., T.D., M.P., M.L.S., G.A., C.Z.S.), Aarhus University Hospital, Denmark
| | - Tove Diedrichsen
- Department of Neurology (A.B., R.A.B., D.D., K.D.H., N.H., T.D., M.P., M.L.S., G.A., C.Z.S.), Aarhus University Hospital, Denmark
| | - Marika Poulsen
- Department of Neurology (A.B., R.A.B., D.D., K.D.H., N.H., T.D., M.P., M.L.S., G.A., C.Z.S.), Aarhus University Hospital, Denmark
| | - Marie Louise Schmitz
- Department of Neurology (A.B., R.A.B., D.D., K.D.H., N.H., T.D., M.P., M.L.S., G.A., C.Z.S.), Aarhus University Hospital, Denmark
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (M.F.)
| | - Grethe Andersen
- Department of Neurology (A.B., R.A.B., D.D., K.D.H., N.H., T.D., M.P., M.L.S., G.A., C.Z.S.), Aarhus University Hospital, Denmark
| | - Claus Z. Simonsen
- Department of Neurology (A.B., R.A.B., D.D., K.D.H., N.H., T.D., M.P., M.L.S., G.A., C.Z.S.), Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark (A.B., R.A.B., C.Z.S.)
| |
Collapse
|
28
|
Kim DH, Kim SW, Han JS, Kim GJ, Basurrah MA, Kim SH, Hwang SH. Are statins effective in preventing chronic rhinosinusitis? A systematic review and meta-analysis. Clin Otolaryngol 2023; 48:820-827. [PMID: 37648372 DOI: 10.1111/coa.14096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/06/2023] [Accepted: 08/20/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES To evaluate the association between statin use and chronic rhinosinusitis (CRS). DESIGN AND SETTING Systematic review and meta-analysis. The methodological quality of studies was assessed using the Newcastle-Ottawa scale. PARTICIPANTS Patients with CRS. MAIN OUTCOME MEASURES Pooled odds ratios (ORs) with 95% confidence interval (CIs) in analyses of studies that compared the prevalence of CRS, nasal polyp, difference of Lund-Kennedy endoscopic score, Lund-Mackay CT score and Sino-nasal Outcome Test-22. RESULTS The analysis included eight studies and 445 465 patients. Patients who used statins were at lower risk for CRS than those who did not (OR = 0.7457, 95% CI = 0.6629-0.8388, p < 0.0001, I2 = 0.0%). Patients with hyperlipidaemia were at higher risk for CRS than those with normal serum levels of lipid (OR = 1.3590, 95% CI = 1.2831-1.4394, p < 0.0001, I2 = 33.3%). However, there were no significant differences in the risk for nasal polyps between CRS patients using statins or not (OR = 1.0931, 95% CI = 0.7860-1.5202, p = 0.5968, I2 = 0.0%). Additionally, statin use was not related to Lund-Kennedy endoscopic scores, Lund-Mackay CT scores or sino-nasal outcome test-22 scores in CRS patients. CONCLUSION The risk for CRS is lower in patients who use statins and those without hyperlipidaemia.
Collapse
Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jae Sang Han
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Geun-Jeon Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | | | - Sun Hong Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| |
Collapse
|
29
|
Abstract
This article presents two ways of quantifying confounding using logistic response models for binary outcomes. Drawing on the distinction between marginal and conditional odds ratios in statistics, we define two corresponding measures of confounding (marginal and conditional) that can be recovered from a simple standardization approach. We investigate when marginal and conditional confounding may differ, outline why the method by Karlson, Holm, and Breen recovers conditional confounding under a "no interaction"-assumption, and suggest that researchers may measure marginal confounding by using inverse probability weighting. We provide two empirical examples that illustrate our standardization approach.
Collapse
Affiliation(s)
| | - Frank Popham
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, United Kingdom
| | - Anders Holm
- Department of Sociology, Social Science Centre, The University of Western Ontario, London, Ontario, Canada
| |
Collapse
|
30
|
Pushpa, Magotra A, Patil CS, Bangar YC, Sindhu V, Chaudhary P, Garg AR. Temporal variation and risk factors associated with reproductive disorders in Hardhenu (Bos taurus × Bos indicus) dairy cattle. Reprod Domest Anim 2023; 58:1404-1412. [PMID: 37605333 DOI: 10.1111/rda.14455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023]
Abstract
This study aimed to investigate the incidence and effect of non-genetic factors on reproductive disorders in the Hardhenu cattle population over a period of 11 years (2010-2021). The study included a total of 1340 cattle for calculating the incidence of reproductive disorders and analysed the occurrence of different reproductive disorders. In the present study, retention of placenta had highest frequency, accounting for approximately 18.36% of the incidence, followed by repeater cows (11.19%), metritis (6.27%), dystocia (0.60%), anestrus (0.45%) and prolapse (0.37%). Chi-square analysis revealed a significant relationship between the year and the incidence of reproductive disorders (p < .05). Logistic regression analysis of temporal variability of reproductive disorders was also analysed, with an increase in the odds from 2014 to 2020, peaking in 2017-2018 and 2018-2019. Logistic regression analysis showed that season and parity did not significantly influence the incidence of reproductive disorders. However, period of calving had a significant impact. Cows calving between 2008 and 2014 had a significantly lower odds ratio (0.13, 95% CI: 0.06-0.30), indicating a decreased risk, while those calving between 2014 and 2017 had a higher odds ratio (0.59, 95% CI: 0.38-0.90), suggesting an increased risk of reproductive disorders. Compared to parity 3, parity 1 (1.344, 95% CI: 0.869-2.08) and parity 2 (1.193, 95% CI: 0.768-1.851) showed highest odds ratio. Similarly, the odds ratio for winter (1.64, 95% CI: 0.93-2.89), summer (1.71, 95% CI: 0.89-3.26) and rainy season (1.64, 95% CI: 0.92-2.91) was higher as compared to autumn. The present results provided valuable insights into the incidence of various reproductive disorders and associated risk factors in Hardhenu cattle. These results can be utilized for targeted interventions to enhance reproductive health and overall productivity in dairy cattle.
Collapse
Affiliation(s)
- Pushpa
- Department of Animal Genetics and Breeding, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, India
| | - Ankit Magotra
- Department of Animal Genetics and Breeding, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, India
| | - C S Patil
- Department of Animal Genetics and Breeding, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, India
| | - Y C Bangar
- Department of Animal Genetics and Breeding, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, India
| | - Vikas Sindhu
- Department of Animal Nutrition, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, India
| | - Pradeep Chaudhary
- Department of Animal Genetics and Breeding, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, India
| | - Asha Rani Garg
- Department of Animal Genetics and Breeding, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, India
| |
Collapse
|
31
|
Sanjari E, Toosizadeh S, Raeisi Shahraki H. Commentary: Modeling mortality risk in patients with severe COVID-19 from Mexico. Front Med (Lausanne) 2023; 10:1247741. [PMID: 37840999 PMCID: PMC10568472 DOI: 10.3389/fmed.2023.1247741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Affiliation(s)
- Elaheh Sanjari
- Student Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Sepideh Toosizadeh
- Student Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Hadi Raeisi Shahraki
- Department of Epidemiology and Biostatistics, Faculty of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| |
Collapse
|
32
|
Gangwar M, Usmani M, Jamal Y, Brumfield KD, Huq A, Unnikrishnan A, Colwell RR, Jutla AS. Environmental Factors Associated with Incidence and Distribution of V. parahaemolyticus and V. vulnificus in Chesapeake Bay, Maryland, USA: A three-year case study. bioRxiv 2023:2023.09.25.559351. [PMID: 37808627 PMCID: PMC10557581 DOI: 10.1101/2023.09.25.559351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Members of the genus Vibrio are ecologically significant bacteria native to aquatic ecosystems globally, and a few can cause diseases in humans. Vibrio-related illnesses have increased in recent years, primarily attributed to changing environmental conditions. Therefore, understanding the role of environmental factors in the occurrence and growth of pathogenic strains is crucial for public health. Water, oyster, and sediment samples were collected between 2009 and 2012 from Chester River and Tangier Sound sites in Chesapeake Bay, Maryland, USA, to investigate the relationship between water temperature, salinity, and chlorophyll with the incidence and distribution of Vibrio parahaemolyticus (VP) and Vibrio vulnificus (VV). Odds ratio analysis was used to determine association between the likelihood of VP and VV presence and these environmental variables. Results suggested that water temperature threshold of 20°C or higher was associated with an increased risk, favoring the incidence of Vibrio spp. A significant difference in salinity was observed between the two sampling sites, with distinct ranges showing high odds ratio for Vibrio incidence, especially in water and sediment, emphasizing the impact of salinity on VP and VV incidence and distribution. Notably, salinity between 9-20 PPT consistently favored the Vibrio incidence across all samples. Relationship between chlorophyll concentrations and VP and VV incidence varied depending on sample type. However, chlorophyll range of 0-10 μg/L was identified as critical in oyster samples for both vibrios. Analysis of odds ratios for water samples demonstrated consistent outcomes across all environmental parameters, indicating water samples offer a more reliable indicator of Vibrio spp. incidence.
Collapse
Affiliation(s)
- Mayank Gangwar
- Geohealth and Hydrology Laboratory, Department of Environmental Engineering Sciences, University of Florida, Gainesville, FL, USA
| | - Moiz Usmani
- Geohealth and Hydrology Laboratory, Department of Environmental Engineering Sciences, University of Florida, Gainesville, FL, USA
| | - Yusuf Jamal
- Geohealth and Hydrology Laboratory, Department of Environmental Engineering Sciences, University of Florida, Gainesville, FL, USA
| | - Kyle D. Brumfield
- Maryland Pathogen Research Institute, University of Maryland, College Park, MD, USA
- University of Maryland Institute for Advanced Computer Studies, University of Maryland, College Park, MD, USA
| | - Anwar Huq
- Maryland Pathogen Research Institute, University of Maryland, College Park, MD, USA
| | - Avinash Unnikrishnan
- Department of Civil, Construction, and Environmental Engineering, UAB School of Engineering, University of Alabama at Birmingham, AL, USA
| | - Rita R. Colwell
- Maryland Pathogen Research Institute, University of Maryland, College Park, MD, USA
- University of Maryland Institute for Advanced Computer Studies, University of Maryland, College Park, MD, USA
| | - Antarpreet S. Jutla
- Geohealth and Hydrology Laboratory, Department of Environmental Engineering Sciences, University of Florida, Gainesville, FL, USA
| |
Collapse
|
33
|
Ortíz de Urbina Comerón P, Zubizarreta-Macho Á, Lobo Galindo AB, Montiel-Company JM, Lorenzo-Gómez MF, Flores Fraile J. Relationship between Prostate Inflammation and Periodontal Disease-A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:6070. [PMID: 37763009 PMCID: PMC10531617 DOI: 10.3390/jcm12186070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
The aim of this systematic review and meta-analysis was to analyze the association between periodontal disease and prostate inflammation with a null hypothesis stating that periodontal disease does not increase the incidence of prostate inflammation. MATERIALS AND METHODS A systematic literature review and meta-analysis of longitudinal observational cohort and case-control studies that evaluated the odds ratio or hazard ratio and confidence interval was undertaken based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations (2020). A total of four databases were consulted in the literature search: PubMed-Medline, Scopus, Embase, and Web of Science. After eliminating duplicated articles and applying the inclusion criteria, seven articles were selected for the qualitative and quantitative analyses. RESULTS Four observational cohort studies and three observational cohort case-control studies were included in the meta-analysis. The four observational cohort studies were combined using the random effects model to estimate a hazard ratio of 1.32 with a confidence interval of 95% between 0.87 and 1.77. The meta-analysis presented high heterogeneity (Q test = 56.1; p value < 0.001; I2 = 94.9%). Moreover, the three observational case-control studies were combined using the random effects model to estimate an odds ratio of 1.62 with a confidence interval of 95% between 1.41 and 1.84. The meta-analysis presented high heterogeneity (Q test = 1.07; p value = 0.782; I2 = 0%). CONCLUSIONS The incidence of periodontal disease does not increase the risk of the incidence of prostate inflammation.
Collapse
Affiliation(s)
- Pablo Ortíz de Urbina Comerón
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008 Salamanca, Spain; (P.O.d.U.C.); (M.-F.L.-G.); (J.F.F.)
| | - Álvaro Zubizarreta-Macho
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008 Salamanca, Spain; (P.O.d.U.C.); (M.-F.L.-G.); (J.F.F.)
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain;
| | - Ana Belén Lobo Galindo
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain;
| | - José María Montiel-Company
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain;
| | - María-Fernanda Lorenzo-Gómez
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008 Salamanca, Spain; (P.O.d.U.C.); (M.-F.L.-G.); (J.F.F.)
- Servicio de Urología del Hospital, Universitario de Salamanca, 37007 Salamanca, Spain
| | - Javier Flores Fraile
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008 Salamanca, Spain; (P.O.d.U.C.); (M.-F.L.-G.); (J.F.F.)
| |
Collapse
|
34
|
Gibbons T, Reavey J, Georgiou EX, Becker CM. Timed intercourse for couples trying to conceive. Cochrane Database Syst Rev 2023; 9:CD011345. [PMID: 37709293 PMCID: PMC10501857 DOI: 10.1002/14651858.cd011345.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
BACKGROUND Many factors influence fertility, one being the timing of intercourse. The 'fertile window' describes a stage in the cycle when conception can occur and is approximately five days before to several hours after ovulation. 'Timed intercourse' is the practice of prospectively identifying ovulation and, thus, the fertile window to increase the likelihood of conception. Methods of predicting ovulation include urinary hormone measurement (luteinising hormone (LH) and oestrogen), fertility awareness-based methods (FABM) (including tracking basal body temperatures, cervical mucus monitoring, calendar charting/tracking apps), and ultrasonography. However, there are potentially negative aspects associated with ovulation prediction, including stress, time consumption, and cost implications of purchasing ovulation kits and app subscriptions. This review considered the evidence from randomised controlled trials (RCTs) evaluating the use of timed intercourse (using ovulation prediction) on pregnancy outcomes. OBJECTIVES To evaluate the benefits and risks of ovulation prediction methods for timing intercourse on conception in couples trying to conceive. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility (CGF) Group Specialised Register, CENTRAL, MEDLINE, and Embase in January 2023. We also checked the reference lists of relevant studies and searched trial registries for any additional trials. SELECTION CRITERIA We included RCTs that compared methods of timed intercourse using ovulation prediction to other forms of ovulation prediction or intercourse without ovulation prediction in couples trying to conceive. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane to select and analyse studies in this review. The primary review outcomes were live birth and adverse events (such as depression and stress). Secondary outcomes were clinical pregnancy, pregnancy (clinical or positive urinary pregnancy test not yet confirmed by ultrasound), time to pregnancy, and quality of life. We assessed the overall quality of the evidence for the main comparisons using GRADE methods. MAIN RESULTS This review update included seven RCTs involving 2464 women or couples. Four of the five studies from the previous review were included in this update, and three new studies were added. We assessed the quality of the evidence as moderate to very low, the main limitations being imprecision, indirectness, and risk of bias. Urinary ovulation tests versus intercourse without ovulation prediction Compared to intercourse without ovulation prediction, urinary ovulation detection probably increases the chance of live birth in couples trying to conceive (risk ratio (RR) 1.36, 95% confidence interval (CI) 1.02 to 1.81, 1 RCT, n = 844, moderate-quality evidence). This suggests that if the chance of a live birth without urine ovulation prediction is 16%, the chance of a live birth with urine ovulation prediction is 16% to 28%. However, we are uncertain whether timed intercourse using urinary ovulation detection resulted in a difference in stress (mean difference (MD) 1.98, 95% CI -0.87 to 4.83, I² = 0%, P = 0.17, 1 RCT, n = 77, very low-quality evidence) or clinical pregnancy (RR 1.09, 95% CI 0.51 to 2.31, I² = 0%, 1 RCT, n = 148, low-quality evidence). Similar to the live birth result, timed intercourse using urinary ovulation detection probably increases the chances of clinical pregnancy or positive urine pregnancy test (RR 1.28, 95% CI 1.09 to 1.50, I² = 0, 4 RCTs, n = 2202, moderate-quality evidence). This suggests that if the chance of a clinical pregnancy or positive urine pregnancy test without ovulation prediction is assumed to be 18%, the chance following timed intercourse with urinary ovulation detection would be 20% to 28%. Evidence was insufficient to determine the effect of urine ovulation tests on time to pregnancy or quality of life. Fertility awareness-based methods (FABM) versus intercourse without ovulation prediction Due to insufficient evidence, we are uncertain whether timed intercourse using FABM resulted in a difference in live birth rate compared to intercourse without ovulation prediction (RR 0.95, 95% CI 0.76 to 1.20, I² = 0%, 2 RCTs, n = 157, low-quality evidence). We are also uncertain whether FABM affects stress (MD -1.10, 95% CI -3.88 to 1.68, 1 RCT, n = 183, very low-quality evidence). Similarly, we are uncertain of the effect of timed intercourse using FABM on anxiety (MD 0.5, 95% CI -0.52 to 1.52, P = 0.33, 1 RCT, n = 183, very low-quality evidence); depression (MD 0.4, 95% CI -0.28 to 1.08, P = 0.25, 1 RCT, n = 183, very low-quality evidence); or erectile dysfunction (MD 1.2, 95% CI -0.38 to 2.78, P = 0.14, 1 RCT, n = 183, very low-quality evidence). Evidence was insufficient to detect a benefit of timed intercourse using FABM on clinical pregnancy (RR 1.13, 95% CI 0.31 to 4.07, 1 RCT, n = 17, very low-quality evidence) or clinical or positive pregnancy test rates (RR 1.08, 95% CI 0.89 to 1.30, 3 RCTs, n = 262, very low-quality evidence). Finally, we are uncertain whether timed intercourse using FABM affects the time to pregnancy (hazard ratio 0.86, 95% CI 0.53 to 1.38, 1 RCT, n = 140, low-quality evidence) or quality of life. No studies assessed the use of timed intercourse with pelvic ultrasonography. AUTHORS' CONCLUSIONS The new evidence presented in this review update shows that timed intercourse using urine ovulation tests probably improves live birth and pregnancy rates (clinical or positive urine pregnancy tests but not yet confirmed by ultrasound) in women under 40, trying to conceive for less than 12 months, compared to intercourse without ovulation prediction. However, there are insufficient data to determine the effects of urine ovulation tests on adverse events, clinical pregnancy, time to pregnancy, and quality of life. Similarly, due to limited data, we are uncertain of the effect of FABM on pregnancy outcomes, adverse effects, and quality of life. Further research is therefore required to fully understand the safety and effectiveness of timed intercourse for couples trying to conceive. This research should include studies reporting clinically relevant outcomes such as live birth and adverse effects in fertile and infertile couples and utilise various methods to determine ovulation. Only with a comprehensive understanding of the risks and benefits of timed intercourse can recommendations be made for all couples trying to conceive.
Collapse
Affiliation(s)
- Tatjana Gibbons
- Nuffield Department of Women's and Reproductive Health, University of Oxford , Oxford, UK
| | - Jane Reavey
- Department of Obstetrics and Gynaecology, Royal Berkshire Hospital, Reading, UK
| | | | - Christian M Becker
- Nuffield Department of Women's and Reproductive Health, University of Oxford , Oxford, UK
| |
Collapse
|
35
|
Yang Y, Yao X, Liu Y, Zhao J, Sun P, Zhang Y, Li K, Chen Y, Zheng J, Deng L, Fan S, Ma X, Guo S, Shuai P, Wan Z. Global and Regional Estimate of HIV-Associated Stroke Burden: A Meta-Analysis and Population Attributable Modeling Study. Stroke 2023; 54:2390-2400. [PMID: 37477007 DOI: 10.1161/strokeaha.123.043410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND This study aimed to determine the correlation between human-immunodeficiency-virus (HIV) infection and stroke, as well as to estimate the global, regional, and national burden of HIV-associated stroke. METHODS A registered meta-analysis was performed by searching PubMed, Embase, and Web of Science for relevant literature up to October 31, 2022. The pooled relative risk of stroke in HIV-infected people was calculated using a random-effects model. HIV prevalence and disability-adjusted life years (DALYs) datasets were obtained from the Joint United Nations Program on HIV and AIDS, and the Global Health Data Exchange, respectively. The population attributable fraction was estimated and delivered to calculate the HIV-associated DALYs of stroke from 1990 to 2019, at the global, regional, and national levels. Pearson correlation analysis were conducted to assess the correlation between the age-standardized rate or estimated annual percentage changes and the sociodemographic index. RESULTS Out of 10 080 identified studies, 11 were included in this meta-analysis. Compared with individuals without HIV-infection, the pooled relative risk of stroke in HIV-infected individuals was 1.40 (95% CI, 1.18-1.65). From 1990 to 2019, the global population attributable fraction of HIV-associated stroke increased almost 3-fold, while the HIV-associated DALYs increased from 18 595 (95% CI, 7485-31 196) in 1990 to 60 684 (95% CI, 24 281-101 894) in 2019. Meanwhile, HIV-associated DALYs varied by region, with Eastern and Southern Africa having the highest value of 126 160 in 2019. Moreover, countries with middle social development index were shouldering the highest increase trend of the HIV-associated DALYs age-standardized rates. CONCLUSIONS HIV-infected individuals face a significantly higher risk of stroke, and the global burden of HIV-associated stroke has increased over the past 3 decades, showing regional variations. Eastern and Southern Africa bear the highest burden, while Eastern Europe and Central Asia have seen significant growth. Health care providers, researchers, and decision-makers should give increased attention to stroke prevention and management in HIV-endemic areas. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: CRD42022367450.
Collapse
Affiliation(s)
- Yumei Yang
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Xiaoqin Yao
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Yuping Liu
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China (Y.L., P. Sun, Z.W.)
| | - Jianhui Zhao
- Department of School of Public Health, and Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, China (J. Zhao, Y.Z., K.L.)
| | - Ping Sun
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China (Y.L., P. Sun, Z.W.)
| | - Yixuan Zhang
- Department of School of Public Health, and Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, China (J. Zhao, Y.Z., K.L.)
| | - Kangning Li
- Department of School of Public Health, and Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, China (J. Zhao, Y.Z., K.L.)
| | - Yan Chen
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
- School of Public Health, Southwest Medical University, Luzhou, China (Y.C., S.F.)
| | - Jinxin Zheng
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, China (J. Zheng)
| | - Ling Deng
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Song Fan
- School of Public Health, Southwest Medical University, Luzhou, China (Y.C., S.F.)
| | - Xiaoxiang Ma
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Shujin Guo
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Ping Shuai
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Zhengwei Wan
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China (Y.L., P. Sun, Z.W.)
| |
Collapse
|
36
|
Shu L, Zhang W, Yaghi S, Grilli A, de Havenon A, Barrett KM, Johnston KC, Goldstein ED. Prestroke and Poststroke Sulfonylurea Exposure and Functional Outcomes: A Post Hoc Analysis of the SHINE Trial. Stroke 2023; 54:e415-e416. [PMID: 37449423 PMCID: PMC10527636 DOI: 10.1161/strokeaha.123.043496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- Liqi Shu
- Department of Neurology, Brown University, Providence, RI, USA
| | - Wenyuan Zhang
- Department of Anesthesiology and Intensive Care, Zhejiang University, Hangzhou, China
| | - Shadi Yaghi
- Department of Neurology, Brown University, Providence, RI, USA
| | - Anais Grilli
- Department of Neurology, Brown University, Providence, RI, USA
| | - Adam de Havenon
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Kevin M. Barrett
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Karen C. Johnston
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | | |
Collapse
|
37
|
Śmiech A, Bulak K, Łopuszyński W, Puła A. Incidence and the risk of occurrence of benign and malignant canine skin tumours in Poland - a five-year retrospective study. J Vet Res 2023; 67:437-446. [PMID: 37786849 PMCID: PMC10541663 DOI: 10.2478/jvetres-2023-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/08/2023] [Indexed: 10/04/2023] Open
Abstract
Introduction The aim of the study was to compile data on the frequency and distribution of canine skin tumours and determine the risk of these being malignant as opposed to benign. This determination proceeded from tumour histogenesis and gave consideration to the dog's breed, sex, age and the anatomical location of tumours. Material and Methods This retrospective five-year epidemiological study included 3,139 canine skin tumours collected in Poland. A univariable logistic regression analysis was performed to determine the odds ratios (ORs) with 95% confidence intervals (CIs). Results Microscopic analysis showed a significant predominance of benign tumours (65.02%) as well as mesenchymal and melanocytic tumours (59.57%). The most frequently diagnosed were mast cell tumours, accounting for 13.79% of all skin tumours, and other common tumour types were lipomas (6.40%), haemangiopericytomas (5.96%) and malignant melanomas (4.65%). The risk of malignant versus benign tumours was 1.212 times higher in the female than in the male dogs. A higher risk of development of malignant epithelial tumours was found in boxers (OR 4.091), German shepherds (OR 4.085) and flat-coated retrievers (OR 43.596). A higher risk of development of malignant mesenchymal tumours was found in golden retrievers (OR 4.693), boxers (OR 2.342), bulldogs (OR 3.469) and Maltese (OR 2.757). Conclusion The results may serve as a reference point for further studies of the complex biology of canine skin tumours.
Collapse
Affiliation(s)
- Anna Śmiech
- Department of Pathomorphology and Forensic Veterinary Medicine, Lublin, Poland
| | - Kamila Bulak
- Department of Pathomorphology and Forensic Veterinary Medicine, Lublin, Poland
| | | | - Agata Puła
- Student Scientific Circle of the University of Life Sciences in Lublin, University of Life Sciences in Lublin, 20-612Lublin, Poland
| |
Collapse
|
38
|
Carrasco-Labra A, Urquhart O, Glick M. A practitioner's guide to developing critical appraisal skills: How to interpret the magnitude of clinical study results. J Am Dent Assoc 2023; 154:836-841. [PMID: 37498263 DOI: 10.1016/j.adaj.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND In the oral health literature, researchers sometimes report measures of association that are inappropriate for their study design. Clinicians using evidence to inform their practice should be able to interpret clinical study results on the basis of the types of measures of association, independent of what the researchers of a study reported. TYPES OF STUDIES REVIEWED The authors summarized which measures of association can be derived from experimental and observational studies and how to interpret them in the context of different study designs. They also suggested how inferences can be made on the basis of particular designs. RESULTS Measures of association derived from randomized controlled trials and cohort studies differ from those of case-control and cross-sectional studies. These differences can be attributed to the temporality between exposures and outcomes inherent in the respective study designs. Different measures of association reported from the same study may lead to different clinical decisions. Furthermore, the same measure of association with the same effect estimate derived from different study designs may contribute to different clinical decisions. CONCLUSIONS AND PRACTICAL IMPLICATIONS Measures of association should be interpreted in the context of a particular study design. Study designs and specific measures of association should be considered when drawing conclusions from clinical studies. Clinicians using the literature to inform practice should be cognizant of measures of association reported for a particular study design and whether the authors have interpreted the measure of association correctly in the context of their chosen study design.
Collapse
|
39
|
Edwards DJ, Liu CY, Dunning K, Fregni F, Laine J, Leiby BE, Rogers LM, Harvey RL. Electric Field Navigated 1-Hz rTMS for Poststroke Motor Recovery: The E-FIT Randomized Controlled Trial. Stroke 2023; 54:2254-2264. [PMID: 37577801 PMCID: PMC10453351 DOI: 10.1161/strokeaha.123.043164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND To determine if low-frequency repetitive transcranial magnetic stimulation targeting the primary motor cortex contralateral (M1CL) to the affected corticospinal tract in patients with hemiparetic stroke augments intensive training-related clinical improvement; an extension of the NICHE trial (Navigated Inhibitory rTMS to Contralesional Hemisphere Trial) using an alternative sham coil. METHODS The present E-FIT trial (Electric Field Navigated 1Hz rTMS for Post-stroke Motor Recovery Trial) included 5 of 12 NICHE trial outpatient US rehabilitation centers. The stimulation protocol remained identical (1 Hz repetitive transcranial magnetic stimulation, M1CL, preceding 60-minute therapy, 18 sessions/6 wks; parallel arm randomized clinical trial). The sham coil appearance mimicked the active coil but without the weak electric field in the NICHE trial sham coil. Outcomes measured 1 week, and 1, 3, and 6 months after the end of treatment included the following: upper extremity Fugl-Meyer (primary, 6 months after end of treatment), Action Research Arm Test, National Institutes of Health Stroke Scale, quality of life (EQ-5D), and safety. RESULTS Of 60 participants randomized, 58 completed treatment and were included for analysis. Bayesian analysis of combined data from the E-FIT and the NICHE trials indicated that active treatment was not superior to sham at the primary end point (posterior mean odds ratio of 1.94 [96% credible interval of 0.61-4.80]). For the E-FIT intent-to-treat population, upper extremity Fugl-Meyer improvement ≥5 pts occurred in 60% (18/30) active group and 50% (14/28) sham group. Participants enrolled 3 to 6 months following stroke had a 67% (31%-91% CI) response rate in the active group at the 6-month end point versus 50% in the sham group (21.5%-78.5% CI). There were significant improvements from baseline to 6 months for both active and sham groups in upper extremity Fugl-Meyer, Action Research Arm Test, and EQ-5D (P<0.05). Improvement in National Institutes of Health Stroke Scale was observed only in the active group (P=0.004). Ten serious unrelated adverse events occurred (4 active group, 6 sham group, P=0.72). CONCLUSIONS Intensive motor rehabilitation 3 to 12 months after stroke improved clinical impairment, function, and quality of life; however, 1 Hz-repetitive transcranial magnetic stimulation was not an effective treatment adjuvant in the present sample population with mixed lesion location and extent. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03010462.
Collapse
Affiliation(s)
- Dylan J. Edwards
- Moss Rehabilitation Research Institute, and Department of Rehabilitation Medicine Thomas Jefferson University, Philadelphia, PA (D.J.E.)
- Exercise Medicine Research Institute and School of Medical and Health Sciences, Edith Cowan University Australia (D.J.E.)
- Burke Neurological Institute, White Plains, NY (D.J.E.)
| | - Charles Y. Liu
- USC Neurorestoration Center, Rancho Los Amigos National Rehabilitation Center, Los Angeles, CA (C.Y.L.)
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, OH (K.D.)
| | - Felipe Fregni
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA (F.F.)
| | - Jarmo Laine
- Nexstim Corporation, Helsinki, Finland (J.L.)
| | | | - Lynn M. Rogers
- The Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL (L.M.R., R.L.H.)
| | - Richard L. Harvey
- The Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL (L.M.R., R.L.H.)
| |
Collapse
|
40
|
Mashele SA, Zwane TB, Kuonza L, Muchengeti MM, Motsuku L. Risk factors for breast cancer among women in Ekurhuleni Metropolitan Municipality, Gauteng province of South Africa, 2017‒2020: a case-control study. Ecancermedicalscience 2023; 17:1593. [PMID: 37799951 PMCID: PMC10550293 DOI: 10.3332/ecancer.2023.1593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction Breast cancer (BC) is the most common cancer among women in South Africa (SA), with an age-standardised incidence rate of 52.6 and an age-standardised mortality rate of 16.0 per 100,000 population. There is a paucity of evidence on the risk factors for BC among women of all races in SA. Given the rising prevalence of BC in SA, literature-based evidence is critical for the appropriate dissemination of preventative measures. This study aimed to identify the risk factors associated with the development of BC among women in Ekhuruleni Metropolitan Municipality. Methods An unmatched case-control study was conducted from 1 January 2017 to 31 December 2020 using secondary data extracted from the Ekurhuleni Population-Based Cancer Registry. Unconditional multivariable logistic regression analysis was carried out using the adjusted odds ratio (aOR). The variables race, employment, human immunodeficiency virus (HIV), smoking and alcohol status were included in the multivariable logistic regression model while the model was adjusted for age. Results A total of 2,217 cases and 851 controls were enrolled in the study. The mean age (±SD) in years was 55.7 (±15.2). The White population group, being self-employed and being HIV positive was significantly associated with reduced odds of BC development. HIV-positive women were 61% less likely to have BC than women who were HIV-negative (aOR 0.39; 95% confidence interval (CI): 0.27‒0.57). White women were 65% less likely to have BC than women of other races (aOR 0.35; 95% CI: 0.29‒0.43). Self-employed women were 59% less likely to have BC than women who were formally employed (aOR 0.41; 95% CI: 0.18‒0.97). No evidence of association was observed between tobacco smoking and BC as well as alcohol consumption and BC. Conclusion There was a 65% reduction in BC risk among White women compared to other races. HIV-positive women demonstrated a 61% lower likelihood of BC while self-employed women showed a 59% reduced risk of developing BC. These findings suggest that being White, self-employed or HIV-positive may provide some protection against BC. However, additional research is needed to validate these results and establish the underlying reasons behind these associations.
Collapse
Affiliation(s)
- Sizeka A Mashele
- South African Field Epidemiology Training Program, National Institute for Communicable Diseases, National Health Laboratory Services, 1 Modderfontein Road, Sandringham, Johannesburg 2192, South Africa
- National Cancer Registry, National Health Laboratory Services, 1 Modderfontein Road, Sandringham, Johannesburg 2192, South Africa
- School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg 2193, South Africa
| | - Thembekile B Zwane
- South African Field Epidemiology Training Program, National Institute for Communicable Diseases, National Health Laboratory Services, 1 Modderfontein Road, Sandringham, Johannesburg 2192, South Africa
| | - Lazarus Kuonza
- South African Field Epidemiology Training Program, National Institute for Communicable Diseases, National Health Laboratory Services, 1 Modderfontein Road, Sandringham, Johannesburg 2192, South Africa
| | - Mazvita M Muchengeti
- National Cancer Registry, National Health Laboratory Services, 1 Modderfontein Road, Sandringham, Johannesburg 2192, South Africa
- School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg 2193, South Africa
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, 19 Jonkershoek Road, Stellenbosch 7600, South Africa
| | - Lactatia Motsuku
- National Cancer Registry, National Health Laboratory Services, 1 Modderfontein Road, Sandringham, Johannesburg 2192, South Africa
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, 19 Jonkershoek Road, Stellenbosch 7600, South Africa
| |
Collapse
|
41
|
Rai A, Riddle M, Mishra R, Nguyen N, Valine K, Fenney M. Use of a Smartphone-Based Medication Adherence Platform to Improve Outcomes in Uncontrolled Type 2 Diabetes Among Veterans: Prospective Case-Crossover Study. JMIR Diabetes 2023; 8:e44297. [PMID: 37561555 PMCID: PMC10450533 DOI: 10.2196/44297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/16/2023] [Accepted: 04/01/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Medication nonadherence is a problem that impacts both the patient and the health system. OBJECTIVE The objective of this study was to evaluate the impact of a novel smartphone app with patient-response-directed clinical intervention on medication adherence and blood glucose control in noninsulin-dependent patients with type 2 diabetes mellitus (T2DM). METHODS We enrolled 50 participants with T2DM not on insulin with smartphones from a rural health care center in Northern Nevada for participation in this case-crossover study. Participants underwent a standard of care arm and an intervention arm. Each study arm was 3 months long, for a total of 6 months of follow-up. Participants had a hemoglobin A1c (HbA1c) lab draw at enrollment, 3 months, and 6 months. Participants had monthly "medication adherence scores" (MAS) and "Self-Efficacy for Appropriate Medication Use Scale" (SEAMS) questionnaires completed at baseline and monthly for the duration of the study. Our primary outcomes of interest were the changes in HbA1c between study arms. Secondary outcomes included the evaluation of the difference in the proportion of participants achieving a clinically meaningful reduction in HbA1c and the difference in the number of participants requiring diabetes therapy escalation between study arms. Exploratory outcomes included the analysis of the variation in medication possession ratio (MPR), MAS, and SEAMS during each study arm. RESULTS A total of 30 participants completed both study arms and were included in the analysis. Dropouts were higher in participants enrolled in the standard of care arm first (9/25, 36% vs 4/25, 16%). Participants had a median HbA1c of 9.1%, had been living with T2DM for 6 years, had a median age of 66 years, and had a median of 8.5 medications. HbA1c reduction was 0.69% in the intervention arm versus 0.35% in the standard of care arm (P=.30). A total of 70% (21/30) of participants achieved a clinically meaningful reduction in HbA1c of 0.5% in the app intervention arm versus 40% (12/30) in the standard of care arm (odds ratio 2.29, 95% CI 0.94-5.6; P=.09). Participants had higher odds of a therapy escalation while in the standard of care arm (18/30, 60% vs 5/30, 16.7%, odds ratio 4.3, 95% CI 1.2-15.2; P=.02). The median MPR prior to enrollment was 109%, 112% during the study's intervention arm, and 102% during the standard of care arm. The median real-time MAS was 93.2%. The change in MAS (1 vs -0.1; P=.02) and SEAMS (1.9 vs -0.2; P<.001) from baseline to month 3 was higher in the intervention arm compared to standard of care. CONCLUSIONS A novel smartphone app with patient-response-directed provider intervention holds promise in the ability to improve blood glucose control in complex non-insulin-dependent T2DM and is worthy of additional study.
Collapse
Affiliation(s)
- Amneet Rai
- Veterans Affairs Sierra Nevada Healthcare System, Reno, NV, United States
- University of Nevada Reno School of Medicine, Reno, NV, United States
| | - Mark Riddle
- Veterans Affairs Sierra Nevada Healthcare System, Reno, NV, United States
- University of Nevada Reno School of Medicine, Reno, NV, United States
| | - Rajendra Mishra
- Veterans Affairs Sierra Nevada Healthcare System, Reno, NV, United States
| | - Nhien Nguyen
- Veterans Affairs Sierra Nevada Healthcare System, Reno, NV, United States
| | - Kelly Valine
- Veterans Affairs Sierra Nevada Healthcare System, Reno, NV, United States
| | - Megan Fenney
- Veterans Affairs Sierra Nevada Healthcare System, Reno, NV, United States
| |
Collapse
|
42
|
Balasubramanian P, Kernan WN, Sheth KN, Ofstad AP, Rosenstock J, Wanner C, Zinman B, Mattheus M, Marx N, Inzucchi SE. Baseline Cardiovascular Risk Factor Control in Patients With Type 2 Diabetes and Coronary Disease Versus Stroke: Secondary Analysis of Cardiovascular Outcome Trials. Stroke 2023; 54:2013-2021. [PMID: 37449424 PMCID: PMC10358436 DOI: 10.1161/strokeaha.122.042053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Patients with type 2 diabetes (T2D) and cardiovascular disease are at increased risk for recurrent ischemic events. Cardiovascular risk factor control is vital for secondary prevention, but how this compares among individuals with different T2D macrovascular complications is unknown. We aimed to determine if there might be differences in risk factor control in patients with T2D with previous stroke versus coronary artery disease (CAD). METHODS Cross-sectional analyses were performed on 12 856 patients with T2D with prior history of stroke with or without CAD from 3 diabetes cardiovascular outcome trials: CARMELINA (The Cardiovascular and Renal Microvascular Outcome Study With Linagliptin), EMPA-REG OUTCOME (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients), and CAROLINA (The Cardiovascular Outcome Study of Linagliptin vs Glimepiride in Type 2 Diabetes). Risk factors at baseline assessed included dyslipidemia, hypertension, smoking, and current antiplatelet/anticoagulant therapy. Control, respectively, was defined as LDL (low-density lipoprotein)-C <100 mg/dL or statin use, systolic blood pressure <140 and diastolic blood pressure <90 mm Hg, not currently smoking, and use of an antiplatelet/anticoagulant medication. The odds ratio of 3 to 4 (or good) versus 0 to 2 (or suboptimal) risk factors controlled was analyzed by logistic regression models. RESULTS The odds for good versus suboptimal risk factor control in patients with CAD alone was higher than in those with stroke alone across all 3 trials odds ratios (95% CI): CARMELINA, 2.05 (1.67-2.51), EMPA-REG OUTCOME, 2.50 (2.10-2.99), and CAROLINA, 1.63 (1.21-2.20). The respective odds ratios were lower (and rendered nonsignificant in CAROLINA) when cardiovascular risk factor control in patients with both CAD and stroke were compared with those with stroke alone: CARMELINA, 1.45 (1.13-1.87); EMPA-REG OUTCOME, 1.62 (1.25-2.08); and CAROLINA, 1.16 (0.74-1.83). CONCLUSIONS In contemporary populations of patients with T2D, there was significant discordance in control of cardiovascular risk factors between patients with stroke versus CAD, with the former having less optimal control. The intermediate results in patients with both CAD and stroke suggest that these differences could be related at least in part to clinician factors. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifiers: NCT01243424, NCT01131676, NCT01897532.
Collapse
Affiliation(s)
| | - Walter N. Kernan
- Section of General Internal Medicine, Department of Medicine (W.N.K), Yale School of Medicine, New Haven, CT
| | - Kevin N. Sheth
- Department of Neurology (K.N.S), Yale School of Medicine, New Haven, CT
| | - Anne Pernille Ofstad
- Boehringer Ingelheim Norway KS, Asker (A.P.O.)
- Oslo Diabetes Research Center, Norway (A.P.O.)
| | | | | | - Bernard Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, ON, Canada (B.Z.)
| | | | - Nikolaus Marx
- Department of Internal Medicine, University Hospital; RWTH Aachen University, Germany (N.M.)
| | - Silvio E. Inzucchi
- Section of Endocrinology, Department of Medicine (S.E.I), Yale School of Medicine, New Haven, CT
| |
Collapse
|
43
|
Zhang S, Liu C, Liu Q, He X, Fu Q, Chen X, Jin X, Chen Z, Yang X, Zhang Q, Li X. The relationship between sublingual immunotherapy for allergic rhinitis and the risk of symptoms in patients with COVID-19 infection. Hum Vaccin Immunother 2023; 19:2236538. [PMID: 37530139 PMCID: PMC10399475 DOI: 10.1080/21645515.2023.2236538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
To evaluated the risk ratio of Allergic rhinitis (AR) people on the symptoms after COVID-19 infection, and explored the relationship between AR and the symptoms after COVID-19 infection. An observational study was performed of people from outpatient department of the Hospital of Chengdu University of Chinese Medicine. Participants completed an electronic survey and between January 10 to January 20, 2023. We divided the participants into three groups according to the disease information of the population: non-AR people group (AR-N), AR patients with sublingual immunotherapy group (AR-S), and AR patients with conventional therapy group (AR-C). A total of 1116 participants were included in the study, with an average age of 21.76 ± 8.713, women accounted for 62.5%, men accounted for 37.5%. The final results showed that the risk of most symptoms after AR-C infection was not different from that of AR-N, except for sore throat, dry and itchy, chest distress, shortness of breath, and dyspnea. AR-S could effectively reduce the risk of post-infection symptoms including: dry and itchy (OR = 0.484, 95%CI: 0.335-0.698), pain (OR = 0.513, 95%CI:0.362-0.728), cough (OR = 0.506, 95% CI:0.341-0.749), expectoration (OR = 0.349, 95% CI:0.244-0.498), fever (OR = 0.569, 95% CI:0.379-0.853), head and body pain (OR = 0.456, 95% CI:0.323-0.644), fatigue (OR = 0.256, 95% CI:0.177-0.371), cold limbs (OR = 0.325, 95%CI:0.227-0.465), diarrhea (OR = 0.246, 95% CI:0.132-0.457), constipation (OR = 0.227, 95%CI:0.100-0.513), hyposmia (OR = 0.456, 95% CI:0.296-0.701), hypogeusia (OR = 0.397, 95% CI:0.259-0.607), chest distress (OR = 0.534, 95% CI:0.343-0.829), shortness of breath (OR = 0.622, 95% CI:0.398-0.974), palpitations (OR = 0.355, 95% CI:0.206-0.613). The risk of symptoms after COVID-19 infection in allergic rhinitis population receiving sublingual immunotherapy is lower.
Collapse
Affiliation(s)
- Shipeng Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, P.R. china
| | - Chenxin Liu
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qiqi Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, P.R. china
| | - Xingyi He
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, P.R. china
| | - Qinwei Fu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, P.R. china
| | - Xi Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, P.R. china
| | - Xin Jin
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, P.R. china
| | - Ze Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, P.R. china
| | - Xiang Yang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, P.R. china
| | - Qinxiu Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, P.R. china
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Director, World Health Organization (WHO) Collaborating Centre, Chengdu, China
| | - Xinrong Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, P.R. china
| |
Collapse
|
44
|
Njoroge A, Shariff MA, Khan HW, Gordillo V, Eclarinal B, Vargas J, Faiz M, Kasubhai M, Jackson T. Assessment of Adverse Childhood Experiences in the South Bronx on the Risk of Developing Chronic Disease as Adults. Cureus 2023; 15:e43078. [PMID: 37680403 PMCID: PMC10482123 DOI: 10.7759/cureus.43078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/09/2023] Open
Abstract
Background Adverse childhood experiences (ACEs) have a negative impact on health outcomes. Using a cross-sectional study design, our objective was to identify the prevalence of ACEs among residents of South Bronx and the increased relationship between such childhood stressors and the prevalence of both chronic disease and modifiable high-risk behavior in adulthood. Methods We recruited patients from a hospital-based, adult primary care clinic in the metropolitan area of the South Bronx. A prospectively designed, observational study recruited patients in a consecutive fashion to conduct a cross-sectional survey between September 2017 and January 2018. The demographic representation comprises a low socioeconomic sector of urban New York City, with low education and immigrant population. A modified ACE questionnaire that included nine ACE categories (Physical Abuse, Sexual Abuse, Household Substance Abuse, Separation from Parents, Incarcerated Household Member, Parental Separation/Divorce, and Bullying) in addition to questions on demographics, high-risk behavior, and diagnosis of chronic disease. Our primary objective was to gather the incidence of ACEs organized by domains. Secondary objectives were to demonstrate any expected increase (as odds ratios (ORs)) in chronic disease or maladaptive social habits when compared to patients with no ACEs within the cohort. The OR for the associations was calculated with logistic regression. Individual logistic regression models for each chronic disease, high-risk behavior, and demographics were used to measure the exposure response of the nine ACE categories. Results A total of 454 patients completed the survey. The average age was 53.1±14.2 years, and females were 49% of the sample. Hispanics were at 61% followed by Blacks at 34%. Participants reported high-risk behavior at 24%, had a high prevalence of chronic illness (82%), and had ACE events at 70%. We found a significant relationship between ACE events and having a chronic disease diagnosis and engagement in high-risk behavior with higher odds of reporting chronic illnesses among participants with exposure to childhood stressors (OR 1.26, 95% confidence interval 1.1-1.5, p=0.002). Of the nine ACE categories, many were independently associated with one or more chronic diseases in adulthood. Conclusion According to our survey data, ACE events in our patient population were more prevalent (30% with four or more exposures), higher than the proposed average of one out of six Americans with four or more exposures nationally according to national statistics. These childhood stressors appeared to have a strong association with the development of high-risk behavior and chronic illnesses.
Collapse
Affiliation(s)
- Alexander Njoroge
- Department of Internal Medicine, NYC HHC (New York City Health and Hospitals Corporation) Lincoln, Bronx, USA
| | - Masood A Shariff
- Department of Internal Medicine, NYC HHC (New York City Health and Hospitals Corporation) Lincoln, Bronx, USA
| | - Hira W Khan
- Department of Internal Medicine, NYC HHC (New York City Health and Hospitals Corporation) Lincoln, Bronx, USA
| | - Victor Gordillo
- Department of Internal Medicine, NYC HHC (New York City Health and Hospitals Corporation) Lincoln, Bronx, USA
| | - Brian Eclarinal
- Department of Internal Medicine, NYC HHC (New York City Health and Hospitals Corporation) Lincoln, Bronx, USA
| | - Jose Vargas
- Department of Internal Medicine, NYC HHC (New York City Health and Hospitals Corporation) Lincoln, Bronx, USA
| | - Mohammad Faiz
- Department of Internal Medicine, NYC HHC (New York City Health and Hospitals Corporation) Lincoln, Bronx, USA
| | - Moiz Kasubhai
- Department of Internal Medicine, NYC HHC (New York City Health and Hospitals Corporation) Lincoln, Bronx, USA
| | - Tranice Jackson
- Department of Internal Medicine, NYC HHC (New York City Health and Hospitals Corporation) Lincoln, Bronx, USA
| |
Collapse
|
45
|
Fitzhugh N, Rasmussen LR, Simoni AH, Valentin JB. Misuse of multinomial logistic regression in stroke related health research: A systematic review of methodology. Eur J Neurosci 2023; 58:3116-3131. [PMID: 37442794 DOI: 10.1111/ejn.16084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 06/13/2023] [Accepted: 06/17/2023] [Indexed: 07/15/2023]
Abstract
Multinomial logistic regression (MLR) is often used to model the association between a nominal outcome variable and one or more covariates. The results of MLR are interpreted as relative risk ratios (RRR) and warrant a more coherent interpretation than ordinary logistic regression. Some authors compare the results of MLR to ordinal logistic regression (OLR), irrespective of the fact that these estimate different quantities. We aim to investigate the time trends in the use and misuse of MLR in studies including stroke patients, specifically the extent to which (1) the results are denoted as anything other than RRR, (2) comparisons are made of results with results of OLR and (3) results have been interpreted coherently. Secondarily, we examine the use of model validation techniques in studies with predictive aims. We searched EMBASE and PubMed for articles using MLR on populations of stroke patients. Identified studies were screened, and information pertaining to our aims was extracted. A total of 285 articles were identified through a systematic literature search, and 68 of these were included in the review. Of these, 60 articles (88%) did not denote exponentiated coefficients of MLR as relative risk ratios but rather some other measure. Additionally, 63 articles (93%) interpreted the results of MLR in a non-coherent manner. Two articles attempted to compare MLR results with those of OLR. Nine studies attempted to use MLR for predictive means, and three used relevant validation techniques. From these findings, it is clear that the interpretation of MLR is often suboptimal.
Collapse
Affiliation(s)
- Nicholas Fitzhugh
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Gistrup, Denmark
- Danish Health Technology Council (Behandlingsrådet), Aalborg, Denmark
| | - Line Ryberg Rasmussen
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Gistrup, Denmark
| | - Amalie Helme Simoni
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Gistrup, Denmark
| | - Jan Brink Valentin
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Gistrup, Denmark
| |
Collapse
|
46
|
Abuelazm M, Mohamed I, Seri AR, Almaadawy O, Abdelazeem B, Brašić JR. Contact Force-Guided versus Contact Force-Blinded Cavo-Tricuspid Isthmus Ablation for Atrial Flutter: A Systematic Review and Meta-Analysis. Diseases 2023; 11:98. [PMID: 37489450 PMCID: PMC10366732 DOI: 10.3390/diseases11030098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/16/2023] [Accepted: 07/16/2023] [Indexed: 07/26/2023] Open
Abstract
Contact force (CF) is a novel approach developed to increase the safety and efficacy of catheter ablation. However, the value of CF-sensing technology for atrial flutter (AFL) cavo-tricuspid isthmus ablation (CTIA) is inconclusive. To generate a comprehensive assessment of optimal extant data on CF for AFL, we synthesized randomized controlled trials (RCTs) and observational studies from Web of Science, SCOPUS, EMBASE, PubMed, and Cochrane until 29 November 2022, using the odds ratio (OR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with a corresponding 95% confidence interval (CI). Two RCTs and three observational studies with a total of 376 patients were included in our analysis. CF-guided ablation was associated with (A) a higher rate of AFL recurrence (OR: 2.26 with 95% CI [1.05, 4.87]) and total CF (MD: 2.71 with 95% CI [1.28, 4.13]); (B) no effect on total procedure duration (MD: -2.88 with 95% CI [-7.48, 1.72]), fluoroscopy duration (MD: -0.96 with 95% CI [-2.24, 0.31]), and bidirectional isthmus block (BDIB) (OR: 1.50 with 95% CI [0.72, 3.11]); and (C) decreased radiofrequency (RF) duration (MD: -1.40 with 95% CI [-2.39, -0.41]). We conclude that although CF-guided CTIA was associated with increased AFL recurrence and total CF and reduced RF duration, it did not affect total procedure duration, fluoroscopy duration, or BDIB. Thus, CF-guided CTIA may not be the optimal intervention for AFL. These findings indicate the need for (A) providers to balance the benefits and risks of CF when utilizing precision medicine to develop treatment plans for individuals with AFL and (B) clinical trials investigating CF-guided catheter ablation for AFL to provide definitive evidence of optimal CF-sensing technology.
Collapse
Affiliation(s)
| | - Islam Mohamed
- Department of Internal Medicine, University of Missouri, Kansas City, MO 64108, USA
| | - Amith Reddy Seri
- Department of Internal Medicine, McLaren Health Care, Flint, MI 48532, USA
- Department of Internal Medicine, Michigan State University, East Lansing, MI 48823, USA
| | - Omar Almaadawy
- Department of Internal Medicine, MedStar Health, Baltimore Internal Medicine Residency Program, Baltimore, MD 21218, USA
| | - Basel Abdelazeem
- Department of Internal Medicine, McLaren Health Care, Flint, MI 48532, USA
- Department of Internal Medicine, Michigan State University, East Lansing, MI 48823, USA
| | - James Robert Brašić
- Section of High-Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Psychiatry, New York City Health and Hospitals/Bellevue, New York, NY 10016, USA
- Department of Psychiatry, New York University Grossman School of Medicine, New York University Langone Health, New York, NY 10016, USA
| |
Collapse
|
47
|
Yoshimoto T, Inoue M, Tanaka K, Koge J, Shiozawa M, Kamogawa N, Ishiyama H, Abe S, Imamura H, Kataoka H, Koga M, Ihara M, Toyoda K. Tmax Mismatch Ratio to Identify Intracranial Atherosclerotic Stenosis-Related Large-Vessel Occlusion Before Endovascular Therapy. J Am Heart Assoc 2023:e029899. [PMID: 37421278 PMCID: PMC10382114 DOI: 10.1161/jaha.123.029899] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/12/2023] [Indexed: 07/10/2023]
Abstract
Background We aimed to clarify which time-to-maximum of the tissue residue function (Tmax) mismatch ratio is useful in predicting anterior intracranial atherosclerotic stenosis (ICAS)-related large-vessel occlusion (LVO) before endovascular therapy. Methods and Results Patients with ischemic stroke who underwent perfusion-weighted imaging before endovascular therapy for anterior intracranial LVO were divided into those with ICAS-related LVO and those with embolic LVO. Tmax ratios of >10 s/>8 s, >10 s/>6 s, >10 s/>4 s, >8 s/>6 s, >8 s/>4 s, and >6 s/>4 s were considered Tmax mismatch ratios. Binominal logistic regression was used to identify ICAS-related LVO, and the adjusted odds ratio (aOR) and 95% CI for each Tmax mismatch ratio increase of 0.1 were calculated. A similar analysis was performed for ICAS-related LVO with and without embolic sources, using embolic LVO as the reference. Of 213 patients (90 women [42.0%]; median age, 79 years), 39 (18.3%) had ICAS-related LVO. The aOR (95% CI) per 0.1 increase in Tmax mismatch ratio in ICAS-related LVO with embolic LVO as reference was lowest with Tmax mismatch ratio >10 s/>6 s (0.56 [0.43-0.73]). Multinomial logistic regression analysis also showed the lowest aOR (95% CI) per 0.1 increase in Tmax mismatch ratio with Tmax >10 s/>6 s (ICAS-related LVO without embolic source: 0.60 [0.42-0.85]; ICAS-related LVO with embolic source: 0.55 [0.38-0.79]). Conclusions A Tmax mismatch ratio of >10 s/>6 s was the optimal predictor of ICAS-related LVO compared with other Tmax profiles, with or without an embolic source before endovascular therapy. Registration clinicaltrials.gov. Identifier NCT02251665.
Collapse
Affiliation(s)
- Takeshi Yoshimoto
- Department of Neurology National Cerebral and Cardiovascular Center Suita Japan
| | - Manabu Inoue
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Kanta Tanaka
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Junpei Koge
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Masayuki Shiozawa
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Naruhiko Kamogawa
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Hiroyuki Ishiyama
- Department of Neurology National Cerebral and Cardiovascular Center Suita Japan
| | - Soichiro Abe
- Department of Neurology National Cerebral and Cardiovascular Center Suita Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery National Cerebral and Cardiovascular Center Suita Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery National Cerebral and Cardiovascular Center Suita Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Masafumi Ihara
- Department of Neurology National Cerebral and Cardiovascular Center Suita Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| |
Collapse
|
48
|
Ge XY, Xie SH, Wang H, Ye X, Chen W, Zhou HN, Li X, Lin AH, Cao SM. Associations between serum trace elements and the risk of nasopharyngeal carcinoma: a multi-center case-control study in Guangdong Province, southern China. Front Nutr 2023; 10:1142861. [PMID: 37465140 PMCID: PMC10351973 DOI: 10.3389/fnut.2023.1142861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/05/2023] [Indexed: 07/20/2023] Open
Abstract
Background Associations between trace elements and nasopharyngeal carcinoma (NPC) have been speculated but not thoroughly examined. Methods This study registered a total of 225 newly diagnosed patients with NPC and 225 healthy controls matched by sex and age from three municipal hospitals in Guangdong Province, southern China between 2011 and 2015. Information was collected by questionnaire on the demographic characteristics and other possibly confounding lifestyle factors. Eight trace elements and the level of Epstein-Barr virus (EBV) antibody were measured in casual (spot) serum specimens by inductively coupled plasma-mass spectrometry (ICP-MS) and enzyme-linked immunosorbent assay (ELISA), respectively. Restricted cubic splines and conditional logistic regression were applied to assess the relationship between trace elements and NPC risk through single-and multiple-elements models. Results Serum levels of chromium (Cr), cobalt (Co), nickel (Ni), arsenic (As), strontium (Sr) and molybdenum (Mo) were not associated with NPC risk. Manganese (Mn) and cadmium (Cd) were positively associated with NPC risk in both single-and multiple-element models, with ORs of the highest tertile compared with the reference categories 3.90 (95% CI, 1.27 to 7.34) for Mn and 2.30 (95% CI, 1.26 to 3.38) for Cd. Restricted cubic splines showed that there was a linear increasing trend between Mn and NPC risk, while for Cd there was a J-type correlation. Conclusion Serum levels of Cd and Mn was positively related with NPC risk. Prospective researches on the associations of the two trace elements with NPC ought to be taken into account within the future.
Collapse
Affiliation(s)
- Xin-Yu Ge
- Department of Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, China
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shang-Hang Xie
- Department of Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hao Wang
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xin Ye
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wenjie Chen
- Department of Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hang-Ning Zhou
- Department of Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xueqi Li
- Department of Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, China
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ai-Hua Lin
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Su-Mei Cao
- Department of Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| |
Collapse
|
49
|
Zheutlin AR, Addo DK, Jacobs JA, Derington CG, Herrick JS, Greene T, Stulberg EL, Berlowitz DR, Williamson JD, Pajewski NM, Supiano MA, Bress AP. Evidence for Age Bias Contributing to Therapeutic Inertia in Blood Pressure Management: A Secondary Analysis of SPRINT. Hypertension 2023; 80:1484-1493. [PMID: 37165900 PMCID: PMC10438422 DOI: 10.1161/hypertensionaha.123.21323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/25/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Despite evidence supporting the cardiovascular and cognitive benefits of intensive blood pressure management, older adults have the lowest rates of blood pressure control. We determined the association between age and therapeutic inertia (TI) in SPRINT (Systolic Blood Pressure Intervention Trial), and whether frailty, cognitive function, or gait speed moderate or mediate these associations. METHODS We performed a secondary analysis of SPRINT of participant visits with blood pressure above randomized treatment goal. We categorized baseline age as <60, 60 to <70, 70 to <80, and ≥80 years and TI as no antihypertensive medication intensification per participant visit. Generalized estimating equations generated odds ratios for TI associated with age, stratified by treatment group based on nested models adjusted for baseline frailty index score (fit [frailty index, ≤0.10], less fit [0.10 RESULTS Participants 60 to <70, 70 to <80, and ≥80 years of age had a higher prevalence of TI in both treatment groups versus participants <60 years of age (standard: 59.7%, 60.5%, and 60.1% versus 56.0%; 29 527 participant visits; intensive: 55.1%, 57.2%, and 57.8% versus 53.8%; 47 129 participant visits). The adjusted odds ratios for TI comparing participants ≥80 versus <60 years of age were 1.32 (95% CI, 1.14-1.53) and 1.25 (95% CI, 1.11-1.41) in the standard and intensive treatment groups, respectively. Adjustment for frailty, cognitive function, or gait speed did not attenuate the association or demonstrate effect modification (all Pinteraction, >0.10). CONCLUSIONS Older age is associated with greater TI independent of physical or cognitive function, implying age bias in hypertension management.
Collapse
Affiliation(s)
- Alexander R Zheutlin
- Department of Internal Medicine (A.R.Z.), Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City
| | - Daniel K Addo
- Intermountain Healthcare Department of Population Health Sciences (D.K.A., J.A.J., C.G.D., J.S.H., T.G., A.P.B.), Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City
| | - Joshua A Jacobs
- Intermountain Healthcare Department of Population Health Sciences (D.K.A., J.A.J., C.G.D., J.S.H., T.G., A.P.B.), Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City
| | - Catherine G Derington
- Intermountain Healthcare Department of Population Health Sciences (D.K.A., J.A.J., C.G.D., J.S.H., T.G., A.P.B.), Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City
| | - Jennifer S Herrick
- Intermountain Healthcare Department of Population Health Sciences (D.K.A., J.A.J., C.G.D., J.S.H., T.G., A.P.B.), Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City
- Informatics, Decision-Enhancement, and Analytic Sciences Center, Veterans Affairs, Salt Lake City Health Care System, Utah (J.S.H., A.P.B.)
| | - Tom Greene
- Intermountain Healthcare Department of Population Health Sciences (D.K.A., J.A.J., C.G.D., J.S.H., T.G., A.P.B.), Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City
| | - Eric L Stulberg
- Department of Neurology (E.L.S.), Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City
| | - Dan R Berlowitz
- Department of Public Health, University of Massachusetts-Lowell (D.R.B.)
| | - Jeff D Williamson
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine (J.D.W.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Division of Public Health Sciences (N.M.P.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Mark A Supiano
- Geriatrics Division, Spencer Fox Eccles School of Medicine, University of Utah Center on Aging, Salt Lake City (M.A.S.)
| | - Adam P Bress
- Intermountain Healthcare Department of Population Health Sciences (D.K.A., J.A.J., C.G.D., J.S.H., T.G., A.P.B.), Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City
- Informatics, Decision-Enhancement, and Analytic Sciences Center, Veterans Affairs, Salt Lake City Health Care System, Utah (J.S.H., A.P.B.)
| |
Collapse
|
50
|
Ratis RC, Dacoregio MI, Simão-Silva DP, Mateus RP, Machado LP, Bonini JS, da Silva WCFN. Confirmed Synergy Between the ɛ4 Allele of Apolipoprotein E and the Variant K of Butyrylcholinesterase as a Risk Factor for Alzheimer's Disease: A Systematic Review and Meta-Analysis. J Alzheimers Dis Rep 2023; 7:613-625. [PMID: 37483326 PMCID: PMC10357125 DOI: 10.3233/adr-220084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/13/2023] [Indexed: 07/25/2023] Open
Abstract
Background Alzheimer's disease (AD) has several risk factors. APOE4 is the main one, and it has been suggested that there may be a synergy between it and BCHE-K as a risk factor. Objective To investigate the association between APOE4 and BCHE-K as a risk factor for AD. Methods We searched PubMed, Web of Science, Embase, and Scopus on August 8, 2021 for studies that analyzed the association of APOE4 and BCHE-K with AD. The random effect model was performed in meta-analysis according to age group. A chi-square was performed with the meta-analysis data to verify if the effect found is not associated only with the E4 allele. Results Twenty-one studies with 6,853 subjects (3,528 AD and 3,325 Controls) were included in the meta-analysis. The quality of the evidence is moderate. There is a positive E4-K association for subjects with AD as shown by the odds ratio of 3.43. The chi-square meta test, which measures the probability that the E4-K association is due to chance, has an odds ratio of 6.155, indicating that the E4-K association is not a random event. The odds ratio of an E4-K association in subjects with AD increases to OR 4.46 for the 65- to 75-year-old group and OR 4.15 for subjects older than 75 years. The probability that the E4-K association is due to chance is ruled out by chi-square meta test values of OR 8.638 and OR 9.558. Conclusion The synergy between APOE4 and BCHE-K is a risk factor for late-onset AD.
Collapse
Affiliation(s)
- Renan C. Ratis
- Laboratory of Neurosciences and Behavior, Department of Pharmacy, State University of the Midwest, Paraná, Brazil
| | | | - Daiane P. Simão-Silva
- Post-Graduate Program in Intellectual Property and Technology Transfer for Innovation, State University of the Midwest, Paraná, Brazil
| | - Rogério P. Mateus
- Evolutionary Biology Laboratory, Department of Biology, State University of the Midwest, Paraná, Brazil
| | - Luciana P.B. Machado
- Evolutionary Biology Laboratory, Department of Biology, State University of the Midwest, Paraná, Brazil
| | - Juliana S. Bonini
- Laboratory of Neurosciences and Behavior, Department of Pharmacy, State University of the Midwest, Paraná, Brazil
| | | |
Collapse
|