[Missing Data Replacement Methods in Different Scenarios].

OBJECTIVE: To compare the effect of different approaches of missing data replacement on the regression coefficient estimates r of "length of stay" on "hospital expenditure". METHODS: Data were extracted from the medical records of patients with head and neck neoplasms who were admitted to Sichuan Cancer Hospital. R 3.4.1 was used for generating and processing simulated datasets. Various scenarios were established by setting up different proportions of missing data and missing mechanisms using Monte Carlo method. Three strategies were tested for replacing missing data: Complete Case method,Expectation Maximization (EM),and Markov Chain Monte Carlo method (MCMC). The regression coefficient estimates r of standardized "length of stay" on standardized logarithmic "hospital expenditure" were calculated using these strategies and compared with that of the original complete dataset,in terms of their accuracy (magnitude of differences in r) and precision (differences in the standard error of r). RESULTS: The three replacement methods were all acceptable (within the limit rc±0.5 sc) when missing data were generated using MAR (2∶1) mechanism,or less than 30% data were simulated as missing using the MCAR and MAR (1∶2) mechanism. The EM method had the best estimation precision. CONCLUSION: Missing data replacement should consider the proportion of missing data and potential mechanisms involved.

Effects of a 12-hour neuromuscular electrical stimulation treatment program on the recovery of upper extremity function in sub-acute stroke patients: a randomized controlled pilot trial.

[Purpose] This study investigated the effects of a 12-hour neuromuscular electrical stimulation program in the evening hours on upper extremity function in sub-acute stroke patients. [Subjects and Methods] Forty-five subjects were randomized to one of three groups: 12-hour neuromuscular electrical stimulation group (n=15), which received 12 hours of neuromuscular electrical stimulation and conventional rehabilitation for the affected upper extremity; neuromuscular electrical stimulation group (n=15), which received 30 min of neuromuscular electrical stimulation and conventional rehabilitation; and control group (n=15), which received conventional rehabilitation only. The Fugl-Meyer assessment, Action Research Arm Test, and modified Ashworth scale were used to evaluate the effects before and after intervention, and 4 weeks later. [Results] The improvement in the distal (wrist-hand) components of the Fugl-Meyer assessment and Action Research Arm Test in the 12-hour neuromuscular electrical stimulation group was more significant than that in the neuromuscular electrical stimulation group. No significant difference was found between the two groups in the proximal component (shoulder-elbow) of the Fugl-Meyer assessment. [Conclusion] The 12-hour neuromuscular electrical stimulation group achieved better improvement in upper extremity motor function, especially in the wrist-hand function. This alternative therapeutic approach is easily applicable and can be used in stroke patients during rest or sleep.

The VDR gene FokI polymorphism and ovarian cancer risk.

The polymorphism of vitamin D receptor (VDR) gene is demonstrated to affect the activity of its encoding protein and the subsequent downstream effects mediated by vitamin D. Mutations in VDR gene FokI have been suggested in the development of various cancers. Whether the polymorphism of the VDR gene FokI confers risk to ovarian cancer still remains controversial across the published studies in different ethnicity. The aim of this meta-analysis was to determine the role of VDR gene FokI variant in the susceptibility to ovarian cancer. Six publications with 14 individual case-control studies involving a total of 10,964 subjects were finally included into our study after a comprehensive literature search of the PubMed, Embase, Web of Science, and Wanfang databases. The strength of the association between the VDR gene FokI polymorphism and ovarian cancer risk was estimated under the allelic (T vs. C), homozygous (TT vs. CC), additive (CT vs. CC), recessive (TT vs. CC + CT), and dominant (CT + TT vs. CC) gene models. The overall odds ratios (ORs) for the contrast models of T vs. C, TT vs. CC, CT vs. CC, and CT + TT vs. CC indicated that the VDR gene FokI variant was related to an increased risk of ovarian cancer (OR(T vs. C) = 1.09, 95 % confidence interval (CI) 1.03-1.15, P(OR) = 0.004; OR(TT vs. CC) = 1.17, 95 % CI 1.04-1.32, P(OR) = 0.011; OR(CT vs. CC) = 1.10, 95 % CI 1.01-1.20, P(OR) = 0.027; OR(CT + TT vs. CC) = 1.12, 95 % CI 1.03-1.21, P(OR) = 0.007). The stratified analysis among the Caucasians also identified a significant association between the VDR gene FokI polymorphism and the susceptibility to ovarian cancer. The present meta-analysis with large available published data has revealed that the VDR gene FokI polymorphism confers susceptibility to ovarian cancer, particularly among the Caucasian population.

A comparative study of diagnostic accuracy in 3026 pleural biopsies and matched pleural effusion cytology with clinical correlation: A methodological issue.

AIM: After reading the article by Ivan K. Poon et al. Certain issues regarding the methodology must be addressed. RESULT: First, it was not sufficient using only sensitivity and specificity. Second, we think the receiver operator characteristic curve (ROC) as well as the index of area under curve (AUC) could better be demonstrated in this, it was not sufficient using only sensitivity and specificity. Second, we think the receiver operator characteristic curve (ROC) as well as the index of area under curve (AUC) could better be demonstrated in this article for a more comprehensive understanding of this diagnostic test accuracy when comparing different tests. CONCLUSION: With using more comprehensive indexes including Youden's index, LR and AUC, the conclusions of Ivan K. Poon and his colleagues would be sodified.

[Warming acupuncture combined with moxibustion at Yongquan (KI 1) for knee osteoarthritis with kidney-marrow deficiency: a randomized controlled trial].

OBJECTIVE: To compare the clinical effect between warming acupuncture combined with moxibustion at Yongquan (KI 1) and simple warming acupuncture for knee osteoarthritis with kidney-marrow deficiency. METHODS: A total of 66 patients of knee osteoarthritis with kidney-marrow deficiency were randomized into an observation group and a control group, 33 cases in each one. Warming acupuncture was applied at Neixiyan (EX-LE 4), Dubi (ST 35), Zusanli (ST 36) and Xuanzhong (GB 39) on the affected side in both of the groups. In the observation group, mild moxibustion at bilateral Yongquan (KI 1) was adopted additionally. Each treatment lasted for 30 min, 3 times a week (once every other day), and the consecutive 6 weeks of treatment were required. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (such as joint pain, stiffness and physical function), the amount of joint effusion and the serum contents of interleukin-1ß(IL-1ß), tumor necrosis factor-α (TNF-α) and high-sensitivity C-reactive protein (hs-CRP) were observed before and after treatment in the two groups. RESULTS: The total effective rate in the observation group was 93.3% (28/30), which was superior to 87.1% (27/30) in the control group (P<0.05). Compared before treatment, the pain scores, stiffness scores, physical function scores, the amount of joint effusion and the contents of IL-1ß, TNF-α and hs-CRP after treatment were significantly reduced in the two groups (P<0.05), and the improvements of these indices in the observation group were superior to the control group (P<0.05). CONCLUSION: Warming acupuncture combined with moxibustion at Yongquan (KI 1) can improve joint function, reduce the amount of joint effusion and the contents of inflammatory response indices for knee osteoarthritis with kidney-marrow deficiency. The therapeutic effect of warming acupuncture combined with moxibustion at Yongquan (KI 1) is better than simple warming acupuncture.

[Acupuncture combined with cinesiotherapy cupping for knee osteoarthritis with qi stagnation and blood stasis syndrome: a randomized controlled trial].

OBJECTIVE: To compare the clinical efficacy between acupuncture combined with cinesiotherapy cupping and acupuncture combined with conventional cupping for knee osteoarthritis (KOA) with qi stagnation and blood stasis syndrome, and to seek a better solution for KOA. METHODS: A total of 78 patients of KOA with qi stagnation and blood stasis syndrome were randomly divided into an observation group and a control group, 39 cases in each group (3 cases in the observation group and 2 cases in the control group lost contact). Both groups were treated with acupuncture at Neixiyan (EX-LE 4), Dubi (ST 35), Xuehai (SP 10), Liangqiu (ST 34), Heding (EX-LE 2), Zusanli (ST 36), Yinlingquan (SP 9), Yanglingquan (GB 34) and Xuanzhong (GB 39). Based on the acupuncture treatment, the control group was treated with conventional cupping. The No. 4 cupping glass was used for Xuehai (SP 10), Liangqiu (ST 34) and Fengshi (GB 31), while the No. 3 cupping glass was used for Yinlingquan (SP 9), while the cupping with appropriate size was used for ashi points; the cupping glass was retained for 5 min. Based on the acupuncture treatment, the observation group was treated with cinesiotherapy cupping. The selection of acupoint and cupping glass was identical as the control group. The patients were instructed to perform knee flexion-extension, hip abduction-adduction, weight-bearing and other active exercise while cupping; the treatment was given once a day, 10 times as a course of treatment; totally three courses were given with an interval of 2 days between the courses. The patient's symptom scores, pain scores and knee function scores were recorded before and after treatment. The amount of joint effusion was measured by ultrasound; the level of interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) in joint effusion were measured by ELISA. RESULTS: After treatment, the total effective rate in the observation group was 94.4% (34/36), which was significantly higher than 86.5% (32/37) in the control group (P<0.05). Compared before treatment, the symptom scores, pain scores, amount of joint effusion and the levels of IL-1, IL-6, TNF-α in joint fluid in both groups all were decreased after treatment, whereas the knee function scores were increased (P<0.05). Compared with the control group, the symptom scores, pain scores, and the levels of IL-1, TNF-α and the amount of joint effusion all were significantly decreased, whereas the knee function scores were increased in the observation group (P<0.05). The level of IL-6 in joint effusion was not significantly different between the observation group and the control group (P>0.05). CONCLUSION: The acupuncture combined with cinesiotherapy cupping could alleviate pain, improve joint function and reduce joint effusion, which is superior to acupuncture combined with conventional cupping.