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1.
Nefrología (Madrid) ; 41(3): 329-336, mayo.-jun. 2021. tab
Artigo em Espanhol | IBECS | ID: ibc-196539

RESUMO

INTRODUCCIÓN: La enfermedad por coronavirus 2019 (COVID-19) es una infección viral causada por un nuevo coronavirus que está afectando a todo el mundo. Hay estudios previos de pacientes en hemodiálisis en centro, pero hay pocos datos sobre población en diálisis domiciliaria. Nuestro objetivo es estudiar la incidencia y evolución de la COVID-19 en una unidad de diálisis domiciliaria (UDD) durante el pico de la pandemia. MÉTODOS: Estudio observacional y retrospectivo que incluye todos los pacientes diagnosticados de COVID-19 de la UDD del Hospital Universitario La Paz (Madrid, España) entre el 10 de marzo y el 15 de mayo de 2020. Se recogieron los datos clínicos de la UDD (57 pacientes en diálisis peritoneal y 22 pacientes en hemodiálisis domiciliaria) y comparamos las características clínicas y la evolución de los pacientes con o sin infección por COVID-19. RESULTADOS: Doce pacientes fueron diagnosticados de COVID-19 (9 diálisis peritoneal, 3 hemodiálisis domiciliaria). No hubo diferencias estadísticamente significativas entre las características clínicas de los pacientes con COVID-19 y el resto de la unidad. La edad media fue 62 ± 18,5 años; la mayoría eran varones (75%). Todos los pacientes menos uno necesitaron hospitalización. Diez pacientes (83%) fueron dados de alta tras una media de 16,4 ± 9,7 días de hospitalización. Dos pacientes fueron diagnosticados durante su hospitalización por otro motivo y fueron los únicos que fallecieron. Los fallecidos eran de mayor edad que los supervivientes. CONCLUSIÓN: La incidencia de COVID-19 en nuestra UDD en Madrid durante el pico de la pandemia fue alto, especialmente en los pacientes en diálisis peritoneal, sin observarse un potencial beneficio para prevenir la infección en los pacientes en diálisis domiciliaria. La edad avanzada y la transmisión nosocomial fueron los principales factores relacionados con peor pronóstico


INTRODUCTION: The 2019 coronavirus (COVID-19) is a viral infection caused by a new coronavirus that is affecting the entire world. There have been studies of patients on in-center hemodialysis, but home dialysis population data are scarce. Our objective is to study the incidence and course of COVID-19 in a home dialysis unit (HDU) at the height of the pandemic. METHODS: An observational, retrospective study enrolling all patients diagnosed with COVID-19 from the HDU of Hospital Universitario La Paz (La Paz University Hospital) (Madrid, Spain) between March 10 and May 15, 2020. We collected clinical data from the HDU (57 patients on peritoneal dialysis and 22 patients on home hemodialysis) and compared the clinical characteristics and course of patients with and without COVID-19 infection. RESULTS: Twelve patients were diagnosed with COVID-19 (9 peritoneal dialysis; 3 home hemodialysis). There were no statistically significant differences in terms of clinical characteristics between patients with COVID-19 and the rest of the unit. The mean age was 62 ± 18.5 years; most were men (75%). All patients but one required hospitalization. Ten patients (83%) were discharged following a mean of 16.4 ± 9.7 days of hospitalization. Two patients were diagnosed while hospitalized for other conditions, and these were the only patients who died. Those who died were older than those who survived. CONCLUSION: The incidence of COVID-19 in our HDU in Madrid at the height of the pandemic was high, especially in patients on peritoneal dialysis. No potential benefit for preventing the infection in patients on home dialysis was observed. Advanced age and nosocomial transmission were the main factors linked to a worse prognosis


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Hemodiálise no Domicílio/estatística & dados numéricos , Estudos Retrospectivos , Pandemias , Incidência , Hospitais Universitários/estatística & dados numéricos , Estatísticas não Paramétricas , Fatores de Tempo , Diálise Peritoneal/estatística & dados numéricos , Espanha/epidemiologia
2.
Epidemiol Serv Saude ; 30(2): e2020722, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34008747

RESUMO

OBJECTIVE: To analyse how testing the population influences the health indicators used to monitor the COVID-19 pandemic in the 50 countries with the highest number of diagnosed cases. METHODS: This was an ecological study using secondary data retrieved on 8/19/2020. Cumulative incidence, mortality rate, case-fatality rate, and proportion of positive tests were calculated. The data were described and presented graphically, with their respective Spearman Correlation Coefficients. RESULTS: The testing rate varied enormously between countries. Cumulative incidence and the proportion of positive tests were correlated with the number of tests, while the mortality rate and case-fatality rate showed low correlation with this indicator. CONCLUSION: Most countries do not test enough to ensure adequate monitoring of the pandemic, and this is reflected in the quality of the indicators. Expanding the number of tests is essential, but it needs to be accompanied by other measures, such as isolation of diagnosed cases and contact tracing.


Assuntos
/estatística & dados numéricos , /epidemiologia , Indicadores Básicos de Saúde , Pandemias , /mortalidade , Saúde Global/estatística & dados numéricos , Humanos , Incidência , Quarentena , Estatísticas não Paramétricas
4.
PLoS One ; 16(4): e0250555, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33891660

RESUMO

Vaccines are effective interventions that can reduce the high burden of diseases globally. However, public vaccine hesitancy is a pressing problem for public health authorities. With the availability of COVID-19 vaccines, little information is available on the public acceptability and attitudes towards the COVID-19 vaccines in Jordan. This study aimed to investigate the acceptability of COVID-19 vaccines and its predictors in addition to the attitudes towards these vaccines among public in Jordan. An online, cross-sectional, and self-administered questionnaire was instrumentalized to survey adult participants from Jordan on the acceptability of COVID-19 vaccines. Logistic regression analysis was used to find the predictors of COVID-19 vaccines' acceptability. A total of 3,100 participants completed the survey. The public acceptability of COVID-19 vaccines was fairly low (37.4%) in Jordan. Males (OR = 2.488, 95CI% = 1.834-3.375, p < .001) and those who took the seasonal influenza vaccine (OR = 2.036, 95CI% = 1.306-3.174, p = .002) were more likely to accept COVID-19 vaccines. Similarly, participants who believed that vaccines are generally safe (OR = 9.258, 95CI% = 6.020-14.237, p < .001) and those who were willing to pay for vaccines (OR = 19.223, 95CI% = 13.665-27.042, p < .001), once available, were more likely to accept the COVID-19 vaccines. However, those above 35 years old (OR = 0.376, 95CI% = 0.233-0.607, p < .001) and employed participants (OR = 0.542, 95CI% = 0.405-0.725, p < .001) were less likely to accept the COVID-19 vaccines. Moreover, participants who believed that there was a conspiracy behind COVID-19 (OR = 0.502, 95CI% = 0.356-0.709, p < .001) and those who do not trust any source of information on COVID-19 vaccines (OR = 0.271, 95CI% = 0.183-0.400, p < .001), were less likely to have acceptance towards them. The most trusted sources of information on COVID-19 vaccines were healthcare providers. Systematic interventions are required by public health authorities to reduce the levels of vaccines' hesitancy and improve their acceptance. We believe these results and specifically the low rate of acceptability is alarming to Jordanian health authorities and should stir further studies on the root causes and the need of awareness campaigns. These interventions should take the form of reviving the trust in national health authorities and structured awareness campaigns that offer transparent information about the safety and efficacy of the vaccines and the technology that was utilized in their production.


Assuntos
Atitude , /prevenção & controle , Vacinação/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Jordânia , Masculino , Razão de Chances , Estatísticas não Paramétricas , Inquéritos e Questionários , Vacinação/estatística & dados numéricos , Recusa de Vacinação/estatística & dados numéricos , Adulto Jovem
5.
Epidemiol Infect ; 149: e102, 2021 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-33902779

RESUMO

Estimating the lengths-of-stay (LoS) of hospitalised COVID-19 patients is key for predicting the hospital beds' demand and planning mitigation strategies, as overwhelming the healthcare systems has critical consequences for disease mortality. However, accurately mapping the time-to-event of hospital outcomes, such as the LoS in the intensive care unit (ICU), requires understanding patient trajectories while adjusting for covariates and observation bias, such as incomplete data. Standard methods, such as the Kaplan-Meier estimator, require prior assumptions that are untenable given current knowledge. Using real-time surveillance data from the first weeks of the COVID-19 epidemic in Galicia (Spain), we aimed to model the time-to-event and event probabilities of patients' hospitalised, without parametric priors and adjusting for individual covariates. We applied a non-parametric mixture cure model and compared its performance in estimating hospital ward (HW)/ICU LoS to the performances of commonly used methods to estimate survival. We showed that the proposed model outperformed standard approaches, providing more accurate ICU and HW LoS estimates. Finally, we applied our model estimates to simulate COVID-19 hospital demand using a Monte Carlo algorithm. We provided evidence that adjusting for sex, generally overlooked in prediction models, together with age is key for accurately forecasting HW and ICU occupancy, as well as discharge or death outcomes.


Assuntos
/epidemiologia , Previsões/métodos , Tempo de Internação/tendências , Modelos Estatísticos , Fatores Etários , Ocupação de Leitos/estatística & dados numéricos , Ocupação de Leitos/tendências , Mortalidade Hospitalar/tendências , Hospitais , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Unidades de Terapia Intensiva/tendências , Tempo de Internação/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Alta do Paciente/tendências , Fatores Sexuais , Espanha/epidemiologia , Estatísticas não Paramétricas , Análise de Sobrevida
6.
Medicine (Baltimore) ; 100(17): e25678, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907138

RESUMO

ABSTRACT: HIV infection has become a chronic disease, with a lower mortality, but a consequent increase in age-related noninfectious comorbidities. Metabolic disorders have been linked to the effect of cART as well to the effects of immune activation and chronic inflammation. Whereas it is known that aging is intrinsically associated with hyperinflammation and immune system deterioration, the relative impact of chronic HIV infection on such inflammatory and immune activation has not yet been studied focusing on an elderly HIV-infected population.The objectives of the study were to assess 29 blood markers of immune activation and inflammation using an ultrasensitive technique, in HIV-infected patients aged ≥75 years with no or 1 comorbidity (among hypertension, renal disease, neoplasia, diabetes mellitus, cardiovascular disease, stroke, dyslipidemia, and osteoporosis), in comparison with age-adjusted HIV-uninfected individuals to identify whether biomarkers were associated with comorbidities. Wilcoxon nonparametric tests were used to compare the levels of each marker between control and HIV groups; logistic regression to identify biomarkers associated to comorbidity in the HIV group and principal component analysis (PCA) to determine clusters associated with a group or a specific comorbidity.A total of 111 HIV-infected subjects were included from the Dat'AIDS cohort and compared to 63 HIV-uninfected controls. In the HIV-infected group, 4 biomarkers were associated with the risk of developing a comorbidity: monocyte chemoattractant protein-1 (MCP-1), neurofilament light chain (NF-L), neopterin, and soluble CD14. Six biomarkers (interleukin [IL]-1B, IL-7, IL-18, neopterin, sCD14, and fatty acid-binding protein) were significantly higher in the HIV-infected group compared to the control group, 11 biomarkers (myeloperoxydase, interleukin-1 receptor antagonist, tumor necrosis factor receptor 1, interferon-gamma, MCP-1, tumor necrosis factor receptor 2, IL-22, ultra sensitivity C-reactive protein, fibrinogen, IL-6, and NF-L) were lower. Despite those differences, PCA to determine clusters associated with a group or a specific comorbidity did not reveal clustering nor between healthy control and HIV-infected patients neither between the presence of comorbidity within HIV-infected group.In this highly selected geriatric HIV population, HIV infection does not seem to have an additional impact on age-related inflammation and immune disorder. Close monitoring could have led to optimize prevention and treatment of comorbidities, and have limited both immune activation and inflammation in the aging HIV population.


Assuntos
Envelhecimento/imunologia , Infecções por HIV/sangue , Infecções por HIV/imunologia , HIV/imunologia , Mediadores da Inflamação/imunologia , Idoso , Envelhecimento/sangue , Biomarcadores/sangue , Doença Crônica , Estudos de Coortes , Comorbidade , Feminino , França , Avaliação Geriátrica , Humanos , Imunidade Ativa , Inflamação , Mediadores da Inflamação/sangue , Modelos Logísticos , Masculino , Análise de Componente Principal , Estatísticas não Paramétricas
7.
Nutrients ; 13(5)2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33922507

RESUMO

The sensitivity of fingertip whole blood to reflect habitual dietary and dose-dependent supplemental omega-3 long-chain polyunsaturated fatty acid (n-3 LCPUFA) intake in premenopausal women was compared to that of venous erythrocytes and plasma fatty acids. Samples were obtained from women in a randomised, double-blind, placebo-controlled trial in which premenopausal women (n = 53) were supplemented with DHA-rich tuna oil capsules and/or placebo (Sunola oil) capsules (6 capsules per day) for 8 weeks to achieve doses of either 0, 0.35, 0.7 or 1.05 g/day n-3 LCPUFA. All blood biomarkers were very similar in their ability to reflect dietary n-3 LCPUFA intake (r = 0.38-0.46 for EPA and DHA intake), and in their dose-dependent increases in n-3 LCPUFA levels after supplementation (R2 = 0.41-0.51 for dose effect on biomarker EPA and DHA levels (mol %)). Fingertip whole blood is an effective alternative to erythrocytes and plasma as a biomarker n-3 LCPUFA intake in premenopausal women.


Assuntos
Suplementos Nutricionais , Eritrócitos/metabolismo , Ácidos Graxos Ômega-3/sangue , Dedos/fisiologia , Biomarcadores/sangue , Feminino , Óleos de Peixe/química , Humanos , Estatísticas não Paramétricas
8.
Nutrients ; 13(4)2021 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-33923923

RESUMO

Although lifestyle-based interventions are the most effective to prevent metabolic syndrome (MetS), there is no definitive agreement on which nutritional approach is the best. The aim of the present retrospective analysis was to identify a multivariate model linking energy and macronutrient intake to the clinical features of MetS. Volunteers at risk of MetS (F = 77, M = 80) were recruited in four European centres and finally eligible for analysis. For each subject, the daily energy and nutrient intake was estimated using the EPIC questionnaire and a 24-h dietary recall, and it was compared with the dietary reference values. Then we built a predictive model for a set of clinical outcomes computing shifts from recommended intake thresholds. The use of the ridge regression, which optimises prediction performances while retaining information about the role of all the nutritional variables, allowed us to assess if a clinical outcome was manly dependent on a single nutritional variable, or if its prediction was characterised by more complex interactions between the variables. The model appeared suitable for shedding light on the complexity of nutritional variables, which effects could be not evident with univariate analysis and must be considered in the framework of the reciprocal influence of the other variables.


Assuntos
Ingestão de Energia , Síndrome Metabólica/epidemiologia , Modelos Biológicos , Nutrientes/metabolismo , Voluntários , Feminino , Humanos , Masculino , Fatores de Risco , Estatísticas não Paramétricas , Resultado do Tratamento
9.
Nutrients ; 13(5)2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33919427

RESUMO

Excessive sucrose consumption is associated with numerous health problems, including dental caries, and is considered to play a critical role in shaping the human microbiota. Here, we aimed to confirm the association between sucrose exposure and oral microbiota profile, develop a short food-based index capturing variation among sucrose consumers and validate it against oral microbiota and dental caries in a derivation cohort with 16- to 79-year-old participants (n = 427). Intake and food preferences were recorded by questionnaires and saliva microbiota by 16S rDNA sequencing. Taxonomic similarities clustered participants into five clusters, where one stood out with highest sucrose intake and predicted sugar related metabolic pathways but lowest species diversity in the microbiota. Multivariate modelling of food intake and preferences revealed foods suitable for a sucrose index. This, similarly to sucrose intake, was related to bacterial pattern and caries status. The validity of the sucrose index was replicated in the population-based Gene-Lifestyle Interactions in Dental Endpoints (GLIDE, n = 105,520 Swedish adults) cohort. This suggested that the index captured clinically relevant variation in sucrose intake and that FFQ derived information may be suitable for screening of sucrose intake in the clinic and epidemiological studies, although adjustments to local consumption habits are needed.


Assuntos
Sacarose na Dieta/farmacologia , Microbiota , Boca/microbiologia , Adolescente , Adulto , Idoso , Bactérias/genética , Estudos de Coortes , Cárie Dentária/microbiologia , Feminino , Humanos , Análise dos Mínimos Quadrados , Masculino , Microbiota/efeitos dos fármacos , Pessoa de Meia-Idade , Análise de Componente Principal , RNA Ribossômico 16S/genética , Estatísticas não Paramétricas , Adulto Jovem
10.
Nutrients ; 13(4)2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33918879

RESUMO

Dietary factors play a major role in the development of non-communicable diseases, however little is known regarding the impact of nutrition on rare diseases like sarcomas. This Rizzoli Orthopedic Institute study aimed to evaluate the relative validity of a Food Frequency Questionnaire (FFQ) to measure the consumption of foods in comparison with a 3-days diary diet in a healthy Italian student population aged between 12 and 17 years. An extended version (including food groups for children) of the semi-quantitative FFQ used in the European Prospective Investigation into Cancer and Nutrition (EPIC) was administered. The validity of the FFQ was assessed by comparing the intakes from the FFQ against the 3-day diary method. 254 Italian subjects were included in the analyses: 128 females; 126 males; 116 from High Secondary School (14-17 years); 138 from Low Secondary School (12-13 years). Mean and median intakes are overall higher in the FFQs than in the food diaries. Spearman correlations adjusted for within-person variability were highest for legumes, vegetables and coffee/tea (>0.5), followed by potatoes, meat, fruits, breakfast cereals, biscuits and candies, and milk/yoghurts (>0.4). Moderate correlations were found for alcoholic drinks, soft drinks, juices, and grains (>0.3). For some food groups, such as fish, potatoes, and bread, correlations tend to become higher when stratifying the analyses for age group. These results demonstrate that the adapted EPIC COS FFQ validated in Italian adults is also appropriate and well understood by Italian children and adolescents.


Assuntos
Dieta , Comportamento Alimentar , Inquéritos e Questionários , Adolescente , Criança , Humanos , Itália , Reprodutibilidade dos Testes , Estatísticas não Paramétricas
11.
Medicine (Baltimore) ; 100(16): e25550, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879705

RESUMO

ABSTRACT: Stroke is the major leading cause of death and severe long-term disability worldwide. The consequences of stroke, aside from diminished survival, have a significant impact on an individual's capability in maintaining self-autonomy and life satisfaction (LS). Thus, this study aimed to assess LS and other specific domains of LS in stroke survivors following their first-ever stroke, and to describe the relationship using socio-demographic and stroke-related variables.This study recruited 376 stroke survivors (244 men and 132 women, mean age: 57 years) 1 year following stroke. Data on participants' LS (measured using the Life Satisfaction Questionnaire [LiSat-11]), socio-demographics, and stroke-related variables were collected.Univariate analysis showed that LS and the 10 specific domains were not associated with the patients' gender or stroke type; however, age at onset, marital status, and vocational situation were significantly associated with some domains in LiSat-11 (Spearman's rho = 0.42-0.87; all P < 0.05). Logistic regression revealed that verbal and cognitive dysfunction were the most negative predictors of LS (odds ratio 4.1 and 3.7, respectively).LS is negatively affected in stroke survivors 1 year post onset. The results indicate that recovering social engagement is a positive predictor of higher LS in stroke survivors. More importantly, the findings revealed that cognitive and verbal dysfunctions were the most prominent negative predictors of the overall gross level of LS. Multidisciplinary rehabilitation for stroke survivors is therefore critical.


Assuntos
Satisfação Pessoal , Qualidade de Vida/psicologia , Acidente Vascular Cerebral/psicologia , Sobreviventes/psicologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Autonomia Pessoal , Participação Social , Estatísticas não Paramétricas , Reabilitação do Acidente Vascular Cerebral , Inquéritos e Questionários
12.
Medicine (Baltimore) ; 100(16): e25627, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879737

RESUMO

ABSTRACT: The aim of the current study was to explore the value of tumor attenuation and quantitative analysis of perfusion parameters obtained from traditional tri-phasic CT scans in grading hepatocellular carcinoma (HCC).Totally 39 patients (42 lesion samples) with pathologically confirmed HCC who underwent tri-phasic CT scans were enrolled. HCC lesions were divided into non-poorly differentiated HCC (NP-HCC; n = 31) and poorly differentiated HCC (pHCC; n = 11). All lesions were divided into 5 groups according to the attenuation on different CT enhancement phase. The values of tumor attenuation on different scanning phases were measured. The following parameters were calculated: arterial enhancement fraction (AEF), portal venous supply coefficient (PVC), and hepatic arterial supply coefficient (HAC). The relationship of perfusion parameters with the histological grade of HCC was analyzed. Receiver operating characteristic curves were generated.No significant correlation was observed between the perfusion parameters and tumor grading. Only HAC showed a non-significant trend in different grades of HCC (pHCC < NP-HCC; P = .07). The pHCC cases had significantly decreased values of tumor attenuation on the unenhanced phase (TAu), tumor attenuation on the portal phase portal phase (TAp), and equilibrium phase (TAe) (P < .01). The difference of tumor attenuation between the portal phase and the unenhanced phase (TAp-TAu) of the pHCC cases was decreased than that of the NP-HCC cases (P < .01), whereas the difference of attenuation between the equilibrium phase and portal phase (TAe-TAp) was significantly higher in the pHCC cases than that in the NP-HCC cases (P < .01). TAe-TAp had the highest area under the curve. The number of tumor enhancement pattern in Group 5 of HCCs with a diameter of 3 cm or more was significantly more than that of HCCs with a diameter of less than 3 cm or with other different enhancement patterns (P < .01).Histological HCC grading cannot be predicted by the perfusion parameters derived from traditional tri-phasic CT scans, whereas the tumor attenuation on different phases and the tumor attenuation differences among different phases, especially the mean value of TAe-TAp, might be useful for non-invasive prediction on the degree of HCC differentiation.


Assuntos
Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/diagnóstico por imagem , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/diagnóstico por imagem , Gradação de Tumores/métodos , Imagem de Perfusão/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/patologia , Feminino , Artéria Hepática/patologia , Humanos , Fígado/irrigação sanguínea , Fígado/patologia , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Perfusão , Veia Porta/patologia , Valor Preditivo dos Testes , Curva ROC , Estatísticas não Paramétricas
13.
BMC Bioinformatics ; 22(1): 126, 2021 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-33731016

RESUMO

BACKGROUND: Identification of features is a critical task in microbiome studies that is complicated by the fact that microbial data are high dimensional and heterogeneous. Masked by the complexity of the data, the problem of separating signals (differential features between groups) from noise (features that are not differential between groups) becomes challenging and troublesome. For instance, when performing differential abundance tests, multiple testing adjustments tend to be overconservative, as the probability of a type I error (false positive) increases dramatically with the large numbers of hypotheses. Moreover, the grouping effect of interest can be obscured by heterogeneity. These factors can incorrectly lead to the conclusion that there are no differences in the microbiome compositions. RESULTS: We translate and represent the problem of identifying differential features, which are differential in two-group comparisons (e.g., treatment versus control), as a dynamic layout of separating the signal from its random background. More specifically, we progressively permute the grouping factor labels of the microbiome samples and perform multiple differential abundance tests in each scenario. We then compare the signal strength of the most differential features from the original data with their performance in permutations, and will observe a visually apparent decreasing trend if these features are true positives identified from the data. Simulations and applications on real data show that the proposed method creates a U-curve when plotting the number of significant features versus the proportion of mixing. The shape of the U-Curve can convey the strength of the overall association between the microbiome and the grouping factor. We also define a fragility index to measure the robustness of the discoveries. Finally, we recommend the identified features by comparing p-values in the observed data with p-values in the fully mixed data. CONCLUSIONS: We have developed this into a user-friendly and efficient R-shiny tool with visualizations. By default, we use the Wilcoxon rank sum test to compute the p-values, since it is a robust nonparametric test. Our proposed method can also utilize p-values obtained from other testing methods, such as DESeq. This demonstrates the potential of the progressive permutation method to be extended to new settings.


Assuntos
Microbiota , Estatísticas não Paramétricas , Probabilidade
14.
Medicine (Baltimore) ; 100(12): e25032, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761660

RESUMO

OBJECTIVE: The study explored the therapeutic value of standard trauma craniectomy (STC) for the treatment of traumatic multiple intracranial hematoma. METHODS: Clinical data of traumatic multiple intracranial hematoma patients who underwent surgical treatment in 2014 and 2015 were collected. The STC group and a control group according to the surgical mode, 48 and 30 cases were randomly selected from each group, respectively. Statistical analysis was performed on the change in the Glasgow coma scale (GCS) score from before the operation to 1 day, 1 week and 1 month postoperatively through repeated analysis of variance and Wilcoxon rank-sum analysis. RESULTS: Significant differences in the GCS were observed at different time points for the two operative modes (P < .01), and an interaction was observed between time and treatment groups (P < .05). The rates of change of the GCS score for the two surgical modes were most obviously different at 3 days and 1 week postoperatively (P ≤ .001, P < .01). No statistically significant differences were observed in the rates of change of the GCS at 1 month postoperatively (P > .05). CONCLUSIONS: Compared to conventional craniotomy, STC has obvious effects on the recovery after disturbance of consciousness at 1 week postoperatively but does not result in a significant improvement in recovery at 1 month postoperatively.


Assuntos
Craniectomia Descompressiva , Hemorragia Intracraniana Traumática/complicações , Hemorragia Intracraniana Traumática/cirurgia , Inconsciência/terapia , Adulto , Análise de Variância , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estatísticas não Paramétricas , Resultado do Tratamento , Inconsciência/etiologia
15.
Eur J Radiol ; 138: 109660, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33756189

RESUMO

PURPOSE: To investigate and histopathologically validate the role of model selection in the design of novel parametric meta-maps towards the discrimination of low from high-grade soft tissue sarcomas (STSs) using multiple Diffusion Weighted Imaging (DWI) models. METHODS: DWI data of 28 patients were quantified using the mono-exponential, bi-exponential, stretched-exponential and the diffusion kurtosis model. Akaike Weights (AW) were calculated from the corrected Akaike Information Criteria (AICc) to select the most suitable model for every pixel within the tumor volume. Pseudo-colorized classification maps were then generated to depict model suitability, hypothesizing that every single model underpins different tissue properties and cannot solely characterize the whole tumor. Single model parametric maps were turned into meta-maps using the classification map and a histological validation of the model suitability results was conducted on several subregions of different tumors. Several histogram metrics were calculated from all derived maps before and after model selection, statistical analysis was conducted using the Mann-Whitney U test, p-values were adjusted for multiple comparisons and performance of all statistically significant metrics was evaluated using the Receiver Operator Characteristic (ROC) analysis. RESULTS: The histologic analysis on several tumor subregions confirmed model suitability results on these areas. Only 3 histogram metrics, all derived from the meta-maps, were found to be statistically significant in differentiating low from high-grade STSs with an AUC higher than 89 %. CONCLUSION: Embedding model selection in the design of the diffusion parametric maps yields to histogram metrics of high discriminatory power in grading STSs.


Assuntos
Imagem de Difusão por Ressonância Magnética , Sarcoma , Humanos , Gradação de Tumores , Curva ROC , Estudos Retrospectivos , Sarcoma/diagnóstico por imagem , Estatísticas não Paramétricas , Carga Tumoral
16.
Medicine (Baltimore) ; 100(11): e24833, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725953

RESUMO

ABSTRACT: To assess the prevalence and factors associated with mild cognitive impairment (MCI) in patients suffering from psoriatic arthritis (PsA).A cross-sectional evaluation was conducted in consecutive PsA patients. Sociodemographic data and the clinimetric variables related to PsA and psoriasis were collected for each patient. MCI was assessed through the Montreal Cognitive Assessment (MoCA). The cognitive performance of PsA patients was compared to healthy subjects using one-way analysis of variance (ANOVA). The correlations among variables were studied by the Spearman rank correlation coefficient. A multivariate logistic regression analysis was carried out to establish the predictors of MCI.The study involved 96 PsA patients and 48 healthy subjects. MCI (defined as a MoCA score < 26/30) was detected in 47 (48.9%) PsA patients. Compared to healthy subjects, the MoCA score resulted significantly lower in PsA patients (P = .015). The main differences involved the denomination and language domains. MoCA was negatively correlated with age (r = -0.354; P < .0001), HAQ-DI (r = -0.227; P = .026), and fatigue (r = -0.222; P = .029), and positively correlated with psoriasis duration (r = 0.316; P = .001) and DLQI (r = 0.226; P = .008).The multivariate logistic regression analysis revealed the duration of psoriasis (P = .0005), age (P = .0038), PASI (P = .0050), and HAQ-DI (P = .0193) as predictors of the MoCA score.MCI is present in a significant proportion of PsA patients, and is mainly determined by age, cutaneous variables, and disability.


Assuntos
Artrite Psoriásica/psicologia , Disfunção Cognitiva/epidemiologia , Índice de Gravidade de Doença , Adulto , Fatores Etários , Análise de Variância , Disfunção Cognitiva/etiologia , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Prevalência , Qualidade de Vida , Fatores de Risco , Estatísticas não Paramétricas
17.
Medicine (Baltimore) ; 100(11): e25186, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33726008

RESUMO

ABSTRACT: The objective of this study was to ascertain changes in symptoms of patients with borderline personality disorder undergoing psychodynamic day treatment with a duration of 9 months and the factors that predict clinical outcome or dropouts from the program.In an observational study, demographic characteristics (age, number of psychiatric hospitalizations, number of suicide attempts, current involvement in work or study activities), day doses of antipsychotic and antidepressant medication, psychiatric symptoms, and social functioning (Health of the Nation Outcome Scales), and symptoms of dissociation (Dissociative Experiences Scale) were assessed in patients at the beginning of treatment (N = 105). Further, psychiatric symptoms and social functioning were assessed at 3 stages: beginning of the program, end of the program, and 1-year follow-up. To study the differences between baseline values and values at the end of the treatment and follow-up values, the Wilcoxon signed-rank test was used. To discover baseline factors related to the effect of the treatment, Spearman correlation coefficients were calculated. To evaluate the differences between patients who completed the program (N = 67) and patients who dropped out (N = 38), differences in baseline factors between both groups were compared, using the Mann-Whitney test for independent samples.Improvement in symptoms (Health of the Nation Outcome Scales - version for external evaluators) at the end of the therapy (N = 67, P < .001) and at the 1-year follow-up (N = 46, P < .001) was found. Experience of an intimate relationship was positively related to clinical improvement at follow-up examinations (P < .001). Predictors of dropout included a higher number of psychiatric hospitalizations (P = .004), suicide attempts (P = .004), more severe pretreatment symptoms (P = .002), and symptoms of dissociation (P = .046).The results indicate that a psychodynamic day treatment is feasible for the treatment of less clinically disturbed patients with a history of intimate relationships. Patients with a higher number of previous psychiatric hospitalizations, more suicide attempts in the past, more severe pretreatment symptoms, and symptoms of dissociation are more likely not to complete the program.


Assuntos
Transtorno da Personalidade Borderline/terapia , Hospital Dia/métodos , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Psicoterapia Psicodinâmica/métodos , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Análise de Regressão , Fatores de Risco , Estatísticas não Paramétricas , Tentativa de Suicídio/estatística & dados numéricos , Resultado do Tratamento
18.
J Math Biol ; 82(5): 37, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33721104

RESUMO

In the spreading of infectious diseases, an important number to determine is how many other people will be infected on average by anyone who has become infected themselves. This is known as the reproduction number. This paper describes a non-parametric inverse method for extracting the full transfer function of infection, of which the reproduction number is the integral. The method is demonstrated by applying it to the timeline of hospitalisation admissions for covid-19 in the Netherlands up to May 20 2020, which is publicly available from the site of the Dutch National Institute of Public Health and the Environment (rivm.nl).


Assuntos
Número Básico de Reprodução/estatística & dados numéricos , /transmissão , Modelos Estatísticos , Pandemias , Simulação por Computador , Análise de Fourier , Humanos , Conceitos Matemáticos , Modelos Biológicos , Países Baixos/epidemiologia , Pandemias/estatística & dados numéricos , Estatísticas não Paramétricas
19.
Nutrients ; 13(3)2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33652968

RESUMO

This study aims to estimate the free sugars intake, identify the primary food sources of free sugars, and explore the relationship between free sugars intake and dental caries among Chinese adolescents. This cross-sectional study included 1517 middle-school students aged 12-14 years in Changsha city, China. Adolescents completed a 12-item Food Frequency Questionnaire (FFQ) and oral health assessment. The students' dental caries experience was available as DMFT score (number of decayed, missing, and filled permanent teeth). Statistical analyses included the Mann-Whitney test, Kruskal-Wallis test, Chi-square test, and binary logistic regression model. The average intake of free sugars was 53.1 g/d in adolescents, and 43.2% of the students consumed more than 50 g of free sugars daily. The primary contributor to free sugars was sugar-sweetened beverages (SSBs). Age, boarders, and high family income were risk factors for excessive free sugars intake (p < 0.05), and increased free sugars intake was a risk factor for dental caries (odds ratio, OR = 1.446, 95% confidence interval: 1.138-1.839). Both the free sugars intake and dental caries prevalence in Chinese adolescents were high. Targeted interventions are urgently needed to address the excessive consumption of free sugars and improve Chinese adolescents' oral health.


Assuntos
Saúde do Adolescente/estatística & dados numéricos , Cárie Dentária/epidemiologia , Dieta/estatística & dados numéricos , Açúcares da Dieta/análise , Saúde Bucal/estatística & dados numéricos , Adolescente , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Distribuição de Qui-Quadrado , Criança , China/epidemiologia , Estudos Transversais , Cárie Dentária/etiologia , Testes de Atividade de Cárie Dentária , Diagnóstico Bucal , Dieta/efeitos adversos , Inquéritos sobre Dietas , Açúcares da Dieta/efeitos adversos , Feminino , Humanos , Modelos Logísticos , Masculino , Razão de Chances , Prevalência , Fatores de Risco , Estatísticas não Paramétricas , Estudantes/estatística & dados numéricos , Bebidas Adoçadas com Açúcar/efeitos adversos , Bebidas Adoçadas com Açúcar/estatística & dados numéricos
20.
Br J Radiol ; 94(1121): 20210005, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33684304

RESUMO

OBJECTIVES: To explore the potential value of multiparametric magnetic resonance imaging (mpMRI) texture analysis (TA) to predict new Gleason Grade Group (GGG). METHODS: Fifty-eight lesions of fifty patients who underwent mpMRI scanning, including T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) prior to trans-rectal ultrasound (TRUS)-guided core prostate biopsy, were retrospectively enrolled. TA parameters were obtained by the postprocessing software, and each lesion was assigned to its corresponding GGG. TA parameters derived from T2WI and DWI were statistically analyzed in detail. RESULTS: Energy, inertia, and correlation derived from apparent diffusion coefficient (ADC) maps and T2WI had a statistically significant difference among the five groups. Kurtosis, energy, inertia, correlation on ADC maps and Energy, inertia on T2WI were moderately related to the GGG trend. ADC-energy and T2-energy were significant independent predictors of the GGG trend. ADC-energy, T2WI-energy, and T2WI-correlation had a statistically significant difference between GGG1 and GGG2-5. ADC-energy were significant independent predictors of the GGG1. ADC-energy, T2WI-energy, and T2WI-correlation showed satisfactory diagnostic efficiency of GGG1 (area under the curve (AUC) 84.6, 74.3, and 83.5%, respectively), and ADC-energy showed excellent sensitivity and specificity (88.9 and 95.1%, respectively). CONCLUSION: TA parameters ADC-energy and T2-energy played an important role in predicting GGG trend. Both ADC-energy and T2-correlation produced a high diagnostic power of GGG1, and ADC-energy was perfect predictors of GGG1. ADVANCES IN KNOWLEDGE: TA parameters were innovatively used to predict new GGG trend, and the predictive factors of GGG1 were screen out.


Assuntos
Imageamento por Ressonância Magnética/métodos , Gradação de Tumores/métodos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Biópsia , Imagem de Difusão por Ressonância Magnética/métodos , Humanos , Masculino , Próstata/patologia , Curva ROC , Estudos Retrospectivos , Software , Estatísticas não Paramétricas , Ultrassonografia de Intervenção/métodos
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