Category: Statistics

Health Inf Manag. 2024 Nov 23:18333583241295717. doi: 10.1177/18333583241295717. Online ahead of print.

ABSTRACT

BACKGROUND: The transition of systems to the International Statistical Classification of Diseases 11th Version (ICD-11) allows access to comprehensive data that accurately portray the complexity of morbidity and mortality data in Malaysia.

OBJECTIVE: To demonstrate Malaysia’s experience in implementing ICD-11, from data collection to downstream data use applications.

METHOD AND IMPLEMENTATION: We describe improvements to existing data source systems and downstream data applications. For non-HIS and HIS (ICD-10) systems, data were manually entered into the health management information system equipped with ICD-11 or automatically mapped from ICD-10 to ICD-11. Following these system improvements, we collected and reported ICD-11 data from all hospitals nationwide, regardless of the individual systems’ status in ICD-11 use.

DISCUSSION: Lessons learnt related to legacy systems; ICD-11 releases and system updates; mapping; reporting; human resources and related applications.

CONCLUSION: With careful planning, standardisation of the collection and use of ICD-11 data can be accomplished with limited resources and in a complex environment with heterogeneous systems.

IMPLICATIONS: Use of ICD-11 data in downstream data applications improves data quality to answer specific business or research questions.

PMID:39578964 | DOI:10.1177/18333583241295717

J Cachexia Sarcopenia Muscle. 2024 Nov 23. doi: 10.1002/jcsm.13643. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with borderline resectable (BR) or locally advanced pancreatic cancer (LAPC) require complex management strategies. This study evaluated the prognostic significance of the perichemotherapy skeletal muscle index (SMI) and carbohydrate antigen 19-9 (CA 19-9) in patients with BRPC or LAPC treated with FOLFIRINOX.

METHODS: We retrospectively evaluated 227 patients with BR or LAPC who received at least four cycles of chemotherapy between 2015 and 2020. We analysed chemotherapy response, changes in SMI (ΔSMI, %) on computed tomography (CT) and CA19-9 to determine their impact on progression-free survival (PFS) and overall survival (OS). After the early application of loco-regional treatments (LRT) within 3 months after completing four cycles of chemotherapy, the outcomes were compared between ΔSMI and CA19-9 subgroups.

RESULTS: Among 227 patients (median age, 60 years; 124 [54.6%] male) with 97 BR and 130 LAPC, 50.7% showed partial response (PR) to chemotherapy, 44.5% showed stable disease and 4.8% showed progressive disease (PD). Post-chemotherapy CA19-9 levels were normalized in 41.0% of patients. The high and low ΔSMI groups (based on the gender-specific cut-off of -8.6% for males and -2.9% for females) comprised 114 (50.2%) and 113 (49.8%) patients, respectively. The high ΔSMI group had poorer survival rates than the low ΔSMI group in both PFS (HR = 1.32, p = 0.05) and OS (HR = 1.74, p = 0.001). Multivariable analysis showed that ΔSMI (high vs. low; PFS, HR = 1.39, p = 0.03; OS, HR = 1.82, p < 0.001) and post-chemotherapy response (PD vs. PR/SD; PFS, HR = 18.69, p < 0.001; OS, HR = 6.19, p < 0.001) were independently associated with both PFS and OS. Additionally, the post-chemotherapy CA19-9 (≥ 37 vs. < 37; HR = 1.48, p = 0.01) was an independent predictor for PFS. Early application of LRT after chemotherapy significantly improved PFS and OS in both ΔSMI groups (all p < 0.05). However, it was not beneficial in the group with high ΔSMI and post-chemotherapy CA19-9 ≥ 37 (PFS, p = 0.39 and OS, p = 0.33).

CONCLUSIONS: Progressive sarcopenic deterioration after four cycles of chemotherapy was associated with poor survival outcomes in patients with BR or LAPC after FOLFIRINOX. We also investigated the optimal clinical setting for the early application LRTs using the ΔSMI and post-chemotherapy CA 19-9.

PMID:39578950 | DOI:10.1002/jcsm.13643

Iran J Immunol. 2024 Nov 23;21(4). doi: 10.22034/iji.2024.103549.2846. Online ahead of print.

ABSTRACT

BACKGROUND: Gamma-delta (γδ) T cells are a distinct subset of T cells with a receptor composed of γ and δ chains. Their ability to directly recognize stress-induced molecules and non-peptide antigens expressed by cancer cells, along with their capacity to produce cytokines and interact with other immune cells, makes them potentially significant contributors to immune-based treatments.

OBJECTIVE: To investigate the presence and frequency of Tγδ cells in tumor-draining lymph nodes of patients with bladder cancer (BC), and to assess their association with prognostic parameters.

METHODS: Forty-nine fresh tumor-draining lymph nodes from untreated patients with BC were minced to obtain single cells. The cells were surface-stained with anti-CD3, anti-TCRγδ, and anti-HLA-DR antibodies, then acquired on a four-color FACSCalibur flow cytometer, and analyzed by FlowJo software.

RESULTS: On average, 2.07% ± 1.99% of CD3+ lymphocytes in regional nodes of BC exhibited a γδ T phenotype. A considerable percentage of these cells (37.90% ± 24.42%) expressed HLA-DR. Statistical analysis revealed that while the frequency of γδ T cells showed no variation among patients with different prognoses, the HLA-DR+ subset was higher in T4 patients than in T2 patients (p=0.031). These cells also tended to be increased in stage III compared to stage II (p=0.077).

CONCLUSION: The data collectively indicated an association of HLA-DR expressing γδ T cells with prognostic factors related to tumor progression (higher T-group and stage), suggesting their potential involvement in disease progression. However, future research, including longitudinal studies with larger cohorts, needs to validate these findings and elucidate the functional roles of γδ T cells in the immune response against BC.

PMID:39578946 | DOI:10.22034/iji.2024.103549.2846

Clin Oral Implants Res. 2024 Nov 23. doi: 10.1111/clr.14384. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare the accuracy of CAD-CAM and conventional guides in the static computer-assisted implant surgery (sCAIS) placement of distal free-end implants.

MATERIAL AND METHODS: A prospective, controlled, and blinded quasi-experimental study was done involving 27 patients (76 implants) distributed into two groups according to the surgical guide manufacturing approach used: conventional (control group [CG]) or CAD-CAM (test group [TG]). The implants were planned in the software and the surgical guides were manufactured. Fully guided implant placement was carried out and the deviations were measured along with secondary variables as potential confounding factors. Descriptive analyses were performed on mean, standard deviation (SD), and interquartile range (IQR). In the comparative/inferential analysis hypothesis, contrasts were made of the quantitative and qualitative variables and multiple linear models were generated to adjust for the different confounding variables recorded.

RESULTS: Coronal horizontal deviation (CHD) was significantly greater in CG (1.52 mm) versus TG (1.04 mm) (p = 0.004). Apical horizontal deviation (AHD) in turn was 1.67 versus 1.46 mm, respectively; angular deviation was 2.87 versus 3.64; and vertical deviation was -0.1 versus -0.05 mm, with no significant differences between the groups (p > 0.05). A greater sleeve height, positioning in premolars versus molars, and the use of shorter implants, were associated with greater accuracy in relation to CHD and/or AHD (p < 0.05). The implant success rate at 1 year was 92.1%, 90.7% in TG, and 100% in CG, being statistically significant (p = 0.026) at the implant level, but not significant at the patient level.

CONCLUSIONS: The CAD-CAM surgical guides proved to be more accurate than the conventional guides in the sCAIS placement of distal free-end implants, with statistically significant differences being observed in terms of CHD. All implant failures occurred in TG (6 implants/3 patients).

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT06404385.

PMID:39578942 | DOI:10.1111/clr.14384

Int J Retina Vitreous. 2024 Nov 22;10(1):90. doi: 10.1186/s40942-024-00610-z.

ABSTRACT

BACKGROUND: The purpose of this study is to evaluate the retinal and choroidal microvascular state in children with congenital isolated growth hormone deficiency (IGHD) and determine the effect of recombinant human growth hormone treatment on these structures compared with healthy controls.

METHODS: The study included children with IGHD under recombinant human GH treatment as group one and another group of healthy controls. Both groups were examined using optical coherence tomography angiography (OCTA). Data concerning superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris (CC), and retinal thickness were recorded.

RESULTS: The study included two equal groups of 30 individuals. Both groups had no statistically significant differences in age, gender, weight, or spherical equivalent. However, subjects of group II were taller than those of group I (p = 0.011). OCTA images of the SCP, DCP, and CC vessel density revealed statistically non-significant differences between the two groups.

CONCLUSION: Children receiving recombinant growth hormone therapy showed no changes in the retinal and choroidal microvasculature or macular thickness.

TRIAL REGISTRATION NUMBER: 1094/03/2024 by Minia University Faculty of Medicine Institutional Review Board. Another registration number is UMIN000055654.

PMID:39578934 | DOI:10.1186/s40942-024-00610-z

Knee Surg Relat Res. 2024 Nov 22;36(1):36. doi: 10.1186/s43019-024-00237-2.

ABSTRACT

PURPOSE: This retrospective single-center study aimed to investigate incidence and risk factors influencing tibial periprosthetic fractures (TPF) in Oxford unicompartmental knee arthroplasty (UKA), with a specific focus on tibial component positioning and sizing.

METHODS: A total of 2063 patients with medial UKA using the Oxford® mobile partial knee implant were analyzed between July 2014 and September 2022. Various preoperative and postoperative radiographic parameters determining pre- and postoperative alignment and implant positioning, incidence and characteristics of periprosthetic fractures, and patient demographics were assessed. Statistical analyses, including Mann-Whitney U test and logistic regression, were conducted to identify significant associations and predictors of tibial fractures.

RESULTS: Of the 1853 cases that were finally included in the study, 19 (1%) patients experienced TPF. The fracture group presented with a significantly shorter relative mediolateral and posteroanterior distance between the keel and cortex [mediolateral: 23.3% (23.2-24.8%) versus 27.1% (25.7-28.3%), p < 0.001; posteroanterior: 8.4% (6.3-10.3%) versus 10.0% (9.8-10.1%), p = 0.004]. Additionally, an increased posterior tibial slope in pre- and postoperative radiographs [preoperative: 10.4° (8.6-11.1°) versus 7.7° (5.4-10.0°), p < 0.001; postoperative 9.1° ± 3.1° versus 7.5° (5.9-9.0°), p = 0.030] was observed in the fracture group. Furthermore, the use of smaller-sized implants (AA) was associated with higher fracture rates (p < 0.001). Anatomical variants, such as a medial overhanging tibial plateau, were not observed.

CONCLUSIONS: In UKA, type Oxford TPF are linked to shorter mediolateral and posteroanterior keel-cortex distances, increased pre- and postoperative PTS, and small implant sizes (AA). Fracture lines often extend from the distal keel to the medial tibial cortex. These findings emphasize the importance of precise implant positioning and sizing to minimize fracture risk. Level of evidence Retrospective single-center study, III.

PMID:39578924 | DOI:10.1186/s43019-024-00237-2

Eur J Pain. 2024 Nov 23. doi: 10.1002/ejp.4761. Online ahead of print.

ABSTRACT

BACKGROUND: Functional neuroimaging studies indicate that central transmission of trigeminal pain may commence up to 48 h prior to the onset of headache. Whether these cyclic changes are associated with somatosensory alteration remains incompletely understood.

METHODS: The present study aimed to investigate the temporal progression of somatosensory alterations preceding the onset of a migraine attack. Patients with menstrually related migraine (n = 10) and matched healthy controls (n = 13) underwent consecutive daily quantitative sensory tests, commencing 6 days prior to the expected onset of the migraine attack and menstruation. Each subject was investigated for 7-11 consecutive days, resulting in 85 and 91 days of experimentation for the respective cohorts.

RESULTS: Electrical/heat/cold pain thresholds showed a phase-dependent decline towards the spontaneous migraine attack, which had commenced 48 h prior to the onset of the headache. The pain thresholds further declined towards the ictal phase, with only the electrical pain threshold reaching statistical significance (ictal vs. preictal). In healthy controls, the pain thresholds remained stable and unaltered during the consecutive daily measurements. In an exploratory analysis, the pain thresholds at baseline (interictal phase) were comparable between both cohorts.

CONCLUSIONS: The data suggest the existence of a trigeminal somatosensory alteration in the preictal phase of migraine, occurring up to 48 h prior to the onset of the headache. This change occurred in a chronologically synchronous manner with the brain activation in the preictal phase in functional neuroimaging studies. It will be important to combine pain threshold measurement and functional neuroimaging in future studies.

SIGNIFICANCE: Our data suggest the existence of a somatosensory behavioural correlate of the functional neuroimaging changes starting 48 h before the onset of headache. Despite the concurrence of the behavioural and functional neuroimaging changes in a chronological sequence, the next step in elucidating the cause of migraine is to combine the behavioural and functional neuroimaging changes in a temporal sequence, i.e. to identify the generator behind the cyclic sensory fluctuation.

PMID:39578922 | DOI:10.1002/ejp.4761

Arch Public Health. 2024 Nov 22;82(1):222. doi: 10.1186/s13690-024-01449-4.

ABSTRACT

BACKGROUND: Healthy eating patterns from sustainable food systems are crucial for population and planetary health. Primary schools are opportune settings for teaching children about food, nutrition and sustainability (FNS) though little is known about the delivery of FNS education in this sector. This study aimed to analyse current approaches to FNS education in Australian primary schools.

METHODS: A cross-sectional online survey with closed- and open-ended questions collected data about (i) teacher perceptions and attributes regarding FNS education; (ii) FNS teaching practices; and (iii) factors influencing FNS education. Statistical analyses were conducted using STATA including descriptive statistics and chi-square analyses to test for associations between categorical variables. Qualitative content and thematic analyses of open-ended questions were conducted using NVivo 14.

RESULTS: Participants were 413 Australian primary school teachers. Teachers considered FNS education as equally important to most curriculum subjects, though frequency of FNS education was low. Less than a third of teachers were trained in FNS education, had access to funding for FNS-related activities or were from schools with policies about including FNS education in the curriculum. There was a significant association between frequency of FNS education and teacher training, access to funding and presence of FNS curriculum policies (all p < 0.001). Teachers who were trained to teach nutrition, food skills or food sustainability (all p < 0.05) were more likely to teach this as both stand-alone and cross-curricular subjects. Teachers described personal factors (workload, stress, scope of practice) that influenced their FNS teaching practices, as well as factors related to students’ families (family responsibility for FNS education, family food practices, family engagement in FNS activities), the curriculum (overcrowding, prioritisation, access to resources) and the broader school environment (time, facilities, funding, training).

CONCLUSIONS: Strengthening the position of FNS education in the primary school sector is an important next step for public health research, policy and practice. Researchers and policy makers should explore future opportunities for training, funding and policy approaches that prioritise FNS within the primary school curriculum and in everyday teaching practice.

PMID:39578915 | DOI:10.1186/s13690-024-01449-4

J Orthop Surg Res. 2024 Nov 22;19(1):785. doi: 10.1186/s13018-024-05288-5.

ABSTRACT

BACKGROUND: Traditional Chinese exercise (TCE) is used as a therapeutic method in patients with postmenopausal osteoporosis. A meta-analysis was performed to evaluate the efficacy of TCE and provide reliable clinical evidence.

METHODS: Eight databases, including the Cochrane Library, PubMed, Embase, Web of Science, Chinese Science Citation Database, Wanfang, China National Knowledge Infrastructure, and Chinese Medical Journal full-text databases, were searched for randomized controlled trials. Meta-analysis was performed using the RevMan (version 5.4) software.

RESULTS: Sixteen studies involving 1,288 patients were included. Compared with conventional treatment alone, TCE improved patients’ bone mineral density, decreased pain, improved balance, improved quality of life, and decreased deoxypyridinoline levels. However, the intervention effects on the biochemical indexes of bone metabolism, including blood calcium, blood phosphorus, osteocalcin, and alkaline phosphatase levels, were not statistically significant.

CONCLUSION: TCE has a significant effect on postmenopausal patients with osteoporosis and can be used as a non-pharmacological treatment. The results of this study should be interpreted with caution because of the large heterogeneity for some indicators.

PMID:39578911 | DOI:10.1186/s13018-024-05288-5

J Orthop Surg Res. 2024 Nov 22;19(1):784. doi: 10.1186/s13018-024-05254-1.

ABSTRACT

PURPOSE: Vertebral body tethering (VBT) is a new growth-modulating surgery for adolescent idiopathic scoliosis (AIS) requiring a distinct skillset and intraoperative setup. We compared perioperative details and outcomes of VBTs performed in a public pediatric orthopedic hospital and a general private hospital setting.

METHODS: We identified all patients receiving VBT for AIS from 1/2020 to 12/2023 with ≥ 6 months post-operative follow-up, with surgeries performed by the same senior surgeons. Clinical, radiological, and surgical details were retrieved.

RESULTS: 24 VBTs were performed in the private setting and 16 in the public setting. Average age at operation was 11.9 ± 1.1 at a Sanders staging of 3.8 ± 1.2 when the major curve Cobb angle was 50.5 ± 8.0°. Tethered curves were most often thoracic in location (23/40) followed by thoracolumbar/lumbar curves (10/40) and double curve tethers (7/40). Overall correction ratio of 68.0 ± 19.0% was achieved. Time from booking to operation (82.2 ± 39.2 vs 63.1 ± 34.4 days, p = 0.112) and operation time (310 ± 86.4 min vs. 289 ± 87.4 min, p = 0.054) were longer in the public and private setting respectively but failed to reach statistical significance. Time to chest drain removal (1.5 ± 0.8 vs. 3.5 ± 1.7 days, p < 0.001) and length of stay (4.3 ± 0.9 vs. 6.6 ± 1.8 days, p < 0.001) were significantly shorter in the private setting, whilst complication rates remained similar (7/24 vs. 3/16, p = 0.456).

CONCLUSION: Expertise, resource availability, and costs differ in the public and private healthcare setting. With regards to VBT, the conditions for referral and surgical outcomes remained similar. Earlier drain removal and discharge for patients managed in the private setting was not associated with an increase in complication rate.

PMID:39578901 | DOI:10.1186/s13018-024-05254-1