Category: Statistics

Heliyon. 2024 Oct 10;10(20):e39198. doi: 10.1016/j.heliyon.2024.e39198. eCollection 2024 Oct 30.

ABSTRACT

PURPOSE: To explore the characteristics of the clinical phenotype of ARDS based on Machine Learning.

METHODS: This is a study on Machine Learning. Screened cases of acute respiratory distress syndrome (ARDS) in the eICU database collected basic information in the cases and clinical data on the Day 1, Day 3, and Day 7 after the diagnosis of ARDS, respectively. Using the Calinski-Harabasz criterion, Gap Statistic, and Silhouette Coefficient, we determine the optimal clustering number k value. By the K-means cluster analysis to derive clinical phenotype, we analyzed the data collected within the first 24 h. We compared it with the survival of cases under the Berlin standard classification, and also examined the phenotypic conversion within the first 24 h, on day 3, and on day 7 after the diagnosis of ARDS.

RESULTS: We collected 5054 cases and derived three clinical phenotypes using K-means cluster analysis. Phenotype-I is characterized by fewer abnormal laboratory indicators, higher oxygen partial pressure, oxygenation index, APACHE IV score, systolic and diastolic blood pressure, and lower respiratory rate and heart rate. Phenotype-II is characterized by elevated white blood cell count, blood glucose, creatinine, temperature, heart rate, and respiratory rate. Phenotype-III is characterized by elevated age, partial pressure of carbon dioxide, bicarbonate, GCS score, albumin. The differences in ICU length of stay and in-hospital mortality were significantly different between the three phenotypes (P < 0.05), with phenotype I having the lowest in-hospital mortality (10 %) and phenotype II having the highest (31.8 %). To compare the survival analysis of ARDS patients classified by phenotype and those classified according to Berlin criteria. The results showed that the differences in survival between phenotypes were statistically significant (P < 0.05) under phenotypic classification.

CONCLUSIONS: The clinical classification of ARDS based on K-means clustering analysis is beneficial for further identifying ARDS patients with different characteristics. Compared to the Berlin standard, the new clinical classification of ARDS provides a clearer display of the survival status of different types of patients, which helps to predict patient prognosis.

PMID:39469677 | PMC:PMC11513467 | DOI:10.1016/j.heliyon.2024.e39198

Mol Ther Nucleic Acids. 2024 Oct 4;35(4):102352. doi: 10.1016/j.omtn.2024.102352. eCollection 2024 Dec 10.

ABSTRACT

Ocular diseases create a significant economic burden and decrease in quality of life worldwide. Drugs and carrier molecules that penetrate ocular tissues after intravenous administration are needed for more efficient and patient-friendly treatment of ocular diseases. Here, ocular barrier-penetrating aptamers were selected through the utilization of in vivo SELEX and intravenous injection in rats. Three aptamers-Apt1, Apt2, and Apt5-were chosen based on their specific accumulation in vascularized ocular tissues and further characterized for their in vivo biodistribution using quantitative reverse-transcription PCR (RT-qPCR). A statistically significant difference between ΔCt values of ocular and control tissues with Apt2 (p < 0.0001) and Apt5 (p < 0.0001) was observed. Interestingly, Apt1 was the most abundant aptamer in the sequencing pool, but it did not show a statistically significant difference in in vivo biodistribution between ocular and control tissues. Overall, this study established a functional in vivo SELEX method for discovering ocular tissue targeting aptamers.

PMID:39469668 | PMC:PMC11513532 | DOI:10.1016/j.omtn.2024.102352

Transpl Int. 2024 Oct 14;37:13495. doi: 10.3389/ti.2024.13495. eCollection 2024.

ABSTRACT

All the factors potentially influencing tacrolimus dose requirement and combinations thereof have never been thoroughly investigated, precluding accurate prediction of tacrolimus starting dose. This prospective, non-interventional, multicenter study in de novo adult kidney transplant recipients over the first year after transplantation aimed to investigate the factors influencing tacrolimus dose-standardized trough blood concentration (C₀/D) over the first week post-transplant (D4-D7, primary objective), D8-M3 and M3-M12 (secondary objectives). Statistical analysis employed mixed linear models with repeated measures. Eighteen sites enrolled 440 patients and followed them up for 9.5 ± 4.1 months. Age at baseline (p = 0.0144), end-stage renal disease (p = 0.0092), CYP3A phenotype (p < 0.0001), dyslipidemia at baseline (p = 0.0031), hematocrit (p = 0.0026), total bilirubin (p = 0.0261) and plasma creatinine (p = 0.0484) independently increased with log(C₀/D) over D4-D7, explaining together 72.3% of the interindividual variability, and representing a robust model to estimate tacrolimus initial dose. Donor age and CYP3A phenotype were also influential over D8-M3 and M3-12, in addition to recipient age. Corticosteroids, diabetes at baseline, and ASAT yielded inconstant results between D8-M3 and M3-M12. We found no ethnicity effect when CYP3A phenotype was accounted for, and no food effect. Intra-individual variability over M3-M12 was moderate, and significantly lower in patients with chronic hepatic disorder (p = 0.0196) or cancer (p = 0.0132).

PMID:39469664 | PMC:PMC11513580 | DOI:10.3389/ti.2024.13495

Musculoskeletal Care. 2024 Dec;22(4):e1950. doi: 10.1002/msc.1950.

ABSTRACT

INTRODUCTION: Worldwide, the unmet rehabilitation needs of adults with musculoskeletal disorders are high. Aquatic exercise is clinically effective in managing musculoskeletal disorders, but access to rehabilitative services is limited.

OBJECTIVE: To determine the feasibility of a community-based aquatic exercise and peer support intervention for patients with musculoskeletal disorders delivered via a multisector partnership between an NHS physiotherapy service, a leisure operator and a social enterprise that creates personalised exercise programmes delivered through an application on a tablet computer. Cost-sharing was implemented after an initial complimentary session.

METHODS: A mixed method service evaluation was undertaken. Patient demographics, attendance, and patient-reported outcomes were summarised using descriptive statistics. Semi-structured interviews and an online survey were employed to explore patient acceptability of the intervention.

RESULTS: Thirty four patients accessed the intervention during the 6-month pilot. Over half were from minority ethnic groups and nearly two thirds were in the bottom three deciles relating to low income. Patients exercised in a group of up to eight, supported by NHS rehabilitation professionals and volunteers. Provision of post-session refreshments encouraged connectivity between patients. Weekly attendance at the programme was high. Patient-reported outcome measures showed favourable changes in pain intensity and function following the intervention. Qualitative data suggest that the intervention was acceptable to patients.

CONCLUSION: Implementation of a community-based aquatic exercise and peer support intervention for people with musculoskeletal disorders via a cross-sector partnership involving the NHS appears feasible and acceptable to patients. Further research is needed to assess the impact on musculoskeletal health and health inequalities.

PMID:39467818 | DOI:10.1002/msc.1950

Ann Ital Chir. 2024;95(5):972-978. doi: 10.62713/aic.3329.

ABSTRACT

AIM: The primary aim of our retrospective chart review is to compare open surgical (OS) tracheostomies performed by specialist and supervised resident surgeons, focusing on surgical time and post-surgical complications. The secondary objective was to compare these data based on the years of surgical experience for both specialists and residents.

METHODS: All patients undergoing surgical tracheostomy at the Unit of Otorhinolaryngology, Head & Neck Department, University of Verona between 1 January 2017, and 31 December 2022, were subjected to a retrospective analysis. A total of 385 OS tracheostomies were included in the study. Procedures conducted by supervised residents across various training years were compared with those performed by junior and senior specialists, focusing on surgical duration and postoperative complications. Subsequently, these data were stratified based on the surgical experience of subgroups: residents were categorized into 4 years of training, and specialists were categorized into junior (with less than 5 years of experience) and senior (with at least 5 years).

RESULTS: Statistical analysis concerning patients’ anatomy revealed a significant increase in operative times among those with no palpable neck landmarks (p = 0.006) and those with previous neck surgery (p = 0.039). Among patients’ comorbidities, only anticoagulant or antiaggregant therapy was found to prolong operative time (p = 0.018), while the ASA score did not correlate with the duration of surgery. Finally, no statistically significant differences in surgical time were observed (p = 0.287), and no significant differences in complication frequency were reported between supervised residents and specialists (p = 0.908), regardless of years of experience.

CONCLUSIONS: Under appropriate supervision, OS tracheostomy has demonstrated safety for residents as early as their first year of residency. Residents can perform tracheostomies without significantly prolonging the duration of the operation or increasing the risk of peri- and post-operative complications.

PMID:39467809 | DOI:10.62713/aic.3329

Ann Ital Chir. 2024;95(5):926-933. doi: 10.62713/aic.3520.

ABSTRACT

AIM: Surgical intervention is crucial in radical resection of renal cell carcinoma (RCC). Different surgical procedures have different oncologic outcomes and safety in patients with RCC. Therefore, we aimed to investigate the oncologic outcomes and safety of retroperitoneal laparoscopic partial nephrectomy (RLPN) versus open partial nephrectomy (OPN) in treating patients with localized RCC.

METHODS: This retrospective cohort study included 160 patients with localized RCC who underwent either OPN or RLPN from January 2016 to June 2020. Out of these patients, 75 patients were treated with OPN and 85 patients were treated with RLPN. After propensity score matching, 130 patients (65 cases in each group) were finally included in the analysis. Additionally, surgical outcomes, three-year survival rates, and renal function parameters were assessed between the two groups, and the data were statistically analyzed using SPSS.

RESULTS: Compared to the OPN group, RLPN demonstrated significantly shorter surgical time, lower estimated blood loss (p < 0.05), and lower incidence of complications (p = 0.024). In contrast, the RLPN group had significantly longer warm ischemia time (p = 0.011) than the OPN group. Furthermore, there were no significant differences in three-year overall survival, disease-free survival, cancer specific survival rates, positive surgical margins, hospitalization time between the RLPN and OPN groups (p > 0.05). The incidence of complications in the RLPN group was significantly lower than that in the OPN group (p = 0.024). Postoperatively, creatinine level was significantly lower following RLPN at one year compared to OPN (p = 0.029).

CONCLUSIONS: RLPN offers advantages in surgical time, estimated blood loss, and postoperative complications, and it positively affects postoperative renal function, while OPN shows a shorter warm ischemia time. These two approaches result in comparable three-year survival rates. This study provides valuable insights into the oncologic outcomes and safety of RLPN compared to OPN in treating localized RCC.

PMID:39467801 | DOI:10.62713/aic.3520

Ann Ital Chir. 2024;95(5):963-971. doi: 10.62713/aic.3547.

ABSTRACT

AIM: This study aimed to investigate the effects of sugammadex on postoperative pulmonary complications and rapid recovery in lung cancer patients undergoing video-assisted thoracic surgery (VATS).

METHODS: A retrospective analysis was conducted on the clinical data of 1131 lung cancer patients. Of these, 631 patients received sugammadex at the end of anesthesia, while 500 patients did not. To mitigate potential confounding factors, propensity score matching (PSM) was employed at a 1:1 ratio. After matching, 435 patients were obtained from each group. Patients who received sugammadex at the end of anesthesia were classified into Group S (n = 435) and those who did not receive sugammadex were Group P (n = 435). Postoperative pulmonary complications, indicators of recovery after surgery, nausea and vomiting, pain and lung infection scores and biochemical indices were compared between the two groups.

RESULTS: Compared to Group P, Group S demonstrated statistically significant improvements across multiple perioperative and postoperative outcomes. Group S exhibited a lower incidence of postoperative pulmonary complications (χ2 = 9.52, p = 0.002), as well as reduced durations for several key time intervals: from the cessation of muscle relaxation to extubation (Z = 12.96, p < 0.001), from the conclusion of surgery to extubation (Z = 13.66, p < 0.001), and total operating theatre occupancy (Z = 5.81, p < 0.001). Furthermore, Group S showed accelerated recovery in terms of time to first oral intake (drink: Z = 3.80, p < 0.001; eat: Z = 3.80, p < 0.001), time to defecate (Z = 3.25, p = 0.001), and time to chest tube removal (Z = 5.04, p < 0.001). Pain management outcomes were also superior in Group S, with lower motor visual analogue scale (VAS) scores at both 24 h (Z = 4.71, p < 0.001) and 48 h (Z = 5.05, p < 0.001) postoperatively. Group S additionally demonstrated a lower modified Clinical Pulmonary Infection Score (mCPIS) (Z = 4.68, p < 0.001), reduced complication rates during the general anesthesia awakening period (χ2 = 23.54, p < 0.001), and a lower incidence of renal function abnormalities (χ2 =12.65, p < 0.001). Certain parameters, including total hospital stay duration and postoperative drainage volume, did not differ significantly between the two groups (p > 0.05).

CONCLUSIONS: Sugammadex can effectively reduce the incidence of postoperative pulmonary complications in lung cancer patients treated with VATS, and help promote their rapid postoperative recovery with significant clinical benefits.

PMID:39467796 | DOI:10.62713/aic.3547

Ann Ital Chir. 2024;95(5):744-759. doi: 10.62713/aic.3577.

ABSTRACT

AIM: Interlocking intramedullary nailing and percutaneous plate implantation are commonly used techniques in the treatment of femoral shaft fractures. This study aimed to determine the most appropriate and effective treatment strategy between interlocking intramedullary nails and percutaneous plate implantation by analyzing and summarizing the available evidence.

METHODS: Relevant articles published from the date of database construction in PubMed, Embase, Web of Science, and Cochrane to 2024 were searched and downloaded according to PRISMA 2020. These studies were screened following pre-established inclusion criteria, and the data were extracted. Methodological quality assessment for retrospective studies was performed using the Newcastle-Ottawa Scale, whereas Review Manager Software was used for methodological quality assessment of randomized controlled trials (RCTs) and statistical analysis.

RESULTS: Only 13 studies containing 1061 patients were included in the meta-analysis. Femoral shaft fractures treated with interlocking intramedullary nailing had shorter operative and fluoroscopic time and less estimated blood loss. Pediatric patients treated with interlocking intramedullary nails had less estimated blood loss and shorter healing time. Interlocking intramedullary nailing group in the retrospective study was associated with shorter operative time and less blood loss, whereas, in the randomized controlled trial (RCT) study, it was associated with less blood loss and shorter healing time.

CONCLUSIONS: Interlocking intramedullary nailing is more advantageous in treating femoral shaft fractures and is a more appropriate option for treating femoral shaft fractures in pediatric patients.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD42024564563.

PMID:39467794 | DOI:10.62713/aic.3577

Ann Ital Chir. 2024;95(5):901-908. doi: 10.62713/aic.3589.

ABSTRACT

AIM: The aim of this study is to investigate if and how decompression alters histopathologic diagnoses of cystic jaw lesions.

METHODS: A retrospective study was conducted on patients with a histologic diagnosis of an odontogenic cystic lesion that was surgically treated with decompression followed by a definitive surgery. The correlation between variables including age, gender, location of the lesion, decompression time and the change in histopathologic diagnosis following decompression was analyzed.

RESULTS: Thirty-nine patients were included in the study. The mean decompression time was 7.87 ± 3.43 months. Post-decompression histologic examination at time of definitive surgery was consistent with the initial biopsy diagnosis in 83.33% (5 of 6) of odontogenic keratocysts (OKCs), 94.11% (16 of 17) of radicular cysts, 100% of dentigerous cysts, and 100% of residual cysts. The change in histopathologic diagnosis of the cystic lesions was not found to be statistically correlated with the study variables.

CONCLUSIONS: Histopathologic diagnoses of odontogenic cystic lesions predominantly remain unchanged after decompression. A treatment protocol based on the initial diagnosis may be appropriate for odontogenic cystic lesions that are considered for decompression before definitive surgery.

PMID:39467793 | DOI:10.62713/aic.3589

Ann Ital Chir. 2024;95(5):894-900. doi: 10.62713/aic.3596.

ABSTRACT

AIM: This retrospective study aimed to evaluate the effectiveness of a nursing model on the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB) in patients undergoing surgery for limb fractures.

METHODS: A total of 100 patients who underwent limb fracture surgery at Zhongnan Hospital of Wuhan University from February 2023 to February 2024 were selected for this study. The research group (n = 58) received nursing care based on the HBM and TPB, while the control group (n = 42) received conventional nursing care. Comparative analyses were conducted on curative effectiveness, the degree of limb swelling, pain intensity (measured by the Visual Analogue Scale [VAS]), symptom recovery time (including pain duration, swelling duration, ambulation time, and length of stay), and self-care management (assessed through behavior management, psychological activities, and status management).

RESULTS: The results indicated no significant differences in curative effectiveness between the two groups (p > 0.05). The research group had fewer grade I and II limb swelling cases than the control group (p < 0.05). Additionally, the research group reported lower VAS scores on postoperative days 3 and 7, earlier ambulation, shorter pain and swelling durations, and reduced length of hospital stay compared to the control group (p < 0.01). Furthermore, self-care management scores, including behavior management, psychological activities, and status management, were significantly higher in the research group after treatment compared to the control group (p < 0.05).

CONCLUSIONS: The nursing model based on HBM and TPB provides benefits for patients undergoing limb fracture surgery by reducing swelling, relieving pain, promoting symptom disappearance, speeding up rehabilitation, and enhancing self-care management.

PMID:39467791 | DOI:10.62713/aic.3596