Category: Statistics

J Multidiscip Healthc. 2023 Dec 27;16:4255-4264. doi: 10.2147/JMDH.S435570. eCollection 2023.

ABSTRACT

OBJECTIVE: In this study, the clinical application and efficacy of three different methods for placing and repositioning patients in the lithotomy position over the bed using stirrups were evaluated.

METHODS: A total of 240 surgical patients who underwent surgery in Chongqing Traditional Chinese Medicine Hospital between July and November 2022 were selected as study participants. Using envelopes, they were randomly divided into three groups of 80 cases each using a randomization method. The groups included the traditional over-bed method, the postural trolley-assisted over-bed method, and the direct over-bed method. Using the Kruskal-Wallis rank-sum test, analysis of variance, and multiple linear regression equations, the placement time, over-bed repositioning time, and total time of the three methods for placing and repositioning in the lithotomy position supported by stirrups were analyzed statistically. In addition, we investigated and examined the satisfaction of nurses and doctors with the aforementioned techniques.

RESULTS: The placement time, repositioning time, and total time were significantly higher for the traditional over-bed method than for the postural trolley-assisted over-bed method and the direct over-bed method (both P < 0.01). However, there was no statistically significant difference between the postural trolley-assisted over-bed method and the direct over-bed method (P > 0.05). Nurses and doctors reported significantly higher satisfaction with the postural trolley-assisted over-bed method and the direct over-bed method compared to the traditional over-bed method (both P < 0.01). In addition, nurses were more satisfied with the direct over-bed method than the postural trolley-assisted over-bed method (P < 0.05).

CONCLUSION: The results of this study demonstrate that the direct over-bed method is preferred for positioning and repositioning patients in the lithotomy position with the support of stirrups.

PMID:38164462 | PMC:PMC10758315 | DOI:10.2147/JMDH.S435570

J Vis. 2024 Jan 2;24(1):1. doi: 10.1167/jov.24.1.1.

ABSTRACT

The spectral shape, irradiance, direction, and diffuseness of daylight vary regularly throughout the day. The variations in illumination and their effect on the light reflected from objects may in turn provide visual information as to the time of day. We suggest that artists’ color choices for paintings of outdoor scenes might convey this information and that therefore the time of day might be decoded from the colors of paintings. Here we investigate whether human viewers’ estimates of the depicted time of day in paintings correlate with their image statistics, specifically chromaticity and luminance variations. We tested time-of-day perception in 17th- to 20th-century Western European paintings via two online rating experiments. In Experiment 1, viewers’ ratings from seven time choices varied significantly and largely consistently across paintings but with some ambiguity between morning and evening depictions. Analysis of the relationship between image statistics and ratings revealed correlations with the perceived time of day: higher “morningness” ratings associated with higher brightness, contrast, and saturation and darker yellow/brighter blue hues; “eveningness” with lower brightness, contrast, and saturation and darker blue/brighter yellow hues. Multiple linear regressions of extracted principal components yielded a predictive model that explained 76% of the variance in time-of-day perception. In Experiment 2, viewers rated paintings as morning or evening only; rating distributions differed significantly across paintings, and image statistics predicted people’s perceptions. These results suggest that artists used different color palettes and patterns to depict different times of day, and the human visual system holds consistent assumptions about the variation of natural light depicted in paintings.

PMID:38165679 | DOI:10.1167/jov.24.1.1

JAMA Netw Open. 2024 Jan 2;7(1):e2349864. doi: 10.1001/jamanetworkopen.2023.49864.

ABSTRACT

IMPORTANCE: Management of gram-negative bloodstream infections (GN-BSIs) with oral antibiotics is highly variable.

OBJECTIVE: To examine the transition from intravenous (IV) to oral antibiotics, including selection, timing, and associated clinical and microbial characteristics, among hospitalized patients with GN-BSIs.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted of 4581 hospitalized adults with GN-BSIs at 24 US hospitals between January 1 and December 31, 2019. Patients were excluded if they died within 72 hours. Patients were excluded from the oral therapy group if transition occurred after day 7. Statistical analysis was conducted from July 2022 to October 2023.

EXPOSURES: Administration of antibiotics for GN-BSIs.

MAIN OUTCOMES AND MEASURES: Baseline characteristics and clinical parameters reflecting severity of illness were evaluated in groups receiving oral and IV therapy. The prevalence of transition from IV to oral antibiotics by day 7, median day of transition, sources of infection, and oral antibiotic selection were assessed.

RESULTS: Of a total of 4581 episodes with GN-BSIs (median age, 67 years [IQR, 55-77 years]; 2389 men [52.2%]), 1969 patients (43.0%) receiving IV antibiotics were transitioned to oral antibiotics by day 7. Patients maintained on IV therapy were more likely than those transitioned to oral therapy to be immunosuppressed (833 of 2612 [31.9%] vs 485 of 1969 [24.6%]; P < .001), require intensive care unit admission (1033 of 2612 [39.5%] vs 334 of 1969 [17.0%]; P < .001), have fever or hypotension as of day 5 (423 of 2612 [16.2%] vs 49 of 1969 [2.5%]; P < .001), require kidney replacement therapy (280 of 2612 [10.7%] vs 63 of 1969 [3.2%]; P < .001), and less likely to have source control within 7 days (1852 of 2612 [70.9%] vs 1577 of 1969 [80.1%]; P < .001). Transitioning patients from IV to oral therapy by day 7 was highly variable across hospitals, ranging from 25.8% (66 of 256) to 65.9% (27 of 41). A total of 4109 patients (89.7%) achieved clinical stability within 5 days. For the 3429 episodes (74.9%) with successful source control by day 7, the median day of source control was day 2 (IQR, 1-3 days) for the oral group and day 2 (IQR, 1-4 days) for the IV group (P < .001). Common infection sources among patients administered oral therapy were the urinary tract (1277 of 1969 [64.9%]), hepatobiliary (239 of 1969 [12.1%]), and intra-abdominal (194 of 1969 [9.9%]). The median day of oral transition was 5 (IQR, 4-6 days). Total duration of antibiotic treatment was significantly shorter among the oral group than the IV group (median, 11 days [IQR, 9-14 days] vs median, 13 days [IQR, 8-16 days]; P < .001]. Fluoroquinolones (62.2% [1224 of 1969]), followed by β-lactams (28.3% [558 of 1969]) and trimethoprim-sulfamethoxazole (11.5% [227 of 1969]), were the most commonly prescribed oral antibiotics.

CONCLUSIONS AND RELEVANCE: In this cohort study of 4581 episodes of GN-BSIs, transition to oral antibiotic therapy by day 7 occurred in fewer than half of episodes, principally with fluoroquinolones, although this practice varied significantly between hospitals. There may have been additional opportunities for earlier and more frequent oral antibiotic transitions because most patients demonstrated clinical stability by day 5.

PMID:38165674 | DOI:10.1001/jamanetworkopen.2023.49864

JAMA Netw Open. 2024 Jan 2;7(1):e2349871. doi: 10.1001/jamanetworkopen.2023.49871.

ABSTRACT

IMPORTANCE: In clinical trials, the early or accelerated continuous renal replacement therapy (CRRT) initiation strategy among adults with acute kidney injury or volume overload has not demonstrated a survival benefit. Whether the timing of initiation of CRRT is associated with outcomes among children and young adults is unknown.

OBJECTIVE: To determine whether timing of CRRT initiation, with and without consideration of volume overload (VO; <10% vs ≥10%), is associated with major adverse kidney events at 90 days (MAKE-90).

DESIGN, SETTING, AND PARTICIPANTS: This multinational retrospective cohort study was conducted using data from the Worldwide Exploration of Renal Replacement Outcome Collaborative in Kidney Disease (WE-ROCK) registry from 2015 to 2021. Participants included children and young adults (birth to 25 years) receiving CRRT for acute kidney injury or VO at 32 centers across 7 countries. Statistical analysis was performed from February to July 2023.

EXPOSURE: The primary exposure was time to CRRT initiation from intensive care unit admission.

MAIN OUTCOMES AND MEASURES: The primary outcome was MAKE-90 (death, dialysis dependence, or persistent kidney dysfunction [>25% decline in estimated glomerular filtration rate from baseline]).

RESULTS: Data from 996 patients were entered into the registry. After exclusions (n = 27), 969 patients (440 [45.4%] female; 16 (1.9%) American Indian or Alaska Native, 40 (4.7%) Asian or Pacific Islander, 127 (14.9%) Black, 652 (76.4%) White, 18 (2.1%) more than 1 race; median [IQR] patient age, 8.8 [1.7-15.0] years) with data for the primary outcome (MAKE-90) were included. Median (IQR) time to CRRT initiation was 2 (1-6) days. MAKE-90 occurred in 630 patients (65.0%), of which 368 (58.4%) died. Among the 601 patients who survived, 262 (43.6%) had persistent kidney dysfunction. Of patients with persistent dysfunction, 91 (34.7%) were dependent on dialysis. Time to CRRT initiation was approximately 1 day longer among those with MAKE-90 (median [IQR], 3 [1-8] days vs 2 [1-4] days; P = .002). In the generalized propensity score-weighted regression, there were approximately 3% higher odds of MAKE-90 for each 1-day delay in CRRT initiation (odds ratio, 1.03 [95% CI, 1.02-1.04]).

CONCLUSIONS AND RELEVANCE: In this cohort study of children and young adults receiving CRRT, longer time to CRRT initiation was associated with greater risk of MAKE-90 outcomes, in particular, mortality. These findings suggest that prospective multicenter studies are needed to further delineate the appropriate time to initiate CRRT and the interaction between CRRT initiation timing and VO to continue to improve survival and reduce morbidity in this population.

PMID:38165673 | DOI:10.1001/jamanetworkopen.2023.49871

Eur Geriatr Med. 2024 Jan 2. doi: 10.1007/s41999-023-00912-9. Online ahead of print.

ABSTRACT

PURPOSE: Existing evidence indicates an association between cognitive functioning and both geriatric depression and suicidality, with mixed evidence regarding the direction of the relationship between cognitive functioning and aspects of geriatric lifetime suicidal ideation. This study aims to examine the relationship between cognitive functioning, depression, and suicide ideation and to explore the intermediary role of depression between cognitive functioning and suicidal ideation in the older adults.

METHODS: A multi-stage random cluster sampling method was used to collect a sample of 3896 individuals aged 60 and above. Descriptive statistics of the sample data were analyzed using one-way ANOVA, and then the correlation between variables was obtained by binary logistic regression analysis. SPSS macro program PROCESS V3.5 was used to test the mediating role of depression in the relationship between cognitive function and lifetime suicidal ideation.

RESULTS: The prevalence of lifetime suicidal ideation among older adults was 3.9%. Lifetime suicidal ideation was associated with depression (OR = 1.308, P < 0.001) but was not significantly correlated with cognitive function (OR = 0.972, P > 0.05). The relationship between cognitive function and depression was also supported in this study (β = – 0.0841, P < 0.001). Depression completely mediated the relationship between cognitive function and lifetime suicidal ideation.

CONCLUSION: There was no significant correlation between cognitive impairment in older adults and a heightened risk of lifetime suicidal ideation. However, this relationship was completely mediated by depression. It is crucial to prevent the onset of depression among older adults with cognitive impairment, as depression is strongly linked to lifetime suicidal ideation.

PMID:38165610 | DOI:10.1007/s41999-023-00912-9

Mol Neurobiol. 2024 Jan 2. doi: 10.1007/s12035-023-03868-w. Online ahead of print.

ABSTRACT

Duchenne muscular dystrophy (DMD) is a genetic disorder that causes muscle weakness and degeneration. In this study, we identified potential biomarkers and drug targets for DMD through a comprehensive meta-analysis of mRNA profiles. We conducted an in-depth analysis of three microarray datasets from the GEO database, utilizing the Affymetrix platform. A rigorous data pre-processing pipeline encompassed background correction, normalization, log2 transformation and probe-to-gene symbol mapping. Robust multi-array average method followed by Limma package in R was employed to ensure differential expression analysis within individual datasets, yielding gene-specific p-values. We identified 63 genes exhibiting statistically significant differential expression across the three datasets (p < 0.05) and an absolute log fold change > 1.5. Functional enrichment analyses of these differentially expressed genes were done, followed by pathway analyses. Our results suggested pertinent biological processes, molecular functions and cellular components associated with DMD. Finally, eight hub genes-COL6A3, COL1A1, COL3A1, COL1A2, POSTN, TIMP1, THBS2 and SPP1-were pinpointed as central players in the network. Two differentially expressed genes with substantial absolute log-fold changes, namely, DMD, downregulated and MYH3, upregulated, were identified as potential therapeutic candidates. In light of these findings, our work contributes not only to understanding DMD at the molecular level but also presents potential targets for therapeutic strategies. Finally, our study facilitates the development of therapeutic interventions that can effectively control and mitigate the impact of DMD.

PMID:38165583 | DOI:10.1007/s12035-023-03868-w

Radiol Phys Technol. 2024 Jan 2. doi: 10.1007/s12194-023-00766-7. Online ahead of print.

ABSTRACT

Somatostatin receptor scintigraphy (SRS) is an essential examination for the diagnosis of neuroendocrine tumors (NETs). This study developed a method to individually optimize the display of whole-body SRS images using a deep convolutional neural network (DCNN) reconstructed by transfer learning of a DCNN constructed using Gallium-67 (⁶⁷Ga) images. The initial DCNN was constructed using U-Net to optimize the display of ⁶⁷Ga images (493 cases/986 images), and a DCNN with transposed weight coefficients was reconstructed for the optimization of whole-body SRS images (133 cases/266 images). A DCNN was constructed for each observer using reference display conditions estimated in advance. Furthermore, to eliminate information loss in the original image, a grayscale linear process is performed based on the DCNN output image to obtain the final linearly corrected DCNN (LcDCNN) image. To verify the usefulness of the proposed method, an observer study using a paired-comparison method was conducted on the original, reference, and LcDCNN images of 15 cases with 30 images. The paired comparison method showed that in most cases (29/30), the LcDCNN images were significantly superior to the original images in terms of display conditions. When comparing the LcDCNN and reference images, the number of LcDCNN and reference images that were superior to each other in the display condition was 17 and 13, respectively, and in both cases, 6 of these images showed statistically significant differences. The optimized SRS images obtained using the proposed method, while reflecting the observer’s preference, were superior to the conventional manually adjusted images.

PMID:38165579 | DOI:10.1007/s12194-023-00766-7

Hernia. 2024 Jan 2. doi: 10.1007/s10029-023-02917-6. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to perform a meta-analysis comparing the short-term and long-term outcomes in laparoscopic groin hernia repair with or without preservation of the uterine round ligament (URL) in females.

METHODS: We searched several databases including PubMed, Web of Science, Cochrane Library, and and CNKI databases. This meta-analysis included randomized clinical trials, and retrospective comparative studies regarding preservation or division of the URL in laparoscopic groin hernia repair in females. Outcomes of interest were age, BMI, type of hernia, type of surgery, operating time, estimated blood loss, time of hospitalization, seroma, concomitant injury, mesh infection, recurrence, uterine prolapse, foreign body sensation, chronic pain, and pregnancy. Meta-analyses and trial sequential analysis were performed with Review Manager v5.3 and TSA software, respectively.

RESULTS: Of 192 potentially eligible articles, 9 studies with 1104 participants met the eligibility criteria and were included in the meta-analysis. There were no significant difference in age (MD-6.58, 95% CI – 13.41 to 0.24; P = 0.06), BMI (MD 0.05, 95%CI – 0.31 to 0.40; P = 0.81), blood loss (MD-0.04, 95% CI – 0.75 to 0.66; P = 0.90), time of hospitalization (MD-0.22, 95% CI-1.13 to 0.69; P = 0.64), seroma (OR 0.71, 95% CI 0.41 to 1.24; P = 0.23), concomitant injury (OR 0.32, 95% CI 0.01 to 8.24; P = 0.68), mesh infection (OR 0.13, 95% CI 0.01 to 2.61; P = 0.18), recurrence (OR 1.13, 95% CI 0.18 to 7.25; P = 0.90), uterine prolapse(OR 0.71, 95% CI 0.07 to 6.94; P = 0.77), foreign body sensation (OR 1.95, 95% CI 0.53 to 7.23; P = 0.32) and chronic pain(OR 1.03 95% CI 0.4 to 2.69; P = 0.95). However, this meta-analysis demonstrated a statistically significant difference in operating time (MD 6.62, 95% CI 2.20 to 11.04; P = 0.0003) between the preservation group and division group. Trial sequential analysis showed that the cumulative Z value of the operating time crossed the traditional boundary value and the TSA boundary value in the third study, and the cumulative sample size had reached the required information size (RIS), indicating that the current conclusion was stable.

CONCLUSION: In summary, laparoscopic groin hernia repair in women with the preservation of the round uterine ligament requires a longer operating time, but there was no advantage in short-term or long-term complications, and there was no clear evidence on whether it causes infertility and uterine prolapse.

PMID:38165537 | DOI:10.1007/s10029-023-02917-6

Hernia. 2024 Jan 2. doi: 10.1007/s10029-023-02938-1. Online ahead of print.

ABSTRACT

BACKGROUND: Enumerating the complications of groin hernia repair might help to highlight the need for improvement in the quality of care. This is imperative in a country without a strong post-operative complication surveillance mechanism. Hence, this review aims to determine the complications encountered during the surgical treatment of groin hernias among Nigerian subjects.

METHODS: Databases like Google Scholar, Scopus, and PubMed were searched. Out of the 140 papers found during the search, only 20 were included in this review. Bassini repair was the most common type of hernia repair used, and neither laparoscopic repair nor posterior approach was utilized in any of the patients. Emergency presentations constituted about 18.5% of the cases. Meta-analysis of the studies showed that more prevalent complications were wound/scrotal edema (derived from four studies), surgical site infections (derived from 17 studies), and hematoma (from 19 studies). The rates were 23% (CI 0-46%; I² = 80.9%), 6% (CI 3-10%; I² = 87.7%), and 5% (CI 2-8%; I² = 83.7%), respectively. The rate of complication in giant hernias was higher than the non-giant hernias and was statistically significant [p < 0.05; OR 1.5 (CI 0.9-2.4)]. Although the recurrence rate is low, there was insufficient follow-up of patients.

CONCLUSION: This review has shown that one-fifth of the patients had emergency repair of hernias and giant groin hernias have higher odds of complications after repair compared to normal-sized ones. The most common complication noted was wound/scrotal edema. None of the hernias was repaired with laparoscopy. Perhaps, establishing a registry might improve the detection of late complications in patients who had groin hernia repair.

PMID:38165536 | DOI:10.1007/s10029-023-02938-1

Lasers Med Sci. 2024 Jan 2;39(1):21. doi: 10.1007/s10103-023-03962-4.

ABSTRACT

This in vitro experimental investigation aimed to evaluate the impact of the combined application of a nanofiber scaffold (NS), a polymeric catalyst primer (PCP) containing 10 mg/mL of heme peroxidase enzyme, and violet LED (LEDv) on the esthetic efficacy (EE), trans-amelodentinal cytotoxicity (TC), and procedural duration of conventional in-office bleaching therapy. To achieve this, 96 standardized enamel/dentin discs were individually placed in artificial pulp chambers. A 35% hydrogen peroxide (H₂O₂) bleaching gel was administered for 45, 30, or 15 min to the enamel, either previously coated with NS + PCP or left uncoated, followed by irradiation with LEDv for 15 min or no irradiation. The established groups were as follows: G1, negative control (no treatment); G2, 35% H₂O₂/45 min; G3, NS + PCP + LEDv; G4, NS + PCP + 35%H₂O₂/45 min + LEDv; G5, NS + PCP + 35%H₂O₂/30 min + LEDv; and G6, NS + PCP + 35%H₂O₂/15 min + LEDv. Extracts (culture medium + gel components diffused through the discs) were collected and applied to odontoblast-like MDPC-23 cells. EE (ΔE₀₀ and ΔWI) and TC were assessed using ANOVA/Tukey analysis (p < 0.05). The EE analysis revealed no statistical differences between G6 and G2 (p > 0.05). Cells in G6 exhibited higher viability and lower oxidative stress compared to other bleached groups (p < 0.05). In conclusion, employing NS + PCP + LEDv to catalyze a 35%H₂O₂ bleaching gel applied for 15 min to the enamel resulted in successful esthetic improvements and reduced the cytotoxicity commonly linked with traditional in-office bleaching procedures.

PMID:38165503 | DOI:10.1007/s10103-023-03962-4