Category: Statistics

Eur J Pediatr. 2024 Dec 6;184(1):66. doi: 10.1007/s00431-024-05893-w.

ABSTRACT

The purpose of this study is to compare the effects of two different ways of stopping incubator humidification on episodes of hypothermia, hyperthermia, hyponatraemia, hypernatraemia, or skin injury. The design is a single site, two-armed, parallel, randomised, clinical trial conducted between April 2019 and March 2022. The setting was a quaternary referral and teaching hospital in Queensland, Australia. There were 140 extremely preterm infants, born < 28 weeks gestational age (GA). Intervention groups were (1) cease humidity: incubator humidification turned from 80% to off at 00.01am on day 8 of life (n = 70); or (2) gradually reduce humidity: incubator humidification reduced by 5% at 00:01 of each day from day 8 until ceased on day 14 (n = 70). The primary outcome was episodes of temperature instability: defined as either hypothermia < 36.5 °C or hyperthermia > 37.5 °C. Secondary outcomes included episodes of hyponatraemia: hypernatraemia or skin injury. One hundred forty infants were enrolled, 70 in each group. No statistically significant differences for any outcomes. Hyperthermia: 77% (n = 54) in the cease group and 73% (n = 51) in the gradual reduction group (P = 0.70). Hypothermia: 53% (n = 37) in the cease group and 37% (n = 26) in the gradual reduction group (P = 0.09). The number of hyponatraemic events was similar for both groups (P = 0.73), as for hypernatraemic events (P = 0.3). Skin injury in week 2 of life: 63% in the cease group and 67% in the gradual reduction group (P = 0.72).

CONCLUSIONS: Ceasing or gradually reducing incubator humidification after day 7 of life had no effect on the number of episodes of hypothermia or hyperthermia in this cohort of extremely preterm infants (EPTI). There was also no effect on the number of episodes of hyponatraemia or hypernatraemia.

TRIAL REGISTRATION: ANZCTR.org.au (Australia New Zealand Clinical Trials Registry). ACTRN 1261 9000 266167 Registered 21/2/2019.

WHAT IS KNOWN: • Incubator humidification is a widely accepted and routine practice in the management of EPTI as it influences transepidermal water loss (TEWL) and supports thermoregulation. However, weaning practices remain varied and inconsistent across the globe. • There remains a paucity of data to inform specific evidenced-based humidification practices.

WHAT IS NEW: • Ceasing or gradually reducing incubator humidification after 7 days had no effect on temperature stability, serum sodium levels, or frequency of skin injury in this cohort of EPTI between day 8 and day 14. • There is no apparent benefit in prolonging incubator humidity beyond day 7 of life in these EPTI.

PMID:39641809 | DOI:10.1007/s00431-024-05893-w

Strahlenther Onkol. 2024 Dec 6. doi: 10.1007/s00066-024-02339-y. Online ahead of print.

ABSTRACT

PURPOSE: The association of cardiac dosimetric parameters with survival in lung cancer patients is well established. However, most research has concentrated on patients undergoing definitive treatment. This study aims to investigate the relationship between cardiac dosimetric parameters and survival in patients receiving postoperative radiotherapy (PORT).

METHODS: Sixty patients who received PORT between 2011 and 2021 were retrospectively evaluated. The substructures of the heart were delineated on the simulation computed tomography scans of the patients. Univariate and multivariate Cox regression analyses were conducted to investigate the correlation between dosimetric parameters and overall survival. The Statistical Package for the Social Sciences (SPSS) version 23.0 (IBM Corp., Armonk, NY, USA) was utilized for statistical analyses.

RESULTS: Right atrium (RA) maximum dose (Dmax) was the only variable that was significantly associated with a shorter OS. Further receiver operating characteristic (ROC) analysis revealed that the optimum cut-off value for RA Dmax was 43.6 Gy, with a sensitivity of 69% and a specificity of 62%. In addition, inclusion of the upper right paratracheal (2R), lower right paratracheal (4R), left pulmonary ligament (9L), and right hilus (10R) lymphatic stations in the treatment field led to an increase in RA Dmax.

CONCLUSION: The results of this retrospective study show that RA Dmax appears to have an impact on overall survival in patients undergoing PORT. Limiting the RA Dmax dose to below 43.6 Gy and avoiding elective nodal irradiation might potentially enhance survival in this patient cohort.

PMID:39641790 | DOI:10.1007/s00066-024-02339-y

Abdom Radiol (NY). 2024 Dec 6. doi: 10.1007/s00261-024-04722-w. Online ahead of print.

ABSTRACT

PURPOSE: Percutaneous ultrasound-guided renal biopsy is essential for diagnosing medical renal disorders in transplant kidneys. A variety of techniques have been advocated. The purpose of this study is to evaluate the safety and efficacy of two different coaxial techniques and biopsy devices.

METHODS: This single-center dual-arm, observation study cohort included 1831 consecutive transplant kidney biopsies performed over a 68-month period. Two coaxial techniques were used, distinguished by whether the 17 gauge (G) coaxial needle was advanced into the renal cortex (intracapsular technique; IC) or to the edge of the cortex (extracapsular technique; EC). One of two needle types could be used with either technique: an 18G side-cutting (Bard Max-Core or Mission) or an 18G end-cutting (Biopince Ultra) needle. In all cases, the cortical tangential technique was used to reduce the risk of central artery transgression and unnecessary medullary sampling. Patients were monitored for 30 days post-procedurally and complications were evaluated using the SIR adverse event classification.

RESULTS: Of the 1831 patients included in the study cohort, 13 suffered severe bleeding complications requiring operative intervention. Of these patients, 8 underwent biopsy with side-cutting needle and IC, 2 with side-cutting needle and approach not specified, 2 with end-cutting needle and IC, and 1 with end-cutting needle and EC. There was no statistically significant difference in the risk of bleeding complications between different coaxial techniques and needle types. However, there was a significantly increased chance of inadequate sampling when comparing the side-cutting needle (1.0%) to the end-cutting needle (0.1%).

CONCLUSIONS: Transplant kidney biopsy performed with two different coaxial techniques and needle types did not show differences in bleeding complications. There is an increased risk of inadequate sampling when using side-cutting relative to end-cutting biopsy devices.

PMID:39641782 | DOI:10.1007/s00261-024-04722-w

Afr J Reprod Health. 2024 Oct 31;28(10s):358-367. doi: 10.29063/ajrh2024/v28i10s.38.

ABSTRACT

Parents often perceive that stunting, wasting, and being underweight in their children are solely influenced by nutritional intake. In reality, various factors contribute to these outcomes. The objective of this study was to identify the factors associated with stunting, wasting, and being underweight in Indonesia. The design was a systematic literature review using the PRISMA procedure. The researchers applied a keyword search to databases collected via Science Direct, PubMed, ProQuest, SAGE and Emerald to find relevant articles published in English from 2016 to 2021. The results of the study found 17 relevant articles and revealed several factors associated with stunting, wasting and being underweight in Indonesia. All factors related to stunting, wasting, and underweight do not stand alone as the only predictors. Instead, they interact and contribute collectively to the occurrence of these conditions.

PMID:39641260 | DOI:10.29063/ajrh2024/v28i10s.38

Aliment Pharmacol Ther. 2024 Dec 6. doi: 10.1111/apt.18430. Online ahead of print.

ABSTRACT

BACKGROUND: Intestinal ultrasound (IUS) is a non-invasive tool for evaluating transmural inflammation in Crohn’s disease (CD). However, its utility is constrained by operator dependency and limited accessibility.

AIMS: To explore the feasibility of serum biomarkers-specifically leucine-rich alpha-2 glycoprotein (LRG)-as an alternative to IUS for assessing transmural inflammation.

METHODS: This retrospective, single-centre study included patients with CD who underwent IUS and measurements of LRG and C-reactive protein (CRP). We assessed correlations between biomarkers and five IUS scores (Limberg score, Bowel Ultrasound Score (BUSS), International Bowel Ultrasound Segmental Activity Score (IBUS-SAS), Simple Ultrasound Score (Simple-US) and Simple Ultrasound Score for Crohn’s Disease (SUS-CD)) using receiver operator characteristic curve analysis and Spearman’s rank correlation coefficient. We conducted subgroup analyses for patients in clinical remission.

RESULTS: We analysed 213 IUS examinations performed on 97 patients; 170 (80%) IUS were during clinical remission. The area under the curve for LRG for each IUS score (0.76, 0.80, 0.77, 0.75 and 0.69, respectively) was superior to that of CRP and was statistically significant, particularly for LS, BUSS, IBUS-SAS and Simple-US (p < 0.001, p = 0.018, p < 0.001 and p < 0.001, respectively). Predictive values remained consistent among patients in remission. LRG demonstrated excellent correlation with IUS scores in both the overall patient population and those in remission.

CONCLUSION: LRG showed a robust correlation with IUS scores, suggesting its potential as a novel indicator for targeting transmural healing in patients with CD.

PMID:39641226 | DOI:10.1111/apt.18430

Minerva Dent Oral Sci. 2024 Dec 6. doi: 10.23736/S2724-6329.24.05064-2. Online ahead of print.

ABSTRACT

BACKGROUND: Anxiety and fear are significant challenges in pediatric dentistry, often leading to avoidance of dental treatment. Some studies suggest a potential link between the dopamine beta-hydroxylase gene and the ABO gene. As ABO blood group type is determined genetically, it could serve as a bioindicator for assessing the impact of genetics on personality traits. The association between blood types and personality characteristics has long been debated.

METHODS: Eighty eligible children, meeting the inclusion criteria, were enrolled in the study. Blood group data were obtained from parents/guardians. Dental anxiety assessment was done using the RMS-Picture scale and pulse oximeter.

RESULTS: The collected data were analyzed statistically.

CONCLUSIONS: The study found no correlation between dental anxiety and ABO blood grouping.

PMID:39641189 | DOI:10.23736/S2724-6329.24.05064-2

Disaster Med Public Health Prep. 2024 Dec 6;18:e306. doi: 10.1017/dmp.2024.271.

ABSTRACT

OBJECTIVES: The mental health of paramedics is critical for disaster response in order to provide rapid and effective interventions. This study aimed to determine the prevalence of post-traumatic stress disorder (PTSD) and related individual and occupational factors in Turkish paramedics during the eleventh month of the COVID-19 pandemic.

METHODS: The “Sociodemographic Information Form,” “Life Events Checklist,” and “Post-Traumatic Stress Disorder Checklist” were used to collect data from 440 randomly selected paramedics in this cross-sectional study.

RESULTS: The prevalence of PTSD was 59.8% in the 11^th month of the COVID-19 pandemic. Multiple regression analysis revealed that approximately 25% of the total PTSD score could be independently explained by paramedics’ general health situation and sociodemographic characteristics; 27% by crisis management skills, long working hours, a lack of equipment, and intensive work; and 40% by past traumatic experiences due to difficult life events during their professional practice, such as responding to gunshot wounds, becoming a victim of a gunshot attack, or sexual assault (P < 0.05).

CONCLUSIONS: Integrating a mental health monitoring system into the health and safety program, providing paramedics with supervision and psychological assistance, and engaging them in disaster preparedness planning would be beneficial.

PMID:39641176 | DOI:10.1017/dmp.2024.271

Circ Cardiovasc Imaging. 2024 Dec 6:e017033. doi: 10.1161/CIRCIMAGING.124.017033. Online ahead of print.

ABSTRACT

BACKGROUND: Persistent immune activation is linked to elevated cardiovascular diseases in people with HIV on antiretroviral therapy. The fat attenuation index (FAI) is a measure of peri-coronary inflammation that independently predicts cardiovascular disease risk in people without HIV. Whether FAI is associated with immune activation is unknown.

METHODS: Peripheral blood T-cell activation and homing phenotypes were measured in people with HIV (n=58) and people without HIV (n=16) without known cardiovascular disease who underwent coronary computed tomography angiography and had FAI measurements. A cross-sectional analysis of an observational cohort was performed. The primary aim was to evaluate associations of T-cell activation and phenotypes with the outcome variables, FAI values of the right coronary artery and left anterior descending artery, which were assessed using multivariable regression models adjusted for age, natal sex, race, low-density lipoprotein cholesterol, body mass index, and use of lipid-lowering medication.

RESULTS: T cells from people with HIV showed greater activation, as measured by cluster of differentiation (CD) 38/human leukocyte antigen – DR isotype coexpression on CD4 central memory and terminally-differentiated effector memory subsets and on CD8 effector memory (TEM), than did cells from people without HIV. Expression of the chemokine receptor C-C Chemokine Receptor 2 was reduced on CD4 central memory and TEM and CD8 TEM and terminally-differentiated effector memory subsets in people with HIV. Among all participants, PD-1 (programmed cell death 1) in CD8 central memory was associated with worsened peri-coronary inflammation of the right coronary artery, whereas perforin/granzyme B on CD8 TEM was associated with improved peri-coronary inflammation of the right coronary artery and left anterior descending artery in adjusted analyses. When accounting for HIV serostatus, CD38/human leukocyte antigen – DR isotype coexpression on CD8 central memory, TEM, and terminally-differentiated effector memory cells was associated with more peri-coronary inflammation of the left anterior descending artery.

CONCLUSIONS: The associations between T-cell activation with FAI are novel and suggest that T-cell activation may be an important driver of peri-coronary inflammation, occurring at an early stage of atherosclerosis, even before the development of clinical disease.

PMID:39641168 | DOI:10.1161/CIRCIMAGING.124.017033

Circ Heart Fail. 2024 Dec 6:e011962. doi: 10.1161/CIRCHEARTFAILURE.124.011962. Online ahead of print.

ABSTRACT

BACKGROUND: In heart failure, sympathetic excess and exercise intolerance impair quality of life. In heart failure with reduced ejection fraction, exercise stimulates a reflex increase in muscle sympathetic nerve activity (MSNA) that relates inversely to peak oxygen uptake (V̇O_2peak). Whether similar sympathoexcitatory responses are present in heart failure with preserved EF (HFpEF) and relate to V̇O_2peak are unknown.

METHODS: In 13 patients with HFpEF (70±6 years), 17 comorbidity-matched controls (CMC; 67±8 years), and 18 healthy controls (65±8 years), we measured heart rate, blood pressure, and MSNA (microneurography) during (1) 7-minute baseline; (2) 2-minute isometric handgrip (40% maximal voluntary contraction) or rhythmic handgrip (50% and 30% maximal voluntary contraction) exercise, followed by 2-minute postexercise circulatory occlusion; and (3) 4-minute 1-leg cycling (2 minutes each at mild and moderate intensity). V̇O_2peak was obtained by open-circuit spirometry.

RESULTS: Resting MSNA was higher and V̇O_2peak was lower in HFpEF versus CMCs and healthy controls (all P<0.05). During handgrip, MSNA increased in all groups (all P<0.05); in HFpEF, MSNA was greater than CMCs and healthy controls during HG and postexercise circulatory occlusion at 40% isometric handgrip (all P<0.05) and HG only at 50% and 30% rhythmic handgrip (all P<0.05). During cycling, MSNA (bursts·min^-1) decreased during mild (-4±4; P=0.01) and moderate (-8±6; P<0.001) cycling in healthy controls, was unchanged during mild (+1±7; P=0.42) and moderate (+2±8; P=0.28) cycling in CMCs, yet increased in HFpEF during mild (+8±8; P<0.001) and moderate (+9±10; P<0.001) cycling. In HFpEF, the change in MSNA during moderate cycling related inversely to relative (r=-0.72; R ²=0.51; P<0.01) and percent-predicted (r=-0.63; R ²=0.39; P=0.03) V̇O_2peak. No statistically significant relationships were detected in controls (P>0.05).

CONCLUSIONS: In contrast to CMCs, patients with HFpEF exhibit augmented MSNA at rest and during exercise. The magnitude of such paradoxical sympathoexcitation during dynamic cycling relates inversely to V̇O_2peak, consistent with a neurogenic, vasoconstrictor limit on exercise capacity in HFpEF.

PMID:39641163 | DOI:10.1161/CIRCHEARTFAILURE.124.011962

Hand (N Y). 2024 Dec 6:15589447241298982. doi: 10.1177/15589447241298982. Online ahead of print.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) is a promising tool to aid in diagnostic accuracy and patient communication. Prior literature has shown that ChatGPT answers medical questions and can accurately diagnose surgical conditions. The purpose of this study was to determine the accuracy of ChatGPT 4.0 in evaluating radiologic imaging of common orthopedic upper extremity bony pathologies, including identifying the imaging modality and diagnostic accuracy.

METHODS: Diagnostic imaging was sourced from an open-source radiology database for 6 common upper extremity bony pathologies: distal radius fracture (DRF), metacarpal fracture (MFX), carpometacarpal osteoarthritis (CMC), humerus fracture (HFX), scaphoid fracture (SFX), and scaphoid nonunion (SN). X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) modalities were included. Fifty images were randomly selected from each pathology where possible. Images were uploaded to ChatGPT 4.0 and queried for imaging modality, laterality, and diagnosis. Each image query was completed in a new ChatGPT search tab. Multinomial linear regression was used to identify variations in ChatGPT’s diagnostic accuracy across imaging modalities and medical conditions.

RESULTS: Overall, ChatGPT provided a diagnosis for 52% of images, with accuracy ranging from 0% to 55%. Diagnostic accuracy was significantly lower for SFX and MFX relative to HFX. ChatGPT was significantly less likely to provide a diagnosis for MRI relative to CT. Diagnostic accuracy ranged from 0% to 40% with regard to imaging modality (x-ray, CT, MRI) though this difference was not statistically significant.

CONCLUSIONS: ChatGPT’s accuracy varied significantly between conditions and imaging modalities, though its iterative learning capabilities suggest potential for future diagnostic utility within hand surgery.

PMID:39641156 | DOI:10.1177/15589447241298982