Category: Statistics

Spine Deform. 2024 Dec 17. doi: 10.1007/s43390-024-01018-3. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the impact of different positions of adolescent idiopathic scoliosis (AIS) patients and examiners on the angle of trunk rotation (ATR) measured during the forward bending test (FBT) with Scoliometer.

METHODS: Adolescents who had come to the hospital for outpatient were recruited. Considering the location of the subject and the examiner, four postural combinations of ATR were measured. After measuring ATR, the subject underwent radiographic measurements for diagnosis of AIS. Mann-Whitney test was used for the inter-group reliability test in two examiners, and the Kruskal-Wallis test was used to measure intra-group differences in ATR for the four positions. The receiver operating characteristic curve and area under the curve were used to evaluate the diagnostic performance of ATR in AIS measured by different postures. Preplanned sensitivity analyses of the primary outcome were performed by subgroup.

RESULTS: Of the 63 participants suspected of having AIS included, there was no statistically significant difference (P > 0.05) observed between ATR measurements taken in different postures. Only the measurements taken by the examiner from behind the subject demonstrated diagnostic capability for AIS (AUC = 0.73 for both feet together and apart, $P<0.05$ ). There was no statistically significant difference ( $P=0.989)$ in diagnostic ability between the subjects who stood with feet together or apart. The sensitivity analysis supports the robustness of the conclusions ( $P>0.05)$ .

CONCLUSION: When the examiner measured from behind the subject, AIS can be effectively diagnosed, regardless of whether the subject is standing on feet apart or feet together. There is no difference in diagnostic ability in ATR between the two forward bending positions.

LEVEL OF EVIDENCE: Level III.

PMID:39690294 | DOI:10.1007/s43390-024-01018-3

Aesthetic Plast Surg. 2024 Dec 17. doi: 10.1007/s00266-024-04619-5. Online ahead of print.

ABSTRACT

BACKGROUND: This retrospective cohort study aimed to assess differences in surgical trauma between the inframammary fold approach and endoscopic transaxillary approach in breast augmentation surgery.

METHODS: One hundred and ninety-four patients who underwent breast augmentation using either an inframammary fold or endoscopic transaxillary approach were enrolled. All procedures were primary and bilateral cases. Patients’ demographics and indicators, such as operation duration, postoperative volume of drainage, drainage duration, length of hospital stay, and postoperative pain scores, were observed and analyzed.

RESULTS: One hundred and five patients underwent inframammary fold incisions, while the remaining 89 received transaxillary incisions. The operation duration was significantly shorter in the inframammary fold group than in the transaxillary group, while the VAS scores were significantly lower (p < 0.001). Similarly, differences in the age and fertility status between the two groups were statistically significant (p < 0.05). However, no statistically significant differences were noted in the scores of the remaining indicators (p < 0.05).

CONCLUSIONS: This research demonstrated that while patients in the endoscopic transaxillary group were typically younger, which is commonly hypothesized to result in superior results, the inframammary fold approach may offer a surgical option with reduced trauma and pain and concomitantly greater convenience and efficiency, yielding high satisfaction levels among Chinese women.

LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

PMID:39690204 | DOI:10.1007/s00266-024-04619-5

Aesthetic Plast Surg. 2024 Dec 17. doi: 10.1007/s00266-024-04616-8. Online ahead of print.

ABSTRACT

BACKGROUND: The prevalence of body dysmorphic disorder (BDD) varies across different clinical settings, with evidence indicating its notable presence not only in psychiatric environments but also in dermatology and plastic surgery. This article aims to investigate the etiological factors associated with the elevated incidence of BDD in plastic surgery outpatient settings, with the ultimate objective of enhancing the assessment process for potential cosmetic procedure candidates.

METHODS: We recruited 531 patients seeking consultations or surgeries at the Department of Plastic Surgery, Peking University Shenzhen Hospital, from October 2022 to February 2024. The Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS) was utilized to diagnose BDD, and the Hospital Anxiety and Depression Scale (HADS) assessed psychological comorbidities. Statistical analyses included Spearman’s correlation, Kruskal-Wallis, and chi-square tests.

RESULTS: BDD was diagnosed in 11.3% of the participants, with significant variations related to gender (p = 0.042) and marital status (p = 0.026). A significant correlation was also displayed between BDD-YBOCS and HADS (Spearman’s rho = 0.266, p < 0.001). Notably, BDD prevalence was higher during the COVID-19 pandemic (13.6%) compared to post-pandemic period (3.4%) (p = 0.003).

CONCLUSION: This study elucidates the significant prevalence of body dysmorphic disorder (BDD) among patients seeking cosmetic surgery, highlighting critical demographic, psychological and environmental factors that contribute to its manifestation. Given the significant prevalence and the multifactorial nature of BDD, it is important to develop comprehensive assessment tools before cosmetic consultation that prioritize mental health alongside aesthetic considerations in the future.

LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:39690202 | DOI:10.1007/s00266-024-04616-8

J Am Chem Soc. 2024 Dec 17. doi: 10.1021/jacs.4c12607. Online ahead of print.

ABSTRACT

NMR is a central tool in the field of metabolomics, thanks to its ability to provide valuable structural and quantitative information with high precision. Most NMR-based metabolomics studies rely on 1D ¹H detection, which is heavily limited by strong peak overlap. ¹³C NMR benefits from a wider spectral dispersion and narrower signal line width but is barely used in metabolomics due to its low sensitivity. Dissolution dynamic nuclear polarization (d-DNP) offers an opportunity to improve ¹³C NMR sensitivity by several orders of magnitude. Here, we show that this emerging hyperpolarized metabolomics approach can provide meaningful information about clinical samples. Achieving sub-mM limits of detection with ¹³C at natural abundance in urine samples was made possible by a meticulous design of the experimental workflow. The analysis of human urine samples from patients with different stages of chronic kidney disease (CKD) was performed using ¹³C d-DNP NMR and benchmarked to conventional ¹H NMR metabolomics at a high magnetic field to explore the complementarity between the two methods. Multivariate analysis of the d-DNP ¹³C NMR dataset provided a statistical model able to distinguish patients with CKD from control patients. Moreover, ¹³C d-DNP NMR spectra highlighted several biomarkers known to be biologically relevant. Some of them were in agreement with those obtained with conventional ¹H NMR, and the results also highlighted the complementarity of biomarker coverage between hyperpolarized and conventional NMR metabolomics. In particular, ¹³C hyperpolarized NMR allowed the annotation of two biomarkers that could not be detected by ¹H NMR because of peak overlap (i.e., guanine and guanidoacetate).

PMID:39690120 | DOI:10.1021/jacs.4c12607

J Magn Reson Imaging. 2024 Dec 17. doi: 10.1002/jmri.29672. Online ahead of print.

ABSTRACT

BACKGROUND: Deep learning (DL) often requires an image quality metric; however, widely used metrics are not designed for medical images.

PURPOSE: To develop an image quality metric that is specific to MRI using radiologists image rankings and DL models.

STUDY TYPE: Retrospective.

POPULATION: A total of 19,344 rankings on 2916 unique image pairs from the NYU fastMRI Initiative neuro database was used for the neural network-based image quality metrics training with an 80%/20% training/validation split and fivefold cross-validation.

FIELD STRENGTH/SEQUENCE: 1.5 T and 3 T T1, T1 postcontrast, T2, and FLuid Attenuated Inversion Recovery (FLAIR).

ASSESSMENT: Synthetically corrupted image pairs were ranked by radiologists (N = 7), with a subset also scoring images using a Likert scale (N = 2). DL models were trained to match rankings using two architectures (EfficientNet and IQ-Net) with and without reference image subtraction and compared to ranking based on mean squared error (MSE) and structural similarity (SSIM). Image quality assessing DL models were evaluated as alternatives to MSE and SSIM as optimization targets for DL denoising and reconstruction.

STATISTICAL TESTS: Radiologists’ agreement was assessed by a percentage metric and quadratic weighted Cohen’s kappa. Ranking accuracies were compared using repeated measurements analysis of variance. Reconstruction models trained with IQ-Net score, MSE and SSIM were compared by paired t test. P < 0.05 was considered significant.

RESULTS: Compared to direct Likert scoring, ranking produced a higher level of agreement between radiologists (70.4% vs. 25%). Image ranking was subjective with a high level of intraobserver agreement ( $94.9\%\pm 2.4\%$ ) and lower interobserver agreement ( $61.47\%\pm 5.51\%$ ). IQ-Net and EfficientNet accurately predicted rankings with a reference image ( $75.2\%\pm 1.3\%$ and $79.2\%\pm 1.7\%$ ). However, EfficientNet resulted in images with artifacts and high MSE when used in denoising tasks while IQ-Net optimized networks performed well for both denoising and reconstruction tasks.

DATA CONCLUSION: Image quality networks can be trained from image ranking and used to optimize DL tasks.

LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 1.

PMID:39690114 | DOI:10.1002/jmri.29672

Bull Cancer. 2024 Dec 16:S0007-4551(24)00461-2. doi: 10.1016/j.bulcan.2024.11.005. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to explore the mechanism by which HIV infection promotes cervical cancer and precancerous lesions.

METHODS: This was a retrospective observational study including 96 patients with high-risk HPV-16 infection who underwent cervical biopsy, cervical conization, or hysterectomy. Among them, 43 patients were diagnosed with both HIV and cervical cancer or precancerous lesions. High-risk HPV infection (HPV16+) positive samples were collected, and total RNA was extracted and amplified by fluorescence quantitative PCR. The expression of HPV E2 and E6 in cervical tissues of HIV-infected and non-HIV-infected patients with high-risk HPV was determined.

RESULTS: As the degree of cervical tissue lesions increased, the proportions of integrated HPV-16 increased significantly within both HIV-negative (P=0.008) and HIV-positive groups (P=0.027). In comparison to the HIV-positive group, although the HIV-negative group had a higher proportion of free type HPV-16 infection (64.3% vs. 35.7%) and a lower proportion of integrated type infection (41.7% vs. 58.3%), the differences were not statistically significant (P=0.117). The lower the CD4+ T lymphocyte level, the greater the possibility of HPV-16 integrated infection.

CONCLUSIONS: Patients with HIV and HPV-16 infection exhibit a significantly higher rate of integrated HPV-16 infection, which is closely linked to HIV-induced immunosuppression, particularly the depletion of CD4+ T lymphocytes. This integration accelerates the progression of cervical lesions, increasing the risk of developing high-grade cervical intraepithelial neoplasia or cervical cancer. These findings underscore the need for targeted screening and therapeutic strategies in HIV-positive women to prevent HPV-related malignancies.

PMID:39690095 | DOI:10.1016/j.bulcan.2024.11.005

Nutr Metab Cardiovasc Dis. 2024 Nov 9:103789. doi: 10.1016/j.numecd.2024.103789. Online ahead of print.

ABSTRACT

AIMS: Atherosclerosis is a life-threatening disease that develops when a plaque builds up inside an artery and progresses silently. Identifying the early pathological changes and the biomarkers of atherosclerosis deserves attention. We aimed to systematically study and integrate the various metabolites of atherosclerosis in the level of disease to provide more evidences to support early prevention and treatment of atherosclerosis.

DATA SYNTHESIS: The protocol was registered with PROPSERO (CRD42023441845). We searched 14,985 records via EMBASE, PubMed, Web of Science, WanFang data, VIP data, and CNKI databases. The collected metabolites were for qualitative and quantitative meta-analysis. The I² statistic estimated heterogeneity, with over 50 % considered to adopt the random-effects model. A total of 49 articles were included in the meta-analysis. We finally integrated 83 and 16 metabolites presented more than two times in inclusion studies, respectively in blood (plasma and serum) and urine. Among them, the level of citric acid (SMD = -10.35 [95%CI -15.03, -5.67], p < 0.001), lactic acid (SMD = 6.32 [95%CI 0.12, 12.52], p < 0.001) and TMAO (SMD = 1.40 [95%CI 0.27, 2.53], p < 0.001) had significant differences between atherosclerosis and controls. And we observed blood stasis syndrome of atherosclerosis patients present arterial ischemia and energy disorder obviously.

CONCLUSIONS: The study provides an in-depth understanding of the roles of metabolites on atherosclerosis progression and prediction primarily in Chinese population, which contributing to development of prevention and therapeutic potential in the future.

PMID:39690044 | DOI:10.1016/j.numecd.2024.103789

Jt Comm J Qual Patient Saf. 2024 Nov 2:S1553-7250(24)00330-1. doi: 10.1016/j.jcjq.2024.10.012. Online ahead of print.

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic affected quality improvement work that was key to hospital-acquired infection (HAI) prevention efforts for many hospitals. Central line-associated bloodstream infection (CLABSI) standardized infection ratios (SIRs) were highly affected by the pandemic.

METHODS: After seeing an increase in CLABSI SIRs through early 2021, a health care system including 12 acute care hospitals in the midwestern United States focused on processes and process measures for CLABSI prevention. Each hospital was asked to identify a medical provider, nursing, and infection prevention lead to champion the work (identified as a CLABSI triad). CLABSI triads emphasized best practice expectations, standardized technology and products, and implemented reporting and trending of compliance. Work started in July 2021, with multiple initiatives rolled out through the end of 2022. CLABSI SIRs and standardized utilization ratios (SURs) were analyzed with interrupted time series analysis; changes in several process measures were analyzed using Wilcoxon rank sum exact testing.

RESULTS: A 47.5% decrease was seen in CLABSI SIR through the study period, with SIR = 0.61 from 2023 to April 2024. The slope of the trend line for CLABSI SIR and central line utilization had a significant downward trend in the intervention time frame (p = 0.04 and p < 0.01, respectively). CLABSI prevention best practices improved statistically during the study period.

CONCLUSION: Intense focus by leadership on key CLABSI prevention process measures was associated with lower CLABSI SIRs.

PMID:39690035 | DOI:10.1016/j.jcjq.2024.10.012

Clin Ther. 2024 Dec 16:S0149-2918(24)00371-0. doi: 10.1016/j.clinthera.2024.11.023. Online ahead of print.

ABSTRACT

PURPOSE: Down syndrome regression disorder (DSRD) is a rare neuropsychiatric condition affecting otherwise healthy individuals with Down syndrome. Multiple studies on DSRD have revealed that immunotherapy with intravenous immunoglobulin (IVIg) is both safe and effective, although site of infusion has never been studied. This study sought to evaluate the safety and tolerability of IVIg in individuals with DSRD receiving home-based infusions.

METHODS: A single-center, retrospective chart review evaluating infusion reactions was performed for individuals meeting criteria for DSRD and having received IVIg infusions between 2019 and 2024. Adverse events (AEs) were evaluated for severity and need for alterations in infusion plan. A cohort of individuals receiving home-based infusions was compared with a cohort of individuals receiving infusions at an academic medical center.

FINDINGS: A total of 315 individuals (162 institutional infusions [51%] and 153 home infusions [49%]) met the inclusion criteria. There were no statistical differences between the demographic and clinical features of the cohorts. Individuals receiving home infusions had the same rate of AE during an infusion (P = 0.14), although they did have a lower number of total AEs (P < 0.001). Individuals receiving home infusions experienced a lower number of behavioral issues with infusions (P = 0.03) and had significantly lower discontinuations of infusions secondary to behavioral issues (P = 0.04).

IMPLICATIONS: Rates of AEs and serious AEs in those with DSRD were the same regardless of site of infusion. These data should be considered in policy regarding the appropriateness of home-based infusions as a safe alternative, when suitable for patients and caregivers, for individuals with DSRD.

PMID:39690018 | DOI:10.1016/j.clinthera.2024.11.023

Surgery. 2024 Dec 16:108937. doi: 10.1016/j.surg.2024.09.050. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic lymphocytic thyroiditis is an autoimmune thyroid disorder and the most common cause of hypothyroidism in women. Many studies suggest that chronic lymphocytic thyroiditis contributes to a diagnostic challenge in thyroid nodules and may increase the risk of developing papillary thyroid cancer. This study examines preoperative clinical factors and tumor characteristics associated with papillary thyroid cancer among patients with chronic lymphocytic thyroiditis.

METHODS: A retrospective review of prospectively collected data of patients who underwent total thyroidectomy between 2009 and 2020 at a tertiary institution was performed. Sociodemographic factors, comorbidities, surgeon-performed ultrasound, fine needle aspiration, tumor characteristics, and final histopathology were studied. Patients were subdivided into 2 groups based on final histopathology: chronic lymphocytic thyroiditis alone and chronic lymphocytic thyroiditis with papillary thyroid cancer. χ² tests were used for independence among categorical variables, and comparisons were based on t tests.

RESULTS: Of 2,200 total thyroidectomy patients, the majority of 250 patients with chronic lymphocytic thyroiditis were women (90.4%) and had a mean age of 50 (±13) years. All patients with chronic lymphocytic thyroiditis underwent preoperative ultrasound, 89.2% (n = 223) underwent fine needle aspiration preoperatively, and 25.2% (n = 63) presented with obstructive symptoms, whereas 53.6% (n = 134) had papillary thyroid cancer on final histopathology and 74.8% (n = 187) underwent central neck lymph node removal. When comparing patients with chronic lymphocytic thyroiditis alone with those with chronic lymphocytic thyroiditis and papillary thyroid cancer, no differences for sex, race, nodule density, nodule size, echogenicity, irregular borders, and number of nodules were identified, but there was a statistically significant difference for obstructive symptoms (37.1% vs 14.9%), multinodular goiter (55.8% vs 32.3%), microcalcifications (18.4% vs 36.6%), Bethesda III fine needle aspiration results (41.4% vs 27.4%), and central neck lymph node removal (58.6% vs 88.8%), respectively (P < .05). Preoperative fine needle aspiration in patients with chronic lymphocytic thyroiditis for papillary thyroid cancer had a positive predictive value of 92.9%, negative predictive value of 83.3%, false positive rate of 13.8%, and false negative rate of 8.8%.

CONCLUSION: Although thyroid ultrasound features may have limited utility for malignancy, fine needle aspiration of index thyroid nodules still demonstrates a high positive predictive value in stratifying patients with chronic lymphocytic thyroiditis with papillary thyroid cancer. A higher level of suspicion preoperatively may be needed to avoid unnecessary lymph node removal for patients with chronic lymphocytic thyroiditis.

PMID:39690015 | DOI:10.1016/j.surg.2024.09.050