Category: Statistics

Curr Probl Diagn Radiol. 2024 Mar 8:S0363-0188(24)00049-5. doi: 10.1067/j.cpradiol.2024.03.002. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine if gadolinium-based contrast agents increase the sensitivity, specificity or reader confidence of malignant potential in musculoskeletal soft tissue tumors.

METHODS: Pre- and post-contrast MRI studies from 87 patients were read by three independent radiologists of different experience. Readers noted malignant potential and confidence in their diagnosis based on pre-contrast and post-contrast MRI studies. Statistical models assessed for agreement between MRI reader diagnosis and pathologic results as well as analyzing effects of contrast on reader confidence. Inter- and intra-observer variabilities of malignant potential were also calculated.

RESULTS: 87 patients (48 benign and 39 malignant; mean [± SD] age 51 ± 17.9 and 57.1 ± 17.1, respectively) were evaluated. For all readers, pre-contrast and post-contrast sensitivities were 68.1 % and 70.6 % while pre-contrast and post-contrast specificities were 84.6 % and 83.8 %, respectively without significant change (p=0.88). There was not a significant association with the use of contrast and prediction of malignant potential with or without the resident reader (p=0.65 and p=0.82). Use of contrast was significantly associated with higher levels of reader confidence (p=0.02) for all readers. Inter- and intra-observer variabilities were in good agreement (W = 0.77 and 0.70).

CONCLUSION: The addition of a post-contrast sequence increased reader confidence in their diagnosis without a corresponding significant increase in accurate prediction of malignant potential.

PMID:38480060 | DOI:10.1067/j.cpradiol.2024.03.002

Bull Cancer. 2024 Mar 12:S0007-4551(24)00074-2. doi: 10.1016/j.bulcan.2024.01.006. Online ahead of print.

ABSTRACT

INTRODUCTION: Quality of life (QoL) and patient satisfaction are major concerns in oncology.

METHODS: The aim of this prospective observational study was to evaluate these parameters according to the mode of administration of anti-HER2 (subcutaneous [SC] versus intravenous [IV]), the place of administration (Home Hospitalization or HOD versus hospital) for patients supervised by an advanced practice nurse (APN).

RESULTS: Between January 2022 and June 2023, 32 patients were included. They were statistically more satisfied with subcutaneous management (P=0.0004), a result explained by the speed of administration (43.5%), comfort during administration (26%) even though some expressed pain on injection and felt less anxiety (26%). Management by the APN seems more appropriate when anti-HER2 drugs were administered in HOD. In HOD, patients perceived an overall improvement in their quality of life, appetite and cognitive abilities, with a reduction in fatigue, pain and depression (P<0.05). However, the rate of outsourcing to HOD remained too low (30.4%), as 56.3% of patients would have liked to be cared for in HOD if they had had the opportunity.

CONCLUSION: SC administration of anti-HER2 under the supervision of an APN has advantages for the patient, resulting in greatest satisfaction and improved patient QOL, preferably in HOD.

PMID:38480056 | DOI:10.1016/j.bulcan.2024.01.006

Am J Obstet Gynecol. 2024 Feb 29:S0002-9378(24)00005-X. doi: 10.1016/j.ajog.2023.12.038. Online ahead of print.

ABSTRACT

BACKGROUND: National Vital Statistics System reports show that maternal mortality rates in the United States have nearly doubled, from 17.4 in 2018 to 32.9 per 100,000 live births in 2021. However, these high and rising rates could reflect issues unrelated to obstetrical factors, such as changes in maternal medical conditions or maternal mortality surveillance (eg, due to introduction of the pregnancy checkbox).

OBJECTIVE: This study aimed to assess if the high and rising rates of maternal mortality in the United States reflect changes in obstetrical factors, maternal medical conditions, or maternal mortality surveillance.

STUDY DESIGN: The study was based on all deaths in the United States from 1999 to 2021. Maternal deaths were identified using the following 2 approaches: (1) per National Vital Statistics System methodology, as deaths in pregnancy or in the postpartum period, including deaths identified solely because of a positive pregnancy checkbox, and (2) under an alternative formulation, as deaths in pregnancy or in the postpartum period, with at least 1 mention of pregnancy among the multiple causes of death on the death certificate. The frequencies of major cause-of-death categories among deaths of female patients aged 15 to 44 years, maternal deaths, deaths due to obstetrical causes (ie, direct obstetrical deaths), and deaths due to maternal medical conditions aggravated by pregnancy or its management (ie, indirect obstetrical deaths) were quantified.

RESULTS: Maternal deaths, per National Vital Statistics System methodology, increased by 144% (95% confidence interval, 130-159) from 9.65 in 1999-2002 (n=1550) to 23.6 per 100,000 live births in 2018-2021 (n=3489), with increases occurring among all race and ethnicity groups. Direct obstetrical deaths increased from 8.41 in 1999-2002 to 14.1 per 100,000 live births in 2018-2021, whereas indirect obstetrical deaths increased from 1.24 to 9.41 per 100,000 live births: 38% of direct obstetrical deaths and 87% of indirect obstetrical deaths in 2018-2021 were identified because of a positive pregnancy checkbox. The pregnancy checkbox was associated with increases in less specific and incidental causes of death. For example, maternal deaths with malignant neoplasms listed as a multiple cause of death increased 46-fold from 0.03 in 1999-2002 to 1.42 per 100,000 live births in 2018-2021. Under the alternative formulation, the maternal mortality rate was 10.2 in 1999-2002 and 10.4 per 100,000 live births in 2018-2021; deaths from direct obstetrical causes decreased from 7.05 to 5.82 per 100,000 live births. Deaths due to preeclampsia, eclampsia, postpartum hemorrhage, puerperal sepsis, venous complications, and embolism decreased, whereas deaths due to adherent placenta, renal and unspecified causes, cardiomyopathy, and preexisting hypertension increased. Maternal mortality increased among non-Hispanic White women and decreased among non-Hispanic Black and Hispanic women. However, rates were disproportionately higher among non-Hispanic Black women, with large disparities evident in several causes of death (eg, cardiomyopathy).

CONCLUSION: The high and rising rates of maternal mortality in the United States are a consequence of changes in maternal mortality surveillance, with reliance on the pregnancy checkbox leading to an increase in misclassified maternal deaths. Identifying maternal deaths by requiring mention of pregnancy among the multiple causes of death shows lower, stable maternal mortality rates and declines in maternal deaths from direct obstetrical causes.

PMID:38480029 | DOI:10.1016/j.ajog.2023.12.038

J Prosthet Dent. 2024 Mar 12:S0022-3913(24)00128-8. doi: 10.1016/j.prosdent.2024.02.012. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: A trial restoration is an important diagnostic tool that can be fabricated through analog or digital pathways. Digital workflows may have improved accuracy, but this is yet to be demonstrated conclusively.

PURPOSE: The purpose of this in vitro study was to compare the dimensional accuracy of trial restorations produced by different analog (molded) and digital (milled and 3D printed) methods. Parameters studied included fabrication methods, Shore-A hardness of silicone putty indices, length of span, and labial tooth levels.

MATERIAL AND METHODS: Digital additive trial restorations were designed on a single virtual cast from maxillary right to left lateral incisor teeth (4 teeth) and from maxillary right to left first premolar teeth (8 teeth). Both designs were identical on the 4 anterior teeth. Each digital trial restoration was 3-dimensionally (3D) printed to produce reference casts. The original cast was 3D printed to produce 44 replica casts. There were 8 experimental groups (4 analog and 4 digital) with 10 specimens each. For the analog groups, 20 silicone indices per reference cast were made: 10 from standard silicone putty (63 to 70 Shore-A hardness) and 10 from hard silicone putty (90 Shore-A hardness). The analog trial restorations were molded on replica casts with silicone indices and bis-acryl resin. The digital trial restorations were either milled or 3D printed and adapted onto replica casts. Each trial restoration was scanned and digitally superimposed onto respective scanned reference casts. Measurements were recorded at 3 levels: cervical, middle, and incisal. The independent samples Kruskal-Wallis, 2-sample Mann-Whitney, and Bonferroni tests were used to compare the distribution of accuracy among all groups (α=.05).

RESULTS: The dimensional accuracy of the different trial restoration fabrication methods was comparable in terms of median values of trueness (how close the readings were to the reference), and no statistically significant difference was found among them (P>.05). When the dimensional accuracy in terms of precision (how close the readings were to each other) were analyzed, the hard putty groups demonstrated a statistically significant better outcome, whereas standard putty consistently showed the poorest result. The incisal level displayed the most significant deviation (P=.005) when all groups were compared. The incisal discrepancy values of the short-span standard putty trial restoration varied by as much as 0.84 mm in some specimens.

CONCLUSIONS: Milled and 3D printed trial restoration fabrication techniques showed dimensional accuracy comparable with that of the analog groups. However, the choice of silicone putty was shown to affect the dimensional accuracy of an analog molded trial restoration. A high Shore-A hardness silicone putty produced the best precision and should be used when fabricating an analog molded trial restoration.

PMID:38480017 | DOI:10.1016/j.prosdent.2024.02.012

J Prosthet Dent. 2024 Mar 12:S0022-3913(24)00143-4. doi: 10.1016/j.prosdent.2024.02.019. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: Precise data are a prerequisite for accurately fitting restorations. Therefore, intraoral scanners have to be reliable. Data on differences between the same model of intraoral scanning systems are lacking.

PURPOSE: This in vitro study evaluated differences in the scanning accuracy of a partially edentulous maxilla between combinations of new intraoral scanners of a single model from the same manufacturer (Primescan; Dentsply Sirona) and several calibration aids.

MATERIAL AND METHODS: The in vitro reference model simulated a maxilla with 6 prepared teeth for a complete arch fixed partial denture. Five precision ceramic balls were used to detect dimensional deviation between the reference model and the scan. Distances were divided into 4 categories, from short distances between 2 neighboring precision balls to the cross-arch distance with the scan path comprising all 5 balls. For each combination of 4 new intraoral scanners and their respective calibration aids, 12 model registrations were generated. The data were statistically analyzed using ANOVA (α=.05).

RESULTS: Distance deviations increased with increasing scan path length and were significantly affected by the covariates “scanner” (P≤.023) and, for 3 of 4 distance categories, the “calibration aid” (short, medium, and long distances: P≤.013). For short and medium distances, acceptable scanning results were achieved for all test groups. The largest deviation was 539 µm for the cross-arch distance.

CONCLUSIONS: Scanning accuracy depends on the scanner and the calibration aid used, in particular, for spans exceeding a single quadrant.

PMID:38480016 | DOI:10.1016/j.prosdent.2024.02.019

Clin Nutr ESPEN. 2024 Apr;60:362-372. doi: 10.1016/j.clnesp.2024.02.025. Epub 2024 Feb 29.

ABSTRACT

BACKGROUND: Irritable bowel syndrome (IBS) is a common gastrointestinal disease characterized by abdominal pain, distension, and altered bowel habits. Probiotics may alleviate IBS symptoms, but clinical trials remain conflicting.

AIMS: To conduct a systematic review and meta-analysis of clinical trials to evaluate the efficacy and safety of probiotics for IBS patients.

METHODS: We searched relevant trials in PubMed, Web of Science, Embase, Cochrane Library, and Google Scholar from 2000 to June 2023. Standardized mean difference (SMD) and 95% confidence interval (CI) were calculated for continuous outcomes. A risk ratio (RR) and a 95% CI were calculated for dichotomous outcomes.

RESULTS: A total of 20 studies involving 3011 patients were obtained. The results demonstrated that probiotics are more effective than placebo in reducing global IBS symptoms improvement rate (RR = 1.401, 95% CI 1.182-1.662, P < 0.001) and quality of life scores (SMD = 0.286, 95% CI = 0.154-0.418, P < 0.001). Subgroup analyses showed that a shorter treatment time (less than eight weeks) could reduce distension scores (SMD = 0.197, 95% CI = 0.038-0.356, P = 0.015). High doses (daily dose of probiotics ≥ 10ˆ10) or multiple strains of probiotics exhibit beneficial effects on abdominal pain (SMD = 0.412, 95% CI = 0.112-0.711, P = 0.007; SMD = 0.590, 95% CI = 0.050-1.129, P = 0.032; respectively). However, there was no significant benefit on global symptom scores (SMD = 0.387, 95% CI 0.122 to 0.653, P = 0.004) with statistically high inter-study heterogeneity (I2 = 91.9%, P < 0.001). Furthermore, there was no significant inter-group difference in terms of adverse events frequency (RR = 0.997, 95% CI 0.845-1.177, P = 0.973).

CONCLUSION: Probiotics are effective and safe for IBS patients. High doses or multiple probiotic strains seem preferable, but definite conclusions are challenging due to the high heterogeneity. Large-scale, well-designed, and rigorous trials are needed to confirm their effectiveness.

PMID:38479936 | DOI:10.1016/j.clnesp.2024.02.025

Clin Nutr ESPEN. 2024 Apr;60:348-355. doi: 10.1016/j.clnesp.2024.02.021. Epub 2024 Feb 27.

ABSTRACT

BACKGROUND & AIMS: Patients receiving oncological esophagectomy or gastrectomy are known to be at high risk for vitamin and micronutrient deficiency before, during and after surgery. However, there are no clear guidelines for these cancer patients regarding postoperative vitamin supplementation.

METHODS: We conducted a metanalysis consisting of 10 studies regarding vitamin and micronutrient deficiencies after oncological gastric or esophageal resection. 5 databases were searched.

RESULTS: Data was sufficient regarding Vitamins B12 and 25-OH D3 as well as calcium. We were able to show deficiencies in 25-OH Vitamin D3 levels (p < 0.001) and lower levels of Vitamin B12 and calcium (bit p < 0.001) when compared to the healthy population.

CONCLUSIONS: Patients from these groups are at risk for vitamin deficiencies. A guideline on postoperative supplementation is needed.

PMID:38479934 | DOI:10.1016/j.clnesp.2024.02.021

Clin Nutr ESPEN. 2024 Apr;60:298-302. doi: 10.1016/j.clnesp.2024.02.020. Epub 2024 Feb 21.

ABSTRACT

BACKGROUND & AIMS: Disruptions in the home parenteral nutrition (HPN) process may lead to failure to achieve the intended treatment purposes. This study aimed to evaluate the mid-term clinical outcome in a group of patients with short bowel syndrome (SBS) after a sudden change in the type of home parenteral nutrition programs from customized to commercially premixed admixtures.

METHODS: The study conducted in 2020 identified 51 patients with SBS: 27 (53%) women and 24 (47%) men. The SBS were classified as SBS with end jejunostomy 23 (45%) patients, with jejuno-colon anastomosis 23 (45%) patients, with jejuno-ileo anastomosis and total colon in continuity 5 (10%) patients. The following therapeutic program-related data were analysed: changes in nutritional status, body mass index (BMI), Controlling Nutritional Status (CONUT) score, and biochemical assessment. For statistical analysis, the Wilcoxon rank-sum and signed-rank paired tests with continuity corrections were used to compare the results. A p-value of <0.001 was considered statistically significant.

RESULTS: There was no statistically significant difference between the analysed groups in total energy, amino acid concentrations, and intravenous volume supplementation. BMI and CONUT assessments of nutritional status and selected biochemical parameters were stable during the study period.

CONCLUSIONS: The study demonstrated that a sudden change in the HPN therapy program from parenteral admixtures, tailored to meet individual patients’ needs, to commercially premixed admixtures had no significant impact on the mid-term clinical condition of patients with SBS.

PMID:38479925 | DOI:10.1016/j.clnesp.2024.02.020

Clin Nutr ESPEN. 2024 Apr;60:187-194. doi: 10.1016/j.clnesp.2024.01.021. Epub 2024 Jan 30.

ABSTRACT

INTRODUCTION: Among the many micronutrients, Vitamin D deficiency has been associated with the severity of Severe Acute Respiratory Syndrome Coronavirus 2 patients.

DESIGN AND METHODS: A retrospective observational study was conducted on Severe acute respiratory syndrome coronavirus 2 patients admitted to a tertiary care hospital between April 5, 2021, and May 5, 2021.

RESULTS: Among 285 patients,77.2 % of the patients who stayed for more than 14 days were either Vitamin D insufficient or deficient [P value < 0.05]. In our study, the mean oxygen saturation at admission was 85.7 % in the Vitamin D deficiency group compared to 95.6 % in Vitamin D sufficiency patients [P value < 0.05]. Mean serum ferritin was 398 ng/ml in the Vitamin D deficiency group compared to 393 ng/ml in Vitamin D sufficiency patients [P value > 0.05]. The mean C-reactive protein was 107.6 mg/ml in the Vitamin D deficiency group compared to 21.8 ng/ml in Vitamin D sufficiency patients [P value < 0.05]. The mean D-Dimer was 2268 ng/ml in the Vitamin D deficiency group compared to 781 ng/ml in Vitamin D sufficiency patients [P value < 0.05]. In the non-survivor group,97.4 % were Vitamin D deficient and insufficient. Only 2 % of the patients who survived were Vitamin D deficient [P value < 0.05].

CONCLUSION: We observed that low 25-hydroxy Vitamin D levels were associated with lower oxygen saturation and higher acute physiology and chronic health evaluation II scores, requiring a more extended stay in the hospital. C-reactive protein and D-dimers were significantly higher in Vitamin D deficient patients, suggesting severe disease. We did not find statistically significant findings in the case of the correlation of serum ferritin levels with Vitamin D status.

PMID:38479909 | DOI:10.1016/j.clnesp.2024.01.021

Clin Nutr ESPEN. 2024 Apr;60:179-186. doi: 10.1016/j.clnesp.2024.01.022. Epub 2024 Jan 24.

ABSTRACT

BACKGROUND AND AIMS: The circadian pattern of eating behaviors has garnered increasing interest as a strategy for obesity prevention and weight loss. It is believed that the benefits stem from aligning food intake with the body’s natural daily rhythms. However, the existing body of evidence is limited in scale and scope and there has been insufficient evaluation of temporal eating behaviors, such as the specific time of day in which the highest calorie consumption occurs, meal frequency, and distribution. This research aims to explore the association between the timing of the largest meal of the day and eating frequency with Body Mass Index (BMI) and obesity.

METHODS: Participants (n = 2050, 18-65y) were part of an exploratory cross-sectional and population-based research, with data collection in a virtual environment. Linear regression analyses and restricted cubic splines evaluated differences in BMI associated with independent eating variables [timing of the largest meal, number of meals/day (as continuous and categorical: ≤3 or >3/day), and each largest meal of the day (breakfast/lunch/dinner)]. Logistic regression models were fitted to assess Odds Ratios (OR) and 95 % Confidence Intervals (CI) of obesity associated with the same independent variables.

RESULTS: Our main findings were that the timing of the largest meal and reporting dinner as the largest meal were associated with higher values of BMI (respectively, 0.07 kg/m² and 0.85 kg/m²) and increased odds of obesity [respectively OR(95%CI):1.04(1.01,1.08), and OR(95%CI):1.67(1.18,2.38)]. Those who realized more than 3 meals/day presented lower values of BMI (-0.14 kg/m²) and 32 % lower odds of having obesity [OR(95%CI):0.68(0.52,0.89)]. Reporting lunch as the largest meal also protected against obesity [OR(95%CI):0.71(0.54,0.93)]. These associations were statistically significant and independent of sex, age, marital status, education level, diet quality, sleep duration, and weekly frequency of physical exercise.

CONCLUSION: Having the largest meal earlier in the day, concentrating the majority of caloric intake during lunch, and consuming more than three meals a day, may present a promising intervention for preventing and treating obesity/overweight.

PMID:38479908 | DOI:10.1016/j.clnesp.2024.01.022