Category: Statistics

Stroke. 2022 Sep 9:101161STROKEAHA121037493. doi: 10.1161/STROKEAHA.121.037493. Online ahead of print.

ABSTRACT

BACKGROUND: In patients with coronary artery disease and concomitant asymptomatic severe carotid stenosis, combined simultaneous coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) has been widely performed despite lack of evidence from randomized trials. We recently showed that the risk of stroke or death within 30 days was higher following CABG+CEA compared with CABG alone. Here, we report long-term outcomes following CABG with versus without CEA.

METHODS: The CABACS (Coronary Artery Bypass Graft Surgery in Patients With Asymptomatic Carotid Stenosis Study) is a randomized, controlled, multicenter, open trial. Patients with asymptomatic severe (≥70%) carotid stenosis undergoing CABG were allocated either CABG+CEA or CABG alone, and follow-up was 5 years. Major secondary end points included nonfatal stroke or death, any death and any nonfatal stroke. Due to low recruitment, the study was stopped prematurely after randomization of 127 patients in 17 centers.

RESULTS: By 5 years, the rate of stroke or death did not significantly differ between groups (CABG+CEA 40.6% [95% CI, 0.285-0.536], CABG alone 35.0% [95% CI, 0.231-0.484]; P=0.58). Higher albeit statistically nonsignificant rates of nonfatal strokes occurred at any time following CABG+CEA versus CABG alone (1 year: 19.3% versus 7.1%, P=0.09; 5 years: 29.4% versus 18.8%, P=0.25). All-cause mortality up to 5 years was similar in both groups (CABG+CEA: 25.4% versus CABG alone: 23.3%, hazard ratio, 1.148 [95% CI, 0.560-2.353]; P=0.71). Subgroup analyses did not reveal any significant effect of age, sex, preoperative modified Rankin Scale and center on outcome events.

CONCLUSIONS: During 5-years follow-up, combined simultaneous CABG+CEA was associated with a higher albeit statistically nonsignificant rate of stroke or death compared with CABG alone. This was mainly due to a nonsignificantly higher perioperative risk following CABG+CEA. Since the power of our study was not sufficient, no significant effect of either procedure could be observed at any time during follow-up.

REGISTRATION: http://www.controlled-trials.com; ISRCTN13486906.

PMID:36082667 | DOI:10.1161/STROKEAHA.121.037493

Turk J Pediatr. 2022;64(4):683-693. doi: 10.24953/turkjped.2021.1309.

ABSTRACT

BACKGROUND: The conflict in Syria following the anti-regime demonstrations that started in March 2011 created one of the greatest humanitarian crises. The United Nations High Commissioner for Refugees (UNHCR) reports that refugee and resettlement experiences can influence the critical stages of intellectual, social, emotional and physical development of children. There is a lack of sufficient information about the prevalence of developmental delay in forcibly displaced children. In this study, we aimed to describe the impact of the Syrian crisis on the development of children after resettlement, factors that are associated with developmental problems and domains in which developmental delays are more likely to occur.

METHODS: Refugee children (n=60) between the ages of 18-72 months admitted to the Yenimahalle Community Health Center Immigrant Health Unit to receive primary health care services between 1 November 2018- 1 March 2019 were included in this study. The control group included 60 Turkish children between 18-72 months admitted to the İsmail Ulucan Family Health Center which is in the same building. Developmental assessments were conducted by the researchers using the Denver II Developmental Screening Test (DDST-II). Sociodemographic characteristics of the child, family and caregivers as well as risk factors related to development were collected using a questionnaire. The interviews with refugee families were conducted with an interpreter.

RESULTS: Developmental delay was more frequent in refugee children compared to Turkish children. The DDST-II were normal in 82.1%, questionable in 10.7% and abnormal in 7.1% of Turkish children; in the study group, 22.2% of the patients were found to be normal, 33.3% were questionable and 44.4% were abnormal. The differences were statistically significant (p < 0.05). Multiple logistic regression analysis revealed that, being a forcibly displaced refugee was the single significant risk factor for developmental delay alone. In the DDST II subdomain analysis, it was seen that high monthly income reduces the risk of caution-delay in personal-social domain. It was found that birth weight below 2500 g increased the risk of caution-delay in the fine-motor and gross-motor domain and being a forcibly displaced refugee and consanguinity increased the risk of caution -delay in the language domain.

CONCLUSIONS: This study showed that being a forcibly displaced refugee was the most important risk factor for developmental delay. We emphasized the importance of surveillance and screening development in these highrisk children as well as early intervention services.

PMID:36082642 | DOI:10.24953/turkjped.2021.1309

Turk J Pediatr. 2022;64(4):640-647. doi: 10.24953/turkjped.2021.5019.

ABSTRACT

BACKGROUND: To evaluate the predictability of clinical and radiological findings in the diagnosis of malrotation.

METHODS: Between 2010 and 2020, children with presumptive diagnosis of malrotation were included. The demographic features, clinical and radiological findings, operative findings and outcome were recorded. The upper gastrointestinal series (UGIS) were evaluated by two radiologists. All parameters were correlated with surgical findings to evaluate the predictability.

RESULTS: Seventy patients were included. The presenting symptom was bilious vomiting in 29 cases (41.4%), and atypical symptoms (non-bilious vomiting, food refusal, etc.) in 40 cases (57%). One of the cases (1.6%) was asymptomatic and diagnosed incidentally during UGIS. 52 cases had abdominal X-ray and 14 (26.9%) of them were normal. Doppler ultrasonography (US) (n=20) revealed evidence of malrotation in 13 cases (65%). The location of duodenojejunal junction (DJJ) in UGIS was compatible with malrotation in 33 cases. 48 (61%) cases underwent surgical exploration; 35 cases had malrotation and seven cases had midgut volvulus. Median followup time was one year (0.5-7 years). Volvulus has recurred in one case and another case operated for volvulus died because of short bowel syndrome. The statistical analysis for predictability revealed that bilious vomiting (sensitivity: 57.1%, specificity: 82.1%), Doppler US (sensitivity: 92.3%, specificity: 75%) and right-sided DJJ in UGIS (sensitivity: 96.8%, specificity: 75%) have highest predictability.

CONCLUSIONS: The bilious vomiting, Doppler US findings and right-sided DJJ have the highest predictability to confirm the diagnosis. However, presenting with atypical symptoms and having atypical or normal findings in UGIS do not rule out malrotation.

PMID:36082638 | DOI:10.24953/turkjped.2021.5019

Turk J Pediatr. 2022;64(4):632-639. doi: 10.24953/turkjped.2021.5048.

ABSTRACT

BACKGROUND: To find the predictor of optimal surgical timing for neonatal necrotizing enterocolitis (NEC) patients by analyzing the risk factors of conservative treatment and surgical therapy.

METHODS: Data were collected from 184 NEC patients (Surgery, n=41; conservative treatment, n=143) between the years 2015 and 2019. Data were analyzed by univariate analysis, and multivariate binary logistic regression analysis.

RESULTS: Univariate analysis showed that statistically significant differences between the surgery and conservative treatment groups. The results of multivariate Logistic regression analysis indicated intestinal wall thickening by B-ultrasound and gestational age were independent factors to predict early surgical indications of NEC (p < 0.05). The true positive rate, false positive rate, true negative rate and false negative rate in the diagnosis of necrotic bowel perforation guided by DAAS (Duke abdominal X-ray score) ≥7 and MD7 (seven clinical metrics of metabolic derangement) ≥3 were 12.8%, 0.0%, 100.0% and 87.2%, respectively.

CONCLUSIONS: In summary, the ultrasound examination in NEC children showing thickening intestinal wall and poor intestinal peristalsis indicated for early operation.

PMID:36082637 | DOI:10.24953/turkjped.2021.5048

Pediatrics. 2022 Sep 9:e2022056735. doi: 10.1542/peds.2022-056735. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Because of the coronavirus disease 2019 pandemic and recommendations from a range of leaders and organizations, the pediatrics subspecialty 2020 recruitment season was entirely virtual. Minimal data exist on the effect of this change to guide future strategies. The aim of this study was to understand the effects of virtual recruitment on pediatric subspecialty programs as perceived by program leaders.

METHODS: This concurrent, triangulation, mixed-methods study used a survey that was developed through an iterative (3 cycles), consensus-building, modified Delphi process and sent to all pediatric subspecialty program directors (PSPDs) between April and May 2021. Descriptive statistics and thematic analysis were used, and a conceptual framework was developed.

RESULTS: Forty-two percent (352 of 840) of PSPDs responded from 16 of the 17 pediatric (94%) subspecialties; 60% felt the virtual interview process was beneficial to their training program. A majority of respondents (72%) reported cost savings were a benefit; additional benefits included greater efficiency of time, more applicants per day, greater faculty involvement, and perceived less time away from residency for applicants. PSPDs reported a more diverse applicant pool. Without an in-person component, PSPDs worried about programs and applicants missing informative, in-person interactions and applicants missing hospital tours and visiting the city. A model based upon theory of change was developed to aid program considerations for future application cycles.

CONCLUSIONS: PSPDs identified several benefits to virtual recruitment, including ease of accommodating increased applicants with a diverse applicant pool and enhanced faculty involvement. Identified limitations included reduced interaction between the applicant and the larger institution/city.

PMID:36082609 | DOI:10.1542/peds.2022-056735

Mol Syst Biol. 2022 Sep;18(9):e11002. doi: 10.15252/msb.202211002.

ABSTRACT

Regulation of gene expression is linked to the organization of the genome. With age, chromatin alterations occur on all levels of genome organization, accompanied by changes in the gene expression profile. However, little is known about the changes in the level of transcriptional regulation. Here, we used a multi-omics approach and integrated ATAC-, RNA- and NET-seq to identify age-related changes in the chromatin landscape of murine liver and to investigate how these are linked to transcriptional regulation. We provide the first systematic inventory of the connection between aging, chromatin accessibility, and transcriptional regulation in a whole tissue. Aging in murine liver is characterized by an increase in chromatin accessibility at promoter regions, but not in an increase in transcriptional output. Instead, aging is accompanied by a decrease in promoter-proximal pausing of RNA polymerase II (Pol II), while initiation of transcription is not decreased as assessed by RNA polymerase mapping using CUT&RUN. Based on the data reported, we propose that these age-related changes in transcriptional regulation are due to a reduced stability of the pausing complex.

PMID:36082605 | DOI:10.15252/msb.202211002

J Biomol Struct Dyn. 2022 Sep 9:1-17. doi: 10.1080/07391102.2022.2114938. Online ahead of print.

ABSTRACT

A series of novel 3-phenyl-1-(alkylphenyl)-9-oxa-4-azaphenanthren-10-ones and (E)-1-phenyl-3-(aryl)prop-2-en-1-ones were synthesized and characterized by IR, ¹H NMR, ¹³C spectroscopy and elemental analysis. The synthesized Compounds 5a-f were subjected to molecular docking simulation with three proteins, namely, tyrosyl-tRNA synthetase, heme oxygenase 1 and acetylcholinesterase to evaluate the antibacterial, antioxidant and acetylcholinesterase inhibition, respectively. Moreover, the docked poses of all compounds inside the proteins were subjected to further dynamic simulation through the calculation of the binding free energy using MM-GBSA analysis. Compound 5d exhibits high potential inhibition against antibacterial, antioxidant and acetylcholinesterase activities. Compounds 3d, 3f, 5a and 5d recorded an important scavenging activity in DPPH and ABTS assays. Investigation of the anti-acetylcholinesterase activity of the synthesized compounds showed that Compounds 5a and 3d are the most potent inhibitors against AchE, with percent inhibition values of 38 and 30%, respectively.Communicated by Ramaswamy H. Sarma.

PMID:36082583 | DOI:10.1080/07391102.2022.2114938

Ir J Psychol Med. 2022 Sep 9:1-8. doi: 10.1017/ipm.2022.40. Online ahead of print.

ABSTRACT

OBJECTIVES: Studies on patient-student relationships have to date largely focused on student attitudes. This study explores attitudes of patients with psychiatric illness in Ireland, towards medical students. Patients’ experience of consent for student involvement is an area of concern in previous studies and is also quantified here.

METHODS: This was a mixed-methods cross-sectional survey of Irish adult psychiatric patients. Quantitative analysis was carried out using SPSS 22 (Statistical Product and Service Solutions, Version 22, IBM). Differences on Likert score between groups (male/female, hospital site, past experience with students/ no experience) were analysed using ordinal logistic regression with a p-value below 0.05 being significant. Qualitative data were analysed by thematic analysis using OpenCode 4.03.

RESULTS: A total of 340 patients completed the survey. The mean age (sd) was 44.8 (16.3). 52.8% were female, 75.2% were outpatients. 24.3% had never met a medical student. Most patients were comfortable seeing students, but preferred students being passive observers. Patients with previous student experience had higher comfort levels and more positive attitudes. Although most patients (63.7%) strongly agreed they had been asked for consent, only 49.3% felt they had been given sufficient information. Qualitative data revealed preference for adequate information and notice of involvement. Patients felt pressured by student presence in certain circumstances.

CONCLUSIONS: Psychiatric patients are comfortable with students but many feel inadequately informed. Patients recognise the benefits of interacting with students. More information is needed regarding circumstances in which patients give consent to involvement with students.

PMID:36082526 | DOI:10.1017/ipm.2022.40

Mil Med. 2022 Sep 9:usac267. doi: 10.1093/milmed/usac267. Online ahead of print.

ABSTRACT

INTRODUCTION: The U.S. Navy offers an attractive opportunity for residency training in orthopedic surgery. The factors that Navy orthopedic residency program leadership finds important in applicant selection for training have not been reported. Additionally, data regarding the academic competitiveness of recently matched applicants have not been previously published. This study presents the results of two surveys administered to all navy orthopedic program directors and department chairmen, as well as data for United States Medical Licensing Examination (USMLE) Steps 1 and 2, medical school class percentile, leadership responsibilities, research endeavors, and letters of recommendation of both matched and unmatched applicants.

MATERIALS AND METHODS: Two anonymous surveys were administered to all program directors and department chairmen at Navy orthopedic residency training programs with questions designed to gauge perceived importance of various application factors when selecting for the match. The results were compiled, and mean levels of importance were reported. Deidentified data were collected on all applicants to Navy orthopedic residency programs from 2015 to 2019. Data points specific to USMLE Step 1 and 2 board scores, medical school class percentile, research, leadership, and letters of recommendation were analyzed using single and multiple logistic regression analyses, and odds ratios for each variable were calculated.

RESULTS: Navy leadership unanimously expressed that clerkship performance at the individual program director’s institution was most important, followed by Steps 1 and 2 licensing examination scores. Single logistic regression analyses showed that Step 1 score and clinical, leadership, and recommendation scores were statistically significant. When controlled for Step 1 score, only academic performance and leadership scores maintained statistical significance.

CONCLUSIONS: Applicants to Navy orthopedic surgery residency programs should strive to be competitive in all aspects of their application, with specific emphasis placed on outstanding performance during orthopedic clerkships, demonstration of leadership characteristics, and academic excellence. With transition to a pass/fail grading system for Step 1, there will be more emphasis on other measures of academic success, such as Step 2 scores and clinical clerkship grades.

PMID:36082505 | DOI:10.1093/milmed/usac267

J Biomech Eng. 2022 Sep 9. doi: 10.1115/1.4055564. Online ahead of print.

ABSTRACT

Musculoskeletal modelling and simulation has been an emerging trend in human gait analysis. It allows the user to isolate certain biomechanical condition and elucidate the dynamics of joints and muscles. This study used an open source musculoskeletal modelling and simulation tool, OpenSim to investigate the biomechanical effect of knee brace. It collected gait data from thirty-eight participants and examined the gait spatio-temporal parameters, joint angles and joint moments. Static optimization was performed to estimate the lower extremity muscle force. Statistical analysis was conducted to identify the difference between normal and abnormal gaits. The results demonstrated the feasibility of this method to investigate the interaction and coordination of lower extremity joints and muscles. The knee brace constrained the range of the motion of the knee during walking. It also changed the walking speed, step length and stance-to-swing ratio. Several significant differences were found in the joint moments and muscle forces of the rectus femoris, gastrocnemius, soleus and tibialis anterior. Musculoskeletal modelling and simulation tool offers a less invasive and practical alternative to analyze human motion. It also offers a means to investigate the effect of medical devices such as knee brace, which can be potentially beneficial for the future design and development of such devices and for derivation of rehabilitation treatment to improve patient’s gait.

PMID:36082472 | DOI:10.1115/1.4055564