Category: Statistics

J Shoulder Elbow Surg. 2024 Mar 21:S1058-2746(24)00192-7. doi: 10.1016/j.jse.2024.03.006. Online ahead of print.

ABSTRACT

BACKGROUND: The use of total shoulder arthroplasty is continuing to rise with its expanding indications. For patients with chronic conditions, such as glenohumeral arthritis and rotator cuff arthropathy, nonoperative treatment is typically done prior to arthroplasty and often includes corticosteroid injections. Recent studies in the shoulder arthroplasty literature as well as applied from the hip and knee literature have focused on the risk of periprosthetic infection. Literature is lacking as to whether the judicious use of corticosteroids in the year prior to arthroplasty influences patient reported outcomes. The purpose of this study was to determine if preoperative corticosteroid injections prior to shoulder arthroplasty affected two-year patient-reported outcomes.

METHODS: Retrospective review of anatomic and reverse total shoulder arthroplasty patients (n=230) was performed at a single institution including multiple surgeons. Patients were included if they had preoperative and a minimum of 2-year postoperative patient reported outcomes, including: ASES, VAS, SANE, VR12-PCS, and VR12-MCS. Patients were included in the injection group if they had received an injection, either glenohumeral or subacromial, within twelve months prior to arthroplasty (inject=134). Subgroup analysis included anatomic (TSA=92) and reverse total shoulder arthroplasty (RSA=138) as well as those with no injection within 12 months prior to surgery. An ANOVA was used to compare outcomes between patients who received an injection and those who did not prior to TSA and RSA.

RESULTS: There were 230 patients included with 134 patients in the injection group and 96 in the no injection group. Patients who received an injection in the year prior to arthroplasty displayed a significantly higher ASES [82 (16.23SD) vs. 76 (19.43SD), p < .01] and SANE [70 (24.49SD) vs. 63 (29.22SD), p < .01] scores versus those who had not received injection. There was no difference when comparing preoperative injection versus no injection in patients undergoing TSA. Those patients undergoing RSA displayed significantly higher ASES scores (p<.01). There were no significant differences in VAS, VR12-PCS, and VR12-MCS among any analysis (P>0.05), and the MCID in ASES was not different between groups (p.09).

CONCLUSION: Corticosteroid injections within twelve months prior to anatomic and reverse total shoulder arthroplasty do not compromise patient reported outcomes during a minimum of two-year follow-up. Although more complications occurred in the injection group, it did not reach statistical significance and warrants further study in a larger population.

PMID:38521485 | DOI:10.1016/j.jse.2024.03.006

J ISAKOS. 2024 Mar 21:S2059-7754(24)00054-3. doi: 10.1016/j.jisako.2024.03.009. Online ahead of print.

ABSTRACT

IMPORTANCE: Peri-operative blood loss during joint replacement procedures is a modifiable risk factor that impacts wound complications, hospital stay and total costs. Tranexamic acid (TXA) is an anti-fibrinolytic that has been widely used in orthopedic surgery, but its efficacy in the setting of total ankle arthroplasty (TAA) has not been quantified to date.

AIM: The purpose of this systematic review and meta-analysis was to evaluate the efficacy and safety of administering TXA in patients undergoing TAA.

EVIDENCE REVIEW: The Medline, Embase and Cochrane library databases were systematically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Five comparative studies examining blood loss following administration of TXA for patients undergoing TAA were included. The outcome measures of interest were blood loss, reduction in hemoglobin concentration, transfusion requirements, total complications and wound complications.

FINDINGS: In total, 194 patients received TXA and 187 patients did not receive TXA while undergoing TAA. Based on the common-effects model for total blood loss for the TXA group versus control, the standardized mean difference (SMD) was -0.7832 (95% CI, -1.1544, -0.4120; P<.0001), in favor of lower total blood loss for TXA. Based on the random-effects model for reduction in hemoglobin for the TXA group versus control, the SMD was -0.9548 (95% CI, -1.7850, -0.1246; P=.0242) in favor of lower hemoglobin loss for TXA. Based on the random-effects model for total complications for the TXA group versus control, the risk ratio was 0.512 (95% CI, 0.1588, 1.6512; P=.1876), in favor of lower total complications for TXA but this was not statistically significant.

CONCLUSIONS: This current review demonstrated that administration of TXA led to a reduction in blood loss and hemoglobin loss without an increased risk of the development of venous thromboembolism in patients undergoing TAA. No difference was observed with respect to total complication rates between the TXA cohort and the control group. TXA appears to be an effective hemostatic agent in the setting of TAA, but further studies are necessary to identify the optimal timing, dosage and route of TXA during TAA.

LEVEL OF EVIDENCE: III.

PMID:38521460 | DOI:10.1016/j.jisako.2024.03.009

Int J Infect Dis. 2024 Mar 21:107003. doi: 10.1016/j.ijid.2024.107003. Online ahead of print.

ABSTRACT

BACKGROUND: Fungal bloodstream infection (fBSI) following pediatric liver transplantation present a significant challenge; however, there remains a paucity of guidance regarding antifungal prophylaxis in this population. This study aimed to evaluate the effectiveness of universal antifungal prophylaxis and propose a desirable strategy.

METHODS: We enrolled 604 pediatric patients who underwent liver transplantation between 2020 and 2023, including 242 patients with empirical prophylaxis and 362 patients with universal prophylaxis. Univariate and multivariate logistic regression analyses were performed to identify independent factors for fBSI.

RESULTS: Eight (2.2%) pediatric recipients in the universal prophylaxis group and 13 (5.4%) in the empirical group developed fBSI (P = 0.038). Universal prophylaxis was a protective factor (P = 0.044), while high-volume intraoperative plasma transfusion and deceased donor liver transplantation were independent risk factors for fBSI (P = 0.035 and 0.008, respectively). Universal antifungal strategy showed an increased OS trend after liver transplantation although without significant statistical difference (P = 0.217). Patients with fBSI had poorer survival than those without fBSI (P < 0.001).

CONCLUSION: Universal prophylaxis strategy for fBSI in pediatric after liver transplantation is desirable as it could markedly decrease the occurrence of fBSI. Pediatric patients with deceased donor and high-volume intraoperative transfusion should be paid more attention to preventing fBSI.

PMID:38521451 | DOI:10.1016/j.ijid.2024.107003

Int J Infect Dis. 2024 Mar 21:107012. doi: 10.1016/j.ijid.2024.107012. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aims to estimate the causal effects of oral antivirals and vaccinations in prevention against all-cause mortality and progression to severe COVID-19 in an integrative setting with both antivirals and vaccinations considered as interventions.

METHODS: We identified hospitalized adult patients (i.e., aged 18 or above) in Hong Kong with confirmed SARS-CoV-2 infection between March 16^th, 2022 and December 31^st, 2022. An inverse probability weighted (IPW) Andersen-Gill model with time-dependent predictors was used to address immortal time bias and produce causal estimates for the protection effects of oral antivirals and vaccinations against severe COVID-19.

RESULTS: Given prescription is made within five days of confirmed infection, nirmatrelvir-ritonavir is more effective in providing protection against all-cause mortality and development into severe COVID-19 than molnupiravir. There was no significant difference between CoronaVac and Comirnaty in the effectiveness of reducing all-cause mortality and progression to severe COVID-19.

CONCLUSIONS: The use of oral antivirals and vaccinations causes lower risks of all-cause mortality and progression to severe COVID-19 for hospitalized SARS-CoV-2 patients.

FUNDING: Health and Medical Research Fund, Hong Kong.

PMID:38521448 | DOI:10.1016/j.ijid.2024.107012

Appetite. 2024 Mar 21:107305. doi: 10.1016/j.appet.2024.107305. Online ahead of print.

ABSTRACT

Effective ways to promote healthful food intake in rural areas are understudied. The paper evaluated whether a two-component, in-store intervention designed to encourage healthy food purchases was associated with improved healthfulness scores of food items purchased by shoppers in rural food deserts. One component introduced a point-of-sales label that assigned a single numerical score to each food item facilitating direct comparisons of the product’s nutrition with those of other products shelved around it. The other component was a one-day nutrition education workshop promoted within the store. Interventions took place in 2015 at two stores in rural counties in the U.S. Midwest. Four stores in similar communities were selected as the control group. We applied a difference-in-difference model to estimate changes in the healthfulness of food items purchased attributable to the intervention among shoppers at the treatment stores (n = 486) and control stores (n = 10,759) using store transaction data. Healthfulness of food items was measured in terms of food scores published by the Environmental Working Group on a 1-10 scale. Both components had minimal impacts on the scores, although 0.2 and 0.1 points increases in the score per item and score per dollar were statistically significant at the 1% level respectively. A year after the intervention, these small effects of the intervention further diminished compared to the immediately after implementation. Results suggest the average effects of intervention across the study communities had limited practical significance but benefited some rural residents who were exposed to the intervention.

PMID:38521414 | DOI:10.1016/j.appet.2024.107305

Transplant Cell Ther. 2024 Mar 21:S2666-6367(24)00292-6. doi: 10.1016/j.jtct.2024.03.019. Online ahead of print.

ABSTRACT

INTRODUCTION: Transplant-associated thrombotic microangiopathy (TA-TMA) is associated with high morbidity and mortality. Although with the introduction of eculizumab the survival has significantly improved, there is still a need for improvement, especially in high-risk patients.

OBJECTIVES: This study aims to describe the results obtained with eculizumab in a pediatric cohort with the attempt to define which risk factors could determine the response to treatment.

METHODS: We designed a national multicentre retrospective study, where children treated with eculizumab for high-risk TA-TMA were included.

RESULTS: Twenty-nine patients were included after a first (n=28) or a second allogeneic hematopoietic stem cell transplantation (HSCT) (n=1) for malignant (n=17) or non-malignant diseases (n=12). Median time from HSCT to TA-TMA diagnosis was 154 days (IQR 103-263). Eleven patients (38%) were initially diagnosed of low – intermediate risk TA-TMA and progressed to high-risk TA-TMA (hrTA-TMA), with a median time of 4 days (IQR 1 – 33). SC5b-9 was increased in 90% of 20 patients where measured. Renal (n=12), pulmonary (n=1) and intestinal (n=1) biopsy confirmed the diagnosis in 12/14 patients (85%). Seventeen patients (58%) presented extrarenal involvement with serositis (n=13, 44,8%), pulmonary (n=12, 41,4%), gastrointestinal (n=8, 27,6%), cardiovascular (n=7, 24,1%) or central nervous system (CNS) (n=2, 6,9%) involvement. Median time from hrTA-TMA diagnosis to the initiation of eculizumab was 7 days (IQR 1-18). Overall, 19 patients (65.5%) responded to eculizumab of whom 17 (58,6%) presented complete response and 2 (6.9%) achieved partial response. The remaining 10 patients (34.5%) did not present any type of response. The TA-TMA ORR was 27.59 % (95% CI 14.87 – 47.66), 55.17% (95% CI 38.43 – 73.48) and 62.07% (95% CI 45.10 – 79.13%) at 1, 3 and 6 months post eculizumab initiation, respectively. In the multivariate analysis the pulmonary involvement decreased the probability of response (HR 0.18, p-value 0.0298). The 1-year OS was 55.2% (95% CI: 35.6-71.0) for the whole cohort and 83.3% (95% CI: 56.7-94.3) for patients who responded to eculizumab. The presence of pulmonary (HR 14.93, p-value 0.0043) and CNS involvement (HR 8.63, p-value 0.0497) presented a statistically significant decrease in survival.

CONCLUSION: We found that patients diagnosed of hrTA-TMA with pulmonary involvement presented a poor response to eculizumab and patients with pulmonary and CNS involvement a significant decreased in survival. With these results, we hypothesize that using eculizumab at an early stage of the disease and before organ damage is established, the response and therefore the survival might significantly improve.

PMID:38521410 | DOI:10.1016/j.jtct.2024.03.019

J Cardiovasc Magn Reson. 2024 Mar 21:101039. doi: 10.1016/j.jocmr.2024.101039. Online ahead of print.

ABSTRACT

BACKGROUND: MRI is an important imaging modality for the assessment and management of adult patients with congenital heart disease (CHD). However, conventional techniques for 3D whole-heart acquisition involve long and unpredictable scan times and methods that accelerate scans via k-space undersampling often rely on long iterative reconstructions. Deep-learning-based reconstruction methods have recently attracted much interest due to their capacity to provide fast reconstructions whilst often outperforming existing state-of-the-art methods. In this study, we sought to adapt and validate a non-rigid motion-corrected model-based deep-learning (MoCo-MoDL) reconstruction framework for 3D whole-heart MRI in a CHD patient cohort.

METHODS: The previously proposed deep-learning reconstruction framework MoCo-MoDL, which incorporates a non-rigid motion-estimation network and a denoising regularisation network within an unrolled iterative reconstruction, was trained in an end-to-end manner using 39 CHD patient datasets. Once trained, the framework was evaluated in 8 CHD patient datasets acquired with seven-fold prospective undersampling. Reconstruction quality was compared with the state-of-the-art non-rigid motion-corrected patch-based low-rank reconstruction method (NR-PROST) and against reference images (acquired with three-or-four-fold undersampling and reconstructed with NR-PROST).

RESULTS: Seven-fold undersampled scan times were 2.1 ± 0.3 minutes and reconstruction times were ~ 30 seconds, approximately 240 times faster than an NR-PROST reconstruction. Image quality comparable to the reference images was achieved using the proposed MoCo-MoDL framework, with no statistically significant differences found in any of the assessed quantitative or qualitative image quality measures. Additionally, expert image quality scores indicated the MoCo-MoDL reconstructions were consistently of a higher quality than the NR-PROST reconstructions of the same data, with the differences in 12 of the 22 scores measured for individual vascular structures found to be statistically significant.

CONCLUSION: The MoCo-MoDL framework was applied to an adult CHD patient cohort, achieving good quality 3D whole-heart images from ~ 2-minute scans with reconstruction times of ~ 30 seconds.

PMID:38521391 | DOI:10.1016/j.jocmr.2024.101039

Asia Pac J Ophthalmol (Phila). 2024 Mar 21:100052. doi: 10.1016/j.apjo.2024.100052. Online ahead of print.

ABSTRACT

IMPORTANCE: Ocular surface squamous neoplasia (OSSN) is a spectrum of malignancies that generally includes conjunctival intraepithelial neoplasia (CIN) and squamous cell carcinoma (SCC). OSSN can be treated with topical therapies including interferon α-2b (IFN), mitomycin C (MMC), or 5-fluorouracil 1% (5FU). Recently, due to unavailability of IFN and toxicity associated with MMC, therapy has shifted towards 5FU.

OBJECTIVE: Herein, we compare the use of 5FU 1% as a primary versus (vs) secondary treatment regimen in eyes with moderate to extensive OSSN.

DESIGN SETTING AND PARTICIPANTS: Retrospective cohort study of 73 consecutive patients with unilateral moderate to extensive OSSN treated at a single tertiary ocular oncology center from 2016 to 2023. Mean follow up time was 478.2 days overall, with 283.0 days for primary 5FU group and 860.3 days for secondary 5FU group.

INTERVENTION: Topical 5FU 1% 4 times daily for 2 weeks with option for 2-weekly extension until tumor control, either as primary treatment or as secondary treatment to surgical resection, topical IFN or topical MMC, or cryotherapy.

MAIN OUTCOMES: Outcome measures included tumor response, need for additional surgery, complications, and visual outcomes.

RESULTS: A comparison (primary vs secondary treatment) revealed no difference in mean tumor basal dimension (19.6 vs 17.2mm, P = 0.46), thickness (3.7 vs 3.4mm, P = 0.64), or tumor extent (4.4 vs 4.5 clock hours, P = 0.92). The primary treatment group showed greater complete tumor control (77% vs 38%, P = 0.04). Multivariable analysis comparison (primary vs secondary treatment) showed primary treatment more likely to achieve complete tumor control (P = 0.01). There was no difference in the complication rate from 5FU treatment between the groups. There was no difference in visual outcome, and no tumor-related metastasis (0%) or death (0%).

CONCLUSION AND RELEVANCE: Topical 5FU 1% is efficacious and safe as a primary or secondary treatment for moderate to extensive OSSN. Tumors treated with primary 5FU 1% demonstrated more complete resolution. In patients with moderate to extensive OSSN, primary treatment with topical 5FU 1% may be warranted.

PMID:38521390 | DOI:10.1016/j.apjo.2024.100052

Anim Biotechnol. 2024 Nov;35(1):2331179. doi: 10.1080/10495398.2024.2331179. Epub 2024 Mar 22.

ABSTRACT

Despite the significant threat of heat stress to livestock animals, only a few studies have considered the potential relationship between broiler chickens and their microbiota. Therefore, this study examined microbial modifications, transcriptional changes and host-microbiome interactions using a predicted metabolome data-based approach to understand the impact of heat stress on poultry. After the analysis, the host functional enrichment analysis revealed that pathways related to lipid and protein metabolism were elevated under heat stress conditions. In contrast, pathways related to the cell cycle were suppressed under normal environmental temperatures. In line with the transcriptome analysis, the microbial analysis results indicate that taxonomic changes affect lipid degradation. Heat stress engendered statistically significant difference in the abundance of 11 microorganisms, including Bacteroides and Peptostreptococcacea. Together, integrative approach analysis suggests that microbiota-induced metabolites affect host fatty acid peroxidation metabolism, which is correlated with the gene families of Acyl-CoA dehydrogenase long chain (ACADL), Acyl-CoA Oxidase (ACOX) and Acetyl-CoA Acyltransferase (ACAA). This integrated approach provides novel insights into heat stress problems and identifies potential biomarkers associated with heat stress.

PMID:38519440 | DOI:10.1080/10495398.2024.2331179

Am J Surg. 2024 Mar 18:S0002-9610(24)00175-2. doi: 10.1016/j.amjsurg.2024.03.014. Online ahead of print.

ABSTRACT

BACKGROUND: As the first comprehensive investigation into hospital readmissions following robotic hepatectomy for neoplastic disease, this study aims to fill a critical knowledge gap by evaluating risk factors associated with readmission and their impact on survival and the financial burden.

METHODS: The study analyzed a database of robotic hepatectomy patients, comparing readmitted and non-readmitted individuals post-operatively using 1:1 propensity score matching. Statistical methods included Chi-square, Mann-Whitney U, T-test, binomial logistic regression, and Kaplan-Meier analysis.

RESULTS: Among 244 patients, 44 were readmitted within 90 days. Risk factors included hypertension (p ​= ​0.01), increased Child-Pugh score (p ​< ​0.01), and R1 margin status (p ​= ​0.05). Neoadjuvant chemotherapy correlated with lower readmission risk (p ​= ​0.045). Readmissions didn’t significantly impact five-year survival (p ​= ​0.42) but increased fixed indirect hospital costs (p ​< ​0.01).

CONCLUSIONS: Readmission post-robotic hepatectomy correlates with hypertension, higher Child-Pugh scores, and R1 margins. The use of neoadjuvant chemotherapy was associated with a lower admission rate due to less diffuse liver disease in these patients. While not affecting survival, readmissions elevate healthcare costs.

PMID:38519401 | DOI:10.1016/j.amjsurg.2024.03.014