Category: Statistics

Gynecol Oncol. 2023 Dec 21;181:54-59. doi: 10.1016/j.ygyno.2023.12.009. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine clinical significance of preoperative and pre-chemotherapy CA-125 in high-risk early-stage epithelial ovarian cancer patients.

METHODS: All patients with stage IA/IB and grade 3, stage IC, clear cell, or completed resected stage II cancer were enrolled in a phase III trial and treated with chemotherapy. Kaplan-Meier method and Cox proportional hazards model were used for statistical analyses.

RESULTS: 427 patients with high-risk early-stage ovarian cancer were enrolled. Of 213 patients with preoperative CA-125 data, 79% had elevated CA-125. Median preoperative CA-125 level was 103 U/mL. Patients with ≤10, 11-15, and > 15 cm tumors had median preoperative CA-125 levels of 62, 131 and 158 U/mL, respectively (p = 0.002). For the 350 patients with data for pre-chemotherapy CA-125 level, 69% had elevated pre-chemotherapy CA-125 above 35 U/mL with median value of 65 U/mL. However, age, race, stage, cell type and grade of disease were not correlated with CA-125 levels before and after surgery. On multivariate analysis, elevated pre-chemotherapy CA-125 independently predicted worse recurrence-free survival (HR = 2.13, 95% CI: 1.23-3.69; p = 0.007) and overall survival (HR = 1.99, 95% CI: 1.10-3.59; p = 0.022) after adjusting for age, stage, cell type and grade of disease. Compared to those with normal CA-125, patients with elevated pre-chemotherapy CA-125 had lower recurrence-free survival (RFS, 87% vs. 75%; p = 0.007) and overall survival (OS, 88% vs. 82%; p = 0.02). However, preoperative CA-125 was not prognostic of RFS (p = 0.699) or OS (p = 0.701).

CONCLUSIONS: Preoperative CA-125 was elevated in nearly 80% of high-risk early-stage ovarian cancer patients. Pre-chemotherapy CA-125 was associated with recurrence-free and overall survival; however, preoperative CA-125 was not prognostic.

PMID:38134754 | DOI:10.1016/j.ygyno.2023.12.009

Neuroimage Clin. 2023 Dec 15;41:103553. doi: 10.1016/j.nicl.2023.103553. Online ahead of print.

ABSTRACT

BACKGROUND: Social anhedonia is common within major depressive disorder (MDD) and associated with worse treatment outcomes. The orbitofrontal cortex (OFC) is implicated in both reward (medial OFC) and punishment (lateral OFC) in social decision making. Therefore, to understand the biology of social anhedonia in MDD, medial/lateral OFC metabolism, volume, and thickness, as well as structural connectivity to the striatum, amygdala, and ventral tegmental area/nucleus accumbens were examined. A positive relationship between social anhedonia and these neurobiological outcomes in the lateral OFC was hypothesized, whereas an inverse relationship was hypothesized for the medial OFC. The association between treatment-induced changes in OFC neurobiology and depression improvement were also examined.

METHODS: 85 medication-free participants diagnosed with MDD were assessed with Wisconsin Schizotypy Scales to assess social anhedonia and received pretreatment simultaneous fluorodeoxyglucose positron emission tomography (FDG-PET) and magnetic resonance imaging (MRI), including structural and diffusion. Participants were then treated in an 8-week randomized placebo-controlled double-blind course of escitalopram. PET/MRI were repeated following treatment. Metabolic rate of glucose uptake was quantified from dynamic FDG-PET frames using Patlak graphical analysis. Structure (volume and cortical thickness) was quantified from structural MRI using Freesurfer. To assess structural connectivity, probabilistic tractography was performed on diffusion MRI and average FA was calculated within the derived tracts. Linear mixed models with Bonferroni correction were used to examine the relationships between variables.

RESULTS: A significantly negative linear relationship between pretreatment social anhedonia score and structural connectivity between the medial OFC and the amygdala (estimated coefficient: -0.006, 95 % CI: -0.0108 – -0.0012, p-value = 0.0154) was observed. However, this finding would not survive multiple comparisons correction. No strong evidence existed to show a significant linear relationship between pretreatment social anhedonia score and metabolism, volume, thickness, or structural connectivity to any of the regions examined. There was also no strong evidence to suggest significant linear relationships between improvement in depression and percent change in these variables.

CONCLUSIONS: Based on these multimodal findings, the OFC likely does not underlie social anhedonia in isolation and therefore should not be the sole target of treatment for social anhedonia. This is consistent with previous reports that other areas of the brain such as the amygdala and the striatum are highly involved in this behavior. Relatedly, amygdala-medial OFC structural connectivity could be a future target. The results of this study are crucial as, to our knowledge, they are the first to relate structure/function of the OFC with social anhedonia severity in MDD. Future work may need to involve a whole brain approach in order to develop therapeutics for social anhedonia.

PMID:38134743 | DOI:10.1016/j.nicl.2023.103553

Best Pract Res Clin Obstet Gynaecol. 2023 Dec 10;92:102434. doi: 10.1016/j.bpobgyn.2023.102434. Online ahead of print.

ABSTRACT

Laparoscopy and robotics are recommended for managing gynecological cancer, as they are associated with lower morbidity and comparable outcomes to open surgery. However, in the case of early cervical cancer, new evidence suggests worse oncological outcomes with these approaches compared to open surgery, though the limited number of robotic cases makes it challenging to draw definitive conclusions for this particular approach. The prior conization has been proposed as a strategy to reduce the risk of tumor spillage and contamination during minimally invasive (MIS) radical hysterectomy (RH). Retrospective studies have indicated that undergoing conization before RH is linked to a reduced risk of recurrences, especially in cervical tumors measuring less than 2 cm. Nevertheless, these studies lack the statistical power needed to definitively establish conization as a recommended step before RH. Furthermore, these studies do not have enough cases utilizing the robotic approach and specific conclusions cannot be drawn from this technique. The question of whether a subset of cases would benefit from preoperative conization and whether conization should be performed to recommend MIS over open surgery remains unanswered. Prospective clinical trials involving women diagnosed with early-stage cervical cancer <2 cm, randomized between undergoing conization before robotic RH or without prior conization are mandatory to assess the role of conization before robotic RH in cervical cancer.

PMID:38134716 | DOI:10.1016/j.bpobgyn.2023.102434

Spectrochim Acta A Mol Biomol Spectrosc. 2023 Dec 12;308:123764. doi: 10.1016/j.saa.2023.123764. Online ahead of print.

ABSTRACT

The early detection of liver cancer greatly improves survival rates and allows for less invasive treatment options. As a non-invasive optical detection technique, Surface-Enhanced Raman Spectroscopy (SERS) has shown significant potential in early cancer detection, providing multiple advantages over conventional methods. The majority of existing cancer detection methods utilize multivariate statistical analysis to categorize SERS data. However, these methods are plagued by issues such as information loss during dimensionality reduction and inadequate ability to handle nonlinear relationships within the data. To overcome these problems, we first use wavelet transform with its multi-scale analysis capability to extract multi-scale features from SERS data while minimizing information loss compared to traditional methods. Moreover, deep learning is employed for classification, leveraging its strong nonlinear processing capability to enhance accuracy. In addition, the chosen neural network incorporates a data augmentation method, thereby enriching our training dataset and mitigating the risk of overfitting. Moreover, we acknowledge the significance of selecting the appropriate wavelet basis functions in SERS data processing, prompting us to choose six specific ones for comparison. We employ SERS data from serum samples obtained from both liver cancer patients and healthy volunteers to train and test our classification model, enabling us to assess its performance. Our experimental results demonstrate that our method achieved outstanding and healthy volunteers to train and test our classification model, enabling us to assess its performance. Our experimental results demonstrate that our method achieved outstanding performance, surpassing the majority of multivariate statistical analysis and traditional machine learning classification methods, with an accuracy of 99.38 %, a sensitivity of 99.8 %, and a specificity of 97.0 %. These results indicate that the combination of SERS, wavelet transform, and deep learning has the potential to function as a non-invasive tool for the rapid detection of liver cancer.

PMID:38134653 | DOI:10.1016/j.saa.2023.123764

J Plast Reconstr Aesthet Surg. 2023 Dec 1;89:40-50. doi: 10.1016/j.bjps.2023.11.049. Online ahead of print.

ABSTRACT

BACKGROUND: A variety of breast reconstruction (BR) options are available. The significance of timing on outcomes remains debated. This study aims to compare complications in breast cancer patients undergoing implant-based and autologous BR immediately after mastectomy or at a delayed time point.

METHODS: We reviewed the ACS-NSQIP database (2008-2021) to identify all female patients who underwent BR for oncological purposes. Outcomes were stratified by technique (implant-based versus autologous) and timing (immediate versus delayed), and included 30-day mortality, reoperation, (unplanned) readmission, and surgical and medical complications.

RESULTS: A total of 21,560 patients were included: 11,237 (52%) implant-based (9791/87% immediate, 1446/13% delayed) and 10,323 (48%) autologous (8378/81% immediate, 1945/19% delayed). Complications occurred in 3666 (17%) patients (implant-based: n = 1112/11% immediate, n = 64/4.4% delayed cohorts; Autologous: n = 2073/25% immediate, n = 417/21% delayed cohorts). In propensity score weighting (PSW) analyses, immediate BR was associated with significantly more complications than delayed BR (p < 0.0001). This was the case for both implant-based and autologous BR, with a greater difference between the two time points noted in implant-based. Confounder-adjusted multivariable analyses confirmed these results.

CONCLUSION: At the 30-day time point, delayed BR is associated with significantly lower complication rates than immediate BR, in both the implant-based and autologous cohorts. These findings are not a blanket recommendation in favor of immediate and/or delayed BR. Instead, our insights may guide surgeons and patients in decision-making and help refine patients’ eligibility in a case-by-case workup.

PMID:38134626 | DOI:10.1016/j.bjps.2023.11.049

Eur J Obstet Gynecol Reprod Biol. 2023 Dec 18;293:91-94. doi: 10.1016/j.ejogrb.2023.12.022. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the association between the O blood type and bleeding tendency in patient undergoing vaginal hysterectomy.

METHODS: This was a retrospective cohort study including all women who had undergone vaginal hysterectomy at our institution between January 2015 and September 2020. All women underwent blood type and complete blood count testing pre- and post-operatively. The estimated intraoperative blood loss, the need for blood transfusion, pre- and postoperative hemoglobin and hematocrit measurements and surgical data were recorded for all patients. Patients with known coagulopathies or those taking antithrombotic medications were excluded from the study. Statistical analysis was performed using student t, χ2, Fischer exact, and ANOVA tests as well as a stepwise logistic regression model.

RESULTS: The study included 106 patients (35.2 %) with O and 195 patients (64.8 %) with non-O (i.e., A, B or AB) blood types. The O blood type was significantly associated with a higher risk for moderate blood loss (defined as a pre- to postoperative Hb or HCT drop >2gr or >6 %, respectively) (p = 0.012), but not with severe (defined as a Hb or HCT drop of >3gr or >9 %, respectively) perioperative bleeding, nor with the need for blood transfusion.

CONCLUSION: The O blood type was found to be significantly associated with moderate but not with severe intraoperative bleeding during and following vaginal hysterectomy.

PMID:38134609 | DOI:10.1016/j.ejogrb.2023.12.022

Mult Scler Relat Disord. 2023 Dec 9;82:105354. doi: 10.1016/j.msard.2023.105354. Online ahead of print.

ABSTRACT

BACKGROUND: Older adults with multiple sclerosis (OAMS) have declines in walking and physical performance that may erode community mobility defined as the spatial extent of mobility in one’s daily life and environment.

OBJECTIVE: This study provided the first application and validation of the University of Alabama Birmingham Study of Aging Life-Space Assessment (UAB LSA) as a measure of community mobility in OAMS.

METHODS: The sample included 97 OAMS and 108 healthy controls (HCs) who completed baseline assessments as part of an ongoing, longitudinal study. The primary assessments included the UAB LSA and timed 25-foot walk (T25FW), short physical performance battery (SPPB), global health score (GHS), and geriatric depression scale (GDS) in both OAMS and HCs, and patient determined disease steps (PDDS) scale in only OAMS.

RESULTS: OAMS had significantly lower UAB LSA scores than HCs (p < .001). UAB LSA scores had strong correlations with T25FW(r_s = -.641) and SPPB(r_s = 0.507) in OAMS, and moderate correlations in HCs (r_s = -.300 & r_s = 0.384). The correlations between UAB LSA and GHS and GDS scores were significant, but small in OAMS (r_s = -.239 & r_s = -.231), and not statistically significant in HCs (r_s = -.009 & r_s = -.166). There was a strong correlation between UAB LSA and PDDS scores in the OAMS sample (r_s = -.605).

CONCLUSION: We provided initial evidence for UAB LSA scores as a measure of community mobility in OAMS.

PMID:38134603 | DOI:10.1016/j.msard.2023.105354

Surg Oncol. 2023 Dec 16;52:102029. doi: 10.1016/j.suronc.2023.102029. Online ahead of print.

ABSTRACT

BACKGROUND: While predictors for postoperative survival in spine tumour patients have been identified, there is limited evidence for predictors of postoperative Quality of Life (QoL), pain and functional outcome.

METHODS: One hundred and fifty-three consecutive patients, who had undergone surgery for symptomatic spinal metastases between June 2016 and April 2019, were interviewed preoperatively and during follow-ups at three, six and 12 months using the EQ-5D-3L, COMI, and ODI questionnaires. Differences in means exceeding the specific Minimal Clinically Important Difference (MCID) values were considered clinically significant.

RESULTS: Thirty-three percent of the patients were reported dead after 12 months. Only one metastasis compared to multiple metastases has 7.9 the Odds for an improved EQ-5D-3L score at three months. No neoadjuvant metastatic irradiation has 6.8 the Odds for the improvement at that time against performed radiation. A preoperative ODI score between 50.1 and 100 has 22.0 times the odds compared to the range from 0 to 50 for an improved EQ-5D-3L after three months, and 12.5 times the odds in favour of improved COMI after three months, and 13.6 times the odds for improvement of ODI at the three-month follow-up. A preoperative COMI score ranging from 5.0 to 10 has 21 times the odds of a COMI between 0 and 5 for an improved EQ-5D-3L score and 11 times the odds for an improved ODI after 12 months. Other predictors showed no statistically significant improvement.

CONCLUSION: An improvement in QoL, pain and spinal function after 12 months can be predicted by a subjective preoperative poor health condition. Impaired spinal function before surgery, a singular metastasis and no previous irradiation is predictive of improved spinal function and quality of life three months after surgery.

PMID:38134591 | DOI:10.1016/j.suronc.2023.102029

Int J Pediatr Otorhinolaryngol. 2023 Dec 11;176:111823. doi: 10.1016/j.ijporl.2023.111823. Online ahead of print.

ABSTRACT

OBJECTIVE: About 8.6 % of children in the United States undergo tympanostomy tube (TT) placement every year. Of these, 24.1 % require a second set of tubes. Adjuvant adenoidectomy in children over 4 years is thought to improve the efficacy of TT. The goal of this study is to characterize the efficacy of adjuvant adenoidectomy at the time of TT placement in children under 4 years, to further improve middle ear function.

METHODS: All patients undergoing TT placement alone or TT placement with adenoidectomy from 2014 to 2016 were reviewed. The primary outcome was need for subsequent tube placement.

RESULTS: A total of 409 patients were included in the study (60.6 % male, 39.4 % female). Median age at initial TT placement was 18 months (range 5-48 months); extreme outliers for age were removed from further analysis. Patients were followed for 1-8 years. 250 patients received TT alone while 159 received TT with adenoidectomy. 120 required a second set of tubes. There was a statistically significant benefit to those undergoing adjuvant adenoidectomy with TT placement: 33.6 % of those receiving TT alone required subsequent tubes, whereas only 22.6 % of patients who underwent TT with adjuvant adenoidectomy required reinsertion (X² = 5.630, p = 0.018). Adjuvant adenoidectomy in patients 0-48 months was associated with decreased likelihood of requiring subsequent tube placement (OR = 0.578, p = 0.018). There was an increased likelihood of experiencing otorrhea in those receiving TT alone compared to the TT with adenoidectomy group (X² = 4.353, df = 1, p = 0.0369).

CONCLUSION: Adjuvant adenoidectomy at the time of initial TT placement may have a role in the management of chronic middle ear disease in patients younger than 4 years. However, further studies and prospective randomized studies are needed to explore if this benefit can also be seen in children without chronic rhinosinusitis or nasal obstruction. The benefit-risk ratio from adenoidectomy and modifications in anesthesia technique in the case of adjuvant adenoidectomy should also be further explored.

PMID:38134590 | DOI:10.1016/j.ijporl.2023.111823

Int J Pediatr Otorhinolaryngol. 2023 Dec 16;176:111824. doi: 10.1016/j.ijporl.2023.111824. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze the visual outcomes and sequelae of endonasal intervention for orbital infections.

INTRODUCTION: Orbital infections pose a serious threat to vision in the pediatric population and can result in complications such as blindness, diplopia, intracranial involvement, and death. [1] Orbital decompression by endonasal intervention is a common treatment to address a variety of orbital infections including orbital cellulitis, orbital abscesses, and subperiosteal abscesses. [2] The outcomes of visual sequelae such as loss or limitation of visual acuity, extraocular movements, and increased intraocular pressure following orbital decompression via endonasal intervention have not been sufficiently investigated in the current literature.

METHODS: This retrospective cohort study was performed at our tertiary care pediatric hospital using data from 69 patients aged 0-18 years who were admitted between 2008 and 2018. Data was extracted from the electronic medical record system.

RESULTS: Following endoscopic sinus surgery, symptoms of orbital infection improved throughout the cohort. Improvement in visual acuity is demonstrated by a statistically significant decrease in the average logMAR value in both the right and left eye (P = 0.002 and P = 0.028 respectively). There was also a significant improvement to normal values postoperatively for patients who initially presented with abnormal tonometry, extraocular movement, and the appearance of eyelids and eyelashes.

CONCLUSION: There is no decline or loss of vision with otolaryngology surgical intervention for orbital cellulitis in our cohort. This retrospective chart review demonstrates the efficacy of surgical intervention on overall visual outcomes following endonasal intervention for orbital infections such as orbital cellulitis, orbital abscesses, and subperiosteal abscesses.

PMID:38134589 | DOI:10.1016/j.ijporl.2023.111824