Category: Statistics

Skeletal Radiol. 2022 Sep 17. doi: 10.1007/s00256-022-04185-4. Online ahead of print.

ABSTRACT

OBJECTIVE: To quantitatively assess the impact of supine and standing positions on the morphological changes in the lumbar intervertebral foramen (LIF) in patients with adult spinal deformity (ASD) using upright CT and conventional supine CT.

MATERIALS AND METHODS: Thirty patients with ASD were prospectively enrolled in this study. All subjects underwent standing whole spine posterior/anterior radiographs, lateral radiographs, and whole spine CT, both in the supine and upright standing positions. Two orthopedic surgeons independently measured nine radiographic parameters in the radiograph and the lumbar foraminal area (FA) and height (FH) in supine and upright CT. Statistical analyses were performed to evaluate the risk of LIF decrease when standing upright compared to the supine position. The chi-squared, t test, Pearson’s coefficients, intra- and inter-rater reliabilities, and ROC curves were calculated. The level of significance was set at p < 0.05.

RESULTS: Among the 300 LIFs, both the lumbar FA and FH were either increased or decreased by > 5% in approximately 30% of LIFs each. The FA decreased in the lower lumbar spine. The concave side had a significantly higher rate of decreased FA and FH than the convex side (p < 0.05 and < 0.05, respectively). ROC analysis showed that narrowing of the intervertebral disc (cutoff > 0.05°) is a risk factor for decreased FA and FH.

CONCLUSIONS: This study describes the details of the changes in the neuroforamen using a novel upright CT. In patients with ASD, approximately 30% of LIFs either increased or decreased in size by > 5% when standing. The risk factors for LIF decrease are the lower lumbar spine, concave side, and narrow side of the disc wedge.

PMID:36114881 | DOI:10.1007/s00256-022-04185-4

Eur J Orthop Surg Traumatol. 2022 Sep 17. doi: 10.1007/s00590-022-03384-y. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this study was to compare outcomes following surgical treatment of tibial plateau fractures in an elderly (≥ 65y) and non-elderly (< 65) population.

METHODS: Patients with tibial plateau fractures were prospectively followed. Patients were included if they were operatively treated, had an Injury Severity Score of < 16, and had follow-up through 12 months. Clinical, radiographic, and functional outcomes were evaluated at the 3, 6, and 12-month follow-up points.

RESULTS: Mean time to radiographic fracture union was by 4.68 and 5.26 months in young and elderly patients, respectively (p = 0.25). There was no difference in self-reported baseline SMFA (p = 0.617). SMFA scores were better in younger patients at 3 months (p = 0.031), however this did not hold when multivariate modeling controlled for other factors. There was no difference at 6 and 12 months (p = 0.475, 0.392). There was no difference in range of knee motion at 3 months. At 6 and 12 months, young patients had statistically but not clinically better range of knee motion (p = 0.045, 0.007). There were no differences in overall reoperation rates, conversion arthroplasty, post-traumatic osteoarthritis or wound complications.

CONCLUSIONS: Age greater than 65 does not appear to portend poorer outcomes after surgical repair of a tibial plateau fracture. The complication profiles are similar. Elderly and younger patients had similar function at 12 months compared to their baseline. These data suggest that age should not be a disqualifying factor when considering whether a patient with a tibial plateau fracture should be treated operatively.

PMID:36114875 | DOI:10.1007/s00590-022-03384-y

Arch Orthop Trauma Surg. 2022 Sep 17. doi: 10.1007/s00402-022-04621-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Complications associated with the application of the Reamer-irrigator-Aspirator (RIA) system are described in the literature. However, to date a systematic review and meta-analysis to assess prevalence of complications associated with the use of the RIA system have not been conducted.

MATERIALS AND METHODS: The review is registered with PROSPERO (CRD42021269982). MEDLINE, the Web of Science Core Collection, and Embase were searched from the inception to 10 August 2021. The primary objective was to assess complications and blood loss associated with the use of the RIA system.

RESULTS: Forty-seven studies involving 1834 procedures performed with the RIA system were finally included. A total of 105 complications were reported, with a pooled estimated overall prevalence of 1.7% with a 95% confidence interval (CI) of 0.40 to 3.60, with cortex perforation being the largest reported complication with a total of 34 incidences. A significant subgroup difference was observed (p = 0.02). In subgroup 1 (bone graft harvesting), complication prevalence was 1.4% (95% CI 0.2-3.4); in subgroup 2 (clearance intramedullary canal) it was 0.7% (95% CI 0.00-6.30) and in subgroup 3 (reaming with RIA system prior to nail fixation) 11.9% (95% CI 1.80-26.40). No statistically significant difference for tibia and femur as RIA system application site was observed (CI 0.69-4.19). In studies reporting blood loss, a mean volume of 803.29 ml, a mean drop of hemoglobin of 3.74 g/dl and a necessity of blood transfusion in 9.72% of the patients were observed.

CONCLUSIONS: The systematic review and meta-analysis demonstrate a low overall prevalence rate of complications associated with the RIA system. However, especially the risk of cortical perforation and the frequently reported relevant intraoperative blood loss are complications that should be anticipated in perioperative management and ultimately considered when using the RIA system.

PMID:36114869 | DOI:10.1007/s00402-022-04621-z

Birth Defects Res. 2022 Sep 17. doi: 10.1002/bdr2.2090. Online ahead of print.

ABSTRACT

BACKGROUND: Environmental factors may influence the development of tetralogy of Fallot (TOF), and DNA methylation patterns may reveal specific chemical signatures of perturbations during cardiac development. We investigated whether blood and buccal cells could be viable surrogates for myocardium.

METHODS: We measured epigenome-wide DNA methylation at 866,895 5′-cytosine-phosphate-guanine-3′ (CpG) sites in blood (n=3), buccal cells (n=3), and right ventricular myocardium (n=4) collected from infants with TOF and compared the percent of differentially methylated CpG sites across tissue types. Gene-specific DNA methylation profiles were also analyzed for ten representative genes associated with heart development. Welch’s ANOVAs compared general methylation between tissue types.

RESULTS: Comparison of DNA methylation profiles across blood, buccal, and myocardium suggested myocardium and buccal samples were most similar, differing in DNA methylation at only 1.3% (11,386) of CpG sites whereas myocardium and blood were most dissimilar, having 146,857 statistically dissimilar methylated CpG sites (~17% dissimilarity; adjusted p < 0.01 for each site). Buccal swabs were significantly more variable (p < .001) than either blood or myocardial samples. In gene-specific analyses, SCO2, GATA4, NOTCH4, WNT7A, and DKK2 showed conserved DNA methylation profiles across tissue types, while HAND1, JAG1, NKX2-5, TBX5 and TBX20 showed more distinctive tissue-specific patterns of DNA methylation.

CONCLUSIONS: Compared with blood, buccal tissue more closely mirrors the myocardial methylome, with >10-fold similarity. Nevertheless, both buccal and blood tissue capture highly conserved DNA methylation patterns at specific genetic loci related to cardiac development. Buccal cheek swabs may be a useful surrogate tissue type for future investigations of TOF-specific epigenetic profiles.

PMID:36114760 | DOI:10.1002/bdr2.2090

J Clin Pharm Ther. 2022 Sep 17. doi: 10.1111/jcpt.13766. Online ahead of print.

ABSTRACT

WHAT IS KNOWN AND OBJECTIVE: Hyperkalaemia is a common medical emergency in patients admitted to hospital. There is a limited evidence base supporting some of the commonly applied treatment strategies. Although, NICE has recommended the use of sodium zirconium cyclosilicate (SZC) (TA599) and patiromer (TA623) in both acute and chronic hyperkalaemia, there is a limited evidence base for their use in acute hyperkalaemia in the hospital setting, particularly when compared to the present standard of care calcium polystyrene sulfonate (CPS).

METHODS: A retrospective review of the electronic patient record system across our hospital over a 6-month period identified 138 patients who received either SZC (65 patients) or CPS (73 patients) to manage hyperkalaemia, investigating their efficacy and cost effectiveness. Results were analysed using simple descriptive statistics. Based on the results a naïve cost comparison between the two drugs was made.

RESULTS AND DISCUSSION: CPS and SZC both effectively reduced plasm potassium concentrations in patients with hyperkalaemia (6.07 and 6.03 mmol/L respectively) by 1.17 mmol/L and 1.24 mmol/L taking a similar amount of time to work (2.97 days vs. 3 days). The principle causes of hyperkalaemia identified were acute kidney injury, medication, and chronic kidney disease. Cost comparison analysis which took into account raw product price and time needed to dispense medications revealed that CPS has slightly better cost effectiveness compared to SZC albeit at a cost of increased staff input.

WHAT IS NEW AND CONCLUSION: Both CPS and SZC were equally effective at lowering acutely raised potassium concentrations. The cost difference between the two products appears to be small. Claims regarding the benefits of newer agents over older established medications need to be properly explored in randomized trials rather than being based on small scale non-comparative studies.

PMID:36114759 | DOI:10.1111/jcpt.13766

Acta Paediatr. 2022 Sep 17. doi: 10.1111/apa.16544. Online ahead of print.

ABSTRACT

AIM: According to the Italian national statistical institute, severe bacterial infections (SBI) in Italy are responsible for 1.7% of mortality under five years of age and their recognition is often challenging, especially in the first stages of the disease. We tried to estimate the prevalence of SBI in our target population and to identify signs and symptoms that could guide in the initial evaluation of a child with a possible SBI.

METHODS: We designed a prospective, multicenter study and enrolled patients aged 0-14 years at the first evaluation to the emergency department with an acute illness lasting a maximum of five days. The presence of variables suggestive of SBI was collected for every enrolled patient. One week after the enrolment, every patient was followed-up by telephone.

RESULTS: SBI is more likely to be detected with the ‘gut feeling’ in both univariate and multivariate models (univariate OR: 7.16, 95%CI: 4.08-12.56; multivariate OR: 5.34, 95%CI:2.78-10.25), while abnormal breathing pattern resulted significative only in univariate model (OR 3.83, 95%CI: 1.98-7.40). Nevertheless, their associated sensitivity is low.

CONCLUSION: SBI is uncommon in the absence of paediatricians’ gut feeling and abnormal respiratory pattern.

PMID:36114734 | DOI:10.1111/apa.16544

Ground Water. 2022 Sep 17. doi: 10.1111/gwat.13252. Online ahead of print.

ABSTRACT

The scope of this work is to discuss the proper choice of macrodispersion coefficients in modeling contaminant transport through the advection dispersion equation (ADE). It is common to model solute concentrations in transport by groundwater with the aid of the ADE. Spreading is quantified by macrodispersivity coefficients, which are much larger than the laboratory observed pore-scale dispersivities. In the frame of stochastic theory, longitudinal macrodispersivity is related to the hydraulic conductivity spatial variability via its statistical moments (mean, variance, integral scales), which are generally determined by geostatistical analysis of field measurements. In many cases, especially for preliminary assessment of contaminant spreading, these data are not available and ad-hoc values are adopted by practitioners. The present study aims at recommending dispersivity values based on a thorough analysis of tens of field experiments. Aquifers are classified as of weak, medium and high heterogeneity and for each class a range of macrodispersivity values is recommended. Much less data are available for the transverse macrodispersivities, which are significantly smaller than the longitudinal one. Nevertheless, a few realistic values based on field data, are recommended for applications. Transport models using macrodispersivities can predict mean concentrations, different from the local ones. They can be used for estimation of robust measures, like plumes spatial moments, longitudinal mass distribution and breakthrough curves at control planes.

PMID:36114728 | DOI:10.1111/gwat.13252

J Diabetes Investig. 2022 Sep 16. doi: 10.1111/jdi.13899. Online ahead of print.

ABSTRACT

AIMS/INTRODUCTION: Clinical evidence is lacking about the influence of sodium-glucose cotransporter 2 inhibitors on white blood cell (WBC) counts, a commonly used and widely available marker of inflammation. The aim of the present analysis was to assess the effect of canagliflozin relative to glimepiride on WBC counts.

MATERIALS AND METHODS: This was a post-hoc subanalysis of the CANDLE trial (Effects of Canagliflozin in Patients with Type 2 Diabetes and Chronic Heart Failure: A Randomized Trial; UMIN000017669), an investigator-initiated, multicenter, open-label, randomized, controlled trial. A total of 233 patients with type 2 diabetes and concomitant heart failure were randomly assigned to either canagliflozin (n = 113) or glimepiride (n = 120) treatment for 24 weeks. Overall, patient baseline characteristics were as follows: mean ± standard deviation age, 68.6 ± 10.1 years; hemoglobin A1c, 7.0 ± 0.9%; left ventricular ejection fraction, 56.7 ± 14.4%; and median N-terminal pro-brain natriuretic peptide, 252 pg/mL (interquartile range 96-563 pg/mL). The mean baseline WBC counts were 6704 cells/μL (95% confidence interval 6,362-7,047) in the canagliflozin group and 6322 cells/μL (95% confidence interval 5,991-6,654) in the glimepiride group. There were no significant differences between treatment groups in terms of changes in WBC counts from baseline to weeks 4 and 12. In contrast, a group difference (canagliflozin minus glimepiride) from baseline to week 24 was significant (mean difference – 456 cells/μL [95% confidence interval -774 to -139, P = 0.005]).

CONCLUSIONS: Our findings suggest that 24 weeks of treatment with canagliflozin, relative to glimepiride, reduced WBC counts in patients with type 2 diabetes and heart failure.

PMID:36114704 | DOI:10.1111/jdi.13899

Nurs Open. 2022 Sep 16. doi: 10.1002/nop2.1363. Online ahead of print.

ABSTRACT

AIMS: To determine the effect of design thinking approach in interprofessional education programme of human sexuality course.

DESIGN: A pre-test and post-test of single-group quasi-experimental study.

METHODS: The 35 nursing students and seven psychology students in their third year were selected by the computer randomly sampling through the lottery method. The course proceeded between September 2019 and January 2020. The participants had received an 8-week, 16-hr design thinking approach in interprofessional education programme of human sexuality course (one section per week, 2 hr per section). We used the nursing attitude toward sexual healthcare scale, nursing intervention toward sexual healthcare scale to assess students’ attitude and behaviour intention toward sexual health care and competence of interprofessional education scale to assess students’ competence of cooperation before and after the teaching programme. Data analysis used descriptive statistics and t-tests. A qualitative reflection log was also provided and analysed for themes. The SQUIRE-EDU checklist was followed.

RESULTS: The students’ attitude and behavioural intention dimension score in the post-test is higher than those in the pre-test and reach statistically significant differences both in total and subscale. Interprofessional core competence score of Observation Experience, Reflective Feedback, Interprofessional Cooperation, Innovative Design, and Applied Technology score in the post-test is higher than those in the pre-test and reach statistically significant differences both in total and subscale. Design thinking in interprofessional education programme of human sexuality course could significantly improve both nursing and psychology students’ attitude, behaviour intention of providing sexual health care and competence of interprofessional cooperation.

PMID:36114695 | DOI:10.1002/nop2.1363

J Diabetes. 2022 Sep 16. doi: 10.1111/1753-0407.13315. Online ahead of print.

ABSTRACT

BACKGROUND: In the euthyroid state, the risk of developing diabetes according to changes in thyroid-stimulating hormone (TSH) levels remains controversial. Additionally, the correlation of various body indices affecting blood glucose levels according to changes in TSH levels over a certain period is not well known.

METHODS: Patients who underwent health check-ups twice at a 2 year interval at a tertiary university hospital between 2009 and 2018 were included. By dividing baseline TSH levels into quartiles (TSH_Q1, Q2, Q3, and Q4), various variables were compared, and their changes after 2 years (∆TSH_Q1, Q2, Q3, and Q4) were confirmed.

RESULTS: Among 15 557 patients, the incidence of diabetes mellitus after 2 years was 2.4% (377/15 557 patients). There was no statistically significant difference in the incidence of diabetes according to TSH_Q (p = 0.243) or ∆TSH_Q (p = 0.131). However, as TSH levels increased, skeletal muscle mass decreased (p < 0.001), and body fat mass and percent body fat significantly increased (p < 0.001). As ∆TSH increased, ∆fasting blood glucose and ∆body mass index also significantly increased (all p < 0.001). The incidence of diabetes decreased significantly as skeletal muscle mass increased (odds ratio 0.734, p < 0.001).

CONCLUSIONS: Owing to the short study period, it was not possible to prove a statistical relationship between the incidence of diabetes mellitus and TSH levels in the euthyroid state. Significant decreases in skeletal muscle mass and increases in body mass index and body fat mass according to baseline TSH levels were demonstrated. Therefore, a focus on improving physical functions, such as increasing muscle mass and decreasing fat, is required in this case.

PMID:36114679 | DOI:10.1111/1753-0407.13315