Category: Statistics

Ann Surg Oncol. 2023 Dec 13. doi: 10.1245/s10434-023-14709-4. Online ahead of print.

ABSTRACT

INTRODUCTION: To analyze the cancer burden in the United States, researchers are relying on the Surveillance, Epidemiology, and End Results (SEER) Program. Our objective was to analyze differences in cancer outcome between Commission on Cancer (CoC)-accredited and non-accredited facilities.

METHODS: The SEER database was queried for diagnosis years 2018 and 2019. Only analytic cases were included. Observed survival was calculated using the Kaplan-Meier method for all cancer sites, stratified by accreditation status. Univariate analyses were performed to quantify differences in survival between cancer cases in CoC-accredited and non-CoC-accredited facilities. Cancers of interest were chosen based on statistical significance (p < 0.01) and clinical significance (> 25% difference in end survival). Multivariate analyses were conducted on cancers of interest.

RESULTS: Overall, there were 602,185 cases from CoC-accredited facilities and 198,492 from non-CoC-accredited facilities. 5 of 59 solid organ cancers showed statistically and clinically significant reductions in survival in non-accredited facilities (lung and bronchus: 27.9%; liver: 41.1%; esophagus: 30.4%; pancreas: 32.7%; intrahepatic bile duct: 39.4%). Multivariate analysis on these 5 cancers was performed. CoC accreditation was a statistically significant variable decreasing the hazard in all 5 cancers (hazard ratio 0.86-0.91; all p-values <0.005). All these cancers demand resource-intensive treatment.

CONCLUSION: Accreditation has a significant impact on survival in 5/59 solid organ cancers. Although accredited facilities may be better apt to handle these cancer cases, the survival in most cancers is not significantly affected by accreditation. However, examining longer-term endpoints elucidate further nuances. Herein, CoC accreditation was found to be an independent variable impacting 2-year survival for a minority of cancers.

PMID:38093167 | DOI:10.1245/s10434-023-14709-4

Oral Maxillofac Surg. 2023 Dec 14. doi: 10.1007/s10006-023-01201-2. Online ahead of print.

ABSTRACT

PURPOSE: The objective of this multicenter study was to examine the differences in maxillo-facial fractures epidemiology across the various phases of the SARS-CoV-2 pandemic.

METHODS: This is a retrospective study on patients who underwent surgery for facial bone fractures in 18 maxillo-facial surgery departments in Italy, spanning from June 23, 2019, to February 23, 2022. Based on the admission date, the data were classified into four chronological periods reflecting distinct periods of restrictions in Italy: pre-pandemic, first wave, partial restrictions, and post-pandemic. Epidemiological differences across the groups were analysed.

RESULTS: The study included 2938 patients. A statistically significant difference in hospitalization causes was detected between the pre-pandemic and first wave groups (p = 0.005) and between the pre-pandemic and partial restriction groups (p = 0.002). The differences between the pre- and post-pandemic groups were instead not significant (p = 0.106). Compared to the pre-pandemic period, the number of patients of African origin was significantly higher during the first wave and the post-pandemic period. No statistically significant differences were found across the periods concerning gender, age, fracture type, treatment approach, and hospital stay duration CONCLUSIONS: The COVID-19 pandemic brought about significant changes in fracture epidemiology, influenced by the restrictive measures enforced by the government in Italy. Upon the pandemic’s conclusion, the fracture epidemiology returned to the patterns observed in the pre-pandemic period.

PMID:38093155 | DOI:10.1007/s10006-023-01201-2

Updates Surg. 2023 Dec 13. doi: 10.1007/s13304-023-01688-0. Online ahead of print.

ABSTRACT

BACKGROUND: There is little information about the relevance of extra-ampullary duodenal adenocarcinoma (EDA) subtypes. The aim of this study was to evaluate the impact of EDA subtypes on surgical and oncological outcomes following pancreatoduodenectomy (PD).

METHODS: Consecutive patients undergoing PD for EDA from 2000 to 2019 were analyzed. Results were stratified by pathologic subtype (intestinal versus non-intestinal). Uni-and multivariable analyses were performed using standard statistical methods.

RESULTS: The study population consisted of 70 patients, of whom 49 (70%) had an intestinal phenotype. EDA with intestinal phenotype was more frequently proximal to the Ampulla of Vater, while non-intestinal EDA was more frequently found distally (76% vs. 33%, p = 0.002). Patients with intestinal EDA were less likely to experience severe morbidity, with decreased reoperation and unplanned Intensive Care Unit admission rates relative to non-intestinal subtypes (2% vs. 29% p = 0.002, and 2% vs. 19%, p = 0.007, respectively). The median follow-up post-pancreatectomy was 73 months. Intestinal EDA was associated with improved overall and disease-free survival, with 3-year and 5-year survival rates of 71% vs. 29% and 53% vs. 24%, respectively. (p = 0.019 and p = 0.025).

CONCLUSION: Intestinal-type EDA, which more often arises from supra-ampullary duodenum, was associated with better postoperative outcomes and improved survival.

PMID:38093152 | DOI:10.1007/s13304-023-01688-0

Eur J Nutr. 2023 Dec 13. doi: 10.1007/s00394-023-03284-9. Online ahead of print.

ABSTRACT

PURPOSE: Longer-term intake of fatty acid (FA)-modified dairy products (SFA-reduced, MUFA-enriched) was reported to attenuate postprandial endothelial function in humans, relative to conventional (control) dairy. Thus, we performed an in vitro study in human aortic endothelial cells (HAEC) to investigate mechanisms underlying the effects observed in vivo.

METHODS: This sub-study was conducted within the framework of the RESET study, a 12-week randomised controlled crossover trial with FA-modified and control dairy diets. HAEC were incubated for 24 h with post-intervention plasma samples from eleven adults (age: 57.5 ± 6.0 years; BMI: 25.7 ± 2.7 kg/m²) at moderate cardiovascular disease risk following representative sequential mixed meals. Markers of endothelial function and lipid regulation were assessed.

RESULTS: Relative to control, HAEC incubation with plasma following the FA-modified treatment increased postprandial NOx production (P-interaction = 0.019), yet up-regulated relative E-selectin mRNA gene expression (P-interaction = 0.011). There was no impact on other genes measured.

CONCLUSION: Incubation of HAEC with human plasma collected after longer-term dairy fat manipulation had a beneficial impact on postprandial NOx production. Further ex vivo research is needed to understand the impact of partial replacement of SFA with unsaturated fatty acids in dairy foods on pathways involved in endothelial function.

PMID:38093120 | DOI:10.1007/s00394-023-03284-9

Langenbecks Arch Surg. 2023 Dec 14;409(1):7. doi: 10.1007/s00423-023-03197-5.

ABSTRACT

PURPOSE: This study aimed to investigate the association of effort-independent variables derived from the preoperative cardiopulmonary exercise test (CPET) with 30-day postoperative complications after elective colorectal surgery.

METHODS: A multicenter (n=4) retrospective explorative study was performed using data of patients who completed a preoperative CPET and underwent elective colorectal surgery. The preoperative slope of the relation between minute ventilation and carbon dioxide production (VE/VCO₂-slope) and the oxygen uptake efficiency slope (OUES), as well as 30-day postoperative complications, were assessed. Multivariable logistic regression analyses and receiver operating characteristic (ROC) curves were used to investigate the prognostic value of the relationship between these preoperative CPET-derived effort-independent variables and postoperative complications.

RESULTS: Data from 102 patients (60.1% males) with a median age of 72.0 (interquartile range 67.8-77.4) years were analyzed. Forty-four patients (43.1%) had one or more postoperative complications (of which 52.3% general and 77.3% surgical complications). Merely 10 (9.8%) patients had a general complication only. In multivariate analysis adjusted for surgical approach (open versus minimally invasive surgery), the VE/VCO₂-slope (odds ratio (OR) 1.08, confidence interval (CI) 1.02-1.16) and OUES (OR 0.94, CI 0.89-1.00) were statistically significant associated with the occurrence of 30-day postoperative complications.

CONCLUSION: The effort-independent VE/VCO₂-slope and OUES might be used to assist in future preoperative risk assessment and could especially be of added value in patients who are unable or unwilling to deliver a maximal cardiorespiratory effort. Future research should reveal the predictive value of these variables individually and/or in combination with other prognostic (CPET-derived) variables for postoperative complications.

TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT05331196.

PMID:38093118 | DOI:10.1007/s00423-023-03197-5

Health Promot Int. 2023 Dec 1;38(6):daad166. doi: 10.1093/heapro/daad166.

ABSTRACT

Engagement in youth programs is a potential means to promote health and well-being across populations of young people. Safer spaces in these youth programs are likely critical in fostering positive health outcomes, but current research on the links between safer spaces and health is limited. In this exploratory study, we examined links between program safety in youth development programs and minoritized status, and health-related quality of life (HRQoL) and psychosomatic health complaints. Participants (N = 282; Mean age = 16.97 years; SD = 2.97) self-identified across various minority status groups, including LGBTQ (30%) and a range of perceived income levels. We tested a statistical model in which safer spaces, LGBTQ status and perceived income predicted HRQoL and health complaints in youth development program participants. LGBTQ status and lower perceived income were related to lower HRQoL and more health complaints, and safer space in youth development programs was related to better HRQoL. We also found an interaction effect, such that safer spaces in youth programs appeared to be especially beneficial for HRQoL for youth with higher incomes. Findings reinforce past research on LGBTQ status and income as factors for youth wellness and mental health. Findings also suggest that perceived safer spaces in youth development programs support better HRQoL and lower health complaints, across populations of participating youth.

PMID:38091620 | DOI:10.1093/heapro/daad166

Phys Med Biol. 2023 Dec 13. doi: 10.1088/1361-6560/ad1549. Online ahead of print.

ABSTRACT

&#xD;The high production cost of commonly used lutetium-based fast scintillators and the development of silicon photomultipliers technology have made bismuth germanate (BGO) a promising candidate for time-of-flight positron emission tomography (TOF PET) detectors owing to its generation of prompt Cherenkov photons. However, using BGO as a hybrid scintillator is disadvantageous owing to its low photon statistics and distribution that does not conform well to a single Gaussian. To mitigate this, a proposal was made to increase the likelihood of detecting the first Cherenkov photons by positioning two photosensors in opposition at the entrance and exit faces of the scintillator and subsequently selectively picking an earlier timestamp. Nonetheless, the timing variation arising from the photon transit time remains affected by the entire length of the crystal, thereby presenting a possibility for further enhancement.&#xD;Approach: In this study, we aimed to improve the timing performance of the dual-ended BGO Cherenkov TOF PET detector by capitalizing on the synergistic advantages of applying depth-of-interaction (DOI) information and crystal surface finishes or reflector properties. A dual-ended BGO detector was implemented using a 3 × 3 × 15 mm3 BGO crystal. Coincidence events were acquired against a 3 × 3 × 3 mm3 LYSO:Ce:Mg reference detector. The timing performance of the dual-ended BGO detectors was analyzed using conventionally proposed timestamp methods before and after DOI correction.&#xD;Results:&#xD;Through a DOI-based correction of photon transit time spread, we demonstrated a further improvement in the timing resolution of the BGO-based Cherenkov TOF PET detector utilizing a dual-ended detector configuration and adaptive arrival time pickoff. We achieved further improvements in timing resolution by correcting the offset spread induced by the fluctuation of timing signal rise time in the dual-ended detector.&#xD;Significance: Although polishing the crystal surface was still favorable in terms of full-width-half-maximum (FWHM) value, incorporating DOI information from the unpolished crystal to compensate for photon travel time facilitated additional enhancement in the overall timing performance, thereby surpassing that achieved with the polished crystal.&#xD.

PMID:38091614 | DOI:10.1088/1361-6560/ad1549

Gigascience. 2022 Dec 28;12:giad106. doi: 10.1093/gigascience/giad106.

ABSTRACT

BACKGROUND: Cancer is widely regarded as a complex disease primarily driven by genetic mutations. A critical concern and significant obstacle lies in discerning driver genes amid an extensive array of passenger genes.

FINDINGS: We present a new method termed DriverMP for effectively prioritizing altered genes on a cancer-type level by considering mutated gene pairs. It is designed to first apply nonsilent somatic mutation data, protein‒protein interaction network data, and differential gene expression data to prioritize mutated gene pairs, and then individual mutated genes are prioritized based on prioritized mutated gene pairs. Application of this method in 10 cancer datasets from The Cancer Genome Atlas demonstrated its great improvements over all the compared state-of-the-art methods in identifying known driver genes. Then, a comprehensive analysis demonstrated the reliability of the novel driver genes that are strongly supported by clinical experiments, disease enrichment, or biological pathway analysis.

CONCLUSIONS: The new method, DriverMP, which is able to identify driver genes by effectively integrating the advantages of multiple kinds of cancer data, is available at https://github.com/LiuYangyangSDU/DriverMP. In addition, we have developed a novel driver gene database for 10 cancer types and an online service that can be freely accessed without registration for users. The DriverMP method, the database of novel drivers, and the user-friendly online server are expected to contribute to new diagnostic and therapeutic opportunities for cancers.

PMID:38091511 | DOI:10.1093/gigascience/giad106

Anesth Analg. 2023 Dec 8. doi: 10.1213/ANE.0000000000006802. Online ahead of print.

ABSTRACT

BACKGROUND: Trauma outcome prediction models have traditionally relied upon patient injury and physiologic data (eg, Trauma and Injury Severity Score [TRISS]) without accounting for comorbidities. We sought to prospectively evaluate the role of the American Society of Anesthesiologists physical status (ASA-PS) score and the National Surgical Quality Improvement Program Surgical Risk-Calculator (NSQIP-SRC), which are measurements of comorbidities, in the prediction of trauma outcomes, hypothesizing that they will improve the predictive ability for mortality, hospital length of stay (LOS), and complications compared to TRISS alone in trauma patients undergoing surgery within 24 hours.

METHODS: A prospective, observational multicenter study (9/2018-2/2020) of trauma patients ≥18 years undergoing operation within 24 hours of admission was performed. Multiple logistic regression was used to create models predicting mortality utilizing the variables within TRISS, ASA-PS, and NSQIP-SRC, respectively. Linear regression was used to create models predicting LOS and negative binomial regression to create models predicting complications.

RESULTS: From 4 level I trauma centers, 1213 patients were included. The Brier Score for each model predicting mortality was found to improve accuracy in the following order: 0.0370 for ASA-PS, 0.0355 for NSQIP-SRC, 0.0301 for TRISS, 0.0291 for TRISS+ASA-PS, and 0.0234 for TRISS+NSQIP-SRC. However, when comparing TRISS alone to TRISS+ASA-PS (P = .082) and TRISS+NSQIP-SRC (P = .394), there was no significant improvement in mortality prediction. NSQIP-SRC more accurately predicted both LOS and complications compared to TRISS and ASA-PS.

CONCLUSIONS: TRISS predicts mortality better than ASA-PS and NSQIP-SRC in trauma patients undergoing surgery within 24 hours. The TRISS mortality predictive ability is not improved when combined with ASA-PS or NSQIP-SRC. However, NSQIP-SRC was the most accurate predictor of LOS and complications.

PMID:38091502 | DOI:10.1213/ANE.0000000000006802

West Afr J Med. 2023 Nov 30;40(11):1173-1180.

ABSTRACT

BACKGROUND: The most prevalent oral diseases, dental caries and periodontal disease, result in pain, discomfort, and loss of oral functions, often leading to poor nutrition.

OBJECTIVES: To assess the prevalence and relationship between oral health and nutritional status among children aged 2 to 5 years in Maiduguri, North-East Nigeria.

METHODS: A cross-sectional study that assessed caries experience, gingival status and nutritional status of children. Anthropometric measurements of weight-for-age and mid-upper arm circumference (MUAC) were used to assess nutritional status. Participants were randomly selected from three private schools. The MUAC was measured using a standardised tape rule. The weight-for-age by sex of the participants was extrapolated from the weight-for-age WHO chart. Oral health was assessed using the WHO Oral Health Survey Methods. Data were analysed using SPSS for Windows (version 23). Statistical significance was placed at 95% confidence and p ≤ 0.05.

RESULTS: There were 239 participants with a male:female ratio of 1.2:1 (SE=0.03). Mean dmft was 0.72 (SE 0.09) and 63.2% had healthy gingiva (SE 0.04). The mean weight was 16.8kg (SE=0.15) and mean MUAC was 15.3 cm. Caries prevalence was associated with nutritional status and positively correlated (r=0.03, P=0.64). Gingival status was associated but inversely correlated with MUAC (r= -0.02, P= 0.76).

CONCLUSION: Normal nutritional status was associated with no caries prevalence and healthy gingiva. Underweight was associated with caries prevalence. Adequate and healthy nutrition promotes good oral health in children.

PMID:38091448