Category: Statistics

Surg J (N Y). 2023 Dec 22;9(4):e135-e144. doi: 10.1055/s-0043-1777790. eCollection 2023 Oct.

ABSTRACT

Introduction Delayed presentation of burn patients, in a developing country with the patient being referred from one center to another higher one, is a common occurrence. Efficient management of such delayed burn wounds thus becomes critical to decrease the morbidity of the patient within economic constraints. The advantages of collagen dressing are numerous. However, there is scarce literature on the timing of its application. Traditionally, it is thought that collagen sheets should be applied within 24 hours of burns as the wound is still sterile. This thus becomes ironical as patients are presenting late. Hence, we studied retrospectively the result of collagen application in delayed presentation of burns. Methods A retrospective study was conducted in which records of pediatric patients of less than 10 years with less than 30% total body surface area scald burns were considered. Collagen dressing was done in all these patients. Presentation time from burns, timing of collagen application, status of wound at various check dresses, complication of burn wound, and total healing times were recorded. Appropriate statistical formulas were used to calculate significance levels for continuous and categorical variables. Result Fifty-three patients, 33 male and 20 female were studied. The most common cause of scald was hot water spillage from baths and cooking, with the anterior trunk being the most involved site. The mean time of presentation of the patient from burns is 71.74 hours and that of collagen application was 76.4 hours. Fourteen (25.4%) patients had wound complications in the form of soakage, fever, and pus. Eight patients had their collagen removed. The average healing time for patients with intact collagen was 12.15 days and that for those on daily dressing was 21.9 days. Conclusion Collagen should be preferred even when the patient presents after 24 hours of burns. A thoroughly washed wound is a necessary prerequisite before collagen application. Burn patients presenting after 3 days have a higher incidence of wound infection. No such time stamp of application of collagen sheets within 24 hours can thus be given for its use as the advantages of adhered and successful collagen dressings outweigh those on daily dressings.

PMID:38197092 | PMC:PMC10746384 | DOI:10.1055/s-0043-1777790

Surg J (N Y). 2023 Dec 28;9(4):e149-e155. doi: 10.1055/s-0043-1770954. eCollection 2023 Oct.

ABSTRACT

Objective This study aims to show the place of muscle-sparing posterolateral thoracotomy in the treatment of spontaneous pneumothorax. Methods It was a single-center study performed in the Department of Thoracic Surgery of Teaching hospital Hassan II of Fez for 8 years. We adopted the nosological definition, which classifies spontaneous pneumothorax into three categories. We included patients over 15 years of age with primary or secondary spontaneous pneumothorax operated by posterolateral thoracotomy without muscle section, and we analyzed the specific indications of this approach. It included 49 patients with primary or secondary spontaneous pneumothorax, operated by muscle-sparing posterolateral thoracotomy. Data were collected from regularly updated computer files of patients, entered by Excel 2013, and analyzed using SPSS.20 software. These data are: epidemiological, clinical, radiological, surgical exploration, surgical procedure, the result of the surgery and the evolution. Results The average age was 42 years. Smoking was found in 61% of cases and pulmonary tuberculosis in 10% of cases. Thoracic computed tomography (CT) showed bullae and blebs in 31% of cases, pleural adhesions and pachypleuritis in 50% of cases, and hydropneumothorax with pachypleuritis in 37% of cases. There is a statistical correlation between pleuropulmonary decortication and pachypleuritis ( p = 0.002) or hydropneumothorax ( p = 0.001) on CT. Bullae and blebs resection was performed in 53% of cases and pleuropulmonary decortication in 63% of cases. A right pleuropneumonectomy was performed in one case. The follow-up was uneventful in 82% of cases. Conclusion Muscle-sparing posterolateral thoracotomy remains the best approach and leads to good results.

PMID:38197090 | PMC:PMC10754642 | DOI:10.1055/s-0043-1770954

Neurol Clin Pract. 2024 Feb;14(1):e200220. doi: 10.1212/CPJ.0000000000200220. Epub 2024 Jan 4.

ABSTRACT

BACKGROUND AND OBJECTIVES: Evidence of effective multifactorial lifestyle interventions for primary stroke prevention is lacking, despite the significant contribution of lifestyle to stroke burden. We aimed to determine the efficacy of health and wellness coaching (HWC) for primary stroke and cardiovascular disease (CVD) prevention in adults at a moderate-to-high CVD risk.

METHODS: This was a parallel, 2-arm, open-label, single-blinded, phase III randomized controlled trial to determine the efficacy of HWC for primary stroke prevention in individuals 30 years and older with a 5-year CVD risk ≥10% as measured by 5-year absolute CVD risk (as measured by the PREDICT tool) at 9 months post-randomization. Eligible participants were those with a 5-year CVD risk ≥10%, with no history of stroke, transient ischemic attack, or myocardial infarction. The relative risk reduction (RRR) and odds ratios (OR) were evaluated separately in those at moderate (10%-14%) 5-year CVD risk and those at high risk (≥15%) at baseline. The Life’s Simple 7 (LS7) score for lifestyle-related CVD risk, as the indicator of cardiovascular health, was a key secondary outcome.

RESULTS: Of a total of 320 participants, 161 were randomized to the HWC group and 159 to the usual care (UC) group. HWC resulted in a statistically significant RRR of -10.9 (95% CI -21.0 to -0.9) in 5-year CVD risk in the higher CVD risk group but no change in the moderate risk group. An improvement in the total LS7 score was seen in the HWC group compared with the UC group (absolute difference = 0.485, 95% CI [0.073 to 0.897], p = 0.02). Improvement in blood pressure scores was statistically significantly greater in the HWC group than in the UC group for those at high risk of CVD (OR 2.28 [95% CI 1.12 to 4.63] and 1.55 [0.80 to 3.01], respectively). No statistically significant differences in mood scores, medication adherence, quality of life, and satisfaction with life scores over time or between groups were seen.

DISCUSSION: Health and wellness coaching resulted in a significant RRR in the 5-year CVD risk compared with UC at 9 months post-randomization in patients with a high baseline CVD risk. There was no improvement in CVD risk in the moderate risk group; hence, this study did not meet the primary hypothesis. However, this treatment effect is clinically significant (number needed to treat was 43). The findings suggest that HWC has potential if further refined to improve lifestyle risk factors of stroke.

PMID:38197084 | PMC:PMC10775165 | DOI:10.1212/CPJ.0000000000200220

Transl Cancer Res. 2023 Dec 31;12(12):3744-3751. doi: 10.21037/tcr-23-1923. Epub 2023 Dec 27.

ABSTRACT

BACKGROUND: Breast cancer is one of the main causes of death among women. RNA binding proteins (RBPs) play a crucial role in the progression of breast cancer, with increasingly detailed understanding of RBP functional molecular mechanisms in breast cancer, the functional research of RBPs may help elucidate the potential mechanisms of tumor occurrence, development, invasion, metastasis and prognosis. DDB1- and CUL4-associated factor 13 (DCAF13) is an RBPs has been identified as a substrate receptor for the CUL4-DDB1 E3 ligase complex. Its expression is related to the prognosis of certain cancer. We tried to explore both co-expressed network and biological functions of DCAF13 in breast cancer.

METHODS: The Cancer Genome Atlas (TCGA) database was used to analyze the different expression of DCAF13 messenger RNA (mRNA) between normal breast tissue and breast carcinoma tissue, and the clinical data about 960 samples were downloaded from the cBio Cancer Genomics Portal (cBioPortal). The expression level of DCAF13, co-expression network, and survival were analyzed. Those with a fold change ≥1 and FDR <0.05 were considered to have statistical significance. Unsupervised clustering of differentially expressed RBPs was performed based on log2-transformed FPKM values using the “pheatmap” package in R. Genes with a Spearman score >0.55 were regarded as moderately co-expressed genes. The Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database was used to construct a co-expression network. Meanwhile, the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) databases were used to identify the biological process cluster and pathway cluster, respectively.

RESULTS: Compared with normal breast tissue, DCAF13 mRNA expression was significantly increased in breast cancer tissue (P<0.01). The Database for Annotation, Visualization and Integrated Discovery (DAVID) was used to identify the functions of the co-expressed network. These genes were mainly enriched in mitosis, nuclear division, metabolic process, recombination, replication and repair of DNA, double-strand break repair, posttranscriptional regulation of gene expression, regulation of cell cycle, division and proliferation, regulation of protein stability and also participation in in regulation of poly(A) RNA binding, mRNA binding, tRNA binding, adenosine triphosphate (ATP) binding. KEGG pathway analysis revealed that the genes were mainly enriched in cell cycle, oocyte meiosis and oxidative phosphorylation. According to survival analysis, upregulation of DCAF13 mRNA was significant for overall survival (OS) (P=0.0163).

CONCLUSIONS: DCAF13 is up-regulated in breast cancer, the OS of patients with DCAF13 up-regulation was obviously reduced. DCAF13 was used as a diagnostic marker and therapeutic target for breast cancer. By building a co-expression network of DCAF13 and conducting bioinformatics analysis, it is possible to find the biomarker to evaluate patient prognosis. This finding provides a new target in mechanism and cell research of breast cancer.

PMID:38197079 | PMC:PMC10774066 | DOI:10.21037/tcr-23-1923

Transl Cancer Res. 2023 Dec 31;12(12):3255-3265. doi: 10.21037/tcr-22-2792. Epub 2023 Dec 27.

ABSTRACT

BACKGROUND: Traditional intensity-modulated radiation therapy (IMRT) planning for cervical cancer is time-consuming and require iterative repeated optimization. In this study, we focused on leveraging multi-criteria optimization (MCO) to reduce the impact of small bowel high-dose indices on other optimization targets, thereby providing a rapid approach to individualized IMRT for cervical cancer patients.

METHODS: Our research involved a cohort of 25 cervical cancer patients who underwent IMRT radiotherapy. The patient inclusion criteria were as follows: (I) histopathological confirmation of cervical cancer, (II) underwent IMRT radiation therapy, and (III) a prescribed dose of 180 cGy/28 fractions for the patient. All plans were replanned by an experienced dosimetrist without the MCO (W-IMRT). On the basis of the W-IMRT plan, the individualized IMRT (I-IMRT) plan was generated under the priority trade-off of reducing the D2cc (D2cc is the minimal dose to the 2 cm3 of the small bowel receiving the maximal dose) index of the small bowel using the MCO method, maintaining target coverage and protecting other organs at risk (OARs) as much as possible. Statistical analysis was performed using the Wilcoxon signature rank test.

RESULTS: When the MCO method was applied to the IMRT plan, the high dose index decreased in the overlapping area between the small bowel and the planning treatment volume (PTV) (P<0.001, respectively). The D2cc index of the small bowel decreased to below 5,200 cGy in all I-IMRT plans. On the other hand, in PTV, the I-IMRT plan achieved a better homogeneity index (HI) compared to the W-IMRT plan. Significant dose reductions were also observed in the bladder (D_mean 144.8 cGy and V₄₀ 1.45%) (P<0.001, respectively), rectum (D_mean 43.9 cGy and V₄₀ 2.7%) (P<0.001, respectively) and bilateral femur heads (D_mean 150 cGy) (P<0.001, respectively).

CONCLUSIONS: Dosimetric differences suggest that the I-IMRT plan using the MCO method provides better protection of other OARs and equivalently in PTV coverage, while lowering the high-dose index in the small bowel as much as possible for patients with cervical cancer, thus providing a rapid approach to achieving individualized IMRT for cervical cancer patients.

PMID:38197072 | PMC:PMC10774067 | DOI:10.21037/tcr-22-2792

Clin Optom (Auckl). 2024 Jan 5;16:17-30. doi: 10.2147/OPTO.S436659. eCollection 2024.

ABSTRACT

INTRODUCTION: Proper access to primary eye care is essential in addressing vision impairment, and tele-eye care examinations are a promising solution that could facilitate this access in many rural or remote areas. Even though remote eye exams are becoming increasingly frequent, comprehensive tele-eye care exams are still limited by the lack of published data. The aim of this study is to compare a comprehensive tele-eye care exam with a gold standard in-person primary eye care exam with an emphasis on refractive measurements, ocular health assessment, confidence level of the eye care providers and patient satisfaction.

METHODS: Sixty-six participants underwent two comprehensive eye exams performed by two eye care providers. One was a gold standard in-person exam, while the other was a remote exam performed by an eye care provider through videoconference. An overall patient satisfaction survey and a questionnaire for visual comfort with a trial frame from each modality were completed and the eye care providers scored their confidence level for each test. Exam results and diagnoses were compared between both modalities.

RESULTS: Tele-refraction has a good to excellent agreement with in-person subjective refraction in terms of sphero-cylindrical power and best corrected visual acuity. There was no statistically significant difference for visual comfort between both modalities. The agreement between in-person and remote exams for ocular health assessment ranged from fair to almost perfect, but there was a low prevalence of ocular pathologies within the study sample. The confidence level of the eye care providers and patient satisfaction were statistically higher in-person.

CONCLUSION: Tele-eye care appears to be statistically and clinically non-inferior to in-person eye exams, especially for refraction, but the low prevalence of ocular pathologies somewhat limits the comparison of its efficacy for ocular health assessment. More studies on comprehensive tele-eye care exams are needed.

PMID:38197048 | PMC:PMC10775700 | DOI:10.2147/OPTO.S436659

Sleep Sci. 2023 Nov 22;16(4):e399-e407. doi: 10.1055/s-0043-1776748. eCollection 2023 Dec.

ABSTRACT

Objective The objective of the present study was to find biomechanical correlates of single-task gait and self-reported sleep quality in a healthy, young population by replicating a recently published study. Materials and Methods Young adults ( n = 123) were recruited and were asked to complete the Pittsburgh Sleep Quality Inventory to assess sleep quality. Gait variables ( n = 53) were recorded using a wearable inertial measurement sensor system on an indoor track. The data were split into training and test sets and then different machine learning models were applied. A post-hoc analysis of covariance (ANCOVA) was used to find statistically significant differences in gait variables between good and poor sleepers. Results AdaBoost models reported the highest correlation coefficient (0.77), with Support-Vector classifiers reporting the highest accuracy (62%). The most important features associated with poor sleep quality related to pelvic tilt and gait initiation. This indicates that overall poor sleepers have decreased pelvic tilt angle changes, specifically when initiating gait coming out of turns (first step pelvic tilt angle) and demonstrate difficulty maintaining gait speed. Discussion The results of the present study indicate that when using traditional gait variables, single-task gait has poor accuracy prediction for subjective sleep quality in young adults. Although the associations in the study are not as strong as those previously reported, they do provide insight into how gait varies in individuals who report poor sleep hygiene. Future studies should use larger samples to determine whether single task-gait may help predict objective measures of sleep quality especially in a repeated measures or longitudinal or intervention framework.

PMID:38197030 | PMC:PMC10773524 | DOI:10.1055/s-0043-1776748

Sleep Sci. 2023 Nov 22;16(4):e439-e445. doi: 10.1055/s-0043-1776796. eCollection 2023 Dec.

ABSTRACT

Introduction Chronic nightmares are a common and disabling feature of posttraumatic stress disorder (PTSD) for which broadly effective treatments are still lacking. While imagery rehearsal therapy (IRT) demonstrates benefits for patients with idiopathic nightmares and some patients with PTSD-related nightmares, research indicates it may be less beneficial for veterans. Narrative therapy (NT) is a form of psychotherapy which is client-centered and value-focused and has demonstrated benefits for PTSD patients. The application of NT principles to IRT may provide a valuable therapeutic approach for treatment in veterans. Objective To perform a retrospective chart review of veteran clients participating in a novel, brief intervention developed by the first author consisting of IRT enhanced with NT principles (N-IRT) for the treatment of nightmares. The primary outcomes were nightmare frequency and intensity, and the secondary outcome was the impact of the intervention on nightmare distress and coping, subjective sleep quality, and overall PTSD symptoms. Materials and Methods We conducted retrospective chart reviews for eight veterans referred to the first author for the treatment of nightmares, who completed N-IRT, including baseline and end-of-treatment measures. The protocol involved a single 60-minute NT-enhanced rescripting session and assigned homework to rehearse the revised dream script, and a follow-up evaluation 4 weeks later. The subjects completed a sleep and nightmare interview developed by the first author and the PTSD Checklist at baseline and after the intervention at the follow-up evaluation. Paired t -tests were conducted to test for pre-to-post differences. Results In the statistical analysis, we observed a statistically significant and clinically meaningful reduction in the frequency ( p = 0.04) and intensity of nightmares ( p = 0.001) from pretreatment to the 1-month follow-up. Measures of nightmare-associated emotional distress, the ability to cope with nightmares, sleep duration and sleep efficiency, as well as overall PTSD symptoms also demonstrated significant improvements. Conclusion These pilot data provide compelling preliminary evidence that a single-session IRT intervention modified with NT (N-IRT) is effective in reducing nightmare frequency and intensity, reducing nightmare distress, improving the act of coping with nightmares, and improving sleep quality and overall PTSD symptoms in veterans. Further investigation of this method with gold-standard clinical trial designs and larger sample sizes is indicated to confirm effectiveness and to better understand the possible mechanisms of treatment effect.

PMID:38197021 | PMC:PMC10773522 | DOI:10.1055/s-0043-1776796

Cureus. 2024 Jan 9;16(1):e51941. doi: 10.7759/cureus.51941. eCollection 2024 Jan.

ABSTRACT

Background The human vertebral column generates movements under versatile, dynamic loads. Understanding how the spine reacts to these movements and loads is crucial for developing new spine implants and surgical treatments for intervertebral disc injuries. Mechanically uni-axial compression models have been extensively studied. However, the spine’s daily loading is not limited to compression, so it is crucial to measure its behavior in all movements (flexion-extension, rotation, and axial compression). Methods This study utilized L1-L5 segments from 19 healthy adult sheep spines. The L2-L3 disc of the first spine underwent only histological evaluation without biomechanical testing to define basic histological parameters. The remaining 18 were divided into three groups of six and subjected to biomechanical tests. Different mechanisms for three groups of spinal segments were prepared, and tests were performed on Shimadzu AG-IS 10 KN (Universal Drawing Press, Kyoto, Japan). An axial load (800 N) was applied to the first group, an axial load with 15 degrees of flexion to the second group, and an axial load with 10 degrees of rotation plus 15 degrees of flexion to the third group. A biomechanical evaluation of the maximum elongation amounts (MEAs) was performed and compared between the groups. Then, the L2-L3 discs were removed from the sheep spines, and a histological examination of the discs was conducted using Hematoxylin-Eosin (HE), Alcian Blue (AB), and Masson’s Trichrome (MT) staining. Results The mean MEA ± Standard Deviation (Range) was 1.39 ± 0.38 (0.91-1.94) for Group 1, 2.02 ± 0.75 (0.91-3.01) for Group 2, and 2.47 ± 1.09 (0.64-3.9) for Group 3. Biomechanically, although MEAs increased from Group 1 to Group 3 (meaning that the mean MEAs increased as the number of types of applied force increased), there was no statistically significant difference between the groups regarding the MEAs (P = 0.092). Histologically, no significant differences were observed between all groups after HE staining. In all groups, hypercellularity, edema in the connective tissue, separation between tissue layers, delamination, and signs of swelling and necrosis in the cells were observed similarly. For the AB staining, there was a decrease in the glycosaminoglycan (GAG) structure in the tissue samples compared to the control tissue, but no significant differences were observed between the groups. However, it was observed that the stratification in Group 3 was slightly more deteriorated than in the other groups. For the MT staining, collagen structure deterioration was observed in all groups. It was observed that the amount of collagen was significantly reduced compared to the control tissue. Conclusion As a result, when the axial load is applied biomechanically, there is more displacement of the vertebral discs in Group 3 with multidimensional movements. Furthermore, histological studies revealed deterioration between tissue layers when exposed to complex movements, and the degradation of stratification in group 3 compared to other loading combinations in groups 2 and 3 may indicate the role of complex loads in the formation of disc herniation.

PMID:38196992 | PMC:PMC10775825 | DOI:10.7759/cureus.51941

Cureus. 2024 Jan 3;16(1):e51625. doi: 10.7759/cureus.51625. eCollection 2024 Jan.

ABSTRACT

Background The human ear is a distinctive facial feature, revealing valuable information about ethnicity, gender, and age. Anthropometric measures play a crucial role in fields such as forensic medicine, prosthetics, and plastic surgery. The external ear, known for its diversity in structure and individual characteristics, has become a subject of interest in various populations. This study aims to determine the mean values of morphometric measurements for both right and left ears while exploring sexual dimorphism in ear dimensions. Methodology A prospective, observational, cross-sectional study was conducted among 200 volunteers from the eastern province of Saudi Arabia, comprising 98 males and 102 females, at the Department of Anatomy, Institute of Medical Sciences, Imam Abdulrahman Bin Faisal University. Participants were randomly selected from King Fahad University Hospital workers and patients. Using a Vernier caliper and after obtaining consent, various aspects of ear morphology were measured. The study employed statistical analyses such as the volunteers’ t-test, Pearson’s coefficient of correlation, and linear regression equations. Results In males, the mean total height of the right and left ears was 6.054 ± 0.5394 and 6.044 ± 0.5235 cm, respectively, while for females, it was 5.489 ± 0.4481 and 5.763 ± 4.8446 cm, respectively. The mean widths, heights, and other dimensions of the ears exhibited variations between genders. Conclusions The study provides comprehensive insights into the dimensions and indices of the pinna among the population of the eastern province of Saudi Arabia. The findings confirmed the presence of sexual dimorphism in the ear measurements, consistent with observations in other ethnic groups.

PMID:38196990 | PMC:PMC10775136 | DOI:10.7759/cureus.51625