Category: Statistics

Ultrasound Obstet Gynecol. 2024 Jan 10. doi: 10.1002/uog.27575. Online ahead of print.

ABSTRACT

OBJECTIVE: Image quality of fetal echocardiography (FE) has improved in the recent era, but few recent studies have reported the accuracy of FE specifically in single ventricle congenital heart disease (SV). Our study aims to assess the ability of FE to correctly predict postnatal anatomy and physiology in SV in a contemporary cohort.

METHODS: The contemporary, clinical reports of FE with SV performed from 7/2017 to 7/2021 were compared with postnatal echocardiograms in a formal quality assurance program. SV were grouped by anatomic subtype. Diagnostic errors were designated as major if the error would have resulted in significant alteration in fetal counseling or postnatal management. Remaining errors were classified as minor. Physiologic discrepancies, including prostaglandin dependency (PGE-D), atrioventricular valve regurgitation (AVVR), pulmonary venous obstruction, and atrial septal restriction were assessed by review of postnatal course.

RESULTS: A total of 119 subjects were analyzed. SV subtypes in the cohort included hypoplastic left heart syndrome (HLHS) (n=68), tricuspid atresia (n=16), double inlet left ventricle (n=12), unbalanced atrioventricular canal (UAVC) (n=11), heterotaxy (n=9), and other (n=3). The rate of major anatomic and physiologic errors was low (n=6, 5.0%). A higher proportion of minor errors were noted in HLHS and tricuspid atresia but the differences were not statistically significant. Physiologic discrepancies were uncommon, with three major discrepancies including underestimation of degree of venous obstruction in one non-HLHS fetus with total anomalous pulmonary venous return, overestimation of atrial septal restriction in one HLHS fetus, and incorrect prediction of PGE-D with 1 false-negative for pulmonary blood flow. No discrepancy in degree of AVVR or atrial septal restriction affected postnatal care. Minor physiologic discrepancies included two false-positive predictions of PGE-D with 1 false-positive for ductal-dependent systemic flow, and 1 false-positive for pulmonary blood flow.

CONCLUSIONS: In this contemporary review of FE in SV at our center, there was high accuracy in describing anatomic and physiologic findings in fetuses with SV. Major physiologic discrepancies were uncommon but included important cases of false-negative prediction of PGE-dependence and underestimation of obstruction of total anomalous pulmonary venous return. These data can both inform more accurate counseling of families with SV fetuses and guide diagnostic improvement efforts. This article is protected by copyright. All rights reserved.

PMID:38197302 | DOI:10.1002/uog.27575

J Osteopath Med. 2024 Jan 11. doi: 10.1515/jom-2022-0124. Online ahead of print.

ABSTRACT

CONTEXT: The evidence for the efficacy of osteopathic manipulative treatment (OMT) in the management of low back pain (LBP) is considered weak by systematic reviews, because it is generally based on low-quality studies. Consequently, there is a need for more randomized controlled trials (RCTs) with a low risk of bias.

OBJECTIVES: The objective of this study is to evaluate the efficacy of an OMT intervention for reducing pain and disability in patients with chronic LBP.

METHODS: A single-blinded, crossover, RCT was conducted at a university-based health system. Participants were adults, 21-65 years old, with nonspecific LBP. Eligible participants (n=80) were randomized to two trial arms: an immediate OMT intervention group and a delayed OMT (waiting period) group. The intervention consisted of three to four OMT sessions over 4-6 weeks, after which the participants switched (crossed-over) groups. The primary clinical outcomes were average pain, current pain, Patient-Reported Outcomes Measurement Information System (PROMIS) 29 v1.0 pain interference and physical function, and modified Oswestry Disability Index (ODI). Secondary outcomes included the remaining PROMIS health domains and the Fear Avoidance Beliefs Questionnaire (FABQ). These measures were taken at baseline (T₀), after one OMT session (T₁), at the crossover point (T₂), and at the end of the trial (T₃). Due to the carryover effects of OMT intervention, only the outcomes obtained prior to T₂ were evaluated utilizing mixed-effects models and after adjusting for baseline values.

RESULTS: Totals of 35 and 36 participants with chronic LBP were available for the analysis at T₁ in the immediate OMT and waiting period groups, respectively, whereas 31 and 33 participants were available for the analysis at T₂ in the immediate OMT and waiting period groups, respectively. After one session of OMT (T₁), the analysis showed a significant reduction in the secondary outcomes of sleep disturbance and anxiety compared to the waiting period group. Following the entire intervention period (T₂), the immediate OMT group demonstrated a significantly better average pain outcome. The effect size was a 0.8 standard deviation (SD), rendering the reduction in pain clinically significant. Further, the improvement in anxiety remained statistically significant. No study-related serious adverse events (AEs) were reported.

CONCLUSIONS: OMT intervention is safe and effective in reducing pain along with improving sleep and anxiety profiles in patients with chronic LBP.

PMID:38197301 | DOI:10.1515/jom-2022-0124

J Wound Care. 2024 Jan 2;33(1):14-21. doi: 10.12968/jowc.2024.33.1.14.

ABSTRACT

OBJECTIVE: Severe soft tissue damage with destruction of the dermis requires plastic reconstructive treatment. For multimorbid patients or patients unable to undergo major reconstructive surgery, use of dermal substitutes, such as a collagen-elastin matrix (CEM) with a split-thickness skin graft (STSG), instead of local or free flap surgery, may be a valid and easy treatment option. We aimed to investigate and compare the outcomes and rate of successful defect reconstruction using CEM plus STSG, using either a one-step approach (simultaneous CEM and STSG) or a two-step approach (CEM and negative wound pressure therapy (NPWT), with secondary STSG transplantation).

METHOD: A single-centre, retrospective follow-up study of patients who had received CEM was conducted. Wounds had been treated with an STSG transplantation covering a CEM (MatriDerm, MedSkin Solutions Dr. Suwelack AG, Germany). Previous attempts at wound closure with conventional methods had failed in the selected patient population, which would usually have resulted in flap surgery.

RESULTS: Overall, 46 patients were included (mean age 60.9±20.0 years), with a total of 49 wound sites. We analysed 38 patients with wounds that did not require flap coverage; 18 patients received the one-step approach and 20 patients received the two-step approach. The mean follow-up in these patients was 22±11.5 months, and one patient was lost to follow-up. Overall, 29 (78.4%) wounds remained closed. Wounds which did not successfully heal were related to comorbidities, such as diabetes, alcohol misuse and smoking. Using the one-step approach, long-term defect coverage was achieved in 13 (76.5%) wounds and 16 (80.0%) wounds were closed using the two-step approach. However, there was no statistically significant differences between the one- or two-step approaches regarding the rate of development of a wound healing disorder.

CONCLUSION: Wound closure was achieved in 38 complex wounds using CEM plus STSG, while 11 wounds needed secondary flap coverage. In the flap-free wounds, there were no statistically significant differences between the one-step versus two-step approach. Using a simple defect reconstruction algorithm, we successfully used CEM plus STSG to treat complex wounds.

PMID:38197274 | DOI:10.12968/jowc.2024.33.1.14

Stat Med. 2024 Jan 10. doi: 10.1002/sim.9994. Online ahead of print.

ABSTRACT

The prevalence of chronic non-communicable diseases such as obesity has noticeably increased in the last decade. The study of these diseases in early life is of paramount importance in determining their course in adult life and in supporting clinical interventions. Recently, attention has been drawn to approaches that study the alteration of metabolic pathways in obese children. In this work, we propose a novel joint modeling approach for the analysis of growth biomarkers and metabolite associations, to unveil metabolic pathways related to childhood obesity. Within a Bayesian framework, we flexibly model the temporal evolution of growth trajectories and metabolic associations through the specification of a joint nonparametric random effect distribution, with the main goal of clustering subjects, thus identifying risk sub-groups. Growth profiles as well as patterns of metabolic associations determine the clustering structure. Inclusion of risk factors is straightforward through the specification of a regression term. We demonstrate the proposed approach on data from the Growing Up in Singapore Towards healthy Outcomes cohort study, based in Singapore. Posterior inference is obtained via a tailored MCMC algorithm, involving a nonparametric prior with mixed support. Our analysis has identified potential key pathways in obese children that allow for the exploration of possible molecular mechanisms associated with childhood obesity.

PMID:38197220 | DOI:10.1002/sim.9994

Int J Neurosci. 2024 Jan 10:1-12. doi: 10.1080/00207454.2023.2299315. Online ahead of print.

ABSTRACT

The objective of this study was to investigate the mechanism of electroacupuncture pretreatment in reducing myocardial ischemia-reperfusion injury in rats.The comparison of HR among the different groups did not yield statistically significant differences (P > 0.05). Additionally, the trend of HR change at different time points within each group was not statistically significant (P > 0.05). In contrast, the comparison of SBP among the different groups showed statistically significant differences (P < 0.05). Furthermore, the trend of SBP change at different time points within each group exhibited significant differences (P < 0.05). Compared to the Sham group, rats in the I/R group and EA control group showed a significant decrease in EF, FS, SOD, p-mTOR/mTOR, GPX4, and FTH1, and an increase in CK-MB, cTnI, LDH, iron, ROS, MDA, ACSL4, and NCOA4 (P < 0.05). Compared to EA control group, rats in the EA group exhibited a significant increase in EF, FS, SOD, p-mTOR/mTOR, GPX4, and FTH1, and a decrease in CK-MB, cTnI, LDH, iron, ROS, MDA, ACSL4, and NCOA4 (P < 0.05). Compared to the EA group, rats in the EA + RAP group showed a significant decrease in EF, FS, SOD, p-mTOR/mTOR, GPX4, and FTH1, and an increase in CK-MB, cTnI, LDH, iron, ROS, MDA, ACSL4, and NCOA4 (P < 0.05).Electroacupuncture preconditioning confers protective effects against myocardial ischemia-reperfusion injury in rats. Its mechanism may involve the activation of the mTOR/ROS signaling pathway by electroacupuncture to inhibit ferroptosis.

PMID:38197187 | DOI:10.1080/00207454.2023.2299315

Phys Chem Chem Phys. 2024 Jan 10. doi: 10.1039/d3cp04854c. Online ahead of print.

ABSTRACT

Vacuum ultraviolet (VUV) photodissociation of N₂ molecules is a source of reactive N atoms in the interstellar medium. In the energy range of VUV optical excitation of N₂, the N-N triple bond cleavage leads to three types of atoms: ground-state N(⁴S) and excited-state N(²P) and N(²D). The latter is the highest reactive and it is believed to be the primary participant in reactions with hydrocarbons in Titan’s atmosphere. Experimental studies have observed a non-monotonic energy dependence and non-statistical character of the photodissociation of N₂. This implies different dissociation pathways and final atomic products for different wavelength regions in the sunlight spectrum. We here apply ab initio quantum chemical and nonadiabatic quantum dynamical techniques to follow the path of an electronic state from the excitation of a particular singlet ¹Σ+u and ¹Π_u vibronic level of N₂ to its dissociation into different atomic products. We simulate dynamics for two isotopomers of the nitrogen molecule, ¹⁴N₂ and ¹⁴N¹⁵N for which experimental data on the branching are available. Our computations capture the non-monotonic energy dependence of the photodissociation branching ratios in the energy range 108 000-116 000 cm^-1. Tracing the quantum dynamics in a bunch of electronic states enables us to identify the key components that determine the efficacy of singlet to triplet population transfer and therefore predissociation lifetimes and branching ratios for different energy regions.

PMID:38197167 | DOI:10.1039/d3cp04854c

Psychol Med. 2024 Jan 10:1-10. doi: 10.1017/S0033291723003665. Online ahead of print.

ABSTRACT

BACKGROUND: We compared dissociative seizure specific cognitive behavior therapy (DS-CBT) plus standardized medical care (SMC) to SMC alone in a randomized controlled trial. DS-CBT resulted in better outcomes on several secondary trial outcome measures at the 12-month follow-up point. The purpose of this paper is to evaluate putative treatment mechanisms.

METHODS: We carried out a secondary mediation analysis of the CODES trial. 368 participants were recruited from the National Health Service in secondary / tertiary care in England, Scotland, and Wales. Sixteen mediation hypotheses corresponding to combinations of important trial outcomes and putative mediators were assessed. Twelve-month trial outcomes considered were final-month seizure frequency, Work and Social Adjustment Scale (WSAS), and the SF-12v2, a quality-of-life measure providing physical (PCS) and mental component summary (MCS) scores. Mediators chosen for analysis at six months (broadly corresponding to completion of DS-CBT) included: (a) beliefs about emotions, (b) a measure of avoidance behavior, (c) anxiety and (d) depression.

RESULTS: All putative mediator variables except beliefs about emotions were found to be improved by DS-CBT. We found evidence for DS-CBT effect mediation for the outcome variables dissociative seizures (DS), WSAS and SF-12v2 MCS scores by improvements in target variables avoidance behavior, anxiety, and depression. The only variable to mediate the DS-CBT effect on the SF-12v2 PCS score was avoidance behavior.

CONCLUSIONS: Our findings largely confirmed the logic model underlying the development of CBT for patients with DS. Interventions could be additionally developed to specifically address beliefs about emotions to assess whether it improves outcomes.

PMID:38197148 | DOI:10.1017/S0033291723003665

J Periodontol. 2024 Jan 10. doi: 10.1002/JPER.23-0514. Online ahead of print.

ABSTRACT

BACKGROUND: ChatGPT’s (Chat Generative Pre-Trained Transformer) remarkable capacity to generate human-like output makes it an appealing learning tool for healthcare students worldwide. Nevertheless, the chatbot’s responses may be subject to inaccuracies, putting forth an intense risk of misinformation. ChatGPT’s capabilities should be examined in every corner of healthcare education, including dentistry and its specialties, to understand the potential of misinformation associated with the chatbot’s use as a learning tool. Our investigation aims to explore ChatGPT’s foundation of knowledge in the field of periodontology by evaluating the chatbot’s performance on questions obtained from an in-service examination administered by the American Academy of Periodontology (AAP).

METHODS: ChatGPT3.5 and ChatGPT4 were evaluated on 311 multiple-choice questions obtained from the 2023 in-service examination administered by the AAP. The dataset of in-service examination questions was accessed through Nova Southeastern University’s Department of Periodontology. Our study excluded questions containing an image as ChatGPT does not accept image inputs.

RESULTS: ChatGPT3.5 and ChatGPT4 answered 57.9% and 73.6% of in-service questions correctly on the 2023 Periodontics In-Service Written Examination, respectively. A two-tailed t test was incorporated to compare independent sample means, and sample proportions were compared using a two-tailed χ² test. A p value below the threshold of 0.05 was deemed statistically significant.

CONCLUSION: While ChatGPT4 showed a higher proficiency compared to ChatGPT3.5, both chatbot models leave considerable room for misinformation with their responses relating to periodontology. The findings of the study encourage residents to scrutinize the periodontic information generated by ChatGPT to account for the chatbot’s current limitations.

PMID:38197146 | DOI:10.1002/JPER.23-0514

J Esthet Restor Dent. 2024 Jan 10. doi: 10.1111/jerd.13194. Online ahead of print.

ABSTRACT

INTRODUCTION: Shade matching is an essential procedure to obtain an esthetic prosthesis. The Direct Visual Shade Matching (DSM) method using shade guides is the most used method by dentists. However, The Indirect Visual Digital Shade Matching (ISM) method based on digital imaging is concerned to be reliable and useful in determining shade matching in dental practice. Several factors such as method, clinical experience, and gender can affect the success of shade matching.

AIM OF THE STUDY: This study aimed to compare these two methods and evaluate the effect of experience and gender on the results.

MATERIALS AND METHODS: Three volunteers’ maxillary central incisor teeth were evaluated using (DSM) and (ISM) methods by 87 examiners (42 males, 45 females). These examiners were further divided into three groups based on their clinical experience: Undergraduate Preclinical Dental Students (UPDS) with 31 examiners, Undergraduate Clinical Dental Students (UCDS) with 34 examiners, and Postgraduate Dental Students from the Department of Prosthodontics (PDS) with 22 examiners. The spectrophotometer device results of three teeth were considered as a reference for shade matching. Statistical analyses of the data were performed using Kruskal-Wallis, Mann-Whitney U, and Chi-square tests.

RESULTS: No significant difference was found between indirect and direct methods according to Perfect Matches (p > 0.05). However, according to Shade Matching Deviation Score (SMDS) values a statistically significant difference was found between the two methods where the best result was obtained with the ISM method (p < 0.05). There was a significant difference between the PDS group and the other two groups in terms of clinical experience (p < 0.05). There was no significant difference between gender groups (p > 0.05).

CONCLUSION: Digital images, captured under standardized lighting conditions, may serve as a reliable alternative method for direct shade matching. The (ISM) method requires a camera, related accessories, and computer skills. However, as these tools are commonly available nowadays, the focus for practitioners should be on effectively learning and applying these tools to achieve the best results. While clinical experience plays a significant role in the shade matching process, gender does not appear to have a substantial influence.

CLINICAL SIGNIFICANCE: This study found no significant differences between the (DSM) and (ISM) methods, leaving the clinical relevance of this method open to debate. However, the ISM method yielded superior responses. Despite requiring specialized tools, conditions, and training, the widespread use of cameras and computers in modern clinics makes the necessary equipment and software readily available. This method enhances clinician-technician communication, potentially improving prosthesis esthetics and patient satisfaction, especially for less experienced clinicians or those with color deficiencies. Further research is crucial to determine its clinical significance.

PMID:38197140 | DOI:10.1111/jerd.13194

Transl Pediatr. 2023 Dec 26;12(12):2213-2221. doi: 10.21037/tp-23-495. Epub 2023 Dec 22.

ABSTRACT

BACKGROUND: The goals of operative treatment for unilateral coronal synostosis (UCS) are to improve appearance and allow unrestricted brain growth. However, for severe unilateral premature closure of the coronal suture, existing methods do not address the compression of the brain or expand the volume of the skull cavity. We report our retrospective experience with bilateral fronto-orbital advancement combined with cranial vault release using a free-floating bone flap (CVR + FFBF) technique and the resulting changes in the anterior cranial vault asymmetry index (ACVAI) and intracranial volume.

METHODS: Twenty patients with UCS who underwent bilateral fronto-orbital advancement combined with CVR + FFBF technique from April 2014 to May 2019 were included. Surgical efficacy was evaluated by the ACVAI and intracranial volume before the operation, 1 week after the operation, and at the last follow-up (average 19.8 months; range, 12 to 40 months). The measurement data are presented as the mean ± standard deviation and were statistically analyzed by t-test.

RESULTS: The ACVAI was 9.07%±3.55% before the operation, 3.56%±3.42% 1 week after the operation, and 3.13%±2.41% at the last follow-up. The ACVAI 1 week after the operation was significantly lower than that before the operation (t=4.827, P<0.001). There was no significant difference between the ACVAI 1 week after the operation and at the last follow-up (t=0.660, P=0.517). The intracranial volume was 1,027.85±112.25 mL in patients before the operation and 1,131.92±161.71 mL in the normal control group, which was a statistically significant difference (t=2.364, P=0.023). The intracranial volume significantly increased 1 week after surgery: 1,081.62±111.10 mL (t=8.703, P<0.001), and this trend continued at the last follow-up (1,386.90±119.30 mL) similarly to the normal control group (1,438.22±89.28 mL). At the last follow-up, there was no significant difference between the two groups (t=1.540, P=0.132).

CONCLUSIONS: For the treatment of UCS, bilateral fronto-orbital advancement combined with CVR + FFBF technique offers functional and cosmetic outcomes in terms of intracranial volume expansion and fronto-orbital symmetry.

PMID:38197103 | PMC:PMC10772842 | DOI:10.21037/tp-23-495