Category: Statistics

Int J Hyperthermia. 2023;40(1):2240548. doi: 10.1080/02656736.2023.2240548.

ABSTRACT

OBJECTIVE: This nonrandomized prospective clinical trial aimed to assess the efficacy, safety and follow-up outcomes of ultrasound-guided high-intensity focused ultrasound (USgHIFU) surgery in patients with breast fibroadenoma.

METHODS: With the approval of the institutional ethics committee and written informed consent, a total of 113 patients diagnosed with breast fibroadenoma by core-needle biopsy in our hospital were recruited. USgHIFU surgery was performed under local anesthesia. Contrast-enhanced ultrasound (CEUS) or contrast-enhanced MRI (CEMRI) was performed to evaluate the nonperfused volume (NPV). The patients were followed up with physical examination and ultrasound imaging.

RESULTS: The clinical outcome of 85 patients with 147 fibroadenomas with a follow-up time of more than 3 months was analyzed in this study. Fifty-two patients had one lesion, twenty-one patients had two lesions and twelve patients had more than two lesions. During USgHIFU, the median localization time for all fibroadenomas was 3 (interquartile range: 1, 5) min, and the median treatment time was 9 (interquartile range: 5, 15) min. Under local anesthesia, all the patients tolerated the treatment well. No serious epidermal burns were observed in any of the patients. Based on CEUS or CEMRI imaging evaluation, the median NPV ratio was 100% (interquartile range: 79.2%, 116.8%). The VRR were 26.77 ± 50.05%, 50.22 ± 42.01% and 72.74 ± 35.39% at 3-6 months, 6-12 months and >12 months, respectively, which showed significant statistical difference (p < .001).

CONCLUSION: Ultrasound-guided HIFU surgery is an effective and safe noninvasive alternative technique for the treatment of breast fibroadenoma.

PMID:37544652 | DOI:10.1080/02656736.2023.2240548

Aust Vet J. 2023 Aug 6. doi: 10.1111/avj.13268. Online ahead of print.

ABSTRACT

OBJECTIVE: To provide complete anatomical and ultrasonographic description of tendons and ligaments at the palmar (plantar) aspect of the cannon and phalangeal regions of the one-humped camel.

DESIGN: Forty-two (21 fore and 21 hind) clinically normal camel cadavers’ limbs disarticulated at the carpal and tarsal joints and three clinically normal mature camels were included in the study. Six cadaver limbs (three fore and three hind) were dissected, and another six limbs specimens (three fore and three hind) were frozen at -20° for 1 week then sectioned transversely with an electric band saw at different distances distal to the carpometacarpal and tarsometatarsal joints. The ultrasonographic study was carried out on the live camels and 30 cadaveric limbs. The shape, echogenicity and measurements (thickness, width and cross-sectional area) of superficial digital flexor tendon (SDFT), deep digital flexor tendon (DDFT), suspensory ligament (SL), and sesamoidean ligaments were recorded and the differences in values between live animals and cadaveric specimens were statistically analysed.

RESULTS: The shape and echogenicity of SDFT, DDFT, and SL, varied between proximal, middle, and distal thirds of the cannon bone and the phalangeal region. There was no significant difference between live animal and cadaveric specimens.

CONCLUSION: This study provided complete description of tendons and ligaments at the palmar (plantar) aspect of the cannon and phalangeal region of the one humped camel. The data obtained serves as a reference guide for practicing veterinarians and for future studies on injury to ligaments and tendons of camel’s distal extremity.

PMID:37544650 | DOI:10.1111/avj.13268

Curr Probl Cardiol. 2023 Aug 4:102006. doi: 10.1016/j.cpcardiol.2023.102006. Online ahead of print.

ABSTRACT

In recent years, there has been a notable and concerning rise in the prevalence of mental disorders, indicating a growing societal challenge that warrants attention and support for affected individuals. Psychiatric problems range on a wide spectrum from as little as work or school related stress to as big as severe depression related to the loss of a loved one, a sense of loneliness, etc. This current generation yields the highest amounts of mental disorder patients due to the newfound pressures, difficulties, and ways of life. According to the Center for Disease Control and Prevention (CDC), more than 1 in 5 U.S. adults live with a mental illness and about 1 in 25 U.S. adults live or lived with a serious mental illness such as schizophrenia, bipolar disorder, or major depression. A similar statistic shows us that about 695,000 people in the U.S. in 2021 died due to some form of heart related disease. That’s 1 in every 5 deaths. More recently, it has been noticed that these psychiatric disorders and heart diseases could be correlated. In this manuscript, we review the current literature on the effect and correlation of psychiatric disorders on the cardiovascular system. We present a review on primarily the “5 major psychiatric disorders,” according to the NIH: depression, autism, ADHD, bipolar disorder, and schizophrenia (Table 1). We will also present a review on stress-induced cardiac diseases, especially more recently with the rise of the COVID-19 Pandemic.

PMID:37544626 | DOI:10.1016/j.cpcardiol.2023.102006

Cir Esp (Engl Ed). 2023 Aug 4:S2173-5077(23)00140-0. doi: 10.1016/j.cireng.2023.04.020. Online ahead of print.

ABSTRACT

INTRODUCTION: Robot-assisted thoracic surgery (RATS) is a rapidly expanding technique. In our study, we aimed to analyze the results of the process to adopt robotic surgery in our Department of Thoracic Surgery.

METHODS: This is an intention-to-treat analysis of a series of consecutive patients operated on using the RATS approach in our hospital from January 2021 to March 2022. Data were registered for patient characteristics, type of surgery, operative times, conversion rate, chest tube duration, length of hospital stay and complications. The IBM SPSS® statistical software was used for the statistical analysis. A cumulative sum analysis of the operating time was performed to define the learning curve.

RESULTS: During the study period, 51 patients underwent robotic surgery, including pulmonary and non-pulmonary interventions. In addition, 15 patients (29.4%) underwent non-pulmonary interventions: one pleural (2%), 2 diaphragmatic (3.9%), and 12 mediastinal (23.5%). Among the mediastinal surgeries, one conversion was necessary (8.3%) for a complex vascular malformation, and 11 were completed by RATS, including 7 (58.3%) thymomas, 3 (25%) pleuro-pericardial cysts, and one (8.3%) neurogenic tumor. Mean operative time was 141 minutes (104-178), mean chest tube duration was 0.9 days (0-2), and mean length of stay was 1.45 days (1-2). Thirty-six patients underwent lung surgery (70.6%). The complete RATS resections (34; 94.4%) included: 3 wedge resections (11.1%), 2 segmentectomies (3.7%), 28 lobectomies (81.5%), and one sleeve lobectomy (3.7%). Mean surgery time was 194.56 minutes (141-247), chest tube duration was 3.92 days (1-8), and length of stay was 4.6 days (1-8). Complications occurred in 4 patients (11.1%). No 90-day mortalities were registered.

CONCLUSIONS: The implementation of RATS was achieved with good clinical results and operative times for all indications. A rapid learning curve was accomplished in short time. Previous VATS experience, patient selection, team training and program continuity are fundamental to successfully develop a RATS program.

PMID:37544607 | DOI:10.1016/j.cireng.2023.04.020

World Neurosurg. 2023 Aug 4:S1878-8750(23)01101-4. doi: 10.1016/j.wneu.2023.07.148. Online ahead of print.

ABSTRACT

OBJECTIVES: Percutaneous cement discoplasty (PCD) was introduced to treat symptomatic vertical instability of the lumbar spine in a minimally invasive way. The aim of the present study was to analyse the complication pattern after PCD and to identify factors that predict the chance of cement leakage, reoperation and length of hospital stay (LOS).

METHODS: 344 patients were treated with PCD within the study period. Clinical features and complications were analysed by applying descriptive statistics, while perioperative factors predictive of cement leakage, reoperation and LOS were identified by regression models.

RESULTS: Cement leakage rate was 30.4 % in the total cohort, however only fifth of them were symptomatic. Cement leakage itself did not have a significant influence on clinical outcome. Other complications and non-surgical adverse events were registered only in 2.0% of cases. Age, BMI, low viscosity cement, lower level of surgeon’s experience and the number of operated levels were identified as risk factors of cement leakage (p<0.01, c-index=0.807). Type of procedure, Charlson comorbidity score, reoperation and non-surgical adverse events significantly increased the LOS (p<0.01). Cement leakage, early surgical practice and high BMI were risk factors for reoperation (p<0.01, c-index=0.72).

CONCLUSION: In summary, PCD is a relatively safe and effective procedure for treating spinal instability due to advanced stage disc degeneration characterized by vacuum phenomenon. Cement leakage is not uncommon but only a radiologic complication without clinical consequences in most cases. On the other hand, it can increase the LOS and it is a significant risk factor for reoperation.

PMID:37544606 | DOI:10.1016/j.wneu.2023.07.148

Neurosci Lett. 2023 Aug 4:137426. doi: 10.1016/j.neulet.2023.137426. Online ahead of print.

ABSTRACT

BACKGROUND: The synaptic vesicle glycoprotein 2 (SV2) has been implicated in synaptic function throughout the brain. Accumulating evidence investigated that SV2C contributed to dopamine release and the disrupted expression of SV2C was considered to be a unique feature of PD that may facilitate dopaminergic neuron dysfunction.

OBJECTIVE: This study aimed to examine the relationship between the SV2C rs1423099 single nucleotide polymorphism and sporadic Parkinson’s disease (PD) in the Chinese Han population.

MATERIALS AND METHODS: This study enrolled 351 patients with sporadic PD and 240 normal controls in Chinese Han population. Peripheral blood DNA was extracted by DNA extraction kits and the rs1423099 genotype was analyzed by Agena MassARRAY DNA mass spectrometry. The differences in genotype and allele distribution frequencies between PD patients and control groups were compared using chi-squared tests or Fisher’s exact tests.

RESULTS: No statistical difference was revealed in age and sex distribution between the cases and control groups, and the distribution of genotype and allele frequencies was consistent with the Hardy-Weinberg equilibrium test. In SV2C rs1423099 dominant model, the frequency of the CC/CT genotype was significantly higher in the PD group compared to the control group (OR =4.065,95% CI: 2.801-10.870, p=0.002). Nevertheless, in the recessive model, CC or CT/TT genotypes have no statistical difference in the two groups (p=0.09). Additionally, in allelic analysis, the C allele was investigated to increase the risk of PD (OR =1.346, 95% CI: 1.036-1.745, p=0.026); Furthermore, subgroup analysis suggested that those carrying the C allele in the male subgroup were at a higher risk to afflicted with PD (OR =1.637, 95% CI: 1.147-2.336, p=0.006).

CONCLUSION: SV2C rs1423099 single nucleotide polymorphism was associated with sporadic Parkinson’s disease in the Chinese Han population, particularly in males.

PMID:37544580 | DOI:10.1016/j.neulet.2023.137426

Neuroscience. 2023 Aug 4:S0306-4522(23)00341-X. doi: 10.1016/j.neuroscience.2023.07.032. Online ahead of print.

ABSTRACT

Mapping variability in cortical spontaneous activity (CSA) is an essential goal of understanding various sources of dark brain energy in human neuroscience. CSA was traditionally characterized using resting-state functional MRI (rfMRI) at 1.5T or 3T magnets while recently with 7T-rfMRI. However, the utility and interpretability of 7T-rfMRI must first be established for its variability. By leveraging rfMRI data from the Human Connectome Project (HCP), we derived CSA metrics with 3T-rfMRI and 7T-rfMRI for the same 84 healthy participants (52 females). The 7T-rfMRI produces different CSA metrics at multiple spatial-scales and their variability from the 3T-rfMRI. These differences were spatially dependent and varied according to specific cortical organization. For the amplitude metric, 7T-rfMRI enhanced its spatial contrasts in the anterior cortex but weakened it in the posterior cortex. An opposite pattern was observed for the connectivity metrics. The reliability changes of these metrics were scale dependent, indicating enhanced reliability for connectivity but weakened reliability for amplitude by 7T-rfMRI. These effects were primarily located in the high-order associate cortex, parsing the corresponding changes in individual differences with respect to 7T-rfMRI: 1) higher connectivity variability between participants and the lower connectivity variability within individual participants, and 2) lower amplitude variability between participants and higher amplitude variability within participants. Our work, for the first time, demonstrated the variability of the human CSA across space, rfMRI settings/platforms, and individuals. We discussed the statistical implications of our findings on CSA-based experimental designs and reproducible neuroscience as well as their translational value for personalized applications.

PMID:37544577 | DOI:10.1016/j.neuroscience.2023.07.032

Contraception. 2023 Aug 4:110138. doi: 10.1016/j.contraception.2023.110138. Online ahead of print.

ABSTRACT

OBJECTIVE(S): To characterize awareness of a 2017 Massachusetts (MA) law that ensures access to a 12-month supply of short-acting contraceptive methods (e.g., pill, patch, vaginal ring) among short-acting contraceptive users in MA and to identify perceived benefits and concerns of a 12-month-supply.

STUDY DESIGN: An online survey was administered to a Qualtrics® panel of MA women who were using short-acting contraceptive methods and were insured by an eligible health plan. The survey’s primary outcome was general awareness of the law; interest in, receipt of, and perceived benefits and risks of a 12-month-supply supply were also elicited. Analysis included descriptive statistics and bivariate and multivariable analyses examining factors associated with awareness of the law.

RESULTS: Among the 207 survey respondents 76% were aware of the law and 93% expressed interest in receiving a 12-month supply of a short-acting method; however, only 9% received it. Respondents identified as White (66%), privately insured (59%), and pill users (44%). Concerns about a 12-monthsupply included privacy, product expiration, and change in personal medical status. Perceived benefits included avoiding multiple trips to pharmacy and increased compliance. Multivariable analyses showed general awareness of the law was only associated with employer-based insurance with those respondents having 75% lower odds of being aware of the law than respondents with Medicaid coverage.

CONCLUSION: Although a high percentage of women surveyed were aware of the law and most were interested in receiving a 12-monthsupply of their short-acting method, the low percentage who have received a 12-monthsupply suggests barriers to policy uptake.

IMPLICATIONS: This study describes perceptions of the 12-monthsupply provision of the contraception ACCESS law. Addressing consumer concerns may be important to improve implementation and dissemination of this state policy change.

PMID:37544574 | DOI:10.1016/j.contraception.2023.110138

J Pain Symptom Manage. 2023 Aug 4:S0885-3924(23)00618-8. doi: 10.1016/j.jpainsymman.2023.07.020. Online ahead of print.

ABSTRACT

INTRODUCTION: Goals of care conversations for seriously ill hospitalized patients are associated with high quality patient-centered care. We aimed to assess the prevalence of documented goals of care conversations for rural hospitalized patients compared to nonrural hospitalized patients.

METHODS: We retrospectively assessed goals of care documentation using a template note for adult patients with predicted 90-day mortality greater than 30% admitted to eight rural and nine nonrural community hospitals between July 2021 and April 2023. We compared predictors and prevalence of goals of care documentation among rural and nonrural hospitals.

RESULTS: Of the 31,098 patients admitted during the study period, 21% were admitted to a rural hospital. Rural patients were more likely than nonrural patients to be > 65 years old (89% vs. 86%, P=<0.0001), more likely to live in a neighborhood classified in the highest quintile of socioeconomic disadvantage (40% vs. 16%, P=<0.0001), and less likely to receive a palliative care consult (8% vs. 18%, p=<0.0001). Goals of care documentation occurred less often for patients admitted to rural versus nonrural community hospitals (2% vs. 7%, p<0.0001). In the base multivariable logistic regression model adjusting for patient characteristics, the odds of goals care documentation was lower in rural versus nonrural community hospitals (aOR 0.4, p=0.0232). In a second multivariable logistic regression model including both patient characteristics and severity of illness, the odds of goals of care documentation in rural community hospitals was no longer statistically different than nonrural community hospitals (aOR 0.5, p=0.1080). Patients who received a palliative care consult had lower prevalence of goals of care documentation in rural versus nonrural hospitals (16% vs. 37%, P=<0.0001).

CONCLUSION: In this study of seventeen rural and nonrural community hospitals, we found low overall prevalence of goals of care documentation with particularly infrequent documentation occurring within rural hospitals. Future study is needed to assess barriers to goals of care documentation contributing to low prevalence of goals of care conversations in rural hospital settings.

KEY MESSAGE: This retrospective study assesses prevalence of goals of care documentation in rural community hospitals. The results indicate goals of care documentation is particularly infrequent in rural community hospitals when compared to nonrural community hospitals.

PMID:37544552 | DOI:10.1016/j.jpainsymman.2023.07.020

Urology. 2023 Aug 4:S0090-4295(23)00671-4. doi: 10.1016/j.urology.2023.07.028. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the feasibility and safety of delayed primary closure (DPC) in Fournier’s gangrene (FG) patients with large genital defects.

METHODS: A single institution retrospective review was performed from October 2020 to December 2022 of adult males that underwent DPC for FG. All patients underwent standard medical management and were assessed for DPC eligibility by the urology service. Clinical data on patient factors and outcomes were collected, and descriptive statistics were assessed.

RESULTS: Of 16 patients that underwent DPC, the average age was 61.1 years and BMI was 34.6 kg/m². Median Charlson Comorbidity Index was 3.5 (IQR 2-5.3) and Fournier’s Gangrene Severity Index was 6.5 (IQR 4.8-8). Median number of debridements was 2.5 (IQR 2-3), with a time to closure of 6.5 days (IQR 3-11) and length of stay of 13 days (IQR 9-16.3). Mean genital defect size was 119 cm² (range 44-346 cm²). Eight patients (50%) were closed using scrotal flaps alone while other patients had advancement flaps using the inner thigh, lower abdomen, and perineum. The majority of patients were discharged home directly (63%). There were four Clavien-Dindo III complications: two partial flap necrosis, one wound dehiscence, and one instance of bleeding. Of patients with follow-up, 6/15 (40.0%) had no known complications.

CONCLUSIONS: DPC is safe and effective for a range of patients presenting with FG. Patients with large defects may benefit from less complex wound management and direct discharge home.

PMID:37544517 | DOI:10.1016/j.urology.2023.07.028