Category: Statistics

Eur Urol Focus. 2022 Apr 21:S2405-4569(22)00081-5. doi: 10.1016/j.euf.2022.04.004. Online ahead of print.

ABSTRACT

BACKGROUND: No clear recommendations are available on whether retrograde intrarenal surgery (RIRS) via flexible ureterorenoscopy or shockwave lithotripsy (SWL) should be preferred for kidney stones ≤2 cm, except for lower-pole stones.

OBJECTIVE: To compare outcomes between RIRS and SWL.

DESIGN, SETTING, AND PARTICIPANTS: This was a single-center randomized controlled trial from March 2015 to May 2018. Patients with a single 6-20-mm kidney stone were enrolled (NCT02645058).

INTERVENTION: Patients were randomized to RIRS or SWL.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint was the single-procedure stone-free rate (SFR) at 1 mo. Two levels of success were set: fragments ≤4 mm (SFR-4) and no residual fragments (SFR-0). Secondary endpoints were the SFR at 6 mo and 1 yr and rates of complications and further treatments.

RESULTS AND LIMITATIONS: A total of 138 patients underwent treatment (70 RIRS vs 68 SWL). In comparison to SWL, RIRS SFR results were higher at 1 mo (SFR-4 70.0% vs 45.6%; p = 0.004; SFR-0 50.0% vs 26.5%; p = 0.004) and 6 mo (SFR-4 79.7% vs 63.6%; p = 0.038; SFR-0 59.4% vs 40.9%; p = 0.032). There was no difference in SFR measures between the groups at 1 yr (SFR-4 p = 0.322; SFR-0 p = 0.392). Overall complications were comparable (p = 0.207), but the complication rate for stones >10 mm was higher for the SWL group (p = 0.021). The need for further treatment was comparable (p = 0.368). In terms of patient satisfaction, 86.8% and 77.1% of patients would choose SWL and RIRS again, respectively (p = 0.24).

CONCLUSIONS: RIRS achieved better SFRs in comparison to SWL at 1 and 6 mo, but not at 1 yr. The RIRS complication rate was lower for stones >10 mm. SWL remains a viable alternative, especially for 6-10-mm stones, providing comparable results to RIRS in the long term.

PATIENT SUMMARY: We compared outcomes for the treatment of kidney stones ≤2 cm with two techniques: flexible ureteroscopy, in which a flexible telescope is passed through the urethra and bladder to reach the ureter between the bladder and kidney; and shockwave lithotripsy, in which shockwaves are applied to the skin over the location of the kidney stone. Ureteroscopy achieved better stone-free results at 1 and 6 months, but not at 1 year.

PMID:35466071 | DOI:10.1016/j.euf.2022.04.004

Hepatobiliary Pancreat Dis Int. 2022 Apr 6:S1499-3872(22)00051-0. doi: 10.1016/j.hbpd.2022.04.001. Online ahead of print.

ABSTRACT

BACKGROUND: Metabolic dysfunction-associated fatty liver disease (MAFLD) is recently proposed an entity by a group of international experts. However, the impact of MAFLD on the prognosis of patients with hepatocellular carcinoma (HCC) is not clear. The aim of this study was to explore the influence of MAFLD for the prognosis of HCC after radical resection.

METHODS: HCC patients who received radical resection were enrolled. The recurrence-free survival (RFS) and overall survival (OS) were compared between MAFLD and non-MAFLD.

RESULTS: A total of 576 HCC patients were included, and among them 114 (19.8%) met the diagnostic criteria of MAFLD. The median RFS was 34.0 months in the MAFLD group and 19.0 months in the non-MAFLD group. The RFS rates at 1-, 3-, and 5-year were 64.9%, 49.1% and 36.1% in the MAFLD group, which were higher than those of the non-MAFLD group (59.4%, 35.3% and 26.5%, respectively, P = 0.01). The mean OS was 57.0 months in the MAFLD group and 52.2 months in the non-MAFLD group. There was no statistical difference in OS rate between the MAFLD group and non-MAFLD group. Similar results were found in HBV-related HCC patients in the subgroup analysis. Univariate analysis revealed that MAFLD was a protective factor for RFS in HCC patients after radical resection (P < 0.05), and there was no association between MAFLD and OS rate (P > 0.05). Multivariate analysis demonstrated that MAFLD was not an independent protective factor for HCC patients with radical resection.

CONCLUSIONS: MAFLD improves RFS rate in HCC patients with radical resection, but is not an independent protective factor and not associated with OS rate.

PMID:35466065 | DOI:10.1016/j.hbpd.2022.04.001

Forensic Sci Int Genet. 2022 Apr 20:102710. doi: 10.1016/j.fsigen.2022.102710. Online ahead of print.

NO ABSTRACT

PMID:35466047 | DOI:10.1016/j.fsigen.2022.102710

Urol Oncol. 2022 Apr 21:S1078-1439(22)00107-7. doi: 10.1016/j.urolonc.2022.03.016. Online ahead of print.

ABSTRACT

BACKGROUND: Biomarkers have the potential to provide clinical guidance, but there is limited data for biomarkers in metastatic hormone sensitive prostate cancer (mHSPC).

METHODS: We performed a retrospective multicenter review from Winship Cancer Institute at Emory University and Georgia Cancer Center for Excellence at Grady Memorial Hospital (2014-2020) in the United States of America (USA). We collected demographics, disease characteristics, and laboratory data, including complete blood counts (CBC) at the start of upfront therapy. We evaluated overall survival (OS) and progression-free survival (PFS) associated with baseline lab values.

RESULTS: 165 patients were included with a median follow-up time of 33.5 months (mo). 105 (63.6%) had Gleason scores of 8-10 and 108 (65.9%) were classified as high-volume disease. 92 patients received upfront docetaxel (55.8%) and 73 received upfront abiraterone (44.2%). Univariate analyses (UVA) and multivariable analyses (MVA) identified worse clinical outcomes (CO) associated with elevated basophils and basophil-to-lymphocyte ratio (BLR). Based on MVA, elevated basophils (defined as ≥0.1, optimal cut) were associated with a hazard ratio (HR) of 3.51 (95% CI 1.65-7.43, P 0.001) for OS and HR of 1.88 (95% CI 1.05-3.38, P 0.034) for PFS. Our MVA also found that BLR ≥0.0142 was associated with HR 2.11 (95% CI 1.09-4.10, P 0.028) for OS; however, PFS was not statistically significant.

CONCLUSION: We conclude that elevated baseline basophils and BLR are associated with worse clinical outcomes in mHSPC. Although results require further validation, BLR is a potential prognostic biomarker.

PMID:35466038 | DOI:10.1016/j.urolonc.2022.03.016

J Sci Med Sport. 2022 Mar 29:S1440-2440(22)00079-2. doi: 10.1016/j.jsams.2022.03.016. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate the impact of acute food and fluid intake or hydration status on the standardised brightness-mode ultrasound measurement of subcutaneous adipose tissue thickness.

DESIGN: Thirty active adults (female n = 10) participated in a randomised cross over study.

METHODS: Participants completed three body composition assessment sessions via standardised brightness-mode ultrasound and Dual-energy X-ray absorptiometry. Participants were assessed under standardised presentation during ‘food only’ and ‘food plus water’ sessions at baseline and reassessed after their allotted intake. ‘Hypohydration plus water’ was undertaken in a hypohydrated state at baseline and reassessed after water intake.

RESULTS: The sum of eight subcutaneous adipose tissue thickness was lower when measured after ‘food only’ or ‘food plus water’ compared to baseline (-0.1 to -0.9 mm; p < 0.01). However, these changes were less than the 95% confidence interval of the technical error of measurement of the investigator. Body mass, dual-energy x-ray absorptiometry total and trunk mass, lean mass and trunk lean mass estimates increased (p < 0.01) following ‘food only’ or ‘food plus water’, and decreased with hypohydration (p < 0.01). Total and regional fat mass estimates were not impacted.

CONCLUSIONS: The sum of eight subcutaneous adipose tissue thickness measured via standardised brightness-mode ultrasound was unaffected by acute food and fluid consumption or hydration status changes. Comparatively, these interventions altered dual-energy x-ray absorptiometry body composition estimates, especially that of lean mass components. Standardised brightness-mode ultrasound can therefore be used to monitor changes in fat patterning when standardised client presentation is not practically achievable.

PMID:35466040 | DOI:10.1016/j.jsams.2022.03.016

Trends Biochem Sci. 2022 Apr 21:S0968-0004(22)00089-5. doi: 10.1016/j.tibs.2022.04.004. Online ahead of print.

ABSTRACT

Proteins are fundamental molecules that mediate diverse biological processes, and protein design can shed light on the molecular mechanisms underlying their biological functions. Huang and colleagues have developed a sequence-independent statistical model for de novo protein design using neural networks (NNs) to learn the distribution of backbone structures with minimal side-chain information.

PMID:35466034 | DOI:10.1016/j.tibs.2022.04.004

Am J Geriatr Psychiatry. 2022 Apr 3:S1064-7481(22)00375-X. doi: 10.1016/j.jagp.2022.03.005. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the associations between the prevalence, treatment, control of hypertension, and trajectories of cognitive performance among Chinese middle-aged and older adults.

DESIGN: An 8-year longitudinal study.

SETTING: China.

PARTICIPANTS: Chinese middle-aged and older adults.

MEASUREMENTS: Data from the China Health and Retirement Longitudinal Study were utilized. Group-based trajectory modeling was performed to identify heterogeneous trajectories of episodic memory and executive function. Multinomial logistic regression models were established to examine the relationships between hypertension status and cognitive trajectories, stratified by sex.

RESULTS: Three episodic memory trajectories and four executive function trajectories were identified in males and females. Hypertension prevalence was associated with worse episodic memory and executive function trajectories in females. Compared with treated hypertensives, untreated hypertensives were more likely to have worse executive function trajectories, both in males and females. Among male treated hypertensives, those with uncontrolled blood pressure (BP) had worse episodic memory trajectories compared with their counterparts with controlled at standard targets, while females with uncontrolled BP demonstrated worse executive function trajectories compared with females controlled at standard targets. There was basically no significant difference in cognitive trajectory memberships between individuals with controlled hypertension corresponding to intensive or standard BP targets.

CONCLUSIONS: The prevalence of hypertension was associated with worse cognitive trajectories, and the treatment and control of hypertension were related to more favorable cognitive trajectories. Intensive BP control target was not associated with additional benefit beyond the recognized protective effect of standard BP targets on cognitive trajectories.

PMID:35466016 | DOI:10.1016/j.jagp.2022.03.005

J Pediatr Nurs. 2022 Apr 21:S0882-5963(22)00098-7. doi: 10.1016/j.pedn.2022.04.008. Online ahead of print.

ABSTRACT

PURPOSE: This present research, mothers of children with chronic illnesses were compared with mothers of children with no chronic illnesses with the aim of determining which factors affect their sleep quality.

DESIGN AND METHODS: The descriptive-type data obtained from this research were collected from 270 mothers of children with chronic illnesses and 197 mothers of healthy children between November 10 and December 10, 2021. All participants were asked to complete a survey. The data were assessed using IBM SPSS Statistics Version 25 and the chi-square test, Fisher’s exact test, t-test, ANOVA (Analysis of Variance), and Logistic Regression Analysis.

RESULTS: The total mean The Pittsburgh Sleep Quality Index (PSQI) score for mothers of chronically ill children was found to be 9.79 ± 3.68 while it was 6.68 ± 3.62 for mothers of heathy children with a statically significant difference (t = 9.075, p = 0.00). The fact that mothers wake up for the care/treatment of their children due to the onset of an illness was found to be associated with poor sleep quality (OR = 0.388 p = 0.017; OR = 0.178, p = 0.000).

CONCLUSIONS: In the present study, it was determined that mothers of children with chronic illnesses suffer from sleep problems and that the sleep quality of those mothers varies depending on the illness types of their children.

PRACTICE IMPLICATIONS: Pediatric nurses are requested to assess the sleep quality of mothers with suitable measurement tools to determine what types of problems affect sleep quality negatively when dealing with children with chronic illnesses in both clinical and non-clinical practices.

PMID:35465997 | DOI:10.1016/j.pedn.2022.04.008

J Hand Surg Am. 2022 Apr 21:S0363-5023(22)00127-7. doi: 10.1016/j.jhsa.2022.02.012. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this randomized trial was to compare the outcomes of using a 3-point prefabricated orthosis with elastic tape versus cast immobilization for the management of nonsurgical mallet finger.

METHODS: This study was conducted in a single center. Individuals with a mallet injury requiring nonsurgical management were randomized to 6 weeks of full-time immobilization with either a 3-point prefabricated orthosis and elastic tape or a cast for distal interphalangeal joint extension. Outcomes were assessed at 12 weeks after the initiation of full-time immobilization and 6 months after injury.

RESULTS: A total of 70 individuals agreed to participate in the study between April 2017 and April 2021. No statistically or clinically significant differences were found between the groups regarding distal interphalangeal joint extension lag, distal interphalangeal joint flexion deficits, function according to the brief Michigan Hand Outcome Questionnaire, and pain on the Numeric Pain Rating Scale. The overall findings for both treatment groups included means of <15° of extensor lag and minimal pain (mean, <1.2 of 10) at the 6-month outcome assessment.

CONCLUSIONS: The use of a 3-point prefabricated orthosis with elastic tape and cast are both appropriate immobilization options for the management of nonsurgical mallet finger.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

PMID:35466009 | DOI:10.1016/j.jhsa.2022.02.012

Eur Urol. 2022 Apr 21:S0302-2838(22)01802-4. doi: 10.1016/j.eururo.2022.03.031. Online ahead of print.

ABSTRACT

CONTEXT: Several recent randomised trials have evaluated the role of combination systemic treatment using androgen deprivation therapy (ADT) plus chemotherapy or an androgen receptor signaling inhibitor (ARSI) in patients with high-risk and/or unfavourable nonmetastatic prostate cancer (nmPC).

OBJECTIVE: To assess the outcomes associated with adding combination systemic treatment to primary definitive local therapy in patients with high-risk and/or unfavourable nmPC.

EVIDENCE ACQUISITION: We queried the PubMed, Web of Science, and Scopus databases and conference abstracts to identify prospective randomised trials examining the value of adding chemotherapy or an ARSI to ADT and primary local therapy with curative intent for nmPC. The primary endpoints were overall survival (OS), cancer-specific survival (CSS), metastasis-free survival (MFS), and failure-free survival (FFS). Secondary endpoints included adverse events (AEs) and pathologic outcomes.

EVIDENCE SYNTHESIS: We identified 15 randomised studies, of which nine evaluated chemohormonal and six investigated ARSI-based treatment strategies. In both radical prostatectomy (RP) and radiation therapy (RT) settings, addition of docetaxel to ADT was associated with significantly better CSS (pooled hazard ratio [HR] 0.68, 95% confidence interval [CI] 0.49-0.95; p = 0.025), MFS (pooled HR 0.82, 95% CI 0.71-0.95; p = 0.008), and FFS (pooled HR 0.70, 95% CI 0.62-0.79; p < 0.001); the difference did not meet the conventional level of statistical significance for OS (pooled HR 0.86, 95% CI 0.73-1.01; p = 0.072). For patients treated with RT alone, docetaxel-based combination treatment did not meet the significance threshold set for OS (p = 0.3), CSS (p = 0.072), or MFS (p = 0.079), but the difference for FFS was statistically significant (pooled HR 0.72, 95% CI 0.63-0.84; p < 0.001). On network meta-analyses including RT studies, ARSI + ADT outperformed docetaxel + ADT for survival endpoints and had a more favourable AE profile.

CONCLUSIONS: Intensification of systemic therapy with docetaxel or an ARSI in addition to ADT improves oncologic endpoints in high-risk and/or unfavourable nmPC treated with local definitive therapy. The highest efficacy was achieved with ARSI + ADT, specifically in patients treated with RT.

PATIENT SUMMARY: Our findings highlight that selected patients with high-risk nonmetastatic prostate cancer benefit from intensification of systemic therapy beyond hormonal treatment.

PMID:35465985 | DOI:10.1016/j.eururo.2022.03.031