Category: Statistics

Langenbecks Arch Surg. 2023 Aug 14;408(1):307. doi: 10.1007/s00423-023-03059-0.

ABSTRACT

PURPOSE: During the COVID-19 pandemic, the new RCSEng guidelines resulted in appendicitis being more commonly managed conservatively to avoid aerosol-generating procedures. This resulted in shorter hospital stays without increased short-term complications. The 2-year outcomes of this change, specifically recurrence and re-admission rates remain unknown.

METHODS: We conducted a multicentre, prospective, observational study including all adult patients treated as appendicitis after the implementation of the new surgical guidelines during the COVID-19 pandemic. Outcomes included initial management failure, re-admission rate, appendicitis recurrence, and interval appendicectomy. A historical cohort prior to the COVID-19 pandemic was used for comparison. Patients were followed up for 2-years post index admission. Categorical and continuous variables were compared using Fisher’s exact test and Student’s T or Mann-Whitney U tests as appropriate.

RESULTS: Sixty-three and 79 patients with appendicitis were included from four NHS trusts, before (A) and after (B) the new intercollegiate guidelines respectively. Operative management was used less frequently in cohort B (28/79 vs 52/63; p<0.001). More patients re-presented in cohort B (14/79 vs 3/63; p=0.020), but not when comparing only those managed conservatively (2/11 vs 13/52; p=1.000). A similar trend was observed for appendicitis recurrence although without statistical significance (2/63 vs 9/79; p=0.112); with loss of trend when comparing those managed conservatively-only (2/11 vs 9/52; p=1.000). Among all patients, four (2.8%) were found to have underlying neoplasia of which three were initially managed conservatively (3/63; 4.8%).

CONCLUSION: Conservative management of appendicitis has previously been shown to have short-term benefits in expedited hospital discharge without early complications. The present study shows it has a higher readmission and appendicitis recurrence rates. The risks of this alongside missed/delayed management of neoplasia needs to be considered alongside the benefits including avoidance of aerosol-generating general anaesthesia and laparoscopy during the COVID-19 pandemic or similar future health crises. Small case numbers limit analysis.

PMID:37578533 | DOI:10.1007/s00423-023-03059-0

Surg Radiol Anat. 2023 Aug 14. doi: 10.1007/s00276-023-03215-7. Online ahead of print.

ABSTRACT

PURPOSE: This retrospective study aimed to determine the prevalence and morphological characteristics of accessory mandibular canals (AMCs) in an eastern Chinese population to provide clinical guidance for reducing intraoperative and postoperative complications.

METHODS: Cone beam computed tomography (CBCT) scans of 300 Chinese patients were used to identify AMCs according to a modification of Naitoh’s classification. The length of the branch (L0) and the upper and lower angles between the branch and mandibular canal were measured on sagittal images. Additionally, the branches were divided into narrow or wide types by calculating the ratio of the branch diameter to the main canal diameter. The location of the bifurcation point was characterized by measuring its distance to the buccal wall of the mandible (L1), lingual wall of the mandible (L2) and alveolar ridge (L3).

RESULTS: The prevalence rate of AMCs was 40.7% (95% CI: 35.1-46.3), and the most common type was the retromolar canal, followed by the forward canal, dental canal, trifid mandibular canals (TMCs) or others, inferior canal and buccolingual canal. Twenty-one cases of multiple branches with unusual patterns were observed in the study. The average values of L0, L1, L2 and L3 were 15.05 ± 0.63 mm, 5.79 ± 0.14 mm, 4.40 ± 0.18 mm and 14.61 ± 0.31 mm, respectively. The mean upper angle and lower angle were 141.59° ± 2.44° and 50.64° ± 2.57°, respectively. Approximately 20.8% of the branches were defined as wide type, and no statistical significance was found between different types.

CONCLUSION: AMCs are not rare anatomic variations of the mandibular canal in the eastern Chinese population; thus, CBCT examination is highly recommended for precise evaluation before surgeries involving the mandibles.

PMID:37578527 | DOI:10.1007/s00276-023-03215-7

Int J Surg. 2023 Aug 14. doi: 10.1097/JS9.0000000000000636. Online ahead of print.

ABSTRACT

BACKGROUND: The value of existing prognostic models for intrahepatic cholangiocarcinoma (ICC) is limited. The inclusion of prognostic gene mutations would enhance the predictive efficacy.

METHODS: In the screening cohorts, univariable Cox regression analysis was applied to investigate the effect of individual mutant genes on overall survival (OS). In the training set, multivariable analysis was performed to evaluate the independent prognostic roles of the clinicopathological and mutational parameters, and a prognostic model was constructed. Internal and external validations were conducted to evaluate the performance of this model.

RESULTS: Among the recurrent mutations, only TP53 and KRASG12 were significantly associated with OS across all three screening cohorts. In the training cohort, TP53 and KRASG12 mutations in combination with seven other clinical parameters (tumor size, tumor number, vascular invasion, lymph node metastasis, adjacent invasion, CA19-9, and CEA), were independent prognostic factors for OS. A mutation-annotated prognostic score (MAPS) was established based on the nine prognosticators. The C-indices of MAPS (0.782 and 0.731 in the internal and external validation cohorts, respectively) were statistically higher than those of other existing models (P<0.05). Furthermore, the MAPS model also demonstrated significant value in predicting the possible benefits of upfront surgery and adjuvant therapy.

CONCLUSIONS: The MAPS model demonstrated good performance in predicting OS of ICC patients. It may also help predict the possible benefits of upfront surgery and adjuvant therapy.

PMID:37578492 | DOI:10.1097/JS9.0000000000000636

Prim Health Care Res Dev. 2023 Aug 14;24:e52. doi: 10.1017/S1463423623000403.

ABSTRACT

AIM: The aim of this study was to identify key policy objectives by investigating the perception of important stakeholders and affected professionals concerning relevance and feasibility of a successful primary care (PC) reform.

BACKGROUND: Since 2013, the Austrian PC system has been undergoing a reform process to establish multiprofessional primary care units. The reforms have various defined objectives and lack clear priorities.

METHODS: After the definition and consensus-based selection of 12 policy objectives, a cross-sectional online survey on their relevance and feasibility was distributed via email and social media to PC and public health networks. The survey was conducted in the period from January to February 2020. Results were analyzed descriptively, and further, Pearson Chi-Square Test or Fisher’s Exact Test was performed for group comparison regarding respondents’ characteristics. Open-ended responses were analyzed using qualitative content analysis.

FINDINGS: In total, 169 questionnaires were completed. A total of 46.3% of the responders had more than 20 years of professional experience (female: 60.5%). A mandatory internship in general practice, vocational training for general practice, and a modern remuneration system were the three top-rated policy objectives regarding relevance. A mandatory internship in general practice, specialization in general practice, and coding of services and diagnosis were assessed as the most feasible objectives. The group comparisons regarding working field, years of professional experience, age, and sex did not show any meaningful results in the evaluation of relevance and feasibility.

DISCUSSION: In the view of the study participants, easily obtainable objectives include adapting the duration and setting of internships for medical students, as well as mandatory vocational training for GP trainees. Further efforts are necessary to achieve complex objectives such as the adoption of a modern remuneration scheme and a comprehensive quality assurance program. Building capacity and creating team-oriented environments are also important aspects of a successful PC reform.

PMID:37577950 | DOI:10.1017/S1463423623000403

Expert Rev Mol Diagn. 2023 Aug 14. doi: 10.1080/14737159.2023.2246883. Online ahead of print.

ABSTRACT

INTRODUCTION: The heat shock protein 90 (Hsp90) is a protein involved in many different biological processes and especially in cell survival. Some of these functions require the participation of other biological molecules, so Hsp90 is a chaperone that takes part in many protein-protein interactions working as a critical signaling hub protein. As a member of the heat shock protein family, Hsp90 expression is regulated under certain environmental and/or stressful situations, therefore Hsp90 concentration can be monitored and linked to these effects.

AREAS COVERED: This review discusses the Hsp90 expression in samples from individuals affected by different diseases (from infectious to cancer origin), and the biological consequences of these disorders, including the potential use of Hsp90 as a biomarker for diagnosis of human diseases.

EXPERT OPINION: The potential of Hsp90 as a biomarker disease has been demonstrated in several studies in relation to infectious diseases and especially cancer. However, further research in this field is still needed, mainly to validate in statistically significant clinical studies that the detection of Hsp90 protein allows the diagnosis of some cancers at an early stage and also that it can act as a biomarker for monitoring the efficacy of their therapies.

PMID:37577928 | DOI:10.1080/14737159.2023.2246883

Expert Opin Drug Saf. 2023 Aug 14. doi: 10.1080/14740338.2023.2247965. Online ahead of print.

ABSTRACT

BACKGROUND: The use of levonorgestrel emergency oral contraceptives (EOCs) is one of the factors that may be associated with ectopic pregnancy. We aimed to investigate the incidence of ectopic pregnancy in EOC users and the association between EOCs and ectopic pregnancy.

RESEARCH DESIGN AND METHODS: We searched for articles that provided the incidence of and the association between levonorgestrel EOCs and ectopic pregnancy in women of reproductive ages in CINAHL Complete, Medline, OpenDissertations, Scopus, Science Direct, and Thai Journal Online. The risk of bias was assessed by Risk Of Bias In Non-randomized Studies or Risk of Bias 2. A meta-analysis was conducted using the random-effects model.

RESULTS: We retrieved 1839 nonredundant articles from the systematic search. The meta-analysis showed that the prevalence of ectopic pregnancy was not statistically different from zero (pooled prevalence estimate = 0.029%; 95%CI: -0.006, 0.065; N = 9; I² = 0) and rare. In addition, levonorgestrel EOCs increased the risk of ectopic pregnancy (OR = 6.17; 95%CI: 3.78, 10.08; N = 5; I² = 43%).

CONCLUSIONS: Women with extrauterine or ectopic pregnancy had higher odds of using levonorgestrel emergency oral contraceptives than those with intrauterine pregnancy. However, the prevalence of ectopic pregnancy is rare.

PMID:37577925 | DOI:10.1080/14740338.2023.2247965

Blood Coagul Fibrinolysis. 2023 Aug 10. doi: 10.1097/MBC.0000000000001248. Online ahead of print.

ABSTRACT

The fibrinolytic system plays an important role in controlling blood coagulation at each stage, from thrombin generation to fibrin clot cleavage. Currently, long-term multiorgan dysfunction post-coronavirus disease 2019 (COVID-19) may include coagulation disorders. Little information is available about the potential causes of post-COVID-19 coagulopathy, but one of them may be subpopulation IgG produced by the immune system against SARS-CoV-2. This article describes the changes in the main parameters of the fibrinolytic system in donors with various titers of anti-SARS-CoV-2 IgG, which is part of a complex study of the hemostasis system in these donor groups. We determined the most significant parameters of the fibrinolytic system, such as potential activity and amount of plasminogen and tissue plasminogen activator (tPA), amount of plasminogen activator inhibitor-1 (PAI-1), inhibitory potentials of α-2-antiplasmin, α-1-antitrypsin, α-2-macroglobulin in the blood plasma of donor groups. The obtained results represent the maximum and minimum values of measurement parameters among donor groups with titers of anti-SARS-CoV-2 IgG at least 10 ± 3 Index (S/C), and their statistical differences from the reference point [donor group with titer of anti-SARS-CoV-2 IgG 0 Index (S/C)]. We established the changes in fibrinolytic parameters depending on the titers of anti-SARS-CoV-2 IgG. One conclusion can be drawn from this: anti-SARS-CoV-2 IgG population may influence coagulation in the post-COVID-19 period. Further research in-vitro and in-vivo experimental models using selected and purified IgG may confirm our previous findings.

PMID:37577922 | DOI:10.1097/MBC.0000000000001248

Int J Fertil Steril. 2023 Oct 1;17(4):306-311. doi: 10.22074/ijfs.2023.562653.1374.

ABSTRACT

BACKGROUND: Women who undergo in vitro fertilization (IVF) cycles should successfully go via multiple stages (i.e., clinical pregnancy, no abortion under 12 weeks, no abortion under 20 weeks, and delivery) to achieve a live birth. In this study, data from multiple IVF cycles and its multiple stages were reanalyzed to illustrate the success factors associated with various stages of IVF cycles in a population of Iranian infertile women.

MATERIALS AND METHODS: This historical cohort study includes 3676 assisted reproductive technology (ART) cycles. Covariates take into account in this study were women’s age, type of infertility (primary, secondary), body mass index (BMI), cause of infertility, history of abortion, duration of infertility, number of oocytes, number of embryos, fertilization rate, semen factors (Spermogram) and having polycystic ovarian syndrome (PCOS) during IVF cycles. Joint modeling was fitted to apply informative cluster size.

RESULTS: Increasing age un women was associated with an increase in the BMI and a positive history of abortion and PCOS, and also, an increase in the number of treatment cycles, while in men was associated with the negative spermogram. With the increase in the number of treatment cycles, the result of the IVF success decreased, but with the increase in the number of embryos, fertilization rate and also, quality and / or quantity parameters of spermogram, we encountered with an increase in the IVF success rate.

CONCLUSION: It seems that a joint model of the number of treatment cycles and the result of IVF is a valuable statistical model that does not ignore the significant effect of cycle numbers, while this issue is ignored usually in the univariate models.

PMID:37577917 | DOI:10.22074/ijfs.2023.562653.1374

Int J Fertil Steril. 2023 Aug 7;17(4):299-305. doi: 10.22074/ijfs.2023.543119.1224.

ABSTRACT

BACKGROUND: One of the most common endocrine disorders of reproductive age women is polycystic ovary syndrome (PCOS). Women with PCOS are at risk for infertility, endometrial cancer, metabolic disorders, and cardiovascular disease. Awareness of the signs and symptoms of PCOS can be effective in diagnosing early stage PCOS and promoting quality of life (QoL). This study assesses the awareness of PCOS in schoolgirls and their mothers.

MATERIALS AND METHODS: This cross-sectional study was carried out on 1580 high school girls and 480 of their mothers in Tehran (capital of Iran) in 2017 and 2018. We used the stratified sampling method and divided Tehran into five geographic regions: north, south, east, west, and central. Schools were randomly selected from each of these regions. Students and their mothers separately answered a self-administered questionnaire that pertained to their knowledge of PCOS. Statistical analyses were carried out with SPSS, version 22 (Inc. Chicago, IL, USA) and R version 3.2.1.

RESULTS: Students had an average age of 16.97 ± 0.84 years and their mothers’ average age was 45.19 ± 5.03 years. The average body mass index (BMI) of the students was 22.01 ± 5.54 kg/m2. The results of this study showed that only 48 students (3.2%) and 148 mothers (27%) had acceptable knowledge about PCOS. The knowledge of students about PCOS was positively related to their mothers’ knowledge about PCOS (P<0.001).

CONCLUSION: The level of PCOS awareness in Iranian women is insufficient and this may affect their QoL. Therefore, the health authorities should implement educational programs to challenge women’s incorrect beliefs about PCOS and increase their awareness of this disease.

PMID:37577916 | DOI:10.22074/ijfs.2023.543119.1224

Int J Fertil Steril. 2023 Aug 7;17(4):281-286. doi: 10.22074/ijfs.2023.561854.1368.

ABSTRACT

BACKGROUND: Monosodium glutamate (MSG) is a popular food flavor enhancer, and a glutamate subset that induces different toxicities such as hepatotoxicity, neurotoxicity, reproductive toxicity, and nephrotoxicity. This study was conducted to assess the effects of MSG on the α7 and α4 nicotinic acetylcholine receptor (nACHR) protein subunits expression of adult rat testis and the safety role of vitamin C.

MATERIALS AND METHODS: For this experimental research, 24 rats were haphazardly grouped into four equal groups (n=6) and orally gavaged for 30 days as follows: control group (distilled water gavage), MSG group (3 g/kg/b.w/ day), vitamin C group (150 mg/kg/b.w/day), and MSG+vitamin C group (3 g/kg/b.w/day+150 mg/kg/b.w/day, respectively) that rats of all groups on the 30^th day were anesthetized, and the left testes were used for of α4 and α7 nACHR protein subunit evaluation by immunohistochemistry (IHC). Statistical computations were performed using Graph Pad Prism software.

RESULTS: The present study revealed a significant reduction in the expression and optical density (OD) of α7 nACHR and α4 nACHR in the seminiferous tubules and intertubular connective tissue in the MSG group compared to the control group. In the MSG+vitamin C group, the expression and OD of α7 nACHR and α4 nACHR increased in the seminiferous tubules and intertubular connective tissue but this improvement was not significant compared to the MSG group.

CONCLUSION: MSG decreased the expression level of nACHR protein subunits, α7 and α4, in the seminiferous tubules and interstitial testicular tissue. Vitamin C in the MSG+vitamin C group could not significantly improve the expression of α7 and α4 nACHR subunits in testicular tissue. Probably, MSG toxicity can be compensated with higher doses of vitamin C.

PMID:37577913 | DOI:10.22074/ijfs.2023.561854.1368