Category: Statistics

BMJ Paediatr Open. 2023 Apr;7(1):e001833. doi: 10.1136/bmjpo-2022-001833.

ABSTRACT

BACKGROUND: Traumatic elbow injuries in children occur frequently and are among the most common traumatic injuries seen in the emergency department (ED) and in general practice. The use of a validated decision rule to enhance selective radiography in paediatric patients with possible elbow fractures may reduce unnecessary exposure to radiation in children.

METHOD AND ANALYSIS: This study is designed as a multicentre prospective cohort study. An expert panel of orthopaedic elbow surgeons, paediatric orthopaedic surgeons and trauma surgeons will initially determine clinical parameters that provide a possible predictive value for elbow fractures. Four hundred children between the ages of 2 and 17 years visiting the ED with pain following elbow trauma will then be included. The clinical parameters will be collected via patient history and physical examination. Elbow radiographs will be obtained in all patients to identify fractures. The data will be processed in a multivariable logistic regression analysis to determine which clinical parameters predict the presence of an elbow fracture. Only the clinical parameters that predict a fracture will be used to formulate the new decision rule: the paediatric elbow trauma (PET) rules. Internal validation of the prediction model will take place after inclusion is complete and by means of a bootstrap analysis on the acquired data. A calculation will be made to determine how many radiographs can potentially be reduced by applying the PET rules and a cost analysis will be performed.

ETHICS AND DISSEMINATION: The study will be conducted according to the principles of the Declaration of Helsinki and in accordance with the Medical Research Involving Human Subjects Act. The Medical Research Ethics Committees United stated on 16 May 2022 that The Medical Research Involving Human Act (WMO) does not apply to this study and an official approval by the committee is not required, reference number; project W22.086.

PMID:37105597 | DOI:10.1136/bmjpo-2022-001833

Appl Neuropsychol Child. 2023 Apr 27:1-9. doi: 10.1080/21622965.2023.2203321. Online ahead of print.

ABSTRACT

The aim was to investigate the effectiveness of a mindfulness-based intervention on improving executive functions and reducing the symptoms of attention deficit hyperactivity disorder in young children. This study employed a quantitative approach using a quasi-experimental, pretest and post-test and follow up design. 56 children between 5 and 7 years of age(M = 6.9, SD= 1.7) with ADHD or with symptoms of inattention and hyperactivity are being recruited to participate in the mindfulness-based intervention. To determine whether there are any significant differences between the two independent (unrelated) groups on executive functions and symptoms of attention deficit hyperactivity disorder, pre-post-follow up test and multiple comparisons are used. Pretest assessments were conducted for both the control and training groups. Following the pretest, a four-weeks of training commenced for the intervention group only. T-test results for the differences in post- test mean scores between the two groups in EF and in ADHD symptoms showed that the training group outperformed the control group. There were statistical differences in EF and in ADHD symptoms between pre and post measures in favor of post test, and between pre and follow up measures in favor of follow up test, but no statistical differences between post and follow up test. This study demonstrates that it is possible to enhance EF skills using mindfulness-based intervention in which young with ADHD are engaged in a series of group play based activities.

PMID:37105569 | DOI:10.1080/21622965.2023.2203321

Int J Stem Cells. 2023 Apr 30. doi: 10.15283/ijsc22101. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Osteoblasts are derived from bone marrow mesenchymal stem cells (BMMSCs) and play important role in bone remodeling. While our previous studies have investigated the cell subtypes and heterogeneity in osteoblasts and BMMSCs separately, cell-to-cell communications between osteoblasts and BMMSCs in vivo in humans have not been characterized. The aim of this study was to investigate the cellular communication between human primary osteoblasts and bone marrow mesenchymal stem cells.

METHODS AND RESULTS: To investigate the cell-to-cell communications between osteoblasts and BMMSCs and identify new cell subtypes, we performed a systematic integration analysis with our single-cell RNA sequencing (scRNA-seq) transcriptomes data from BMMSCs and osteoblasts. We successfully identified a novel preosteoblasts subtype which highly expressed ATF3, CCL2, CXCL2 and IRF1. Biological functional annotations of the transcriptomes suggested that the novel preosteoblasts subtype may inhibit osteoblasts differentiation, maintain cells to a less differentiated status and recruit osteoclasts. Ligand-receptor interaction analysis showed strong interaction between mature osteoblasts and BMMSCs. Meanwhile, we found FZD1 was highly expressed in BMMSCs of osteogenic differentiation direction. WIF1 and SFRP4, which were highly expressed in mature osteoblasts were reported to inhibit osteogenic differentiation. We speculated that WIF1 and sFRP4 expressed in mature osteoblasts inhibited the binding of FZD1 to Wnt ligand in BMMSCs, thereby further inhibiting osteogenic differentiation of BMMSCs.

CONCLUSIONS: Our study provided a more systematic and comprehensive understanding of the heterogeneity of osteogenic cells. At the single cell level, this study provided insights into the cell-to-cell communications between BMMSCs and osteoblasts and mature osteoblasts may mediate negative feedback regulation of osteogenesis process.

PMID:37105556 | DOI:10.15283/ijsc22101

J Appl Biomech. 2023 Apr 27:1-5. doi: 10.1123/jab.2022-0271. Online ahead of print.

ABSTRACT

Electromechanical delay (EMD) of muscle is influenced in part by its in-series arrangement with connective tissue. Therefore, studying EMD might provide a better understanding of the muscle-connective tissue interaction. Here, EMD of the thoracic and lumbar erector spinae muscles were investigated under conditions that could influence muscle-connective tissue interaction. A total of 19 participants performed isometric back extension contractions in 3 different postures that influence lumbar spine angle: sitting, standing, and kneeling. They then performed a 15-minute dynamic stretching routine and repeated the standing contractions. Mean lumbar flexion angles of 0.5°, 9.9°, and 19.8° were adopted for standing, kneeling, and sitting, respectively. No statistically significant differences in the thoracic erector spinae EMD were found between the different postures. Lumbar erector spinae EMD was significantly longer in the sitting (94.1 ms) compared to the standing (69.9 ms) condition, with no differences compared to kneeling (79.7 ms). There were no statistically significant differences of the thoracic or lumbar erector spinae EMDs before and after dynamic stretching. These results suggest that dynamic stretching does not affect the mechanical behavior of the muscle-tendon-aponeurosis units in a way that alters force generation and transmission, but a sitting posture can alter how force is transmitted through the musculotendinous complex of the lumbar erector spinae.

PMID:37105546 | DOI:10.1123/jab.2022-0271

Ann Coloproctol. 2023 Apr 28. doi: 10.3393/ac.2022.00913.0130. Online ahead of print.

ABSTRACT

PURPOSE: Most predictive factors for lymph node metastasis in rectal neuroendocrine tumors (NETs) have been based on local and endoscopic resection. We aimed to evaluate the risk factors for lymph node metastasis in patients who underwent radical resection for rectal NETs and stratify the risk of lymph node metastasis.

METHODS: Sixty-four patients who underwent radical resection for rectal NETs between January 2001 and January 2018 were included. We investigated the risk factors of lymph node metastasis using clinicopathologic data. We also performed a risk stratification for lymph node metastases using the number of previously known risk factors. For oncologic outcomes, the 5-year overall survival and recurrence-free survival were evaluated in both groups.

RESULTS: Among the patients who underwent radical surgery, 32 (50.0%) had lymph node metastasis and 32 (50.0%) had non-lymph node metastasis. In the multivariable analysis, only the male sex was identified as a risk factor for lymph node metastasis (odds ratio, 3.70; 95% confidence interval, 1.13-12.11; P=0.030). When there were 2 or more known risk factors, the lymph node metastasis rate was significantly higher than when there were one or no risk factors (odds ratio, 3.667; 95% confidence interval, 1.023-13.143; P=0.046). There was also no statistical difference between the 2 groups in 5-year overall survival (P=0.431) and 5-year recurrence-free survival (P=0.144).

CONCLUSION: We found that the rate of lymph node metastasis increased significantly when the number of known risk factors is 2 or more. Favorable oncological outcomes have been observed in patients who undergo surgery, even those with lymph node metastasis.

PMID:37105525 | DOI:10.3393/ac.2022.00913.0130

Ann Thorac Surg. 2023 Apr 25:S0003-4975(23)00401-0. doi: 10.1016/j.athoracsur.2023.04.019. Online ahead of print.

ABSTRACT

BACKGROUND: To evaluate the impact of proximal versus extensive repair on mortality, and how this impact is influenced by patient characteristics.

METHODS: 5510 acute type A aortic dissection (ATAAD) patients from 13 Chinese hospitals (2016-2021) were categorized by proximal versus extensive repair: 4038 patients for model derivation using eXtreme gradient boosting and 1472 patients for model validation.

RESULTS: Operative mortality of extensive repair was higher than proximal repair (10.4% vs 2.9%; odd ratio [OR] 3.833 [95%CI 2.810-5.229], P<0.001) with the number needed to harm (NNH) of 15 (95%CI 13-19). Seven top features of importance were selected to develop Alphabet risk model (age, body mass index, platelet-leucocyte ratio, albumin, hemoglobin, serum creatinine, urea nitrogen, and preoperative malperfusion), with an AUC of 0.767 (95%CI 0.733-0.800) and 0.727 (95%CI 0.689-0.764) in the derivation and validation cohort, respectively. The absolute rate differences in mortality between two repair strategies increased progressively as predicted risk rose, however, it did not become statistically significant until the predicted risk exceeded 4.5%. Extensive repair was associated with similar risk of mortality (OR 2.540 [95%CI 0.944-6.831]) for patients with risk probability <4.5%, but higher risk (OR 2.164 [95%CI 1.679, 2.788]) for patients with risk probability >4.5% compared with proximal repair.

CONCLUSIONS: Extensive repair is associated with higher mortality than proximal repair; however, it did not carry a significantly higher risk of mortality until the predicted probability exceed a certain threshold. Choosing the right surgery should be based on individualized risk prediction and treatment effect.

PMID:37105511 | DOI:10.1016/j.athoracsur.2023.04.019

J Biomed Inform. 2023 Apr 25:104372. doi: 10.1016/j.jbi.2023.104372. Online ahead of print.

ABSTRACT

Phenotype-based prioritization of candidate genes and diseases has become a well-established approach for multi-omics diagnostics of rare diseases. Most current algorithms exploit semantic analysis and probabilistic statistics based on Human Phenotype Ontology and are commonly superior to naive search methods. However, these algorithms are mostly less interpretable and do not perform well in real clinical scenarios due to noise and imprecision of query terms, and the fact that individuals may not display all phenotypes of the disease they belong to. We present a Phenotype-driven Likelihood Ratio analysis approach (PheLR) assisting interpretable clinical diagnosis of rare diseases. With a likelihood ratio paradigm, PheLR estimates the posterior probability of candidate diseases and how much a phenotypic feature contributes to the prioritization result. Benchmarked using simulated and realistic patients, PheLR shows significant advantages over current approaches and is robust to noise and inaccuracy. To facilitate clinical practice and visualized differential diagnosis, PheLR is implemented as an online web tool (http://phelr.nbscn.org).

PMID:37105510 | DOI:10.1016/j.jbi.2023.104372

J Biomed Inform. 2023 Apr 25:104367. doi: 10.1016/j.jbi.2023.104367. Online ahead of print.

ABSTRACT

Cytokine release syndrome (CRS), also known as cytokine storm, is one of the most consequential adverse effects of chimeric antigen receptor therapies that have shown otherwise promising results in cancer treatment. When emerging, CRS could be identified by the analysis of specific cytokine and chemokine profiles that tend to exhibit similarities across patients. In this paper, we exploit these similarities using machine learning algorithms and set out to pioneer a meta-review informed method for the identification of CRS based on specific cytokine peak concentrations and evidence from previous clinical studies. To this end we also address a widespread challenge of the applicability of machine learning in general: reduced training data availability. We do so by augmenting available (but often insufficient) patient cytokine concentrations with statistical knowledge extracted from domain literature. We argue that such methods could support clinicians in analyzing suspect cytokine profiles by matching them against the said CRS knowledge from past clinical studies, with the ultimate aim of swift CRS diagnosis. We evaluate our proposed methods under several design choices, achieving performance of more than 90% in terms of CRS identification accuracy, and showing that many of our choices outperform a purely data-driven alternative. During evaluation with real-world CRS clinical data, we emphasize the potential of our proposed method of producing interpretable results, in addition to being effective in identifying the onset of cytokine storm.

PMID:37105509 | DOI:10.1016/j.jbi.2023.104367

J Endod. 2023 Apr 25:S0099-2399(23)00235-2. doi: 10.1016/j.joen.2023.04.007. Online ahead of print.

ABSTRACT

INTRODUCTION: The efficacy of sodium hypochlorite (NaOCl) as an intracanal irrigant is widely debated in endodontic therapy. This study aimed to analyze and compare the penetration abilities of different modes of NaOCl application and assess the impact of various agitation strategies on promoting root canal cleanliness.

MATERIALS AND METHODS: This study included 168 single-rooted mandibular premolars that were randomly divided into eight groups. The two modes of application of 5% NaOCl evaluated were intracanal heating and preheating, and the agitation strategies included ultrasonic, sonic, and manual dynamic agitations (MDAs). The samples were sectioned and observed at a magnification of 1000× under a scanning electron microscope.

RESULTS: The analysis of variance test showed a statistically significant difference among the various groups of agitation (P < 0.05). The post hoc Tukey test confirmed that preheated NaOCl with ultrasonic agitation, intracanal-heated NaOCl with sonic agitation, and MDA had significantly higher debris scores of 1, 4, and 5, respectively, in the apical third of the canal.

CONCLUSION: The results indicated that the combination of intracanal-heated NaOCl and ultrasonic agitation is an effective method for reducing debris in the root canal system. These findings highlight the importance of considering both the mode of application and the agitation strategies when optimizing the use of NaOCl as an intracanal irrigant in endodontic therapy.

PMID:37105500 | DOI:10.1016/j.joen.2023.04.007

J Stomatol Oral Maxillofac Surg. 2023 Apr 25:101488. doi: 10.1016/j.jormas.2023.101488. Online ahead of print.

ABSTRACT

INTRODUCTION: The current most common technique for mandibular split is the sagittal split osteotomy described by Obwegeser and modified by Dalpont and Epker. Several studies have shown a lower face enlargement while employing these techniques. The supra-basilar sagittal split osteotomy described in 2017 seems to be an interesting alternative as mandibular angles remain in continuity with the internal valve. The aim of this study was to evaluate lower face enlargement by comparing two techniques: sagittal split osteotomy and supra-basilar sagittal split.

MATERIALS AND METHODS: Cephalograms were analyzed before and after surgery. Bigonial distances (BGD) were measured in frontal cephalograms, ramus length and distances between upper and lower incisors on lateral cephalogram. Control of those measures was also performed by measuring the Nasion-Anterior Clinoid distance and intercanthal distance to assess the comparability and error rate. Finally, a comparison of cephalograms before and after surgery to assess bigonial enlargement, ramus elongation and advancement was performed.

RESULTS: Out of the 69 patients, 18 had a Bilateral Sagittal Split (BSSO) and 52 had a Supra-Basilar Sagittal Split (SBSSO). The error rate and patients’ characteristics were the same in the two groups. A statistically significant widening of the bigonial distance with the BSSO in comparison with the SBSSO was found (BGD difference: 5.82 mm (BSSO) vs – 1.47 mm (SBSSO), p < 0,001). A greater ramus elongation with the SBSSO was found (ramus elongation: 1.12 mm (BSSO) vs 5.1 mm (SBSSO)). This study has shown that the supra-basilar sagittal split is an interesting way to avoid the widening of the mandibular angles.

PMID:37105491 | DOI:10.1016/j.jormas.2023.101488