Category: Statistics

Neurol Sci. 2022 Oct 7. doi: 10.1007/s10072-022-06430-z. Online ahead of print.

ABSTRACT

BACKGROUND: Low back pain is a musculoskeletal disorder (MSD), and Kegel exercise is considered as one of the non-surgical management methods. Therefore, the present systematic review and meta-analysis aimed to estimate the results of randomized clinical trials (RCT) about the effect of pelvic floor muscle-strengthening exercises on reducing low back pain‏.‏ METHODS: The present study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline (2020) to January 2022. The relevant studies were searched in the MagIran, SID, PubMed, Embase, Web of Science (WoS), Scopus, ClinicalTrials.gov databases and Google Scholar motor engine using related MeSH/Emtree terms, which were combined with free text word. The heterogeneity of the studies was checked using I² statistic.

RESULTS: Finally, 19 RCTs with a sample size of 456 subjects in the intervention group and 470 in the control group were included in the meta-analysis. The low back pain intensity in the intervention group decreased up to 1.261 ± 0.213 (SMD ± 95% CI) with I² = 87.60 more than that in the control group (P <0.001). The low back pain intensity in postpartum women decreased up to 1.614 ± 0.312 (95% CI) followed by pregnant women as 1.282 ± 0.479 (SMD ± 95% CI) more than that in other populations. But due to high the heterogeneity in all sub-groups (I² > 80%) this result should be considered with caution. Meta-regression analysis showed the effect of pelvic floor muscle-strengthening exercises increased by increasing the year of publication, quality assessment score of the article, and the number of weeks of intervention (P<0.05).

CONCLUSION: Based on the results of the present meta-analysis, pelvic floor muscle-strengthening exercises significantly reduce the low back pain intensity. Therefore, these exercises can be regarded as a part of a low back pain management plan.

PMID:36205811 | DOI:10.1007/s10072-022-06430-z

Eur Arch Otorhinolaryngol. 2022 Oct 7. doi: 10.1007/s00405-022-07678-z. Online ahead of print.

ABSTRACT

OBJECTIVES: Thyroglobulin, produced exclusively by thyroid follicular cells, serves as a specific tumor marker for the follow-up of differentiated thyroid cancer (DTC) patients after thyroidectomy. However, its role as a predictor of malignancy in patients with thyroid nodules is controversial. We assessed the potential role of preoperative serum thyroglobulin concentration to predict DTC in patients without a preoperative diagnosis of malignancy who underwent partial or total thyroidectomy.

METHODS: This retrospective study included patients with a preoperative diagnosis of benign multinodular goiter (MNG) or a thyroid nodule with indeterminate cytology (INC) (Bethesda system categories III/IV) who underwent partial or total thyroidectomy between January 2014 and May 2019. We compared the patients’ demographic, clinical, imaging, and biochemical data according to their final diagnosis: DTC or benign thyroid nodular disease. Further statistical analysis included odds ratio calculation and receiver operating characteristic (ROC) curve analysis.

RESULTS: Of 131 patients who met inclusion and exclusion criteria, the indication for surgery was benign MNG in 69 patients and a thyroid nodule with INC in 62 patients. A final diagnosis of DTC was reported in 18 of the 69 benign MNG patients (26%) and in 30 of the 62 thyroid nodule with INC patients (48%). The preoperative measurements of nodule diameter and serum thyroid-stimulating hormone and thyroglobulin concentrations did not significantly differ between patients with a final diagnosis of DTC and those with benign histology.

CONCLUSIONS: Preoperative serum thyroglobulin alone is insufficient to differentiate between malignant and benign thyroid nodular disease.

PMID:36205785 | DOI:10.1007/s00405-022-07678-z

Eur Radiol. 2022 Oct 7. doi: 10.1007/s00330-022-09155-x. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to demonstrate the effectiveness of spectral photon-counting CT (SPCCT) in quantifying fibrous cap (FC) thickness, FC area, and lipid-rich necrotic core (LRNC) area, in excised carotid atherosclerotic plaques by comparing it with histopathological measurements.

METHODS: This is a single-center ex vivo cross-sectional observational study. Excised plaques of 20 patients (71 +/- 6 years; 13 men), obtained from carotid endarterectomy were scanned with SPCCT using standardized acquisition settings (120k Vp/19 μA; 7-18 keV, 18-30 keV, 30-45 keV, 45-75 keV, and 75-118 keV). FC thickness, FC area, and LRNC area were quantified and compared between high-resolution 3D multi-energy CT images and histopathology using the Wilcoxon signed-ranks test and Bland-Altman analysis. Images were interpreted twice by two radiologists separately, blinded to the histopathology; inter- and intra-rater reliability were assessed with the intra-class correlation coefficients (ICC).

RESULTS: FC thickness and FC area did not show significant differences between the SPCCT-derived radiological measurements versus the histopathological measurements (p value range 0.15-0.51 for FC thickness and 0.053-0.30 for FC area). For the LRNC area, the p value was statistically non-significant for reader 1 (range 0.36-0.81). The Bland-Altman analysis showed mean difference and 95% confidence interval for FC thickness, FC area, and LRNC area, 0.04 (-0.36 to 0.12) square root mm, -0.18 (-0.34 to -0.02) log₁₀ mm² and 0.10 (-0.088. to 0.009) log₁₀ mm² respectively.

CONCLUSION: The result demonstrated a viable technique for quantifying FC thickness, FC area, and LRNC area due to the combined effect of high spatial and energy resolution of SPCCT.

KEY POINTS: • SPCCT can identify and quantify different components of carotid atherosclerotic plaque in ex vivo study. • Components of atherosclerotic plaque did not show significant differences between the SPCCT-derived radiological measurements versus the histopathological measurements.

PMID:36205768 | DOI:10.1007/s00330-022-09155-x

Knee Surg Sports Traumatol Arthrosc. 2022 Oct 7. doi: 10.1007/s00167-022-07188-9. Online ahead of print.

ABSTRACT

The aim of this paper is to close the knowledge-to-practice gap around statistical power. We demonstrate how four factors affect power: p value, effect size, sample size, and variance. This article further delves into the advantages and disadvantages of a priori versus post hoc power analyses, though we believe only understanding of the former is essential to addressing the present-day issue of reproducibility in research. Upon reading this paper, physician-scientists should have expanded their arsenal of statistical tools and have the necessary context to understand statistical fragility.

PMID:36205762 | DOI:10.1007/s00167-022-07188-9

Osteoporos Int. 2022 Oct 7. doi: 10.1007/s00198-022-06562-0. Online ahead of print.

ABSTRACT

Fracture risk was elevated in Parkinson’s disease (PD) patients compared with controls in this nationwide study. Among PD patients, the risk of fracture increased linearly with PD severity, whereas no difference in fracture risk was observed according to PD duration.

INTRODUCTION: Parkinson’s disease (PD) is reported to be associated with a high risk of fractures. Several studies found an association between severity and duration of PD and falls or bone mineral density, but those factors have not been considered in most previous research. The aim of this study was to determine the fracture risk in PD patients according to their disease severity and duration.

METHODS: This population-based, retrospective cohort study used data from the Korean National Health Insurance Service database. The study population included 10,333 patients with prevalent PD and 6,501,464 comparison cohort. Fracture risks according to the prevalence, severity, and duration of PD were evaluated using Cox proportional hazard methods.

RESULTS: Fracture risk was elevated in PD patients at all sites compared with controls (adjusted hazard ratio [aHR] 1.49, 95% confidence interval [CI] 1.44-1.56 for any fracture). When comparing fracture sites, hip fractures showed the largest risk increase in PD patients (aHR 2.16, 95% CI 1.95-2.38). Among PD patients, the risk of any fracture increased linearly with PD severity and was highest in patients with severe disease (aHR 1.65, 95% CI 1.53-1.79 compared with controls). Meanwhile, no significant association was observed between PD duration and fracture risk.

CONCLUSIONS: The prevalence of PD was related to an increased risk of fractures in this nationwide study, and PD severity was linearly associated with fracture risk. PD prevalence and severity should be considered when evaluating the risk factors of fracture in clinical practice.

PMID:36205727 | DOI:10.1007/s00198-022-06562-0

Plast Reconstr Surg. 2022 Oct 7. doi: 10.1097/PRS.0000000000009799. Online ahead of print.

ABSTRACT

BACKGROUND: Botulinum toxin type A is an easy and efficacious treatment for gingival smile. However, the optimal dose and injection site are controversial.

OBJECTIVE: We compared the reduction in gingival exposure using two methods with different doses and injection sites.

METHODS: In this prospective self-controlled study, healthy participants with gingival smile (anterior gingival exposure of >3 mm) underwent two treatment methods. First, participants received a single-point injection of 2 U botulinum toxin type A per side (simplified method). After 8 months, the individualized method was performed with 2-5 U of botulinum toxin type A (total 4-10 U), which was injected at 1-2 sites according to pretreatment severity. Data were collected at baseline and at 4, 12, and 32 weeks of follow up.

RESULTS: Fifty-five participants were enrolled. Anterior gingival exposure and bilateral posterior gingival exposure were significantly reduced 4 and 12 weeks after botulinum toxin type A injection (P ≤ 0.05) with both methods. These parameters returned to baseline by 32 weeks (P > 0.05). Posttreatment anterior gingival exposure at 4 weeks and 12 weeks with the individualized method was significantly lower compared with the simplified method (both P ≤ 0.05). Patient satisfaction with the individualized method was preferred compared with the simplified method (P ≤ 0.05). Few adverse events were observed with both methods without statistical significance.

CONCLUSIONS: It is necessary to increase the injection dose and tailor the injection site according to the pretreatment severity of anterior gingival smile.

PMID:36205701 | DOI:10.1097/PRS.0000000000009799

Plast Reconstr Surg. 2022 Oct 7. doi: 10.1097/PRS.0000000000009792. Online ahead of print.

ABSTRACT

INTRODUCTION: The insertion of gluteal silicone implants by intramuscular technique leads patients to develop gluteus maximus muscle atrophy. The objective of the present study was to correlate the muscular atrophy of the gluteus maximus proportional to the volume of the silicone implants used. The secondary objectives were to assess volumetry of the gluteus maximus muscle in the late follow-up, positioning of the implants and to verify association between volumetric muscle recovery and practice of physical exercise.

METHODS: This is a prospective study. The sample was composed of 22 patients who were operated and followed up on an outpatient basis and through gluteus computed tomography in 3 different moments: pre-operative, 12-month post-operative and late post-operative (≥ 96 months).

RESULTS: Computed Tomography 3D reconstruction and volumetric analysis showed a median atrophy of 6.68% of the gluteus maximus muscle volume in 12 months and 7.47% in the late post-operative period. The correlation between relative volume of the implant and atrophy percentage of the gluteus maximus didn’t present statistically significant results. There was an association between the practice of physical exercise and volumetry recovery of the gluteus maximus. No patient presented gluteal implant rotation.

CONCLUSION: There isn’t correlation between proportional volume of implants and atrophy percentage of gluteus maximus muscle, when using implants up to 400cm3. The gluteus maximus muscle presents atrophy in the late follow-up of augmentation gluteoplasty with implants surgery. There is recovery of muscle volumetry on the patients that practice physical activities. Intramuscular plane implants demonstrated stability in their long-term positioning.

PMID:36205700 | DOI:10.1097/PRS.0000000000009792

West J Emerg Med. 2022 Aug 19;23(5):706-715. doi: 10.5811/westjem.2022.6.55551.

ABSTRACT

INTRODUCTION: Previous studies suggest improved intubation success using video laryngoscopy (VL) vs direct laryngoscopy (DL), yet recent randomized trials have not shown clear benefit of one method over the other. These studies, however, have generally excluded difficult airways and rapid sequence intubation. In this study we looked to compare first-pass success (FPS) rates between VL and DL in adult emergency department (ED) patients with difficult airways.

METHODS: We conducted a secondary analysis of prospectively collected observational data in the National Emergency Airway Registry (NEAR) (January 2016-December 2018). Variables included demographics, indications, methods, medications, devices, difficult airway characteristics, success, and adverse events. We included adult ED patients intubated with VL or DL who had difficult airways identified by gestalt or anatomic predictors. We stratified VL by hyperangulated (HAVL) vs standard geometry VL (SGVL). The primary outcome was FPS, and the secondary outcome was comparison of adverse event rates between groups. Data analyses included descriptive statistics with cluster-adjusted 95% confidence intervals (CI).

RESULTS: Of 18,123 total intubations, 12,853 had a predicted or identified anatomically difficult airway. The FPS for difficult airways was 89.1% (95% CI 85.9-92.3) with VL and 77.7% (95% CI 75.7-79.7) with DL (P <0.00001). The FPS rates were similar between VL subtypes for all difficult airway characteristics except airways with blood or vomit, where SGVL FPS (87.3%; 95% CI 85.8-88.8) was slightly better than HAVL FPS (82.4%; 95% CI, 80.3-84.4). Adverse event rates were similar except for esophageal intubations and vomiting, which were both less common in VL than DL. Esophageal intubations occurred in 0.4% (95% CI 0.1-0.7) of VL attempts and 1.5% (95% CI 1.1-1.9) of DL attempts. Vomiting occurred in 0.6% (95% CI 0.5-0.7) of VL attempts and 1.4% (95% CI 0.9-1.9) of DL attempts.

CONCLUSION: Analysis of the NEAR database demonstrates higher first-pass success with VL compared to DL in patients with predicted or anatomically difficult airways, and reduced rate of esophageal intubations and vomiting.

PMID:36205675 | DOI:10.5811/westjem.2022.6.55551

Dermatol Ther. 2022 Oct 7:e15907. doi: 10.1111/dth.15907. Online ahead of print.

ABSTRACT

BACKGROUND: Topical timolol and lasers are widely used for the treatment of infantile hemangioma (IH), and they can replace propranolol as the first-line treatment of IH. We aimed to investigate the efficacy and safety of topical timolol alone or lasers plus topical timolol versus lasers alone for the treatment of IH using a meta-analysis.

METHODS: We searched the PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases. A more conservative random effect model meta-analysis technique was used to analyze the efficacy and adverse reactions of timolol and lasers.

RESULTS: Ten RCTs with a total of 979 patients with IH were included in this meta-analysis. Treatment with topical timolol alone was as effective as lasers in treating IH (risk ratio [RR] = 0.99, p = 0.94), with similar adverse events. The difference was not statistically significant (RR = 1.67, p = 0.14). Combined treatment with topical timolol and lasers showed a favorable response rate compared with treatment with either lasers (RR = 1.23, p = 0.01) or topical timolol (RR = 1.35, p = 0.001) alone. Furthermore, compared to topical timolol alone, the combined treatment indicated similar risks of adverse events (RR = 0.70, p = 0.38) but fewer risks of adverse events (RR = 0.39, p = 0.004) compared to lasers alone.

CONCLUSIONS: This meta-analysis provided evidences that a combined treatment with topical timolol and lasers might be more effective than a single treatment strategy in infants with IH, and with no significant increase in adverse reactions. The combination of topical timolol and laser therapy might be the preferred choice for the treatment of IHs.

PMID:36205218 | DOI:10.1111/dth.15907

East Mediterr Health J. 2022 Sep 29;28(9):690-694. doi: 10.26719/emhj.22.059.

ABSTRACT

BACKGROUND: The United Arab Emirates has set the goal to reduce traffic-related deaths to 3 per 100 000 people by 2021. To do this, authorities must assess the factors related to risky driving behaviour.

AIMS: To verify if there are any correlations between driving behaviour and certain variables, including years of driving experience, daily hours of sleep, general markers of mental health, and symptoms of attention deficit hyperactivity disorder (ADHD).

METHODS: Two hundred and seventy-five participants responded to a survey made up of the Manchester driver behaviour questionnaire, the general health questionnaire, the adult ADHD self-report scale, and 2 additional questions. Spearman’s coefficient was calculated for correlations between these variables, at statistical significance level P < 0.05.

RESULTS: Years of driving experience and hours of sleep had no correlations with driving performance. Markers of general mental health had a weak correlation with risky driving behaviour, and symptoms of ADHD had moderate correlation with risky driving behaviour.

CONCLUSION: Policymakers and public health officials should screen for ADHD during driver licensing examination.

PMID:36205208 | DOI:10.26719/emhj.22.059