Category: Statistics

Epilepsy Behav. 2023 Jun 3;144:109281. doi: 10.1016/j.yebeh.2023.109281. Online ahead of print.

ABSTRACT

OBJECTIVE: Executive and attentional deficits are often described in Juvenile Myoclonic Epilepsy (JME). We aimed to evaluate the short-term impact of rehabilitation developed for the most frequent cognitive deficits of persons with JME.

METHODS: Thirty-three patients entered this study which consisted of 12 individual sessions once a 60-minute week, divided into planning/organization, attention, and impulsivity. Twenty-seven patients finished the protocol, and all patients had pre-and-post evaluations from neuropsychological tests and self-rating questionnaires. Generalized Estimating Equations (GEE) inferential statistics were used to verify the protocol’s effect, and a 95% confidence interval was adopted.

RESULTS: We found significant improvement in selective attention (TMT A [p < 0.01] and Stroop test 2 [p = 0.03]), inhibitory control (Stroop test 3 [p = 0.02], FAS [p < 0.01], CPT commissions [p < 0.01]), mental flexibility [WCST categories p < 0.01] and implicit decision making (IGT blocks A [p < 0.01], B [p = 0.02], C [p < 0.01] and D [p < 0.01]). All components of the Behavioral Rating Index of Executive Functions metacognition index and the general quotient had significant improvement (initiative [p ≤ 0.01], working memory [p ≤ 0.01], planning and organization [p ≤ 0.01], task monitor [p = 0.02] and organization of materials [p = 0.02]). Regarding the Behavioral Regulation Index, the “Emotional Control” was improved [p = 0.03]. The attentional component and general scores of the Adult Self-Report Scale for Adults also changed significantly [p ≤ 0.01].

SIGNIFICANCE: Executive function and attention had an improvement in objective and subjective tests. The context-dependent reactive mechanism of impulsivity improved in instruments based on the ecological evaluation. Our findings, though preliminary due to a lack of controls and practice effect corrections, support that cognitive rehabilitation may be a valuable resource to alleviate cognitive deficits in patients with JME.

PMID:37276803 | DOI:10.1016/j.yebeh.2023.109281

Semergen. 2023 Jun 3;49(6):101996. doi: 10.1016/j.semerg.2023.101996. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective was to evaluate the consumption of fish in pregnant women and its association with maternal and infant outcomes.

MATERIAL AND METHODS: In this observational study carried out at the La Fe University and Polytechnic Hospital in Valencia, 300 pregnant women participated. The participants were divided into 2 groups according to their fish consumption during pregnancy for comparison. The χ² test or ANOVA test were applied for comparisons for qualitative and quantitative variables respectively.

RESULTS: It was observed that 49% of women consumed adequate amounts of fish during pregnancy (2 or 3 weekly servings). Significant differences were observed for iron supplementation (higher in women with inadequate fish consumption), threatened pregnancy loss (higher in women with inadequate fish consumption), infant size (better in women with adequate fish consumption), and arterial O₂ pressure (better in women with adequate fish consumption). In regard to the other components of the dietary pattern, no differences were observed but the adequacy of intake for grains and white meat was very poor (less than 5.0%).

CONCLUSIONS: Half of the women met the recommendations for fish intake during pregnancy and presented an overall healthier eating pattern but without statistical significance.

PMID:37276743 | DOI:10.1016/j.semerg.2023.101996

J Clin Neurosci. 2023 Jun 3;114:17-24. doi: 10.1016/j.jocn.2023.05.025. Online ahead of print.

ABSTRACT

Patients with Parkinson’s Disease presented gait impairment. Applying additional weights to enhancing sensory input may improve gait impairment. We assumed that gait impairment could be improved when patients walked with additional forearm weights, and the gait improvement was associated with clinical characteristic of Parkinson’s Disease. Thirty patients with Parkinson’s Disease and 30 age-sex matched controls were recruited. Spatiotemporal and joint kinematics parameters were evaluated by a three-dimensional motion capture system in normal walking and walking with sandbags, respectively. The comparisons of spatiotemporal parameters were analyzed using t-test or nonparametric tests. The comparison of joint kinematic data was analyzed using statistical parametric mapping. The correlation between motor symptom and gait parameters changes was analyzed using Pearson’s correlation analysis. During normal walking, patients showed deteriorated gait compared with controls. After applying weights to forearms patients increased cadence (p = 0.004), speed (p < 0.001) and step length (p = 0.048), and decreased stride time (p = 0.003). The hip angles significantly increased during 5%-23% and 87%-100% of gait cycle, while knee angles during 9%-25% and 88%-98% of the gait cycle, and ankle angles in 92%-100% of gait cycle. The gait parameters of patients with forearm-loading showed no significant difference compared with healthy subjects walking normally. The change of gait parameters correlated positively with the axial and tremor severity while correlated negatively with the rigidity sub-score. Patients with tremor dominant subtype also showed greater improvement of speed and step time compared with patients with postural instability/gait difficulty subtype. Applying added weights bilaterally to the forearms of patients can normalize gait patterns. Notably, patients with higher scores on axial and tremor and lower rigidity scores gained more benefits.

PMID:37276741 | DOI:10.1016/j.jocn.2023.05.025

J Plast Reconstr Aesthet Surg. 2023 Apr 18;83:172-179. doi: 10.1016/j.bjps.2023.04.039. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative bleeding requiring reoperation is an untoward event in breast surgery. Topical tranexamic acid (TXA) has been routinely used to reduce the risk of postoperative bleeding in some surgical fields. In breast surgery, it is not routinely used owing to scarce information. We investigated whether the intraoperatively applied topical TXA reduces the incidence of postoperative hematoma in reduction mammaplasty surgeries.

METHODS: This retrospective, single-center cohort study comprises of 415 consecutive patients who underwent reduction mammaplasty between 2019 and 2021. The prophylactic use of topically applied TXA (20 mg/ml) was implemented as a part of the hospital protocol in November 2020. The patients who were rinsed with TXA before the wound closure were compared with those who were not rinsed. The results were analyzed using statistical tests, two-sided Pearson’s Chi-Square and Fisher’s exact tests.

RESULTS: Topical TXA significantly reduced the number of postoperative hematomas requiring evacuation (p = 0.008). In the non-TXA control group, 12 (5.8%) hematomas were observed out of 208 patients. In the topical TXA group, only one (0.6%) hematoma occurred among the 168 patients. A tendency towards fewer wound infections, seromas, and other minor wound-healing problems can also be seen in the topical TXA group (ns). No adverse events of topical TXA were detected.

CONCLUSIONS: The incidence of postoperative hematomas decreased to a tenth after the introduction of topical TXA in reduction mammaplasty surgeries. This simple procedure may save patients from reoperations owing to bleeding. Randomized controlled trials are warranted.

PMID:37276736 | DOI:10.1016/j.bjps.2023.04.039

J Plast Reconstr Aesthet Surg. 2023 Apr 19;83:155-164. doi: 10.1016/j.bjps.2023.04.050. Online ahead of print.

ABSTRACT

BACKGROUND: The field of facial vascularized composite allotransplantation (fVCA) is still new and a limited number of patients have undergone the procedure. This has led to a lack of understanding about the impact of fVCA rejection on standard laboratory markers (e.g., CBC, BMP, CRP) for the acute management of these patients. It is not clear if rejection elicits a systemic inflammatory response that influences common inflammatory markers such as WBC and CRP. A comprehensive understanding of changes in these markers could help in the management of fVCA patients in the acute setting.

METHODS: The medical records of 8 fVCA patients with a total of 9 transplants were reviewed retrospectively, and data on standard laboratory values (CBC, BMP, LFTs, CRP) and vital signs were extracted. To examine the relationship between laboratory values and rejection status, linear mixed models were used to analyze the data, taking into account their longitudinal nature (repeated measures).

RESULTS: A statistically significant relationship was found between the Banff grade of rejection and the relative number of basophils in the patient’s blood during rejection (p = 0.005). In addition, in patients with clinical signs of rejection (e.g., facial erythema, edema) and skin biopsy showing Banff ≥ II, CRP was found to be significantly elevated (p = 0.03). The WBC count remained stable during rejection, and the relative number of neutrophils was lower at the time of rejection, indicating possible consumption at the site of rejection.

CONCLUSION: During fVCA rejection, most standard laboratory parameters and vital signs appear to be stable. However, the levels of CRP and basophils were elevated during rejection, while the neutrophil count was lower. Leukocytosis can likely be used as a marker of microbial infection in fVCA patients, as WBC does not seem to increase at the time of allograft rejection.

PMID:37276734 | DOI:10.1016/j.bjps.2023.04.050

J Plast Reconstr Aesthet Surg. 2023 Apr 17;83:109-116. doi: 10.1016/j.bjps.2023.04.005. Online ahead of print.

ABSTRACT

BACKGROUND: The expanded forehead flap has its unique advantage in nasal reconstruction. The authors present their 12-year experience with nasal reconstruction with an expanded forehead flap. The esthetic and functional outcomes were assessed with long-term subjective and objective evaluations.

METHODS: A retrospective analysis was conducted of consecutive patients who underwent nasal reconstruction with the expanded forehead flap from 2009 to 2021 performed by the senior author (F.F.). Data were collected and analyzed regarding defect characteristics, processes of treatment, and complications. Subjective esthetic and functional outcomes were assessed through questionnaires FACE-Q (Face Questionnaire) and NOSE (Nasal Obstruction Symptom Evaluation). The objective esthetic outcome was assessed by a senior resident through the viewing of clinical photographs.

RESULTS: One hundred and fifty-five patients underwent nasal reconstruction with an expanded forehead flap. The average expansion period was 174 days, and the injection volume was 685.7 ml. There were 15 complications. One hundred and eight patients (69.6%) were satisfied, and 19 patients (12.2%) were very satisfied with the outcome. The differences between postoperative and preoperative scores of FACE-Q were statistically significant (p < 0.01). Sixty-nine percent of patients complained of bilateral eyebrow asymmetry, 27.1% of patients reported partial recovery of frontal deformity with dissatisfaction, and 2.6% of patients considered not recovered at all. The results of 78 patients (50.3%) were considered “satisfied,” and 41 patients (26.5%) were considered “very satisfied” by objective evaluation.

CONCLUSION: Nasal reconstruction with an expanded forehead flap was a safe technique with good esthetic outcomes. Although problems with the asymmetry of the eyebrows and frontal deformation were presented, the influence was minimal and well-accepted by most patients.

PMID:37276728 | DOI:10.1016/j.bjps.2023.04.005

Thromb Res. 2023 May 13;228:54-60. doi: 10.1016/j.thromres.2023.05.008. Online ahead of print.

ABSTRACT

BACKGROUND: Even though antithrombotic therapy has probably little or even negative effects on the well-being of people with cancer during their last year of life, deprescribing antithrombotic therapy at the end of life is rare in practice. It is often continued until death, possibly resulting in excess bleeding, an increased disease burden and higher healthcare costs.

METHODS: The SERENITY consortium comprises researchers and clinicians from eight European countries with specialties in different clinical fields, epidemiology and psychology. SERENITY will use a comprehensive approach combining a realist review, flash mob research, epidemiological studies, and qualitative interviews. The results of these studies will be used in a Delphi process to reach a consensus on the optimal design of the shared decision support tool. Next, the shared decision support tool will be tested in a randomised controlled trial. A targeted implementation and dissemination plan will be developed to enable the use of the SERENITY tool across Europe, as well as its incorporation in clinical guidelines and policies. The entire project is funded by Horizon Europe.

RESULTS: SERENITY will develop an information-driven shared decision support tool that will facilitate treatment decisions regarding the appropriate use of antithrombotic therapy in people with cancer at the end of life.

CONCLUSIONS: We aim to develop an intervention that guides the appropriate use of antithrombotic therapy, prevents bleeding complications, and saves healthcare costs. Hopefully, usage of the tool leads to enhanced empowerment and improved quality of life and treatment satisfaction of people with advanced cancer and their care givers.

PMID:37276718 | DOI:10.1016/j.thromres.2023.05.008

J Infect Public Health. 2023 May 30;16(8):1220-1229. doi: 10.1016/j.jiph.2023.05.032. Online ahead of print.

ABSTRACT

BACKGROUND: Institutions must have access to antibiograms to monitor changes in antimicrobial resistance and direct empirical antibiotic therapy. The first facility-specific cumulative antibiogram was launched in the ICU in 2019. Consequently, many antibiogram-operation-related actions have been adopted in the institution based on reported data. This study aimed to analyze the cumulative antibiogram reports for multiple intensive care units (ICUs) for 2020, and compare the antimicrobial susceptibility testing (AST) patterns between the 2019 and 2020 years in an academic medical center.

METHODS: This cross-sectional study was performed of routine bacterial culture and AST data extracted from a laboratory information system in a 2252-bed capacity hospital. Only the first diagnostic isolate of a given species per patient per year was included in the study. Interpretation and reporting were done in accordance with the applicable Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing guidelines.

RESULTS: Of the 46,791 clinical isolates, the Gram-negative bacilli isolation rate witnessed a significant increase: 35,670 isolates in 2020 versus. 33,652 isolates in 2019. Klebsiella pneumoniae showed a statistically significant increase, mainly in pediatric, emergency, and cardiothoracic ICUs (p < 0.001). Neonatal and pediatric ICUs showed statistically significant increases in Pseudomonas aeruginosa and Proteus mirabilis isolates (p < 0.001). A statistically significant decrease was noted in the prevalence of Acinetobacter, Escherichia coli, Burkholderia cepacia, and Enterobacter cloacae. The sensitivities of K. pneumoniae and E. coli to imipenem and tigecycline significantly improved (p < 0.001). The sensitivity to colistin was significantly decreased (p < 0.001). The sensitivity of P. aeruginosa isolates to colistin and carbapenems was improved (p < 0.001). We reported a statistically significant decrease in all Gram-positive cocci (11,121 in 2020 versus. 11,528 in 2019). Staphylococcus aureus showed a statistically significant increase (p < 0.001), particularly in the medical ICU.

CONCLUSION: The high susceptibility rates of Enterobacteriaceae toward colistin and tigecycline, should be cautiously considered in empiric therapy while looking for alternatives. The majority of isolates of Gram-positive cocci were coagulase negative staphylococci (CONS), we still need to confirm whether they are true pathogens or commensals before considering anti-staphylococcal agents in the empirical therapy. We underscored some corrective actions that might have improved the susceptibility rates, such as antibiotic cycling.

PMID:37276716 | DOI:10.1016/j.jiph.2023.05.032

Mar Pollut Bull. 2023 Jun 3;192:115103. doi: 10.1016/j.marpolbul.2023.115103. Online ahead of print.

ABSTRACT

Elemental composition, multivariate statistical analyses with the absolute principal component score-multiple linear regression (APCS-MLR) model, and different pollution indices in Upper and Lower Southwestern Ganges-Brahmaputra-Meghna (GBM) delta sediments were studied to characterize pollution, ecological risk and quantify potential toxic element sources of the area. Toxic metals concentrations were higher in Lower Delta and individual pollution indices showed Upper Delta was moderately polluted by arsenic, chromium, cobalt, copper and lead, and Lower Delta was moderately-strongly polluted by the same metals. Synergistic indices include Potential Ecological, Toxic, Nemerow, and Pollution Risk indices in Upper and Lower Delta sediment ranged from 47.17-128.07, 2.03-12.19, 29.92-65.42, 0.28-1.62, and 69.17-246.90, 8.00-13.47, 20.53-152.92, 1.18-1.58, indicated low and moderate risk pollution, respectively. Statistical models represent the metals dominantly originated from nature for Upper Delta, and both natural and anthropogenic activities contributed to Lower Delta sediment. The study found that the modern deposit in Lower Delta became more contaminated and thus enhanced ecological risk.

PMID:37276710 | DOI:10.1016/j.marpolbul.2023.115103

Hear Res. 2023 Jun 1;435:108820. doi: 10.1016/j.heares.2023.108820. Online ahead of print.

ABSTRACT

Optical coherence tomography has become the most popular approach to experimental measures of sound-induced vibrations within the mammalian cochlea. Because it is relatively easy to use and works in the unopened cochlea, the measurement of vibratory tuning curves has become highly reliable, and averaging data from multiple animals in different experimental cohorts is now possible. Here I tested a modern statistical approach to compare cohorts for differences in the magnitude and phase of vibration. A linear mixed-effect approach with first, second, third, and fourth-order models to fit the data was tested. The third-order model best fit both the magnitude and phase data without having terms that did not contribute substantively to improving the R² or the p-value for the independent variables. It identified a difference between cohorts of mice that were different and no difference between cohorts that should not be different. Thus, this approach provides a way to simply compare a full set of tuning curves between cohorts. While further analyses by the investigator will always be needed to study specific details related to the study hypothesis, this statistical technique provides a simple way for the cochlear physiologist to perform an initial assessment of whether the cohorts are same or different.

PMID:37276685 | DOI:10.1016/j.heares.2023.108820