Category: Statistics

JAMA Otolaryngol Head Neck Surg. 2022 Aug 11. doi: 10.1001/jamaoto.2022.2285. Online ahead of print.

ABSTRACT

IMPORTANCE: Obstructive sleep apnea (OSA) is associated with a rise in serum inflammatory markers, which may be attenuated by sleep surgery.

OBJECTIVE: To evaluate whether sleep surgery was associated with improved levels of proinflammatory markers in adults with OSA.

DATA SOURCES: Two authors independently searched Cochrane, Embase, and PubMed databases from inception through June 14, 2022.

STUDY SELECTION: Two authors searched the Cochrane, Embase, and PubMed databases for studies comparing preoperative and postoperative levels of serum biomarkers in patients undergoing sleep surgery.

DATA EXTRACTION AND SYNTHESIS: Data were extracted from included articles into a structured proforma. Meta-analyses of the standardized mean difference (SMD) were conducted in random-effects models. To ensure relevance to clinicians and patients, the probability of benefit and number needed to treat were calculated for outcomes that demonstrated a statistically significant effect after sleep surgery.

MAIN OUTCOMES AND MEASURES: The primary outcome was the preoperative and postoperative levels of serum biomarkers in patients undergoing sleep surgery, including C-reactive protein (CRP), glucose, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and interleukin-6 (IL-6). Data analysis was performed from April to May 2022.

RESULTS: Of the 3218 studies screened, 26 studies with 1187 patients (mean [SD] age, 42.8 [11.1] years; 932 [78.5%] men and 255 [21.5%] women) were included. Soft-tissue sleep surgery was associated with a large decrease in CRP (SMD, -0.377; 95% CI, -0.617 to -0.137), total cholesterol (SMD, -0.267; 95% CI, -0.417 to -0.116), LDL (SMD, -0.201; 95% CI, -0.344 to -0.058), IL-6 (SMD, -1.086; 95% CI, -1.952 to -0.221), tumor necrosis factor-α (SMD, -0.822; 95% CI, -1.617 to -0.027), triglyceride (SMD, -0.186; 95% CI, -0.301 to -0.071), and leptin (SMD, -0.519; 95% CI, -0.954 to -0.083) in patients with OSA. Meta-regression highlighted that increased age, higher preoperative score for cumulative sleep time percentage with oxyhemoglobin saturation less than 90% (CT90), and greater change in CT90 postoperatively were associated with a greater decrease in serum CRP levels after soft-tissue sleep surgery. A greater reduction in apnea hypopnea index (AHI) was strongly associated with a greater reduction in total cholesterol and LDL. A greater reduction in body mass index and AHI were also associated with a greater increase in HDL.

CONCLUSIONS AND RELEVANCE: The findings of this systematic review and meta-analysis of 26 studies suggest that sleep surgery is associated with decreased levels of CRP, total cholesterol, LDL, triglyceride, IL-6, leptin, and TNF-α, which may improve the inflammatory and cardiometabolic profile of patients who undergo sleep surgery.

PMID:35951318 | DOI:10.1001/jamaoto.2022.2285

Cranio. 2022 Aug 11:1-9. doi: 10.1080/08869634.2022.2107146. Online ahead of print.

ABSTRACT

OBJECTIVE: The relationships between temporomandibular disorders (TMDs) and negative affectivity/emotions across cultures and the emotional predictors for TMDs in Southeast Asian youths were investigated.

METHODS: The presence of TMDs and negative affectivity/emotions were determined with the Fonseca Anamnestic Index (FAI) and Depression, Anxiety, Stress Scales-21 (DASS-21). Statistical evaluations were done with non-parametric and logistic regression analyses (α.

RESULTS: The total sample comprised 400 Singaporean and 501 Indonesian youths (mean age 19.30 ± 1.48 years; 65.0% women) of whom 47.0% and 59.3% had mild-to-severe TMDs, respectively. For both cultures, participants with TMDs had significantly greater negative affectivity, depression, anxiety, and stress than those with no TMDs. Indonesian youths also presented higher levels of emotional distress than their Singaporean counterparts. Correlations between FAI and anxiety/stress scores were moderately strong.

CONCLUSION: Cultural variations can influence the expression of TMDs and emotional distress. Being female and anxious increased the risk of TMDs.

PMID:35951310 | DOI:10.1080/08869634.2022.2107146

J Ultrasound. 2022 Aug 11. doi: 10.1007/s40477-022-00705-z. Online ahead of print.

ABSTRACT

OBJECTIVE: Histopathological analysis of the relationship between penile elastography and erectile dysfunction.

MATERIAL AND METHOD: 12 patients who applied to our clinic for erectile dysfunction in the last 1 year and accepted this study were included. Preoperative two-dimensional shear wave elastography imaging was performed in 12 patients and recorded in the Pascal (kPa) unit. Approximately 0.5 × 0.5 × 0.5 cm tissue samples were taken from the right and left cavernous tissue during penile prosthesis implantation operation. Tissue samples were sent to the pathology department. The percentage of the area covered by muscle fibers and elastic fibers in the corpus cavernosum was noted semi-quantitatively (ratio of muscle fibers and cavernous body elastic fiber score). All data obtained were compared with each other.

RESULTS: Cavernous body elastic fiber score data(Grouped Score 1, 2 and 3) and percentage of cavernous body muscle fibers data (Grouped %10, %20, %30… %100) were compared with Shear wave elastography data (kPa). The results were not statistically significant according to the Kruskal Wallis Test. Cavernous body elastic fiber score and the percentage of cavernous body muscle fibers were also compared, it was not statistically significant according to the Kruskal Wallis test and Spearman’s correlation test.

CONCLUSIONS: Penile shear wave elastography can be used clinically to quantitatively assess the amount of smooth muscle cells and elastic fibers in the penis, but it deserves to be studied with a larger number of patients and a more specific interpretation of the pathology preparation.

PMID:35951284 | DOI:10.1007/s40477-022-00705-z

Radiol Med. 2022 Aug 11. doi: 10.1007/s11547-022-01531-3. Online ahead of print.

ABSTRACT

BACKGROUND: Pleomorphic xanthoastrocytoma (PXA) is a rare low-grade brain tumor. To date, limited studies have analyzed factors affecting survival outcomes and defined the therapeutic strategy. The aim of this retrospective analysis was to investigate the clinicopathologic characteristics of PXA and identify factors associated with outcomes.

METHODS: We retrospectively analyzed a cohort of 16 adult and children patients with PXA who underwent primary resection from 1997 to 2019, referred to our Radiation Oncology Unit and to Meyer’s Paediatric Hospital. We also reviewed the relevant literature.

RESULTS: All patients underwent primary surgical resection; 10 patients received adjuvant radiation treatment course, ranging from DTF 54 to 64 Gy; 8 of them received, in addition, concurrent adjuvant chemotherapy; 6 patients underwent only radiological follow-up. After a median follow up was 60 months: median OS was 34.9 months (95% CI 30-218), 1-year OS 87%, 5-years OS 50%, 10-years OS 50%; median PFS 24.4 months (95% CI 13-156), 1-year PFS 80%, 5-years PFS 33%, 10-years PFS 33%. A chi-square test showed a significant association between OS and recurrent disease (p = 0.002) and with chemotherapy adjuvant treatment (p = 0.049). A borderline statistical significant association was instead recognized with BRAF mutation (p = 0.058).

CONCLUSIONS: Despite our analysis did not reveal a strong prognostic or predictive factor able to address pleomorphic xanthoastrocytoma management; however, in selected patients could be considered the addition of adjuvant radiation chemotherapy treatment after adequate neurosurgical primary resection. Furthermore, recurrent disease evidenced a detrimental impact on survival.

PMID:35951279 | DOI:10.1007/s11547-022-01531-3

Spine Deform. 2022 Aug 11. doi: 10.1007/s43390-022-00549-x. Online ahead of print.

ABSTRACT

PURPOSE: Degenerative changes of the lumbar spine lead in general to decrease of lumbar lordosis (LL). This change affects the overall balance of the spine, and when surgery is deemed, necessary restoration of the LL is considered. How this restoration can be achieved is a matter of controversy. The main purpose of this cadaveric study was to investigate the different steps of common posterior surgical techniques to understand the contribution of each successive step in restoring LL.

METHODS: Ten fresh-frozen human lumbar spine specimens were used to perform a sequential correction and instrumentation with a pedicle screw construct.

RESULTS: The mean LL angle measured at L3-L4 in intact condition was 12.9°; after screw insertion and compression, this increased to 13.8° (+ 7%, p = 0.04), after bilateral facetectomy to 16.3° (+ 20%, p = 0.005), after discectomy and insertion of interbody cage to 18.0º (+ 9%, p = 0.012), after resection of the lamina and the processes spinosus to 19.8° (+ 10%, p = 0.017), and after resection of the anterior longitudinal ligament to 25.4° (+ 22%, p = 0.005).

CONCLUSIONS: Each step contributed statistically significant to restoration of segmental lordosis with bilateral facetectomy contributing the most in terms of percentage.

LEVEL OF EVIDENCE: IV.

PMID:35951242 | DOI:10.1007/s43390-022-00549-x

Psicol Reflex Crit. 2022 Aug 11;35(1):26. doi: 10.1186/s41155-022-00229-9.

ABSTRACT

The Mood Disorders Questionnaire (MDQ) is a 3-item scale that is frequently used in bipolar disorders (BD) screening and questions the symptoms of BD, its effect on functionality, and the coexistence of symptoms. The aim of this study is to evaluate the prevalence of positive screening of the MDQ among general population and to investigate the associated risk factors.In this cross-sectional study, the sample was randomly selected from household data to represent the city population. A total of 432 participants were asked to fill in MDQ, CAGE (cutting down, annoyance by criticism, guilty feeling, and eye-openers) questionnaire, which consists of four clinical interview questions proven to aid in the diagnosis of alcoholism, and clinical and sociodemographic data form.The Cronbach’s alpha value of our current study was 0.813 for MDQ. The prevalence of MDQ positivity was found 7.6%. The estimated prevalence rate of bipolar disorders varied between 0.3 and 13.4% according to different cut-off values. Multivariate logistic regression models showed that the presence of possible alcohol addiction, shift work history, and body mass index (BMI) were statistically significant predictors of MDQ positivity.The prevalence of MDQ positivity found is similar to studies in literature. Keeping in mind that psychometric properties of the MDQ, positive screen results should be cautiously interpreted due to the presence of other risk factors and comorbidities.

PMID:35951270 | DOI:10.1186/s41155-022-00229-9

Med J (Ft Sam Houst Tex). 2022 Jul-Sep;(Per 22-07/08/09):54-60.

ABSTRACT

BACKGROUND: COVID-19 is a rapidly propagating respiratory virus causing a global pandemic. At the time of development of this study, not much was known about susceptibility to severe illness, especially without other known risk factors. Retrospective research suggested vitamin D level may correlate with severity of illness. This prospective, observational study seeks to determine if vitamin D level at admission is correlated with severity of illness as determined by needing intensive care unit (ICU)-level care within this first 28 days after admission. This study also looked at the relationship of vitamin D level at admission and mortality, need for ventilator, and number of hospital-free, ICU-free, and ventilator-free days in the 28 days after initial admission.

METHODS: This study is a prospective, observational study of patients admitted to Brooke Army Medical Center (BAMC), San Antonio, TX, for a diagnosis or complication of COVID-19 illness. A vitamin D level was drawn at admission and chart review was used at the end of 28 days after admission to identify outcome measures. Fisher’s Exact test was used for categorical variables, and Kruskal-Wallis test was used for all continuous variables.

RESULTS: Deficient vitamin D level at admission (less than 20ng/mL) was associated with an increased risk of requiring ICU-level care during the 28-day period after initial admission (p=0.028). Secondary outcomes measurements also favored the hypothesis, but none were statistically significant.

CONCLUSIONS: This prospective, observational study further strengthens the hypothesis vitamin D level at admission is correlated with severity of illness in COVID-19 illness; however, this small study was limited in its ability to control for confounders. It does not prove causation, nor does it imply vitamin D supplementation will prevent COVID-19 or improve outcomes in COVID-19. Further research should aim to include a larger cohort to better understand the relationship of vitamin D level and severity of illness in COVID-19 disease.

PMID:35951233

Int J Clin Pharm. 2022 Aug 11. doi: 10.1007/s11096-022-01465-w. Online ahead of print.

ABSTRACT

BACKGROUND: Multitargeted tyrosine kinase inhibitors (TKIs) are used to treat advanced non-small cell lung cancer (NSCLC). Their efficacy and safety have been studied in randomized controlled trials.

AIM: This meta-analysis aimed to summarize the most up-to-date evidence regarding the efficacy and adverse events of TKIs in NSCLC treatment.

METHOD: Randomized controlled trials were searched from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. The intervention arm was the TKI-containing group, and the control arm was the TKI-free group. Objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival, and adverse events were extracted and synthesized. The last search was performed in April 2022. Two researchers independently screened articles, extracted data, and evaluated the quality of the included studies. The Cochrane risk-of-bias tool was used to assess the quality of each study. Random or fixed-effect models were used in statistical methods. I² statistics were used to assess heterogeneity.

RESULTS: Thirty-one studies (12,517 patients) were included. Compared to the control group, the TKI group had significantly higher ORR (relative risk RR 1.52, 95% confidence interval, CI [1.29, 1.80], P < 0.05), DCR (RR 1.34, 95%CI [1.19, 1.51], P < 0.05), and prolonged PFS (hazard ratio HR 0.67, 95%CI [0.59, 0.77], P < 0.05). The TKI group showed a higher rate of adverse events (RR 1.70, 95%CI [1.34, 2.16], P < 0.05) and grade 3-5 adverse events (RR 1.59, 95% CI [1.35, 1.88], P < 0.05).

CONCLUSION: TKIs could increase ORR and DCR and prolong PFS for advanced NSCLC. Adverse events should be closely monitored.

PMID:35951217 | DOI:10.1007/s11096-022-01465-w

J Autism Dev Disord. 2022 Aug 11. doi: 10.1007/s10803-022-05690-0. Online ahead of print.

ABSTRACT

According to Bayesian/predictive coding models of autism, autistic individuals may have difficulties learning probabilistic cue-outcome associations, but empirical evidence has been mixed. The target cues used in previous studies were often straightforward and might not reflect real-life learning of such associations which requires learners to infer which cue(s) among many to track. Across two experiments, we compared adult learners with varying levels of autistic traits on their ability to infer the correct cue to learn probabilistic cue-outcome associations when explicitly instructed to do so or when exposed implicitly. We found no evidence for the effect of autistic traits on probabilistic learning accuracy, contrary to the predictions of Bayesian/predictive coding models. Implications for the current Bayesian/predictive coding models are discussed.

PMID:35951205 | DOI:10.1007/s10803-022-05690-0

Can J Public Health. 2022 Aug 11. doi: 10.17269/s41997-022-00672-2. Online ahead of print.

ABSTRACT

Attributing individual deaths to extreme heat events (EHE) in Canada and elsewhere is important for understanding the risk factors, protective interventions, and burden of mortality associated with climate change. However, there is currently no single mechanism for identifying individual deaths due to EHE and different agencies have taken different approaches, including (1) vital statistics coding based on medical certificates of death, (2) probabilistic methods, and (3) enhanced surveillance. The 2018 EHE in Montréal provides an excellent case study to compare EHE deaths identified by these different approaches. There were 353 deaths recorded in the vital statistics data over an 8-day period, of which 102 were potentially attributed to the EHE by at least one approach and 251 were not attributed by any approach. Only nine of the 102 deaths were attributed to the EHE by all three approaches, 23 were attributed by two approaches, and 70 were attributed by only one approach. Given that there were approximately 50 excess deaths during the EHE, it remains unclear exactly which of the total 353 deaths should be attributed to the extreme temperatures. These results highlight the need for a more systematic and cooperative approach to EHE mortality in Canada, which will continue to increase as the climate changes.

PMID:35951167 | DOI:10.17269/s41997-022-00672-2