Category: Statistics

J Plast Reconstr Aesthet Surg. 2021 Oct 22:S1748-6815(21)00481-2. doi: 10.1016/j.bjps.2021.09.044. Online ahead of print.

ABSTRACT

Insensate flaps are used in several reconstructions. A search of the literature showed that most studies are limited to particular flaps in specific body areas. There is a lack of uniform scientific data on the pattern of sensory recovery in various body parts for different kinds of flaps. We conducted a prospective observational study for over one year to study the pattern of sensory return in 74 flaps and studied the disparity in the return of sensation of touch, pain, warmth and cold. After that, we analyzed the relationship between sensory return in flaps and the region of the body (head and neck/upper limb/lower limb), type of flap (cutaneous/fasciocutaneous/musculocutaneous), age of patient and type of wound bed (surgically created defect/raw area such as post trauma, post debridement). Touch sensations were assessed by Semmes-Weinstein (SW) monofilament of 5.01 number, pain was assessed using a sterile 26 G needle, cold sensation was assessed using water at 4 °C and warm sensation was assessed using water at 44 °C. The sensations were evaluated at one-fourth and one-half of distance from the periphery to the center, at eight equidistant points along the circumference and at the center of the flap. Sensations were observed to return in the periphery of the flap earlier and in the center later. Touch sensation was recovered the earliest (three months onwards), followed by sensations of pain, warmth and cold (around the sixth month). Flaps performed in the head and neck showed the best recovery of sensation. Best recovery of sensation was observed in cutaneous flaps. Flaps performed on surgically created defects showed better recovery of sensation compared with flaps performed to cover raw areas; however, the differences were statistically nonsignificant. Children showed better recovery of sensations; however, this was not statistically significant. Sensory nerve coaptation is recommended in flaps folded on themselves and in fasciocutaneous flaps of the lower limb.

PMID:34840119 | DOI:10.1016/j.bjps.2021.09.044

Arab J Gastroenterol. 2021 Nov 25:S1687-1979(21)00060-5. doi: 10.1016/j.ajg.2021.05.021. Online ahead of print.

ABSTRACT

BACKGROUND AND STUDY AIMS: Progressive familial intrahepatic cholestasis (PFIC) is an autosomal recessively inherited disease that causes intrahepatic-hepatocellular cholestasis. PFIC constitutes approximately 10-15% of cholestatic liver diseases in children. The aim of this study is to draw attention to this group of diseases, which pose a higher risk, in societies where consanguineous marriage is more common, and to share our experiences since the studies in the literature, regarding this group of diseases are case series with small number of patients.

PATIENTS AND METHODS: This cross-sectional study was conducted on 34 patients who were admitted with jaundice and diagnosed by genetic analysis, between January 2015 and July 2020.

RESULTS: We found 17.6% of patients with PFIC type 1, 55.9% patients had PFIC type 2, 14.7% patients had PFIC type 3, 8.8% patients had PFIC type 4 and 2.9% patients had PFIC type 5. Partial internal biliary diversion was performed in 5 (14.7%) patients, who had severe itching during follow-up, did not respond to medical treatment, and did not have significant fibrosis in liver biopsy yet. The degree of itching before PIBD was rated as +4 (cutaneous erosion, bleeding and scarring), in 5 patients and the rates were 0 (absent) in two patients, and +1 (mild itching) in 3 patients, 6 months after PIBD, these differences were statistically significant(p = 0.027). The mean weight z score was-1.43 (-3.72-+0.73), before PIBD, while it was 0.39(-1.86 -+2.45), six months after PIBD; the diference was statistically significant(p = 0.043). Liver transplantation was performed in 12 (35.3%) patients with significant fibrosis in liver biopsy and developing signs of portal hypertension.

CONCLUSION: The PFIC disease group is a heterogeneous disease group that is difficult to diagnose and treat. It should be considered in patients with cholestasis and/or pruritus and those with a history of consanguineous marriage between parents and death of a sibling with similar clinical symptoms.

PMID:34840097 | DOI:10.1016/j.ajg.2021.05.021

Eur Urol Oncol. 2021 Nov 25:S2588-9311(21)00190-5. doi: 10.1016/j.euo.2021.10.007. Online ahead of print.

ABSTRACT

BACKGROUND: There is an ongoing need to develop prognostic biomarkers to improve the management of clear cell renal cell carcinoma (ccRCC).

OBJECTIVE: To leverage enriched pathways in ccRCC to improve risk-stratification.

DESIGN, SETTING, AND PARTICIPANTS: We retrospectively identified two complementary discovery cohorts of patients with ccRCC who underwent (1) radical nephrectomy (RNx) with inferior vena cava tumor thrombectomy (patients = 5, samples = 24) and (2) RNx for localized disease and developed recurrence versus no recurrence (n = 36). Patients with localized ccRCC (M0) in The Cancer Genome Atlas (TCGA, n = 386) were used for validation.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: A differential expression gene (DEG) analysis was performed on targeted RNA next-generation sequencing data from both discovery cohorts. Using TCGA for validation, Kaplan-Meier survival analysis and multivariable Cox proportional hazard testing were utilized to investigate the prognostic impact of DEGs, cell cycle proliferation (CCP), and a novel epithelial-mesenchymal transition (EMT) score on progression-free (PFS) and disease-specific (DSS) survival.

RESULTS AND LIMITATIONS: In the discovery cohorts, we observed overexpression of WT1 and CCP genes in the tumor thrombus versus the primary tumor, as well as in patients with recurrence versus those without recurrence. A hallmark pathway analysis demonstrated enrichment of the EMT- and CCP-related pathways in patients with high WT1 expression in the TCGA (validation) ccRCC cohort. CCP and EMT scores were derived in the validation cohort, which was stratified into four risk groups using Youden Index cut points: CCP^low/EMT^low, CCP^low/EMT^high, CCP^high/EMT^low, and CCP^high/EMT^high. The CCP^high/EMT^high risk group was associated with the worst PFS and DSS (both p < 0.001). In a multivariable analysis, CCP^high/EMT^high was independently associated with poor PFS and DSS (hazard ratio = 4.6 and 10.3, respectively; p < 0.001).

CONCLUSIONS: We demonstrate the synergistic prognostic impact of EMT in tumors with a high CCP score. Our novel EMT score has the potential to improve risk stratification and provide potential novel therapeutic targets.

PATIENT SUMMARY: Genes involved in epithelial-mesenchymal transition provides important prognostic information for patients with clear cell renal cell carcinoma.

PMID:34840106 | DOI:10.1016/j.euo.2021.10.007

Surgeon. 2021 Nov 25:S1479-666X(21)00160-8. doi: 10.1016/j.surge.2021.09.003. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with advanced illnesses are often admitted with acute surgical emergencies. There is currently no evidence characterising such admissions. We aimed to evaluate emergency patients, managed non-operatively, who died during the same admission.

METHODS: This single-centre retrospective, observational study collected data points for a 12 month period including age, prior documented do not resuscitate order (DNAR), existing cancer, Charlson Comorbidity Index, frailty, surgical diagnosis, interval from admission to death and care given. Patients who underwent surgical intervention were excluded. Non-parametric tests were used for statistical analysis.

RESULTS: A total of 72 patients were included in this study, of which 68.1% died within 6 days of admission (median 4.0 days). Patients with visceral perforation, obstruction, bowel ischaemia or known malignancy were more likely to die within 6 days than those with pancreatitis, sepsis or new malignancy (median 2 vs 7 days, p < 0.001). Patients with frailty (2 vs 4 days, p = 0.017) and existing DNAR (3 vs 4 days, p = 0.048) died more rapidly than those without. Age and comorbidity index did not impact time to death.

CONCLUSION: Frailty, surgical diagnosis and existing DNAR were predictors of shorter admission to death interval, while age and comorbidity index were not. This has implications on inpatient palliative care service planning.

PMID:34840066 | DOI:10.1016/j.surge.2021.09.003

Cont Lens Anterior Eye. 2021 Nov 25:101544. doi: 10.1016/j.clae.2021.101544. Online ahead of print.

ABSTRACT

PURPOSE: Contact lens discomfort (CLD) is a major concern that can lead to the decreased or abandoned use of contact lenses. Contact lens users with dry eye disease are more likely to present with CLD. This study was conducted to evaluate the efficacy of a bioprotective preservative free, hypotonic, 0.15% hyaluronic acid (HA)-3% Trehalose artificial tear in managing dry eye symptoms in contact lens wearers.

METHODS: A prospective, single-arm, observational pilot study to evaluate the effectiveness of treatment with HA-Trehalose artificial tears in contact lens wearers (N = 33) aged 18-45 years with symptoms of ocular discomfort. Participants used a preservative-free, hypotonic HA-Trehalose artificial tear (1 drop/4 times per day) for 84 days. Participants were assessed using Visual Analogue Scale (VAS) for dry eye symptoms (pain, photophobia, dry eye sensation, blurry vision, foreign body sensation, itching, tingling/burning, and sticky eye feeling), Ocular Surface Disease Index (OSDI), Contact Lens Dry Eye questionnaire (CLDEQ-8), Berkley Dry Eye Flow-Chart (DEFC) on Day 0 and Day 84 and tear break-up time (TBUT), ocular surface staining with fluorescein and lissamine green, tear meniscus evaluation, and visual acuity on Day 0, 35, and 84.

RESULTS: All VAS symptoms (except tingling/burning and sticky eye feeling), OSDI, CLEDQ-8, and DEFC showed statistically significant (p < 0.05) improvement from baseline (Day 0) to Day 84. Similarly, corneal (fluorescein) and conjunctival (lissamine green) quality improved during the study (p < 0.05 at Day 84 versus baseline). Tear break-up time (TBUT), conjunctival (lissamine green) staining, and tear meniscus decreased but the changes were not statistically significant. Visual acuity did not change during the study. There were no ocular or systemic adverse events.

CONCLUSIONS: This study showed that the instillation of a preservative-free, hypotonic, HA-Trehalose artificial tear in contact lenses wearers with dry eye syndrome significantly improved symptoms and reduced associated signs such as corneal and conjunctival staining.

PMID:34840071 | DOI:10.1016/j.clae.2021.101544

J Infect Chemother. 2021 Nov 17:S1341-321X(21)00319-6. doi: 10.1016/j.jiac.2021.11.008. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to perform a meta-analysis to summarize the overall evidence from randomized controlled trials related to higher-intensity anticoagulation in hospitalized patients with COVID-19.

METHODS: A systematic literature search was performed in electronic databases to identify randomized controlled trials comparing the clinical outcomes between intermediate/ therapeutic anticoagulation and prophylactic anticoagulation. Meta-analyses with random-effects models were used to estimate the pooled odds ratio (OR) for outcomes of interest at a 95% confidence interval (CI).

RESULTS: Eight randomized controlled trials were included, with a total of 5405 hospitalized patients with COVID-19. The meta-analysis revealed no statistically significant difference in the odds of mortality (pooled OR = 0.92; 95% CI 0.71-1.19) but a statistically significant reduction in the odds of development of thrombotic events (pooled OR = 0.55; 95% CI 0.42-0.72), and significantly increased odds of development of major bleeding (pooled OR = 1.81; 95% CI 1.20-2.72) with the use of intermediate/therapeutic anticoagulation, relative to prophylactic anticoagulation. Subgroup analysis in patients with a severe course of COVID-19 observed a statistically significant reduction in the odds of development of thrombotic events (pooled OR = 0.66; 95% CI 0.45-0.98) but no significant difference in the odds of development of major bleeding events (pooled OR = 1.37; 95% CI 0.74-2.56), with the use of intermediate/therapeutic anticoagulation, relative to prophylactic anticoagulation.

CONCLUSION: There could be net clinical benefits with higher-intensity dosing of anticoagulation relative to prophylactic-dosing of anticoagulation among hospitalized patients with severe COVID-19.

PMID:34840039 | DOI:10.1016/j.jiac.2021.11.008

Eur J Cancer. 2021 Nov 25:S0959-8049(21)01177-1. doi: 10.1016/j.ejca.2021.10.019. Online ahead of print.

NO ABSTRACT

PMID:34840027 | DOI:10.1016/j.ejca.2021.10.019

Arch Pediatr. 2021 Nov 26:S0929-693X(21)00229-3. doi: 10.1016/j.arcped.2021.11.001. Online ahead of print.

ABSTRACT

OBJECTIVES: This study was conducted to examine the effect of healthy lifestyle beliefs on their attitudes toward physical activity, nutrition, exercise, and weight-related self-efficacy lifestyles in Turkish adolescents.

METHODS: This study used a methodological and descriptive design. The study was conducted with 445 adolescents aged 13-18 years. The data were collected using a Descriptive Information Form, the Healthy Lifestyle Beliefs Scale for Adolescents, the Nutrition Exercise Attitudes Scale, and the Attitudes Toward Physical Activity Scale. Mean and percentage values, t-test, ANOVA test, and linear regression analysis were used in the analysis of the research data.

RESULTS: A statistically significant difference was found between adolescents’ obesity status, paternal educational level, maternal educational level, income status, and the mean scores obtained for healthy lifestyle beliefs, nutrition and exercise attitudes, physical activity attitudes, and weight-related self-efficacy, as well as between sex and mean scores for attitudes toward nutrition, exercise, and physical activity. In the model created with regression analysis, it was found that the adolescents’ healthy lifestyle beliefs and sociodemographic variables explained 96.3% of their attitudes toward nutrition and exercise, 93.6% of physical activity attitudes, and 96.5% of weight-related self-efficacy levels, with statistical significance.

CONCLUSION: According to the results of the study, healthy lifestyle beliefs are an important predictor of adolescents’ attitudes toward nutrition, exercise, and physical activity as well as their weight-related self-efficacy. We recommend that school nurses consider healthy lifestyle beliefs when creating intervention programs for adolescents .

PMID:34840020 | DOI:10.1016/j.arcped.2021.11.001

J Voice. 2021 Nov 25:S0892-1997(21)00323-4. doi: 10.1016/j.jvoice.2021.09.019. Online ahead of print.

ABSTRACT

OBJECTIVES: The overall goal of the survey was to ascertain from belters common characteristics of belting and belters as determined by their own experience. The survey sought information from those who responded to an online questionnaire stating they were professional singers who had been paid to sing as belters and were comfortable using the sound quality called belting. The survey asked various questions regarding the definition of the word belting, how the singers learned to belt, whether or not they could explain the auditory and kinesthetic experience of belting and their history with vocal health. This was a partial follow-up to a study done by one of the authors in 2007 on the same topic and with the same general population which was never submitted for publication. The data from that study, which was longer and more complex, will be referenced where the present survey has similar data, partly to see if answers may have changed in the time since data was collected more than a decade ago.

METHODS: The survey was an online questionnaire on Google. A call to respond to the survey was put forth by the authors through their network of colleagues, associates and students with the request that respondents also share the survey with others they knew. The questionnaire consisted of 30 questions and garnered a total of 238 responses from professional singers who consider themselves to be belters. Data was collected between February 1, 2019 and July 31, 2019 Topics included Demographics, Vocal Training Background, Definitions, and Vocal Health.

RESULTS/CONCLUSION: The data collected presents demographics on vocal training, professional experience, gender, age, performance venues, definitions of key words, and vocal health issues. The majority of respondents are female, from the USA, have had training, and sing other styles of music in a belt quality. Specific statistics on each question are given. The earlier study, from 2007, referenced several similar questions from a smaller group of respondents. Corresponding information will be presented where applicable at the end of the article for purposes of comparison.

PMID:34840021 | DOI:10.1016/j.jvoice.2021.09.019

Biosens Bioelectron. 2021 Nov 17:113810. doi: 10.1016/j.bios.2021.113810. Online ahead of print.

ABSTRACT

Exploring reliable and highly-sensitive SARS-CoV-2 antibody diagnosis by point-of-care (POC) manner, holds great public health significance for extensive COVID-19 screening and controlling. Unfortunately, the currently applied gold based lateral flow immunoassay (GLFIA) may expose both false-negative and false-positive interpretations owing to the sensitivity and specificity limitations, which may cause significant risk and waste of public resources for large population screening. To simultaneously overcome the drawbacks of GLFIA, a novel fluorescent LFIA based on signal amplification and dual-antigen sandwich structure was established with largely improved sensitivity and specificity. The compact three-dimensional incorporation of hydrophobic quantum dots within dendritic affinity templates and multilayer surface derivation guaranteed a high and robust fluorescence of single label, which lowered the false negative rate of GLFIA prominently. A dual-antigen sandwich structure using labeled/immobilized SARS-CoV-2 spike receptor binding domain antigen for capturing total human SARS-CoV-2 antibody was developed, instead of general indirect antibody capturing approach, to reduce the false positive rate of GLFIA. Over 300 cases of COVID-19 negative and 97 cases of COVID-19 positive samples, the current assay revealed a 100% sensitivity and 100% specificity confirmed by both polymerase chain reaction (PCR) and chemiluminescence immunoassay (CLIA), compared with the considerable misinterpretation cases by currently applied GLFIA. The quantitative results verified by receiver operating characteristic curve and other statistical analysis indicated a well-distinguished positive/negative sample groups. The proposed strategy is highly sensitive towards low concentrated SARS-CoV-2 antibody serums and highly specific towards serums from COVID-19 negative persons and patients infected by other viruses.

PMID:34840014 | DOI:10.1016/j.bios.2021.113810