Category: Statistics

Behav Res Ther. 2021 Nov 17;148:103999. doi: 10.1016/j.brat.2021.103999. Online ahead of print.

ABSTRACT

OBJECTIVES: Social anxiety disorder (SAD) and alcohol use disorder (AUD) are highly comorbid and this comorbidity is associated with poorer clinical outcomes. Integrating exposure-based treatment for SAD into the context of typical AUD treatment programs should improve engagement and treatment outcomes for this population.

METHODS: After initial development of a fully integrated, intensive outpatient program (IOP) for individuals with comorbid SAD and AUD, patients with SAD and AUD were recruited from a community-based SUD specialty clinic (N = 56) and randomized to either (a) usual care (UC), consisting of the evidence-based Matrix Model of Addiction IOP; or (b) the Fully Integrated Treatment (FIT) for comorbid SAD and AUD IOP. Participants were assessed on indices of social anxiety and alcohol use.

RESULTS: By the 6-month follow-up, those in FIT showed superior improvement to UC on number of drinking days in the past 30 days and social anxiety severity at follow-up, but there were no differences between groups on quantity of alcohol consumed on drinking days. Alcohol-related problems improved in both groups, with no statistically significant differences. Within-group improvement was observed in FIT (but not in UC) on drinking to cope with social anxiety and avoidance of social situations without alcohol, but between-group effects were non-significant. In sum, the integrated treatment of SAD and AUD led to greater reductions in both the frequency of drinking and in social anxiety symptoms than usual care.

CONCLUSIONS: Targeting social anxiety in the context of AUD treatment is a promising approach to improving the treatment of this common comorbidity.

PMID:34813986 | DOI:10.1016/j.brat.2021.103999

J Stomatol Oral Maxillofac Surg. 2021 Nov 20:S2468-7855(21)00263-9. doi: 10.1016/j.jormas.2021.11.004. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate, by means of cone beam computed tomography (CBCT), the volume change of maxillary sinuses in patients that underwent orthodontic maxillary posterior en masse intrusion anchored with miniplates.

MATERIALS AND METHODS: The sample consisted of pretreatment (T1) and posttreatment (T2) CBCT scans obtained from 14 patients (4 male and 10 female), with a mean age of 32.4 years, that underwent orthodontic maxillary posterior en masse intrusion anchored with miniplates in the zygomatic crest. The mean treatment duration was 20 months and the mean intrusion movement was 2.4 mm. Maxillary sinus volume was measured by means of the software ITK SNAP (version 3.8.0) in T1 and T2 CBCT scans. The changes in sinuses volume were calculated by T1-T2 values. Data were analyzed statistically with Wilcoxon test at 5% of level of significance and the method error was analyzed with Wilcoxon test, intraclass correlation and Dahlberg’s formula.

RESULTS: The mean difference (T1-T2) was -242.85 mm³ (p = 0.396) for the right sinus and -32.5 mm³ (p = 0.875) for the left sinus. A slight increase in the volume of the sinuses was shown although these results were not statistically significant.

CONCLUSION: The orthodontic maxillary posterior en masse intrusion anchored with miniplates did not influence significantly the maxillary sinus volume.

PMID:34813966 | DOI:10.1016/j.jormas.2021.11.004

Neuroimage. 2021 Nov 20:118729. doi: 10.1016/j.neuroimage.2021.118729. Online ahead of print.

ABSTRACT

The course of attention deficit hyperactivity disorder (ADHD) from adolescence into adulthood shows large variations between individuals; nonetheless determinants of interindividual differences in the course are not well understood. A frequent problem in ADHD, associated with worse outcomes, is emotion dysregulation. We investigated whether emotion dysregulation and integration of emotion-related functional brain networks affect interindividual differences in ADHD severity change. ADHD severity and resting state neuroimaging data were measured in ADHD and unaffected individuals at two points during adolescence and young adulthood. Bivariate latent change score models were applied to investigate whether emotion dysregulation and network integration affect ADHD severity changes. Emotion dysregulation was gauged from questionnaire subscales for conduct problems, emotional problems and emotional lability. Better emotion regulation was associated with a better course of ADHD (104 participants, 44 females, age range: 12-27). Using graph analysis, we determined network integration of emotion-related functional brain networks. Network integration was measured by nodal efficiency, i.e., the average inverse path distance from one node to all other nodes. A pattern of low nodal efficiency of cortical regions associated with emotion processing and high nodal efficiency in subcortical areas and cortical areas involved in implicit emotion regulation predicted a better ADHD course. Larger nodal efficiency of the right orbitofrontal cortex was related to a better course of ADHD (99 participants, 42 females, age range: 10-29). We demonstrated that neural and behavioral covariates associated with emotion regulation affect the course of ADHD severity throughout adolescence and early adulthood beyond baseline effects of ADHD severity.

PMID:34813971 | DOI:10.1016/j.neuroimage.2021.118729

Spine J. 2021 Nov 20:S1529-9430(21)01028-7. doi: 10.1016/j.spinee.2021.11.007. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Prolonged bedrest induces accumulation of intramuscular lipid concentration (ILC) in the lumbar musculature; however, spatial distribution of ILC has not been determined. Artificial gravity (AG) mitigates some adaptations induced by 60-day bedrest by creating a head-to-feet force while participants are in a supine position.

PURPOSE: To quantify the spatial distribution of accumulation of ILC in the lumbar musculature after 60-day bedrest, and whether this can be mitigated by AG exposure.

STUDY DESIGN: Prospective longitudinal study.

PATIENT SAMPLE: Twenty-four healthy individuals (8 females) participated in the study: Eight received 30 min continuous AG (cAG); Eight received 6 × 5min AG (iAG), interspersed with rests; Eight were not exposed to AG (CRTL).

OUTCOME MEASURES: From 3T magnetic resonance imaging (MRI), axial images were selected to assess lumbar multifidus (LM), lumbar erector spinae (LES), quadratus lumborum (QL), and psoas major (PM) muscles from L1/L2 to L5/S1 intervertebral disc levels. Chemical shift-based 2-echo lipid/water Dixon sequence was used to measure tissue composition. Each lumbar muscle was segmented into four equal quartiles (from medial to lateral).

METHODS: Participants arrived at the facility for the baseline data collection before undergoing a 60-day strict 6° head-down tilt (HDT) bedrest period. MRI of the lumbopelvic region was conducted at baseline and Day-59 of bedrest. Participants performed all activities, including hygiene, in 6° HDT and were discouraged from moving excessively or unnecessarily.

RESULTS: At the L4/L5 and L5/S1 intervertebral disc levels, 60-day bedrest induced a greater increase in ILC in medial and lateral regions (∼+4%) of the LM than central regions (∼+2%; P<0.05). A smaller increase in ILC was induced in the lateral region of LES (∼+1%) at L1/L2 and L2/L3 than at the centro-medial region (∼+2%; P<0.05). There was no difference between CRTL and intervention groups.

CONCLUSIONS: Inhomogeneous spatial distribution of accumulation of ILC was found in the lumbar musculature after 60-day bedrest. These findings might reflect pathophysiological mechanisms related to muscle disuse and contribute to localized lumbar spine dysfunction. Altered spatial distribution of ILC may impair lumbar spine function after prolonged body unloading, which could increase injury risk to vulnerable soft tissues, such as the lumbar intervertebral discs. These novel results may represent a new biomarker of lumbar deconditioning for astronauts, bedridden, sedentary individuals, or those with chronic back pain. Changes are potentially modifiable but not by the AG protocols tested here.

PMID:34813960 | DOI:10.1016/j.spinee.2021.11.007

JBRA Assist Reprod. 2021 Nov 23. doi: 10.5935/1518-0557.20210062. Online ahead of print.

ABSTRACT

OBJECTIVE: This current survey investigated the role of the Forkhead 3 box protein (foxp3) gene and serum vitamin D levels in women with recurrent spontaneous abortion (RSA).

METHODS: The mRNA level of the foxp3 gene in peripheral blood was evaluated in women with a history of RSA (N=40) and in controls (N=40) via quantitative polymerase chain reaction. We employed the enzyme-linked immunosorbent assay to assess the serum levels of 1,25-dihydroxyvitamin D3 (1,25(OH)2 D) in both groups. The Mann-Whitney U test and Pearson’s correlation coefficient were used to statistically compare study groups between and within themselves, respectively.

RESULTS: Although mRNA levels of foxp3 were higher in women with RSA than in controls, we observed no significant change in mRNA levels of foxp3 between the two groups (p=0.16). An important positive correlation was observed between foxp3 mRNA levels and 1,25(OH)2 D in controls (p=0.003). In contrast, the correlation between foxp3 expression and 1,25(OH)2 D was not significant in the case group (p=0.14). Serum vitamin D levels were lower in women with RSA than in controls (p<0.001).

CONCLUSIONS: Our findings demonstrated that 1,25Vitamin D3 along with other molecules might help prevent RSA by providing for an anti-inflammatory state not necessarily through foxp3 expression or T cell differentiation.

PMID:34812598 | DOI:10.5935/1518-0557.20210062

Clin Otolaryngol. 2021 Nov 23. doi: 10.1111/coa.13898. Online ahead of print.

ABSTRACT

OBJECTIVE: Epistaxis is the most common otolaryngological emergency and up to one third of patients in treated on an inpatient basis take oral anticoagulants (OAC). Direct oral anticoagulants (DOAC), an OAC subgroup, have been on the market since 2010 and are being increasingly prescribed due to the cardiologic and hematologic guidelines that favour them over vitamin K antagonists (VKA), the older of the OAC subgroups. The present study aims to investigate which subgroup of epistaxis patients taking OACs has a more favourable outcome.

DESIGN/SETTING: A systematic review and meta-analysis were performed according to the PRISMA 2020 statement using the PubMed and Cochrane Library databases. Continuous data was analysed and standardized mean difference (SMD) was calculated according to Hedges’ g. Dichotomous data was analysed and the Mantel-Haenszel method was applied to establish the odds ratio (OR). Heterogeneity was assessed according to the I² statistics.

MAIN OUTCOME/RESULTS: A total of 8 reports covering 1390 patients were included in the final synthesis. The pooled analysis demonstrated significantly shorter hospital stays in the DOAC group (SMD= -0.22, 95% CI -0.42 to -0.02, P= .03) and a significantly higher rate of posterior bleeding in the VKA group (OR= .39, 95% CI .23 to .68, P= .001). No statistically significant differences with regard to recurrence rates, admission rates, the need for transfusion, or surgical intervention (P= .57, .12, .57 and .38 respectively) were found.

CONCLUSION: According to this meta-analysis, epistaxis patients taking DOACs have a more favourable outcome than patients taking VKAs.

PMID:34812585 | DOI:10.1111/coa.13898

Ther Apher Dial. 2021 Nov 23. doi: 10.1111/1744-9987.13764. Online ahead of print.

ABSTRACT

INTRODUCTION: Quantitative measurement of anti-A/-B antibody titers is important during ABO-incompatible living kidney transplantation (ABOi-LKT).

METHODS: We conducted a multi-institutional study to measure the antibody titers using the automated column agglutination technique (auto-CAT) and tube test (TT) method in ABOi-LKT recipients. Statistical analysis was performed to evaluate the two methods.

RESULTS: We examined 111 samples from 35 ABOi-LKT recipients at four institutions. The correlation coefficient of the two methods was >0.9; the concordance rate and clinically acceptable concordance rate for the IgG titers were 60.4% and 88.3%, respectively. Perioperative status did not influence the statistical significance. Parallel changes were observed in the IgG antibody titers measured using the auto-CAT or TT technique by desensitizing therapy in time-course monitoring.

CONCLUSION: Auto-CAT is comparable with the TT technique and is feasible for IgG anti-A/B antibody titration in ABOi-LKT recipients. This article is protected by copyright. All rights reserved.

PMID:34812590 | DOI:10.1111/1744-9987.13764

J Orthop Res. 2021 Nov 23. doi: 10.1002/jor.25230. Online ahead of print.

ABSTRACT

Metal on polyethylene (MoP) total hip arthroplasty prostheses are known to release metal debris. Basic science studies suggest that metal implants induce a pro-inflammatory response that ultimately chemoattracts leukocytes including macrophages and neutrophils to the surgical site. This raises concern of higher risk of infection with these prosthesis through the “trojan horse” mechanism by which neutrophils and macrophages transport intracellular pathogens from a remote site. This study compared the infection occurrence between MoP and ceramic on polyethylene (CoP) implants to determine if a higher infection rate in MoP is present. We reviewed a consecutive series of 6,052 CoP and 4,550 MoP primary total hip arthroplasty (THA) patients from 2015-2019. The occurrence of periprosthetic joint infection at two years was defined according to the 2018 ICM definition. Statistical analysis consisted of descriptive statistics, univariate analysis, and regression modeling. When compared to CoP, MoP patients were older, included more females, had a higher body mass index, and more commonly affected by comorbidities according to Elixhauser score. Total revisions were higher in the MoP group (3.19% vs 2.41%) The absolute incidence of PJI was higher in MoP (2.40% vs 1.64%). When we adjusted for confounding factors, MoP was found independently associated with a higher PJI risk. Despite MoP and CoP both being widely used for primary THA, we found a higher incidence of PJI in MoP patients. The association remained significant when controlled for possible confounders. We hypothesize that leukocyte recruitment to these implants may play a role and should be further investigated. This article is protected by copyright. All rights reserved.

PMID:34812555 | DOI:10.1002/jor.25230

Orthop Surg. 2021 Nov 22. doi: 10.1111/os.13172. Online ahead of print.

ABSTRACT

OBJECTIVES: To explore the difference between tracheostomy and non-tracheostomy and identify the risk factors associated with the need for tracheostomy after traumatic cervical spinal cord injury (TCSCI).

METHODS: The demographic and injury characteristics of 456 TCSCI patients, treated in the Xinqiao Hospital from 2010 to 2019, were retrospective analyzed. Patients were divided into the tracheostomy group (n = 63) and the non-tracheostomy group (n = 393). Variables included were age, gender,smoking history, mechanism of injury, concomitant injury, American Spinal Injury Association (ASIA) Impairment Scale, the neurological level of injury, Cervical Spine Injury Severity Score (CSISS), surgery, and length of stay in ICU and hospital. SPSS 25.0 (SPSS, Chicago, IL) was used for statistical analysis and ROC curve drawing. Chi-square analysis was applied to find out the difference of variables between the tracheostomy and non-tracheostomy groups. Univariate logistic regression analysis (ULRA) and multiple logistic regression analysis (MLRA) were used to identify risk factors for tracheostomy. The area under the ROC curve (AUC) was used to evaluate the performance of these risk factors.

RESULTS: Of 456 patients who met the inclusion criteria, 63 (13.8%) underwent tracheostomy. There were differences in age (χ² = 6.615, P = 0.032), mechanism of injury (χ² = 9.87, P = 0.036), concomitant injury (χ² = 6.131, P = 0.013),ASIA Impairment Scale (χ² = 123.08, P < 0.01), the neurological level of injury (χ² = 34.74, P < 0.01), and CSISS (χ² = 19.612, P < 0.01) between the tracheostomy and non-tracheostomy groups. Smoking history, CSISS ≥ 7, AIS A and, NLI ≥ C5 were identified as potential risk factors for tracheostomy by ULRA. Smoking history (OR = 2.960, 95% CI: 1.524-5.750, P = 0.001), CSISS ≥ 7 (OR = 4.599, 95% CI: 2.328-9.085, P = 0.000), AIS A (OR = 14.213, 95% CI: 6.720-30.060, P = 0.000) and NLI ≥ C5 (OR = 8.312, 95% CI: 1.935-35.711, P = 0.004) as risk factors for tracheostomy were determined by MLRA. The AUC for the risk factors of tracheostomy after TCSCI was 0.858 (95% CI: 0.810-0.907).

CONCLUSIONS: Smoking history, CSISS ≥ 7, AIS A and, NLI ≥ C5 were identified as risk factors needing of tracheostomy in patients with TCSCI. These risk factors may be important to assist the clinical decision of tracheostomy.

PMID:34812567 | DOI:10.1111/os.13172

Microsurgery. 2021 Nov 23. doi: 10.1002/micr.30844. Online ahead of print.

ABSTRACT

INTRODUCTION: Physiologic microsurgical procedures to treat lymphedema include vascularized lymph node transfer (VLNT) and lymphovenous bypass (LVB). The purpose of this study was to assess 30-day outcomes of VLNT and LVB using the National Surgical Quality Improvement Program (NSQIP) database.

METHODS: NSQIP was queried (2012-2018) for lymphatic procedures for upper extremity lymphedema after mastectomy. Prophylactic lymphatic procedures and those for lower extremity lymphedema were excluded. Outcomes were assessed for three groups: LVB, VLNT, and patients who had procedures simultaneously (VLNA+LVB). Primary outcomes measured were operative time, 30-day morbidities, and hospital length of stay.

RESULTS: The study included 199 patients who had LVB (n = 43), VLNT (n = 145), or VLNT+LVB (n = 11). There was no difference in co-morbidities between the groups (p = 0.26). 30-day complication rates including unplanned reoperation (6.9% VLNT vs. 2.3% LVB) and readmission (0.69% VLNT vs. none in LVB) were not statistically significant (p = 0.54). Surgical site infection, wound complications, deep vein thromboembolism, and cardiac arrest was also similar among the three groups. Postoperative length of stay for VLNT (2.5 days± 2.3), LVB (1.9 days± 1.9), and VLNT+LVB (2.8 days± 0.3) did not differ significantly (p = 0.20). Operative time for LVB (305.4 min ± 186.7), VLNT (254 min ± 164.4), and VLNT+LVB (295.3 min ± 43.2) was not significantly different (p = 0.21).

CONCLUSIONS: Our analysis of the NSQIP data revealed that VLNT and LVB are procedures with no significant difference in perioperative morbidity. Our results support that choice of VLNT versus LVB can be justifiably made per the surgeon’s preference and experience as the operations have similar complication rates.

PMID:34812535 | DOI:10.1002/micr.30844