Category: Statistics

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2021 Mar 28;46(3):272-277. doi: 10.11817/j.issn.1672-7347.2021.190378.

ABSTRACT

OBJECTIVES: To explore the risk factors for femoral neck fracture in elderly population.

METHODS: A total of 124 elderly patients (≥60 years old) in hospital for trauma were enrolled, including 71 patients (57%) with femoral neck fracture and 53 non-femoral neck fracture patients (43%). All patients’ age, gender, body mass index (BMI), bone mineral density (BMD), thigh length and average circumference were collected. Single factor analysis and multivariate logistic regression analysis were performed to explore whether the above factors were risk factors for femoral neck fracture.

RESULTS: Single factor analysis showed that the age, gender, BMI, BMD, thigh length, and average thigh circumference between the 2 groups were statistically different (all P<0.05), and multi-factor logistic regression analysis showed that age, gender, BMI, BMD, thigh length, and average thigh circumference were influencing factors for femoral neck fracture in elderly population (all P<0.05).

CONCLUSIONS: Older age, female, lower BMI index (low body weight), lower BMD (osteoporosis), longer thigh length, and lower average circumference are risk factors for femoral neck fracture in the elderly population.

PMID:33927074 | DOI:10.11817/j.issn.1672-7347.2021.190378

BMJ Open. 2021 Apr 29;11(4):e049093. doi: 10.1136/bmjopen-2021-049093.

ABSTRACT

OBJECTIVES: Randomised controlled trials conducted using cohorts and routinely collected data, including registries, electronic health records and administrative databases, are increasingly used in healthcare intervention research. A Consolidated Standards of Reporting Trials (CONSORT) statement extension for trials conducted using cohorts and routinely collected data (CONSORT-ROUTINE) has been developed with the goal of improving reporting quality. This article describes the processes and methods used to develop the extension and decisions made to arrive at the final checklist.

METHODS: The development process involved five stages: (1) identification of the need for a reporting guideline and project launch; (2) conduct of a scoping review to identify possible modifications to CONSORT 2010 checklist items and possible new extension items; (3) a three-round modified Delphi study involving key stakeholders to gather feedback on the checklist; (4) a consensus meeting to finalise items to be included in the extension, followed by stakeholder piloting of the checklist; and (5) publication, dissemination and implementation of the final checklist.

RESULTS: 27 items were initially developed and rated in Delphi round 1, 13 items were rated in round 2 and 11 items were rated in round 3. Response rates for the Delphi study were 92 of 125 (74%) invited participants in round 1, 77 of 92 (84%) round 1 completers in round 2 and 62 of 77 (81%) round 2 completers in round 3. Twenty-seven members of the project team representing a variety of stakeholder groups attended the in-person consensus meeting. The final checklist includes five new items and eight modified items. The extension Explanation & Elaboration document further clarifies aspects that are important to report.

CONCLUSION: Uptake of CONSORT-ROUTINE and accompanying Explanation & Elaboration document will improve conduct of trials, as well as the transparency and completeness of reporting of trials conducted using cohorts and routinely collected data.

PMID:33926985 | DOI:10.1136/bmjopen-2021-049093

J Neurosci. 2021 Apr 29:JN-RM-1932-20. doi: 10.1523/JNEUROSCI.1932-20.2021. Online ahead of print.

ABSTRACT

Forrest Gump or Matrix? Preference-based decisions are subjective and entail self-reflection. However, these self-related features are unaccounted for by known neural mechanisms of valuation and choice. Self-related processes have been linked to a basic interoceptive biological mechanism, the neural monitoring of heartbeats, in particular in ventromedial prefrontal cortex (vmPFC), a region also involved in value encoding. We thus hypothesized a functional coupling between the neural monitoring of heartbeats and the precision of value encoding in vmPFC. Human participants of both sexes were presented with pairs of movie titles. They indicated either which movie they preferred, or performed a control objective visual discrimination that did not require self-reflection. Using magnetoencephalography, we measured heartbeat-evoked responses (HERs) before option presentation, and confirmed that HERs in vmPFC were larger when preparing to the subjective, self-related task. We retrieved the expected cortical value network during choice with time-resolved statistical modeling. Crucially, we show that larger HERs before option presentation are followed by stronger value encoding during choice in vmPFC. This effect is independent of overall vmPFC baseline activity. The neural interaction between HERs and value encoding predicted preference-based choice consistency over time, accounting for both inter-individual differences and trial-to-trial fluctuations within individuals. Neither cardiac activity nor arousal fluctuations could account for any of the effects. HERs did not interact with the encoding of perceptual evidence in the discrimination task. Our results show that the self-reflection underlying preference-based decisions involves HERs, and that HER integration to subjective value encoding in vmPFC contributes to preference stability.SIGNIFICANCE STATEMENT:Deciding whether you prefer Forrest Gump or Matrix is based on subjective values, which only you, the decision-maker, can estimate and compare, by asking yourself. Yet, how self-reflection is biologically implemented and its contribution to subjective valuation are not known. We show that in ventromedial prefrontal cortex, the neural response to heartbeats, an interoceptive self-related process, influences the cortical representation of subjective value. The neural interaction between the cortical monitoring of heartbeats and value encoding predicts choice consistency, i.e. whether you consistently prefer Forrest Gump over Matrix over time. Our results pave the way for the quantification of self-related processes in decision making and may shed new light on the relationship between maladaptive decisions and impaired interoception.

PMID:33926998 | DOI:10.1523/JNEUROSCI.1932-20.2021

Eur Respir J. 2021 Apr 29:2004047. doi: 10.1183/13993003.04047-2020. Online ahead of print.

ABSTRACT

Four-metre gait speed (4MGS) is a simple physical performance measure and surrogate marker of frailty that is associated with adverse outcomes in older adults. We aimed to assess the ability of 4MGS to predict prognosis in patients hospitalised with acute exacerbations of COPD (AECOPD).213 participants hospitalised with AECOPD (52% male, mean age and FEV₁, 72 years and 35% predicted) were enrolled. 4MGS and baseline demographics were recorded at hospital discharge. All-cause readmission and mortality were collected for 1 y after discharge, and multivariable Cox-proportional hazards regression were performed. Kaplan-Meier and Competing risk analysis was conducted comparing time to all-cause readmission and mortality between 4MGS quartiles.111 participants (52%) were readmitted, and 35 (16%) died during the follow-up period. 4MGS was associated with all-cause readmission, with an adjusted subdistribution hazard ratio of 0.868 (95% CI 0.797-0.945; p=0.001) per 0.1 m·s^-1 increase in gait speed, and with all-cause mortality with an adjusted subdistribution hazard ratio of 0.747 (95% CI: 0.622-0.898; p=0.002) per 0.1 m·s^-1 increase in gait speed. Readmission and mortality models incorporating 4MGS had higher discrimination than age or FEV₁% predicted alone, with areas under the receiver operator characteristic curves of 0.73 and 0.80 respectively. Kaplan-Meier and Competing Risk curves demonstrated that those in slower gait speed quartiles had reduced time to readmission and mortality (log rank both p<0.001).4MGS provides a simple means of identifying at-risk patients with COPD at hospital discharge. This provides valuable information to plan post-discharge care and support.

PMID:33926974 | DOI:10.1183/13993003.04047-2020

BMJ Open. 2021 Apr 29;11(4):e044472. doi: 10.1136/bmjopen-2020-044472.

ABSTRACT

OBJECTIVES: To assess the communicative quality of colorectal cancer patient decision aids (DAs) about treatment options, the current systematic review was conducted.

DESIGN: Systematic review.

DATA SOURCES: DAs (published between 2006 and 2019) were identified through academic literature (MEDLINE, Embase, CINAHL, Cochrane Library and PsycINFO) and online sources.

ELIGIBILITY CRITERIA: DAs were only included if they supported the decision-making process of patients with colon, rectal or colorectal cancer in stages I-III.

DATA EXTRACTION AND SYNTHESIS: After the search strategy was adapted from similar systematic reviews and checked by a colorectal cancer surgeon, two independent reviewers screened and selected the articles. After initial screening, disagreements were resolved with a third reviewer. The review was conducted in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DAs were assessed using the International Patient Decision Aid Standards (IPDAS) and Communicative Aspects (CA) checklist.

RESULTS: In total, 18 DAs were selected. Both the IPDAS and CA checklist revealed that there was a lot of variation in the (communicative) quality of DAs. The findings highlight that (1) personalisation of treatment information in DAs is lacking, (2) outcome probability information is mostly communicated verbally and (3) information in DAs is generally biased towards a specific treatment. Additionally, (4) DAs about colorectal cancer are lengthy and (5) many DAs are not written in plain language.

CONCLUSIONS: Both instruments (IPDAS and CA) revealed great variation in the (communicative) quality of colorectal cancer DAs. Developers of patient DAs should focus on personalisation techniques and could use both the IPDAS and CA checklist in the developmental process to ensure personalised health communication and facilitate shared decision making in clinical practice.

PMID:33926980 | DOI:10.1136/bmjopen-2020-044472

BMJ Open. 2021 Apr 29;11(4):e044569. doi: 10.1136/bmjopen-2020-044569.

ABSTRACT

INTRODUCTION: Despite available pharmacological and psychological treatments, remission rates for bipolar disorder remain relatively low. Current research implicates the experience of childhood trauma as a potential moderator of poor treatment outcomes among individuals with bipolar disorder. To date, the evidence reporting the influence of childhood trauma on the treatment outcomes of pharmacological and/or psychological interventions for adolescents and adults with bipolar disorder has not been systematically reviewed.

METHOD AND ANALYSIS: MEDLINE Complete, Embase, PsycINFO and the Cochrane Central Register of Controlled Trials will be searched to identify randomised and nonrandomised studies of pharmacological and/or psychological interventions for bipolar disorder, which also assessed childhood trauma. To be eligible for inclusion, studies must have been conducted with adolescents or adults (≥10 years). Data will be screened and extracted by two independent reviewers. The methodological quality of the included studies will be assessed with the Cochrane Collaboration’s Risk of Bias tool and the Newcastle-Ottawa Scale. If deemed viable, a meta-analysis will be conducted using a random effects model. Heterogeneity of evidence will be estimated with the I² statistics.

ETHICS AND DISSEMINATION: This systematic review will use only previously published data. Therefore, ethical approval is not required. The results will be written in concordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, published in peer-reviewed journals and presented at relevant conferences.

PROSPERO REGISTRATION NUMBER: CRD42020201891.

PMID:33926981 | DOI:10.1136/bmjopen-2020-044569

Zhonghua Bing Li Xue Za Zhi. 2021 May 8;50(5):447-452. doi: 10.3760/cma.j.cn112151-20201204-00900.

ABSTRACT

Objective: To investigate the value of chromosomes 7 and 8 polysomy in circulating tumor cells (CTCs) for the diagnosis of non-small cell lung cancer, and the correlation of CTCs with clinical pathological characteristics and epidermal growth factor receptor (EGFR) mutations in cancer tissue. Methods: Fifty-seven patients with non-small cell lung cancer and 21 patients with benign lung diseases were enrolled at Beijing Chaoyang Hospital, Capital Medical University, Beijing, China from November 2017 to October 2020. Negative enrichment combined with immunofluorescence in situ hybridization (imFISH) was used to identify CTCs polysomy on chromosomes 7 and 8. EGFR mutations in 56 lung cancer patients was detected using ARMS-PCR. Results: CTCs were detected in 93.0% (53/57) of non-small cell lung cancers and 28.6% (6/21) benign lung lesions. The difference between lung cancer patients and the control cohort was statistically significant (P<0.01). Receive operator curve (ROC) analyses showed that, when the cut-off value was 1 cell/3.2 mL, Youden index had the highest sensitivity of 93.0% and specificity of 71.4% (AUC=0.906, 95%CI:0.833-0.980, P<0.01). The positive rate of CTCs in stage Ⅲ-Ⅳ cancers was significantly higher than that in stage Ⅰ-Ⅱ (P=0.023). No significant correlation was observed between positive rate of CTCs or chromosome polysomy and age, gender, smoking status, pathologic types and EGFR mutation status. The number of CTCs in EGFR mutated group was higher than that in the non-mutated group (6.5±1.1 vs. 3.7±0.7, P=0.045). The detection rate for CTCs ≥5 in the EGFR mutated group was also higher than the EGFR non-mutated group (52.0% vs. 19.4%,P=0.010). Conclusion: Detection of CTCs with chromosomes 7 and 8 polysomy has potential value in auxiliary diagnosis of non-small cell lung cancer, and the number of CTCs is correlated to TNM stage and EGFR gene mutation status.

PMID:33915649 | DOI:10.3760/cma.j.cn112151-20201204-00900

Zhonghua Yan Ke Za Zhi. 2021 May 11;57(5):358-365. doi: 10.3760/cma.j.cn112142-20200621-00412.

ABSTRACT

Objective: To evaluate the visual quality after phacoemulsification and implantation of a rotational asymmetric refractive intraocular lens in patients with high myopia and cataract. Methods: A retrospective cohort study. Sixty-two patients (92 eyes) of the First Affiliated Hospital of Zhengzhou University from June 2017 to December 2019 were evaluated after phacoemulsification and implantation of a rotational asymmetric refractive intraocular lens (LS-313 MF30). According to the axial length, the participants were allocated to either a control group or a high myopia group. Among the 33 patients (46 eyes) in the control group, the axial length was shorter than 26 mm; among the 29 patients (46 eyes) in the high myopia group, the axial length was more than 26 mm. The high myopia group was further divided into two subgroups. The super high myopia subgroup included 12 patients (18 eyes), and the axial length was ≥30 mm; the high myopia subgroup consisted of 17 patients (28 eyes), and the axial length was<30 mm and ≥26 mm. Uncorrected distance visual acuity, uncorrected intermediate visual acuity and uncorrected near visual acuity were recorded after surgery. The follow-up time was more than 6 months. At the end of the follow-up, patients’ contrast sensitivity (CS), reading acuity, reading speed and visual quality questionnaire results were assessed. The main statistical methods were two-way repeated measures analysis of variance, independent sample t-test, one-way analysis of variance and Kruskal-Wallis test. Results: There were no significant differences in gender distribution, age, or follow-up time between the control and high myopia groups, the control and high myopia subgroup, or the super high myopia subgroup (all P>0.05). At the end of the follow-up, the uncorrected distance, intermediate and near visual acuity of the super high myopia subgroup was 0.07±0.11, 0.34±0.08 and 0.20±0.09, respectively. The difference in postoperative visual acuity was not statistically significant (all P>0.05). The CS and CS with glare of the high myopia group (3 cpd: 1.48±0.18, 1.42±0.16; 6 cpd: 1.75±0.18, 1.76±0.15; 12 cpd: 1.44±0.24, 1.43±0.19; 18 cpd: 0.90±0.23, 0.85±0.20) were significantly different from the control group (3 cpd: 1.66±0.18, 1.62±0.16; 6 cpd: 1.88±0.14, 1.85±0.11; 12 cpd: 1.54±0.18, 1.53±0.14; 18 cpd: 1.06±0.18, 1.01±0.15) (P<0.05), except at 12 cpd (P=0.05). The CS and CS with glare of the super high myopia subgroup (3 cpd: 1.39±0.21, 1.31±0.13; 6 cpd: 1.66±0.16, 1.64±0.12; 12 cpd: 1.32±0.23, 1.31±0.18; 18 cpd: 0.75±0.16, 0.73±0.15) were worst (all P<0.05). A significant difference between the high myopia subgroup and the control group was only found at 3 cpd (1.53±0.13 vs. 1.66±0.18, 1.50±0.13 vs. 1.62±0.16; both P<0.05). The reading acuity and reading speed of the super high myopia subgroup were lower than the high myopia subgroup and the control group, while the differences were not statistically significant (all P>0.05). The questionnaire survey showed that there was no significant difference in the proportion of glare and halo between the two subgroups and the control group (both P>0.05). No patients reported dissatisfaction. The rate of glasses independents was 11/12 in the super high myopia subgroup, 15/17 in the high myopia subgroup and 31/33 in the control group, with no significant difference (P>0.05). Conclusions: The rotational asymmetric refractive intraocular lens is suitable for patients with high myopia and cataract, and has good far and near vision after operation. However, it could result in relatively low CS for super high myopia patients, so rigorous preoperative examination must be done. (Chin J Ophthalmol, 2021, 57: 358-365).

PMID:33915639 | DOI:10.3760/cma.j.cn112142-20200621-00412

Zhonghua Wai Ke Za Zhi. 2021 May 1;59(5):370-377. doi: 10.3760/cma.j.cn112139-20200904-00686.

ABSTRACT

Objective: To investigate the safety and clinical efficacy of osteotomy after halo pelvic traction in severe scoliosis accompanied with split cord malformation. Methods: The clinical data of 14 patients with severe scoliosis accompanied with split cord malformation admitted to the Department of Spinal Surgery, Guizhou Orthopedic Hospital from August 2015 to August 2019 were retrospectively analyzed.There were 6 males and 8 females, aged (19.8±5.0) years (range:13 to 34 years). All patients received spinal orthopedic surgery after halo pelvic traction for 3 to 7 weeks.The data of traction time, height, Cobb angle in the main curved coronal plane and sagittal plane, lung function and nutritional status of the patient were collected before and after the treatment. Paired t test was used to compare the evaluation indexes. Results: The traction time of the 14 patients was (35.2±8.3)days (range:20 to 49 days), and the height of them increased from (156.7±7.6)cm (range:141 to 166 cm) before traction to (167.0±6.4)cm (range:154 to 177 cm) after traction（t=-10.49，P<0.01）. The Cobb angle on the main curved coronal plane decreased from (117.4±17.2) ° (range: 91°to 176°) before traction to (56.4±8.1) ° (range:44°to 68°) after traction（t=13.90，P<0.01）. The sagittal Cobb angle decreased from (92.5±11.6) ° (range:62°to 132°) before traction to (41.7±7.7) °(range:29°to 51°) after traction（t=12.11，P<0.01）. No complications such as loosening of nailing and infection occurred during traction, and no decrease of nerve function occurred. Nine patients underwent single segment acromial transpedicle osteotomy and five underwent double segment adjacent asymmetric shortening osteotomy. None of the patients underwent longitudinal fracture resection. The lung function and nutritional status were improved after traction and surgery(all P<0.01). Postoperative follow-up was (22.5±9.1)months (range:12 to 36 months). At the last follow-up, the coronal Cobb angle was (56.3±7.1) °, and the sagittal Cobb angle was (37.7±6.5) °, showing no statistically significant difference from the angle after traction(t=0.16,P=0.88; t=2.28,P=0.32). There was no loss of orthopedic angle. None of the patients had internal fixation displacement, loosening or fracture. Conclusion: The treatment of severe scoliosis with accompanied with split cord malformation by halo pelvic traction is safe and effective, which is worthy of further confirmation by large sample study.

PMID:33915628 | DOI:10.3760/cma.j.cn112139-20200904-00686

Zhonghua Yan Ke Za Zhi. 2021 May 11;57(5):348-352. doi: 10.3760/cma.j.cn112142-20200802-00521.

ABSTRACT

Objective: To investigate the clinical characteristics, possible etiology and surgical efficacy of acute acquired concomitant esotropia (AACE) with atypical etiology. Methods: Case-control study. Twelve patients, including 7 males and 5 females, who complained of diplopia and were diagnosed with AACE in Tianjin Eye Hospital from January to December 2019 and underwent surgical treatment were included. The duration of the disease was (8.83±3.71) months. All patients underwent routine ocular examination except amblyopia and ocular organic lesions. MRI examination of the orbits and the brain was performed in all the patients in order to screen orbital and craniocerebral diseases, and patients denied that the existence of common causes of AACE (such as occlusion of one eye, mental or psychological factors, medium to high myopia, etc. during medical examination). The characteristics of the disease, the difference of deviation angle at 33 cm and 5 m, and the changes of deviation angle and stereopsis before and after surgery were analyzed. The forced duction test was performed before operation, and the distance between the sclera margin and the midpoint of the medial rectus muscle attachment was measured and compared with the patients with intermittent exotropia (10 cases) and comitant esotropia (10 cases). Paired sample t-test and one-way analysis of variance were used for statistical analysis. Results: The mean spherical equivalent was (1.70±0.88) D in all AACE patients, and the deviation angle was (22.42±5.82) prism diopter (PD) at 33 cm and (20.00±4.86) PD at 5 m in primary gaze, which were not statistically significant (P=0.371). The force duction test showed no obvious tension or contracture of the medial rectus and no paralysis. In patients with AACE, the horizontal distance from the midpoint of the medial rectus to the limbus was (5.20±0.27) mm, versus (5.30±0.25) mm in intermittent exotropia patients and (5.30±0.31) mm in concomitant esotropia patients. All the differences were not statistically significant (P=0.618). All the patients with AACE had residual esotropia (mean, 3.42 to 6.33 PD) at 6 weeks, 3 months, and 6 months postoperatively, and their stereopsis improved more than before, with no stereopsis in 2 patients before surgery and stereopsis in all 12 patients after surgery. Conclusions: AACE patients with atypical etiology do not have high myopia and hyperopia. There is no significant difference between the distance and near angles. The occurrence of esotropia is related to decompensation of esophoria, which may result in clinical symptoms of diplopia. Conventional surgery can reduce esotropia and restore stereoscopic vision, but there is still a small amount of esophoria after surgery. There is no abnormality in the attachment point of the medial rectus muscle. (Chin J Ophthalmol, 2021, 57: 348-352).

PMID:33915637 | DOI:10.3760/cma.j.cn112142-20200802-00521