Category: Statistics

J Sport Rehabil. 2022 Mar 12:1-10. doi: 10.1123/jsr.2021-0236. Online ahead of print.

ABSTRACT

CONTEXT: The etiology of patellofemoral pain has remained elusive, potentially due to an incomplete understanding of how pain, motor control, and kinesiophobia disrupt central nervous system functioning.

OBJECTIVE: To directly evaluate brain activity during experimental knee pain and its relationship to kinesiophobia in patients with patellofemoral pain.

DESIGN: Cross-sectional.

METHODS: Young females clinically diagnosed with patellofemoral pain (n = 14; 14.4 [3.3] y; body mass index = 22.4 [3.8]; height = 1.61 [0.1] m; body mass = 58.4 [12.7] kg). A modified Clarke test (experimental pain condition with noxious induction via patella pressure and quadriceps contraction) was administered to the nondominant knee (to minimize limb dominance confounds) of patients during brain functional magnetic resonance imaging (fMRI) acquisition. Patients also completed a quadriceps contraction without application of external pressure (control contraction). Kinesiophobia was measured using the Tampa Scale of Kinesiophobia. The fMRI analyses assessed brain activation during the modified Clarke test and control contraction and assessed relationships between task-induced brain activity and kinesiophobia. Standard processing for neuroimaging and appropriate cluster-wise statistical thresholds to determine significance were applied to the fMRI data (z > 3.1, P < .05).

RESULTS: The fMRI revealed widespread neural activation in the frontal, parietal, and occipital lobes, and cerebellum during the modified Clarke test (all zs > 4.4, all Ps < .04), whereas neural activation was localized primarily to frontal and cerebellar regions during the control contraction test (all zs > 4.4, all Ps < .01). Greater kinesiophobia was positively associated with greater activity in the cerebello-frontal network for the modified Clarke test (all zs > 5.0, all Ps < .01), but no relationships between kinesiophobia and brain activity were observed for the control contraction test (all zs < 3.1, all Ps > .05).

CONCLUSIONS: Our novel experimental knee pain condition was associated with alterations in central nociceptive processing. These findings may provide novel complementary pathways for targeted restoration of patient function.

PMID:35279019 | DOI:10.1123/jsr.2021-0236

J Sport Rehabil. 2022 Mar 12:1-12. doi: 10.1123/jsr.2021-0204. Online ahead of print.

ABSTRACT

CONTEXT: Unilateral training of the uninjured limb could be a useful therapeutic tool to induce cross-education in periods of immobilization, however, the effectiveness of this training in patients with anterior cruciate ligament (ACL) reconstruction is unknown.

OBJECTIVE: To determine the effectiveness of unilateral training of the uninjured limb on muscle strength and knee function in patients with ACL reconstruction.

DESIGN: Systematic review and meta-analysis.

EVIDENCE ACQUISITION: An electronic search was performed in the MEDLINE, LILACS, CENTRAL, Embase, Scopus, Web of Science, CINAHL, SPORTDiscus, and PEDro databases from inception until March 2021. The authors included randomized clinical trials that evaluated the effectiveness of unilateral training of the uninjured limb on muscle strength and knee function in patients after ACL reconstruction.

EVIDENCE SYNTHESIS: Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, 5 studies were included. The standardized mean difference for isometric quadriceps strength was 0.60 at 8 to 12 weeks (95% confidence interval, 0.29 to 0.92; P = .01; I2 = 6%). There was a high quality of evidence according to the Grading of Recommendation, Assessment, Development and Evaluation rating. Four studies assessed knee function through different self-administered questionnaires at 8, 24, and 26 weeks. Only one study reported significant differences in knee function at 8 weeks, favoring the unilateral training group.

CONCLUSIONS: There was a moderate to high quality of evidence, with statistical significance that the addition of unilateral training to standard rehabilitation improved the cross-education of quadriceps strength after ACL reconstruction. More research is needed to assess the consistency of these results. International Prospective Register of Systematic Reviews registration number: CRD42020199950.

PMID:35279020 | DOI:10.1123/jsr.2021-0204

J Stroke Cerebrovasc Dis. 2022 Mar 9;31(5):106427. doi: 10.1016/j.jstrokecerebrovasdis.2022.106427. Online ahead of print.

ABSTRACT

INTRODUCTION: Ipsilateral nonstenotic (<50%) internal carotid artery (ICA) plaque, cardiac atriopathy, and patent foramen ovale (PFO) may account for a substantial proportion of embolic stroke of undetermined source (ESUS).

METHODS: Consecutive stroke patients at our center (2019-2021) with unilateral, anterior circulation ESUS were categorized into the following mutually exclusive etiologies: (1) nonstenotic ipsilateral ICA plaque (NSP, ≥3mm in maximal axial diameter), (2) sex-adjusted mod-to-severe left atrial enlargement (LAE), (3) PFO, and (4) “occult ESUS” (patients who failed to meet criteria for these 3 groups). Descriptive statistics and multivariable logistic regression were used to model group characteristics.

RESULTS: Of 132 included patients, the median age was 65 (IQR 56-73), 74 (56%) of whom were White, and 54 (41%) were female. Twenty-one patients (16%) had NSP proximal to the infarct territory, 17 (13%) had LAE, 9 (7%) had a PFO, and 85 (64%) had no other mechanism. Patients with LAE were older (p=0.004), and had more frequent intracranial occlusions of the internal carotid and proximal middle cerebral artery (p=0.048), while tobacco use was most commonly found among patients with NSP (75%) when compared to other ESUS groups (p=0.02). Five of 9 patients with LAE who underwent outpatient telemetry had paroxysmal atrial fibrillation (56%), while zero patients with PFO or NSP had paroxysmal atrial fibrillation (p=0.005). Older age (adjusted OR [aOR] 1.05, 95%CI 1.03-1.07), coronary artery disease (aOR 3.22, 95%CI 1.61-6.44) and hypertension (aOR 2.16, 95%CI 1.14-4.06) were independently associated with LAE, while only tobacco use was associated with NSP when compared to other ESUS subclassifiers (OR 3.18, 95%CI 1.08-0.42). Age and tobacco use were both inversely associated with PFO (aOR 0.93, 95%CI 0.88-0.98, and aOR 0.10, 95%CI 0.02-0.90, respectively).

CONCLUSIONS: Certain clinical and radiographic features may be useful in predicting the proximal source of occult cerebral emboli, and can be used for cost-effective outpatient diagnostic testing.

PMID:35279004 | DOI:10.1016/j.jstrokecerebrovasdis.2022.106427

J Clin Neurosci. 2022 Mar 9;99:82-88. doi: 10.1016/j.jocn.2022.03.013. Online ahead of print.

ABSTRACT

The incidence of acoustic neuromas in the United States is 1.09 per 100,000 with 23,739 newly diagnosed cases in the years 2004 to 2010. Because the recent literature has supported that frailty can serve as a more accurate predictor of patient outcomes when evaluated with age, and is an important variable to consider in the course of patient treatment. The objective of this study was to compare the outcomes of frail patients who had undergone surgery for acoustic neuroma with their non-frail counterparts.The authors conducted a retrospective cohort study of geriatric patients receiving cranial neurosurgery for acoustic neuroma between 2016 and 2017 by using the Nationwide Readmission Database. A total of 396 frail patients and 402 non-frail patients were identified through the database of undergoing surgery for acoustic neuroma. Frail patients had statistically higher rates of readmission (p < 0.01), post-operative infection (p < 0.01), facial paralysis (p < 0.01), urinary tract infection (p < 0.01), hydrocephalus (p < 0.01), and dysphagia (p < 0.01). These post-op morbidities likely led to the increased length of stay (p < 0.01), non-routine discharge (p < 0.01), and all payer cost seen in frail patients (p < 0.01). However, no significant difference was found between frail and non-frail patients with regards to CSF leak, post hemorrhagic anemia, myocardial infarction, and mortality. Patient frailty status is a significant predictor of poor outcomes in the postoperative sequelae of acoustic neuroma surgery. Further, models including patient frailty plus age outperformed those using age alone for prediction of several postoperative complications.

PMID:35278933 | DOI:10.1016/j.jocn.2022.03.013

J Clin Neurosci. 2022 Mar 9;99:99-108. doi: 10.1016/j.jocn.2022.03.004. Online ahead of print.

ABSTRACT

BACKGROUND: Automated segmentation methods are developed to help with the segmentation of different brain areas. However, their reliability has yet to be fully investigated. To have a more comprehensive understanding of the distribution of changes in Alzheimer’s disease (AD), as well as investigating the reliability of different segmentation methods, in this study we compared volumes of cortical and subcortical brain segments, using HIPS, volBrain, CAT and BrainSuite automated segmentation methods between AD, mild cognitive impairment (MCI) and healthy controls (HC).

METHODS: A total of 182 MRI images were taken from the minimal interval resonance imaging in Alzheimer’s disease (MIRIAD; 22 AD and 22 HC) and the Alzheimer’s disease neuroimaging initiative database (ADNI; 43 AD, 50 MCI and 45 HC) datasets. Statistical methods were used to compare different groups as well as the correlation between different methods.

RESULTS: The two methods of volBrain and CAT showed a strong correlation (p’s < 0.035 Bonferroni corrected for multiple comparisons). The two methods, however, showed no significant correlation with BrainSuite (p’s > 0.820 Bonferroni corrected). Furthermore, BrainSuite did not follow the same trend as the other three methods and only HIPS, volBrain and CAT showed strong conformity with the past literature with strong correlation with mini mental state examination (MMSE) scores.

CONCLUSION: Our results showed that automated segmentation methods HIPS, volBrain and CAT can be used in the classification of HC, AD and MCI. This is an indication that such methods can be used to inform researchers and clinicians of underlying mechanisms and progression of AD.

PMID:35278936 | DOI:10.1016/j.jocn.2022.03.004

Mar Pollut Bull. 2022 Mar 9;177:113515. doi: 10.1016/j.marpolbul.2022.113515. Online ahead of print.

ABSTRACT

The accumulation of marine litter on coastal seabeds is influenced by various anthropogenic and environmental factors. To identify litter accumulation areas on the seafloor, it is necessary to understand the interaction of these parameters. This study analyses the seafloor litter occurrence in the southeastern North Sea, based on samples collected between October 2017 and March 2019. Litter data were combined with hydrographic, high-resolution in situ measurements and further geographic as well as anthropogenic factors for statistical analyses. Benthic litter showed a mean density of 2473 ± 3116 items km^-2, and plastics consisting mainly of fisheries-related items represented the majority of identified objects. The statistical analyses suggest that salinity and temperature gradients, the meridional bottom currents, as well as the distance of the station to the coastline have a significant effect on benthic litter abundance. Direct combination of litter sampling and hydrographic measurements can improve the understanding of seabed litter dynamics.

PMID:35278906 | DOI:10.1016/j.marpolbul.2022.113515

Placenta. 2022 Mar 5;121:53-60. doi: 10.1016/j.placenta.2022.03.001. Online ahead of print.

ABSTRACT

INTRODUCTION: Obstructive sleep apnoea (OSA), a condition characterised by intermittent hypoxia and reoxygenation during sleep, is associated with an increased risk of adverse pregnancy outcomes including gestational diabetes and hypertensive disorders of pregnancy. The biological mechanisms of these associations are poorly understood. The impact of OSA on placental function has not been well characterised.

METHODS: We performed 3′ mRNA sequencing on placenta from women with obesity and OSA (n = 11) and women with obesity and no OSA (n = 9).

RESULTS: After correcting for multiple testing, there were no statistically significant differences in gene expression between OSA and no OSA groups (adjusted p < 0.05). In unadjusted analyses, 101 genes were differentially expressed in OSA compared to no OSA placentae (p < 0.01). In Reactome pathway and GO term analysis, this included downregulation of genes involved in O-linked glycosylation (B3GNT5 and B3GNT8) and Wnt signalling (TRABD2B and FRZB) pathways. In gene set enrichment analysis, genes within 24 pathways had a non-random distribution in OSA compared to no OSA placentae (adjusted p < 0.05). This included an increase in genes relating to the reversible hydration of carbon dioxide in OSA placentae, a potential novel mechanism contributing to the development of adverse pregnancy outcomes in women with OSA.

DISCUSSION: There is overall similarity in the placental transcriptome of women with obesity who do and do not have OSA during pregnancy. Alterations in the reversible hydration of carbon dioxide are a potential mechanism contributing to the development of adverse pregnancy outcomes in maternal OSA, however this finding requires validation in larger cohorts.

PMID:35278842 | DOI:10.1016/j.placenta.2022.03.001

Accid Anal Prev. 2022 Mar 9;169:106633. doi: 10.1016/j.aap.2022.106633. Online ahead of print.

ABSTRACT

INTRODUCTION: Despite demonstrated effectiveness of child restraint system (CRS), its use in China is extremely low due to the lack of national legislation requiring the use of CRS, as well as lack of child passenger safety knowledge among caregivers. Implementing an effective intervention is urgently needed to promote the use of CRS. In this study, we primarily evaluated the effectiveness of biomechanical visualization delivered in the context of CRS education to promote CRS use.

METHODS: We conducted a cluster randomised controlled trial to test the effects of educational intervention programs on increased use of CRS. Participants included caregivers from 8 pre-schools located in two cities (i.e., Chaozhou and Shantou) in China. Following a baseline survey, 8 pre-schools were randomly assigned into 1 of 4 groups with 2 schools in each group: 1) CRS education-only, 2) CRS education with behavioral skill training, 3) CRS education with biomechanical visualization, and 4) control. The primary outcome was CRS use, and the secondary outcomes included scores of child passenger safety-related knowledge and CRS use-related attitudes. The effect of the intervention was assessed among caregivers at two time points: baseline preintervention and 6 months postintervention.

RESULTS: More than 70% caregivers had never used CRS at baseline. No statistically significant between-group differences CRS use were observed at baseline preintervention (34.2%, 25.4%, 29.6% and 21.9%, respectively, P = 0.18). However, compared to the control group, odds of CRS non-use was significantly lower in caregivers assigned to the CRS education with biomechanical visualization (adjusted odd ratio (AOR) = 0.11, 95% confidence interval (CI) = 0.07-0.17), CRS education with behavioral skill training (AOR = 0.15, 95%CI = 0.10-0.24) and CRS education-only (AOR = 0.26, 95%CI = 0.17-0.41) groups, respectively. Statistically significant differences were also observed in the secondary outcomes postintervention across groups. Specifically, the CRS education with biomechanical visualization and CRS education with behavioral skill training groups had higher mean knowledge change scores than the CRS education-only group (3.3 ± 1.5 vs. 2.9 ± 2.2, p = 0.035 and 3.2 ± 1.9 vs. 2.9 ± 2.2, p = 0.039, respectively). We also observed a significantly higher increase in the attitudes scores in the CRS education with biomechanical visualization group compared with the CRS education-only group (4.7 ± 2.1 vs. 3.5 ± 2.8,p = 0.026).

CONCLUSIONS: This study shows that both biomechanical visualization and behavioral skill training supplements to education improved understanding of CRS knowledge compared to education only, and all three strategies led to increased CRS use. Importantly, CRS education with biomechanical visualization was shown to be more effective than CRS education alone in improving caregiver’s knowledge and attitudes. The use of biomechanical visualization may be an effective supplement to traditional education programs.

PMID:35278847 | DOI:10.1016/j.aap.2022.106633

J Biomech. 2022 Mar 2;135:111027. doi: 10.1016/j.jbiomech.2022.111027. Online ahead of print.

ABSTRACT

This study aimed to elucidate the overall spatial distribution of palmar aponeurosis (PA) thickness, d, and Young’s modulus, E, through two-dimensional ultrasound and shear wave elastography. Statistical analysis of the collected data of 14 subjects shows that the ICC_3,1 of thickness, d, and Young’s modulus, E, is 0.974 and 0.985 separately, which means thickness, d, and Young’s modulus, E, have acceptable retest reliability. According the results of this study, it is concluded that the thickness, d, and Young’s modulus, E, of the PA both exhibit specific spatial dependence. Along the direction from the capitate bone to the four fingers, the thickness, d, and Young’s modulus, E, of the four longitudinal bundles of the PA show a downward trend like Boltzmann’s function, with the maximum value at the capitate bone and the minimum values at palmar creases. The determination coefficients (R²) of the thickness, d, and Young’s modulus, E, fitting curves are all above 0.910 in all healthy subjects, whose palmar aponeurosis thickness, d, and Young’s modulus, E, distribution characteristics in space show satisfying consistency.

PMID:35278821 | DOI:10.1016/j.jbiomech.2022.111027

J Stomatol Oral Maxillofac Surg. 2022 Mar 9:S2468-7855(22)00058-1. doi: 10.1016/j.jormas.2022.03.011. Online ahead of print.

ABSTRACT

BACKGROUND: YouTube has been increasingly used as a source of information by patients in the field of health, but many studies revealed poor information quality. This study evaluated the content and quality of YouTube videos on Temporomandibular Joint Arthrocentesis (TMJA) as an information resource for patients.

MATERIAL AND METHODS: YouTube search with the two keywords “temporomandibular joint arthrocentesis” and ”temporomandibular joint lavage” was performed. The first 160 videos were listed for each term according to relevancy. Results were assessed for inclusion and categorized for source, purpose, target, arthrocentesis method described, and the narrator of the videos. An evaluation was performed independently by two oral and maxillofacial surgeons. The quality of videos was analyzed for the content and defined as poor, moderate, and excellent. DISCERN was also performed by scoring between 0 and 5.

RESULTS: A total of 43 videos were evaluated. The most upload source was individual users (46.5%) and the most video upload purpose was information for professionals (37.2%). The method with the most information about was the two-needle technic, which had a rate of 44.2 percent. The average usefulness score of the videos was 3.00 and 57.1% of the videos resulted in poor quality. A statistically significant positive high correlation was found between DISCERN and usefulness scoring (r=0.793; p<0.001).

CONCLUSION: The majority of YouTube videos are of poor quality and this situation affects the patients’ decisions about treatment. Health professionals should be aware of the content on YouTube and produce high-quality, accurate, and up-to-date information for patient education.

PMID:35278759 | DOI:10.1016/j.jormas.2022.03.011