Category: Statistics

Eur J Surg Oncol. 2022 Jun 9:S0748-7983(22)00484-X. doi: 10.1016/j.ejso.2022.05.034. Online ahead of print.

ABSTRACT

AIM: The endoscopic approach for early-stage endometrial cancer (EC) treatment is considered gold standard. Some authors expressed their concern regarding uterine manipulator (UM) as a risk factor for tumor spillage and dissemination allowing peritoneal or lympho-vascular spaces invasion (LVSI). This meta-analysis aimed to evaluate the effect of UM on the presence of LVSI, recurrence rate and presence of atypical or malignant peritoneal cytology in patients with endometrial cancer.

METHODS: We searched electronic databases including PubMed, MEDLINE, Embase, Scopus, EBSCO, Google Scholar, and ClinicalTrials.gov. The pooled results were used to evaluate the association between the use of UM and oncological outcomes. This systematic review was reported according to PRISMA statement 2020. Statistical meta-analysis was performed using Review Manager software.

RESULTS: This systematic review included 18 studies (3 prospective studies, 13 retrospective studies, and 2 RCT). The pooled results showed no significant difference (RR: 0.86, 95% CI, 0.69 to 1.08) in the incidence of LVSI between manipulated hysterectomy and total abdominal hysterectomy (TAH) and between UM group and non-UM group in minimally invasive surgery (RR: 1.18, 95% CI, 0.76 to 1.85), no significant difference in the rate of recurrence (RR: 1.11, 95% CI, 0.71 to 1.74), in the incidence of positive peritoneal cytology between manipulated and non-manipulated hysterectomies in minimally invasive surgery (RR: 1.89, 95% CI, 0.74 to 4.83) and before and after the use of uterine manipulator (RR: 1.21, 95% CI, 0.68 to 2.16). We found a positive association between malignant cytology and hysterectomies in which a uterine manipulator had been used in a sub-group analysis where LH/LAVH were compared to TAH. (RR = 2.26, 95% CI, 1.08-4.71. P = 0.03).

CONCLUSIONS: This meta-analysis supports that the use of uterine manipulator for minimally invasive treatment of endometrial cancer does not increase the rate of recurrence and LVSI. Therefore, the opportunity of any other studies on its use in endometrial cancer women should be questioned.

PMID:35725683 | DOI:10.1016/j.ejso.2022.05.034

Fertil Steril. 2022 Jun 17:S0015-0282(22)00318-1. doi: 10.1016/j.fertnstert.2022.05.015. Online ahead of print.

NO ABSTRACT

PMID:35725672 | DOI:10.1016/j.fertnstert.2022.05.015

ISA Trans. 2022 Jun 10:S0019-0578(22)00295-6. doi: 10.1016/j.isatra.2022.06.001. Online ahead of print.

ABSTRACT

The model of complex dynamical network (CDN) can be represented as the mathematic graph, in which some characteristics may emerge from the dynamic nodes group (NG) and links group (LG). This paper primarily focuses on the feature appearing from the dynamic links. The average link weight (ALW), as a novel quantitative index to describe the characteristic of dynamic links is introduced. Inspired by the Hebb’s neuroscience theory, the Hebb complex dynamical network (HCDN) is constructed. The ALW of the HCDN can track a given target via external stimulus signals with adaptive amplifiers’ proportional coefficients. In other words, the stationary network implies the ALW is a constant in time. Finally, two simulation examples are performed to validate the proposed adaptive update law’s effectiveness.

PMID:35725668 | DOI:10.1016/j.isatra.2022.06.001

Trials. 2022 Jun 20;23(1):520. doi: 10.1186/s13063-022-06438-y.

ABSTRACT

BACKGROUND: Major depressive disorder (MDD) is a leading cause of disease morbidity. Combined treatment with antidepressant medication (ADM) plus psychotherapy yields a much higher MDD remission rate than ADM only. But 77% of US MDD patients are nonetheless treated with ADM only despite strong patient preferences for psychotherapy. This mismatch is due at least in part to a combination of cost considerations and limited availability of psychotherapists, although stigma and reluctance of PCPs to refer patients for psychotherapy are also involved. Internet-based cognitive behaviorial therapy (i-CBT) addresses all of these problems.

METHODS: Enrolled patients (n = 3360) will be those who are beginning ADM-only treatment of MDD in primary care facilities throughout West Virginia, one of the poorest and most rural states in the country. Participating treatment providers and study staff at West Virginia University School of Medicine (WVU) will recruit patients and, after obtaining informed consent, administer a baseline self-report questionnaire (SRQ) and then randomize patients to 1 of 3 treatment arms with equal allocation: ADM only, ADM + self-guided i-CBT, and ADM + guided i-CBT. Follow-up SRQs will be administered 2, 4, 8, 13, 16, 26, 39, and 52 weeks after randomization. The trial has two primary objectives: to evaluate aggregate comparative treatment effects across the 3 arms and to estimate heterogeneity of treatment effects (HTE). The primary outcome will be episode remission based on a modified version of the patient-centered Remission from Depression Questionnaire (RDQ). The sample was powered to detect predictors of HTE that would increase the proportional remission rate by 20% by optimally assigning individuals as opposed to randomly assigning them into three treatment groups of equal size. Aggregate comparative treatment effects will be estimated using intent-to-treat analysis methods. Cumulative inverse probability weights will be used to deal with loss to follow-up. A wide range of self-report predictors of MDD heterogeneity of treatment effects based on previous studies will be included in the baseline SRQ. A state-of-the-art ensemble machine learning method will be used to estimate HTE.

DISCUSSION: The study is innovative in using a rich baseline assessment and in having a sample large enough to carry out a well-powered analysis of heterogeneity of treatment effects. We anticipate finding that self-guided and guided i-CBT will both improve outcomes compared to ADM only. We also anticipate finding that the comparative advantages of adding i-CBT to ADM will vary significantly across patients. We hope to develop a stable individualized treatment rule that will allow patients and treatment providers to improve aggregate treatment outcomes by deciding collaboratively when ADM treatment should be augmented with i-CBT.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04120285 . Registered on October 19, 2019.

PMID:35725644 | DOI:10.1186/s13063-022-06438-y

Gynecol Oncol. 2022 Jun 17:S0090-8258(22)00407-3. doi: 10.1016/j.ygyno.2022.06.007. Online ahead of print.

ABSTRACT

OBJECTIVE: Sentinel lymph node mapping (SNM) has gained popularity in managing apparent early-stage endometrial cancer (EC). Here, we evaluated the long-term survival of three different approaches of nodal assessment.

METHODS: This is a multi-institutional retrospective study evaluating long-term outcomes of EC patients having nodal assessment between 01/01/2006 and 12/31/2016. In order to reduce possible confounding factors, we applied a propensity-matched algorithm.

RESULTS: Overall, 940 patients meeting inclusion criteria were included in the study, of which 174 (18.5%), 187 (19.9%), and 579 (61.6%) underwent SNM, SNM followed by backup lymphadenectomy (LND) and LND alone, respectively. Applying a propensity score matching algorithm (1:1:2) we selected 500 patients, including 125 SNM, 125 SNM/backup LND, and 250 LND. Baseline characteristics of the study population were similar between groups. The prevalence of nodal disease was 14%, 16%, and 12% in patients having SNM, SNM/backup LND and LND, respectively. Overall, 19 (7.6%) patients were diagnosed with low volume nodal disease. The survival analysis comparing the three techniques did not show statistical differences in terms of disease-free (p = 0.750) and overall survival (p = 0.899). Similarly, the type of nodal assessment did not impact survival outcomes after stratification based on uterine risk factors.

CONCLUSION: Our study highlighted that SNM provides similar long-term oncologic outcomes than LND.

PMID:35725656 | DOI:10.1016/j.ygyno.2022.06.007

Magy Onkol. 2022 Jun 20;66(2):153-156. Epub 2021 Apr 27.

ABSTRACT

Malignant tumors were the leading cause of death in Hungary between 1990 and 2018 according to the central statistical office (www.ksh.hu). While the mortality of cerebrovascular diseases is decreasing, cancer-related mortality is getting worse, despite the improvement of both diagnostic and therapeutic opportunities. The exact number of synchronous double and triple cancers in Hungary is unknown, and their therapeutic pathways are unclear. Currently there is no data available regarding these questions in the National Cancer Registry. In this case report we present the diagnostic and therapeutic algorithm of a patient with a triple malignancy.

PMID:35724393

Magy Onkol. 2022 Jun 20;66(2):94-99. Epub 2022 May 16.

ABSTRACT

Skin melanoma is not among malignancies with the highest incidences and mortalities worldwide; however, the observed constant increase in newly diagnosed cases is troublesome. According to the database of the Hungarian Cancer Registry, the number of newly reported cases doubled between 2001 and 2019, which is consistent with international data. Notwithstanding, within the same interval, Hungarian mortality did not change significantly according to the database of the Hungarian Statistical Office, which is in contrast to international trends. The increasing incidence together with unchanging mortality resulted in better survival rates and hence more favorable follow-up data in our country. Advancements in secondary prevention programs and better efficacy of modern therapeutic interventions in the last decade may have contributed to the observed improvement in the survival rates of Hungarian melanoma patients.

PMID:35724385

J Athl Train. 2022 Jun 20. doi: 10.4085/1062-6050-0097.22. Online ahead of print.

ABSTRACT

CONTEXT: Certified athletic therapists in Ireland and Canada serve essential concussion assessment and management roles, but their healthcare practices and concussion knowledge are unestablished.

OBJECTIVE: To examine Irish and Canadian athletic therapist cohorts: 1) concussion knowledge, 2) current concussion assessment and management techniques across all job settings, and 3) concussion assessment and management practices associations with years of clinical experience and highest degree attained.

DESIGN: Cross-sectional cohort.

SETTING: Online survey.

PATIENTS OR OTHER PARTICIPANTS: Licensed Irish (49.7%;n=91/183) and Canadian (10.1%;n=211/2,090) athletic therapists.

MAIN OUTCOME MEASURES: Athletic therapists completed an online survey assessing their demographics, concussion knowledge (symptom recognition, patient-clinician scenarios), annual concussions assessed, and assessment and return-to-play (RTP) measures using a modified, previously validated survey. Symptom recognition consisted of 20 (8 true, 12 false) signs and symptoms recognition questions scored as total correct. Descriptive statistics and odds ratios (OR) were used to examine survey responses where appropriate.

RESULTS: Irish (86.8%;n=46/53) and Canadian (93.4%;n=155/166) athletic therapists indicated RTP guidelines as the most common method for determining RTP. Symptom recognition was 72.8±17.0% among Irish and 76.6±17.0% among Canadian athletic therapists. Irish (91.2%;n=52/57) and Canadian (95.3%;n=161/178) athletic therapists reported standardized sideline assessments as the most common concussion assessment method. Irish and Canadian athletic therapists’ two-domain (Irish:38.6%[n=22/57]; Canadian:73.6%[n=131/178]) and three-domain (Irish:3.5%[n=2/57]; Canadian:19.7%[n=35/178]) minimum assessments (i.e. symptoms, balance, and/or neurocognitive) were not associated with education or clinical experience (p≥0.068), except for Canadian athletic therapists with Master’s degrees having greater odds of completing two-domain assessments at initial evaluation than those with Bachelor’s degrees (OR[95%CI]=1.8[1.41-1.95]).

CONCLUSIONS: Irish and Canadian athletic therapists demonstrated similar concussion knowledge to prior research; however, the majority did not fully adhere to international consensus concussion assessment guidelines as evidenced by low two- and three- domain assessment use. Athletic therapists should aim to implement multidimensional concussion assessments to ensure optimal healthcare practices and patient safety.

PMID:35724361 | DOI:10.4085/1062-6050-0097.22

J Athl Train. 2022 Jun 20. doi: 10.4085/1062-6050-0132.22. Online ahead of print.

ABSTRACT

Increasing attention is directed on identifying aspects of football participation for targeted policy change that reduces concussion risk. Prior work evaluated concussion risk during the pre- and regular-seasons, leaving the spring season largely unexplored. This nationally representative observational investigation of 19 Division I collegiate football programs evaluated concussion rates and head impact exposure during the pre-season, regular season, and spring practices from 2014-2019. All participating programs recorded incidence concussions and a subset (n=6) also measured head impact exposure. Analyses by time of year and session type indicated concussion rates and head impact exposure during all practice sessions and contact only practices were significantly higher in the spring and pre-season compared to the regular season (p’s<0.05). Concussion rates during the spring season and pre-season were statistically similar. This investigation identified comparable concussion risk between the spring and pre-seasons, highlighting the need for targeted policy intervention to protect athlete health and safety.

PMID:35724362 | DOI:10.4085/1062-6050-0132.22

Kardiol Pol. 2022 Jun 20. doi: 10.33963/KP.a2022.0150. Online ahead of print.

ABSTRACT

BACKGROUND: The left circumflex (Cx) artery is the most challenging of coronary branches in terms of diagnostics because the clinical presentation and electrocardiography (ECG) results do not always suggest critical occlusion despite its presence. Therefore, it is important to determine the factors contributing to the clinical manifestation and outcome, such as culprit location.

AIMS: To determine the relation between the location of the culprit plaque and clinical outcomes in the LCx artery.

METHODS: Data from the Polish Registry of Invasive Cardiology Procedures (ORPKI) concerning percutaneous coronary intervention (PCI) procedures have been extracted and analyzed using appropriate statistical tests.

RESULTS: Patients with proximal occlusion received a worse grade using the Killip score. Patients with thrombolysis in myocardial infarction (TIMI) score 0 presented worse clinical presentation in each of the occlusion locations. Periprocedural cardiac arrest and death rate was the highest among patients with proximal Cx occlusion. Death rate among patients with proximal occlusion and non ST segment elevation myocardial infarction (NSTEMI) was greater than among patients with distal occlusion and ST segment elevation myocardial infarction (STEMI).

CONCLUSIONS: Among patients with proximal occlusions of the Cx artery and TIMI 0 grade flow in initial angiogram, a STEMI-like approach should be undertaken apart from initial ECG findings. This is driven by a higher rate of critical and fatal complications such as cardiac arrest and periprocedural death. Fatal complications occur more often in patients with proximal occlusion of Cx than in medial or distal occlusion. Grade IV according to the Killip score can suggest proximal culprit location.

PMID:35724333 | DOI:10.33963/KP.a2022.0150