Category: Statistics

IEEE Trans Biomed Eng. 2022 May 3;PP. doi: 10.1109/TBME.2022.3171493. Online ahead of print.

ABSTRACT

OBJECTIVE: Acoustic emission (AE) sensed from knee joints during weight-bearing movements greatly increases with joint deterioration, but the relationship between AE patterns and specific anatomical damage, as seen for example in magnetic resonance imaging (MRI), is unknown. This knowledge is essential to validate AE biomarkers for the evaluation of knee joints, and forms the objective of this exploratory work to associate knee AE and MRI.

METHODS: A novel processing framework is proposed to enable direct correlation between static 3D MRI of knees and their dynamic 1D AE during sit-stand-sit movements. It comprises a method to estimate articular cartilage thickness according to joint angle from knee MRI, and a method to derive statistically representative waveform features according to joint angle from movement and load-dependent knee AE.

RESULTS: In 10 subjects diagnosed with knee osteoarthritis, age 55~79 years and body mass index 25~35 kg/m2, a strong inverse relationship between knee AE and cartilage thickness in the medial tibiofemoral compartment around the fully standing position was observed. Knees with thinner articular cartilage generated more AE with higher amplitude, greater energy, longer duration, and higher frequencies, in agreement with the assumption of more intense articulation friction under full body weight.

CONCLUSION: AE provides promising quantitative biomarkers in knee joint disease.

SIGNIFICANCE: These findings provide impetus for the further development of AE as a low-cost non-invasive biomarker modality to improve the management of knee joint disease.

PMID:35503843 | DOI:10.1109/TBME.2022.3171493

Otolaryngol Head Neck Surg. 2022 May 3:1945998221099028. doi: 10.1177/01945998221099028. Online ahead of print.

ABSTRACT

OBJECTIVE: Airborne aerosol transmission, an established mechanism of SARS-CoV-2 spread, has been successfully mitigated in the health care setting through the adoption of universal masking. Upper airway endoscopy, however, requires direct access to the face, thereby potentially exposing the clinic environment to infectious particles. This study quantifies aerosol production during rigid nasal endoscopy (RNE) and RNE with debridement (RNED) as compared with intubation, a posited gold standard aerosol-generating procedure.

STUDY DESIGN: Prospective cross-sectional study.

SETTING: Subspecialty single-center clinic and surgical study.

METHOD: Three aerosol detectors (NANOSCAN-3910, OPS-3330, and APS-3321) with a particle size sensitivity of 10 to 20,000 nm were utilized to detect particulate production during the clinical care of 209 patients undergoing RNE/RNED and 25 patients undergoing intubation.

RESULTS: RNE and RNED produced statistically significant particles over baseline in 29.3% and 51.0% of subjects (P = .003-.049 and .002-.047, respectively). Intubation produced statistically significant particles in 31.2% (P = .001-.015). The mean ± SD particle diameter in all tests was 69.9 ± 10.5 nm with 99.7% <300 nm. There were no statistical differences in particle production among RNE, RNED, and intubation. The presence of concomitant cough, sneeze, or prolonged speech similarly did not significantly affect particle production during any procedure.

CONCLUSIONS: Instrumentation of nasal airway produces airborne aerosols to a similar degree of those seen during intubation, independent of reactive patient behaviors such as cough or sneeze. These data suggest that an improved understanding is necessary of both the definition of an aerosol-generating procedure and the functional consequences of procedural aerosol generation in clinical settings.

PMID:35503253 | DOI:10.1177/01945998221099028

Cureus. 2022 Mar 28;14(3):e23557. doi: 10.7759/cureus.23557. eCollection 2022 Mar.

ABSTRACT

INTRODUCTION: Venipuncture is often a painful procedure causing significant anxiety, distress, and psychological consequences. We evaluated the efficacy of estradiol cream and compared it with a eutectic mixture of local anesthetics (EMLA) cream for alleviation of venipuncture pain and to make cannulation easy in female obese patients.

MATERIALS AND METHODS: The clearance from the Institutional Ethical Committee as well as prior written and informed consent were obtained from the participants. A total of 105 obese female adult patients aged between 25 and 64 years belonging to the American Society of Anesthesiologists (ASA) physical status I and II with body mass index (BMI) > 30 kg/m² were included in our study. The study participants were randomly allocated into three groups: In group I, a placebo cream was applied; in group II, estradiol cream was applied, and in group III, EMLA cream was applied. Any abnormal sensation at the site of application of the cream was noted and followed up at 0, 2, and 6 hours for the same. The primary outcome was the measurement of the severity of the pain experienced during venipuncture using the visual analog scale (VAS). Ease of cannulation was our secondary outcome. VAS was compared with the Z test. Statistical Package for the Social Sciences (SPSS) v16.0 software (SPSS Inc., Chicago) was used for statistical analysis. A p-value of <0.05 was considered statistically significant.

RESULT: The final analysis was carried out on 25 patients in group I, 27 patients in group II, and 33 patients in group III. There was no significant improvement in the ease of cannulation in group II when compared to group I. The mean VAS was similar in group I and group II, whereas it was significantly reduced in group III (p < 0.05).

CONCLUSION: EMLA cream was found to significantly reduce the pain of venipuncture in comparison to placebo and estradiol cream. There is no beneficial effect of estradiol cream in reducing the pain from venipuncture or in ease of cannulation compared to placebo.

PMID:35503278 | PMC:PMC9044105 | DOI:10.7759/cureus.23557

Rev Environ Health. 2022 May 3. doi: 10.1515/reveh-2021-0166. Online ahead of print.

ABSTRACT

As environmental and occupational noise can be health hazards, recent studies have investigated the effects of noise exposure during pregnancy. Despite biological plausibility and animal studies supporting an association, studies focusing on congenital anomalies and perinatal mortality as outcomes of noise exposure are still scarce. We performed a scoping review to collect, summarise, and discuss the existing scientific research about the relationships between noise exposure during pregnancy and congenital anomalies and/or perinatal mortality. We searched electronic databases for papers published between 1970 and March 2021. We included 16 studies (seven on congenital anomalies, three on perinatal mortality, and two on both congenital anomalies and perinatal mortality). We assessed four studies on congenital hearing dysfunction as the definition of congenital anomalies includes functional anomalies. We found few studies on this topic and no studies on the combined effects of occupational and environmental noise exposures. Evidence suggests a small increase in the risk of congenital anomalies in relation to occupational and to a lesser extent environmental noise exposure. In addition, few studies investigated perinatal mortality and the ones that did, used different outcome definitions, so no conclusions could be made. However, a recent big cross-sectional study demonstrated an association between road traffic noise and stillbirth. A few studies suggest a possible association between congenital hearing dysfunction and occupational noise exposure during pregnancy. Future studies with larger samples, better exposure assessments, and better statistical modelling strategies are needed to investigate these relationships further.

PMID:35503245 | DOI:10.1515/reveh-2021-0166

JAMA Netw Open. 2022 May 2;5(5):e229968. doi: 10.1001/jamanetworkopen.2022.9968.

ABSTRACT

IMPORTANCE: In recent years, specialized musculoskeletal urgent care centers (MUCCs) have opened across the US. Uninsured patients may increasingly turn to these orthopedic-specific urgent care centers as a lower-cost alternative to emergency department or general urgent care center visits.

OBJECTIVE: To assess out-of-pocket costs and factors associated with these costs at MUCCs for uninsured and underinsured patients in the US.

DESIGN, SETTING, AND PARTICIPANTS: In this survey study, a national secret shopper survey was conducted in June 2019. Clinics identified as MUCCs in 50 states were contacted by telephone by investigators using a standardized script and posing as uninsured patients seeking information on the out-of-pocket charge for a new patient visit.

EXPOSURES: State Medicaid expansion status, clinic Medicaid acceptance status, state Medicaid reimbursement rate, median income per zip code, and clinic region.

MAIN OUTCOMES AND MEASURES: The primary outcome was each clinic’s out-of-pocket charge for a level 3 visit, defined as a new patient office visit requiring medical decision-making of low complexity. Linear regression was used to examine correlations of price with clinic policy against accepting Medicaid, median income per zip code, and Medicaid reimbursement for a level 3 visit.

RESULTS: Of 565 MUCCs identified, 558 MUCCs were able to be contacted (98.8%); 536 of the 558 MUCCs (96.1%) disclosed a new patient visit out-of-pocket charge. Of those, 313 (58.4%) accepted Medicaid insurance and 326 (60.8%) were located in states with expanded Medicaid at the time of the survey. The mean (SD) price of a visit to an MUCC was $250 ($110). Clinic policy against accepting Medicaid (β, 22.91; 95% CI, 12.57-33.25; P < .001), higher median income per zip code (β, 0.00056; 95% CI, 0.00020-0.00092; P = .003), and increased Medicaid reimbursement for a level 3 visit (β, 0.737; 95% CI, 0.158-1.316; P = .01) were positively correlated with visit price. The overall regression was statistically significance (R2 = 0.084; P < .001).

CONCLUSIONS AND RELEVANCE: In this survey study, MUCCs charged a mean price of $250 for a new patient visit. Medicaid acceptance policy, median income per zip code, and Medicaid reimbursement for a level 3 visit were associated with differences in out-of-pocket charges. These findings suggest that accessibility to orthopedic urgent care at MUCCs may be limited for underinsured and uninsured patients.

PMID:35503219 | DOI:10.1001/jamanetworkopen.2022.9968

Sleep Breath. 2022 May 3. doi: 10.1007/s11325-022-02613-2. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to analyze the relationship between serum amyloid A (SAA) concentrations in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and their magnetic resonance imaging (MRI) of resting brain function.

METHODS: Male patients with OSAHS were enrolled from January to June 2019 in Suzhou Ninth People’s Hospital Affiliated to Soochow University, and nineteen healthy male volunteers were selected as the normal control group. The patients with OSAHS were divided into mild, moderate, and severe groups according to their apnea-hypopnea index (AHI). Early in the morning after the polysomnography (PSG), blood samples were collected and serum levels of serum amyloid A (SAA) were measured by enzyme-linked immunosorbent assay. All subjects were scored by the Auditory Verbal Learning Test (AVLT) scale. Resting brain function images of healthy male volunteers and patients in the severe group were collected by 3.0 T magnetic resonance scanner. SPSS25.0 software was used for statistical analysis.

RESULTS: The SAA of the OSAHS group (n = 43) were higher than those of control group (n = 19). The scores of AVLT-immediate and AVLT-delay in the severe OSAHS group were lower than those in the control group (P < 0.05), and it was negatively correlated with SAA. In the severe OSAHS group, the rest state Function Connection (rsFC) in temporal lobe, marginal lobe, and frontal lobe was lower than that in the control group (P < 0.05) and was significantly negatively correlated with SAA. The rsFC in bilateral parietal lobes was higher than that in the control group (P < 0.05), was significantly positively correlated with SAA, and was negatively correlated with AVLT-delay.

CONCLUSIONS: The significant increase in SAA concentration in patients with OSAHS correlated with brain rsFC intensity, providing a reference role for the diagnosis, treatment, and prognosis of cognitive dysfunction in patients with OSAHS.

PMID:35503197 | DOI:10.1007/s11325-022-02613-2

World J Urol. 2022 May 3. doi: 10.1007/s00345-022-04016-0. Online ahead of print.

ABSTRACT

PURPOSE: To systematically review the published literature on surgical margins as a risk factor for local recurrence (LR) in patients undergoing partial nephrectomy (PN) for pT1 renal cell carcinomas (RCC).

EVIDENCE ACQUISITION: A systematic literature search of relevant databases (MEDLINE, Embase and the Cochrane Library) was performed according to the PRISMA criteria up to February 2022. The hypothesis was developed using the PPO method (Patients = patients with pT1 RCC undergoing PN, Prognostic factor = positive surgical margins (PSM) detected on final pathology versus negative surgical margins (NSM) and Outcome = LR diagnosed on follow-up imaging). The primary outcome was the rate of PSM and LR. The risk of bias was assessed by the QUIPS tool.

EVIDENCE SYNTHESIS: After assessing 1525 abstracts and 409 full-text articles, eight studies met the inclusion criteria. The percentage of PSM ranged between 0 and 34.3%. In these patients with PSM, LR varied between 0 and 9.1%, whereas only 0-1.5% of LR were found in the NSM-group. The calculated odds ratio (95% confident intervals) varied between 0.04 [0.00-0.79] and 0.27 [0.01-4.76] and was statistically significant in two studies (0.14 [0.02-0.80] and 0.04 [0.00-0.79]). The quality analysis of the included studies resulted in an overall intermediate to high risk of bias and the level of evidence was overall very low. A meta-analysis was considered unsuitable due to the high heterogeneity between the included studies.

CONCLUSION: PSM after PN in patients with pT1 RCC is associated with a higher risk of LR. However, the evidence has significant limitations and caution should be taken with the interpretation of this data.

PMID:35503118 | DOI:10.1007/s00345-022-04016-0

J Math Biol. 2022 May 3;84(6):47. doi: 10.1007/s00285-022-01746-y.

ABSTRACT

The evolutionary relationships among organisms have traditionally been represented using rooted phylogenetic trees. However, due to reticulate processes such as hybridization or lateral gene transfer, evolution cannot always be adequately represented by a phylogenetic tree, and rooted phylogenetic networks that describe such complex processes have been introduced as a generalization of rooted phylogenetic trees. In fact, estimating rooted phylogenetic networks from genomic sequence data and analyzing their structural properties is one of the most important tasks in contemporary phylogenetics. Over the last two decades, several subclasses of rooted phylogenetic networks (characterized by certain structural constraints) have been introduced in the literature, either to model specific biological phenomena or to enable tractable mathematical and computational analyses. In the present manuscript, we provide a thorough review of these network classes, as well as provide a biological interpretation of the structural constraints underlying these networks where possible. In addition, we discuss how imposing structural constraints on the network topology can be used to address the scalability and identifiability challenges faced in the estimation of phylogenetic networks from empirical data.

PMID:35503141 | DOI:10.1007/s00285-022-01746-y

Am J Sports Med. 2022 May 3:3635465221092144. doi: 10.1177/03635465221092144. Online ahead of print.

ABSTRACT

BACKGROUND: Hip arthroscopy for femoroacetabular impingement (FAI) in athletes, including military servicemembers, has resulted in variable outcomes. The prevalence of low back pain (LBP) and psychiatric disorders (PSYs) is high among patients undergoing hip arthroscopy.

PURPOSE: To determine the effect of LBP, PSYs, and the combination of both on outcomes in servicemembers treated arthroscopically for FAI.

STUDY DESIGN: Cohort study; Level of evidence, 2.

METHODS: Between April 2016 and June 2020, a total of 108 consecutive active-duty servicemembers underwent hip arthroscopy by a single surgeon at a single military medical center. Servicemembers were grouped according to the presence of preoperative LBP (Group LBP), a PSY (Group PSY), or both (Group Both), and outcomes were compared with those of servicemembers without these comorbidities (Group None). The minimum follow-up was 6 months. The primary outcome measure was return to duty (RTD). Secondary outcomes included the Nonarthritic Hip Score (NAHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL) subscale, and Hip Outcome Score-Sports (HOS-S) subscale.

RESULTS: All servicemembers’ final duty status was confirmed, with a mean follow-up of 2 years (range, 6 months-4.3 years). The prevalence of preoperative LBP and PSY was 27% and 39%, respectively. RTD was 59% (10/17) in Group LBP, 10% (3/30) in Group PSY, 0% (0/12) in Group Both, and 47% (23/49) in Group None. Compared with Group None, the risk of discontinuing military service was statistically higher in Group PSY (relative risk [RR], 1.70 [95% CI, 1.41-1.99]) and Group Both (RR, 1.88 [95% CI, 1.62-2.15]) but not in Group LBP (RR, 0.78 [95% CI, 0.15-1.40]). The mean preoperative secondary outcomes all significantly improved postoperatively in Group None (NAHS, 58 to 75 [P < .001]; HOS-ADL, 63 to 74 [P < .001]; HOS-S, 44 to 57 [P < .001]). Among the comorbid groups, the mean HOS-S did not significantly improve (Group LBP, 45 to 48 [P = .71]; Group PSY, 36 to 44 [P = .22]; Group Both 43 to 45 [P = .75]), and <50% of these servicemembers achieved HOS-S meaningful clinical benefit metrics.

CONCLUSION: Preoperative LBP, PSY, and a combination of both negatively affected outcomes after hip arthroscopy. Preoperative counseling is crucial in setting realistic outcome expectations.

PMID:35503098 | DOI:10.1177/03635465221092144

Ann Ital Chir. 2022;93:235-240.

ABSTRACT

OBJECTIVE: The present study aims to investigate the therapeutic effect and safety of radiofrequency ablation (RFA) of the great saphenous vein in the treatment of varicose veins of the lower extremities.

METHODS: Sixty-nine affected limbs of 45 patients were treated with RFA of the great saphenous vein. All patients underwent retrograde puncture of the distal great saphenous vein under the guidance of B-ultrasound. An RFA catheter was introduced 1 cm below the junction of the great saphenous vein and the femoral vein. A tumescent solution was injected around the femoral vein, and the great saphenous vein was ablated section by section from the upper part to the lower part. Twelve months after RFA, color Doppler ultrasound was used to evaluate the closure of great saphenous vein, and changes in the clinical class, etiology, anatomy, pathology (CEAP) classification before and after treatment were compared. The visual analogue score (VAS) was used to evaluate the local pain on the first and third day after operation. The incidence of complications (e.g., phlebitis, thrombosis, infection) was also evaluated.

RESULTS: The ablation of the 69 affected limbs in all the 45 patients was successful. Instant B-ultrasound revealed occlusion of the great saphenous vein and the disappearance of blood flow immediately after ablation. There was no reoccurrence in all patients at the 12 month follow-up. The CEAP classification grade after treatment was significantly lower than that before the treatment, and the difference was statistically significant (χ2 = 4.188, P<0.05). The VAS scores on the first and third days after operation were 1.85 ± 0.35 and 0.59 ± 0.21, respectively. Pain was mild, and only two patients required painkillers. No complications were noted, with the exception of five cases of local ecchymosis.

CONCLUSION: RFA of the great saphenous vein may represent an effective method for treating varicose veins of the lower extremities. RFA has the advantages of producing less trauma, fewer complications, and a lower incidence of recurrence.

KEY WORDS: B-ultrasonography, Pain, Radiofrequency ablation, Varicose veins.

PMID:35503057