Category: Statistics

Int Urol Nephrol. 2021 Nov 27. doi: 10.1007/s11255-021-03075-3. Online ahead of print.

ABSTRACT

PURPOSE: The main purpose of this study was to analyze the characteristics of dyspepsia and contributing factors in Montenegrin maintenance hemodialysis patients.

METHODS: The study included 43 patients undergoing hemodialysis with symptoms of dyspepsia and 40 control dyspeptic subjects with preserved kidney function. All subjects underwent an interview about dyspeptic symptoms, physical and biochemical examination, and upper gastrointestinal endoscopy with pathohistological analysis of biopsy specimens.

RESULTS: Early satiety, bloating and heartburn were the most common symptoms in hemodialysis patients but without significant difference in frequency in relation to controls. Chronic kidney disease patients had statistically lower concentration of total proteins and albumin (p < 0.001), as well lower BMI values (p = 0.002). Despite this, no significant correlation of laboratory parameters with dyspeptic symptoms was found. Pathohistological examination indicated that the most common finding in hemodialysis patients was chronic active gastritis (58%), while chronic atrophic gastritis was significantly more common in dialytic patients (p = 0.032). Patients on hemodialysis had more frequently atrophy of corpus mucosa, which was positively related to dialysis duration (p = 0.001) and negatively related to pH values (p = 0.004) and bicarbonate concentration (p = 0.049). Helicobacter pylori was considerably more common in patients who underwent shorter time on hemodialysis (p < 0.001) and had higher values of bicarbonate (p = 0.037).

CONCLUSION: Maintenance hemodialysis patients are at risk for chronic gastric diseases that correlated with both dialysis vintage and duration.

PMID:34837575 | DOI:10.1007/s11255-021-03075-3

Biomech Model Mechanobiol. 2021 Nov 27. doi: 10.1007/s10237-021-01533-6. Online ahead of print.

ABSTRACT

Evaluation of the bony anatomy of the glenohumeral joint is frequently required for surgical planning and subject-specific computational modeling and simulation. The three-dimensional geometry of bones is traditionally obtained by segmenting medical image datasets, but this can be time-consuming and may not be practical in the clinical setting. The aims of this study were twofold. Firstly, to develop and validate a statistical shape modeling approach to rapidly reconstruct the complete scapular and humeral geometries using discrete morphometric measurements that can be quickly and easily measured directly from CT, and secondly, to assess the effectiveness of statistical shape modeling in reconstruction of the entire humerus using just the landmarks in the immediate vicinity of the glenohumeral joint. The most representative shape prediction models presented in this study achieved complete scapular and humeral geometry prediction from seven or fewer morphometric measurements and yielded a mean surface root mean square (RMS) error under 2 mm. Reconstruction of the entire humerus was achieved using information of only proximal humerus bony landmarks and yielding mean surface RMS errors under 3 mm. The proposed statistical shape modeling facilitates rapid generation of 3D anatomical models of the shoulder, which may be useful in rapid development of personalized musculoskeletal models.

PMID:34837584 | DOI:10.1007/s10237-021-01533-6

Clin Oral Investig. 2021 Nov 27. doi: 10.1007/s00784-021-04309-5. Online ahead of print.

ABSTRACT

OBJECTIVES: To three-dimensionally evaluate deviations of full-arch intraoral (IO) scans from reference desktop scans in terms of translations and rotations of individual teeth and different types of (mal)occlusion.

MATERIALS AND METHODS: Three resin model pairs reflecting different tooth (mal)positions were mounted in the phantom head of a dental simulation unit and scanned by three dentists and three non-graduate investigators using a confocal laser IO scanner (Trios 3®). The tooth-crown surfaces of the IO scans and reference scans were superimposed by means of best-fit alignment. A novel method comprising the measurement of individual tooth positions was used to determine the deviations of each tooth in the six degrees of freedom, i.e., in terms of 3D translation and rotation. Deviations between IO and reference scans, among tooth-(mal)position models, and between dentists and non-graduate investigators were analyzed using linear mixed-effects models.

RESULTS: The overall translational deviations of individual teeth on the IO scans were 76, 32, and 58 µm in the lingual, mesial, and intrusive directions, respectively, resulting in a total displacement of 114 µm. Corresponding rotational deviations were 0.58° buccal tipping, 0.04° mesial tipping, and 0.14° distorotation leading to a combined rotation of 0.78°. These deviations were the smallest for the dental arches with anterior crowding, followed by those with spacing and those with good alignment (p < 0.05). Results were independent of the operator’s level of education.

CONCLUSIONS: Compared to reference desktop scans, individual teeth on full-arch IO scans showed high trueness with total translational and rotational deviations < 115 µm and < 0.80°, respectively.

CLINICAL RELEVANCE: Available confocal laser IO scanners appear sufficiently accurate for diagnostic and therapeutic orthodontic applications. Results indicate that full-arch IO scanning can be delegated to non-graduate dental staff members.

PMID:34837565 | DOI:10.1007/s00784-021-04309-5

Int Urol Nephrol. 2021 Nov 27. doi: 10.1007/s11255-021-03068-2. Online ahead of print.

ABSTRACT

PURPOSE: To assess the impact of preoperative chronic kidney disease (CKD) on perioperative morbidity and mortality in a contemporary cohort undergoing renal surgery in an era of increased prevalence of minimally invasive surgery and partial nephrectomy.

METHODS: The National Surgery Quality Improvement Program dataset was queried to identify patients undergoing radical nephrectomy (RN) or partial nephrectomy (PN) between 2010 and 2018. CKD staging was assigned based on creatinine clearance calculated using the Cockcroft-Gault formula. Multivariable logistic regression was performed to assess the effect of preoperative CKD stage on postoperative outcomes, including a composite variable encompassing multiple major complications.

RESULTS: We analyzed 19,545 patients with CKD undergoing renal surgery. CKD stage ≥ 2 predicted an increase in major perioperative complications, OR 1.54 (95% CI 1.46-1.63); p < 0.01. The risk of perioperative morbidity increased linearly with increasing CKD stage. Patients with CKD stage > 2 also demonstrated increased 30-day mortality, OR 1.87 (95% CI 1.26-2.48); p < 0.01. Adjusting for surgery type, CKD staging predicted perioperative mortality in patients undergoing RN only, and perioperative morbidity in RN and PN.

CONCLUSIONS: Here, we demonstrate a statistically significant increase in the risk of major postoperative complications following RN and PN with increasing CKD stage. Amongst patients undergoing RN, we also demonstrate increasing 30-day mortality with increasing CKD stage. Importantly, we highlight the ability of CKD staging to predict major perioperative outcomes with greater magnitude of effect than surgery type alone. Thus, we provide a model for translating CKD staging into operative risk amongst patients undergoing surgery for a renal mass.

PMID:34837574 | DOI:10.1007/s11255-021-03068-2

Metabolomics. 2021 Nov 27;17(12):105. doi: 10.1007/s11306-021-01857-5.

ABSTRACT

INTRODUCTION: Gestational diabetes mellitus (GDM) significantly increases maternal and fetal health risks, but factors predictive of GDM are poorly understood.

OBJECTIVES: Plasma metabolomics analyses were conducted in early pregnancy to identify potential metabolites associated with prediction of GDM.

METHODS: Sixty-eight pregnant women with overweight/obesity from a clinical trial of a lifestyle intervention were included. Participants who developed GDM (n = 34; GDM group) were matched on treatment group, age, body mass index, and ethnicity with those who did not develop GDM (n = 34; Non-GDM group). Blood draws were completed early in pregnancy (10-16 weeks). Plasma samples were analyzed by UPLC-MS using three metabolomics assays.

RESULTS: One hundred thirty moieties were identified. Thirteen metabolites including pyrimidine/purine derivatives involved in uric acid metabolism, carboxylic acids, fatty acylcarnitines, and sphingomyelins (SM) were different when comparing the GDM vs. the Non-GDM groups (p < 0.05). The most significant differences were elevations in the metabolites’ hypoxanthine, xanthine and alpha-hydroxybutyrate (p < 0.002, adjusted p < 0.02) in GDM patients. A panel consisting of four metabolites: SM 14:0, hypoxanthine, alpha-hydroxybutyrate, and xanthine presented the highest diagnostic accuracy with an AUC = 0.833 (95% CI: 0.572686-0.893946), classifying as a “very good panel”.

CONCLUSION: Plasma metabolites mainly involved in purine degradation, insulin resistance, and fatty acid oxidation, were altered in early pregnancy in connection with subsequent GDM development.

PMID:34837546 | DOI:10.1007/s11306-021-01857-5

Bull Math Biol. 2021 Nov 27;84(1):8. doi: 10.1007/s11538-021-00968-3.

ABSTRACT

Kidney disease and renal disorders account for a significant proportion of health complications in mid-late adulthood worldwide. Many renal deficiencies are due to improper formation of the kidneys before birth, which are caused by disorders in the developmental process that arise from genetic and/or environmental factors. Mathematical modelling can help build on experimental knowledge to increase our understanding of the complexities of kidney organogenesis. In this paper, we present a discrete cell-based model of kidney development. Specifically, we model the tip of the developing ureteric tree to investigate the behaviours of cap mesenchyme cells which are required to sustain ureteric tip growth. We find that spatial regulation of the differentiation of cap mesenchyme cells through cellular signalling is sufficient to ensure robust ureteric tip development. Additionally, we find that increased adhesion interactions between cap mesenchyme cells and the ureteric tip surface can lead to a more stable tip-cap unit. Our analysis of the various processes on this scale highlights essential components for healthy kidney growth and provides insight into mechanisms to be studied further in order to replicate the process in vitro.

PMID:34837548 | DOI:10.1007/s11538-021-00968-3

Int J Biometeorol. 2021 Nov 27. doi: 10.1007/s00484-021-02225-7. Online ahead of print.

ABSTRACT

This study aimed to compare the peloid therapy and kinesio tape treatments in chronic lateral epicondylitis. While home exercise program and cold application were applied to the control group, peloid therapy (5 days a week for 3 weeks at 45 °C for 30 min each day, a total of 15 treatment days) was applied in addition to the first group, and kinesio taping (6 treatment days 2 times a week) was applied to the second group. Patients were evaluated with visual analog scale (VAS), grip strength with Jamar hydraulic dynamometer, Arm, Shoulder, and Hand Disabilities (DASH), quality of life in Short Form-36 (SF-36), and Patient-Rated Forearm Evaluation Questionnaire (PRFEQ) was recorded before treatment, after treatment (third week), and 1 month after the end of treatment. In this study, 156 patients with chronic lateral epicondylitis were included. In the follow-up of the patients, there was a statistically significant improvement in the hand grip strength, DASH, PRFEQ, VAS, and SF-36 scores in the 1st month follow-up after the treatment compared to the pre-treatment control in all groups (p < 0.001). At the end of the treatment, the hand grip strength (p = 0.002), DASH (p < 0.001), PRFEQ pain (p < 0.001) and function (p = 0.007), SF-36 physical health (p = 0.002) scores were statistically significant in the peloid therapy group compared to the control group. At the 1st month after the end of treatment, hand grip strength, VAS, DASH, PRFEQ pain, function, daily activities, and SF-36 physical health scores (all of p < 0.001) were statistically significant in the peloid treatment group compared to the control group. Peloid treatment was found to be more effective than kinesio taping in SF-36 physical health (p = 0.007) and PRFEQ pain (p = 0.003) scores in the 1st month follow-up after treatment. Peloid therapy in addition to exercise seems more effective in chronic lateral epicondylitis. Randomized controlled long-term studies are needed.ClinicalTrials ID: NCT04687943.

PMID:34837528 | DOI:10.1007/s00484-021-02225-7

J Cancer Res Clin Oncol. 2021 Nov 27. doi: 10.1007/s00432-021-03859-1. Online ahead of print.

ABSTRACT

INTRODUCTION: Melanoma-associated antigen A2 (MAGE-A2) is a member of the cancer-testis antigen family differentially overexpressed in a variety of malignancies and is associated with tumor development. However, clinical significance and prognostic value of MAGE-A2 in different histological subtypes of testicular germ cell tumors (TGCTs) have not been explored.

MATERIALS AND METHODS: Here, we aimed to investigate the clinical significance and prognostic impact of MAGE-A2 expression in TGCTs compared to benign tumors as well as adjacent normal tissues and then between seminomas and non-seminomas groups using immunohistochemistry on tissue microarrays.

RESULTS: The results indicated a statistically significant difference between overexpression of MAGE-A2 and histological subtypes of TGCTs. A statistically significant association was found between a high level of nuclear expression of MAGE-A2 protein and advanced pT stage (P = 0.022), vascular invasion (P = 0.037), as well as involvement of rete testis (P = 0.022) in embryonal carcinomas. Increased nuclear expression of MAGE-A2 was observed to be associated with more aggressive behaviors and tumor progression rather than cytoplasmic expression in these cases. Further, high level nuclear expression of MAGE-A2 had shorter disease-specific survival (DSS) or progression-free survival (PFS) compared to patients with moderate and low expression of MAGE-A2, however, without a statistically significant association.

CONCLUSION: Our results confirm that increased nuclear expression of MAGE-A2 has a clinical significance in embryonal carcinomas and is associated with progression of disease. Moreover, MAGE-A2 may act as a potential predictive biomarker for the prognosis in embryonal carcinomas if follow-up period becomes longer. Further investigations for the biological function of MAGE-A2 are required in future studies.

PMID:34837545 | DOI:10.1007/s00432-021-03859-1

Graefes Arch Clin Exp Ophthalmol. 2021 Nov 27. doi: 10.1007/s00417-021-05314-w. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the long-term visual, refractive, tomographic, and aberrometric outcomes of corneal collagen crosslinking (CXL) with or without hypoosmolar riboflavin solution in the treatment of progressive keratoconus patients with thin corneas.

METHODS: Charts of consecutive progressive keratoconus patients with thinnest corneal thickness less than 470 µm who underwent corneal collagen CXL with or without hypoosmolar riboflavin solution and using a standardized protocol for treatment and examinations were analyzed retrospectively. The indication for hypoosmolar riboflavin use was a central corneal thickness less than 400 µm as measured by ultrasound pachymetry after epithelial debridement and before exposure to ultraviolet A (UVA) light. Uncorrected distance visual acuity (UDVA), best spectacle-corrected distance visual acuity (CDVA), manifest refraction, slit lamp biomicroscopy, corneal tomography, corneal aberrometry, and endothelial cell counts were evaluated at baseline and yearly at all postoperative follow-up examinations until month 36. The outcomes of corneal CXL procedure performed using hypoosmolar riboflavin were compared to those performed using the standard procedure.

RESULTS: Twenty-three eyes (19 patients) were treated using hypoosmolar riboflavin application, and 30 eyes (28 patients) were treated using the standard procedure. Compared to baseline, the mean UDVA, CDVA, and keratometric readings improved statistically significantly in both groups at postoperative year 3, without any statistically significant between-group differences. Progression was not observed in any patient eye in either group. No significant endothelial cell loss and no sight threating complication were observed in any patient eye.

CONCLUSION: At 3 years follow-up, the safety and efficacy of CXL using hypoosmolar riboflavin solution seems to be similar to that of standard CXL in progressive keratoconic eyes with thin corneas. The visual, refractive, keratometric, tomographic and aberrometric outcomes of the two procedures were comparable, as well.

PMID:34837507 | DOI:10.1007/s00417-021-05314-w

Liver Transpl. 2021 Nov 27. doi: 10.1002/lt.26379. Online ahead of print.

ABSTRACT

BACKGROUND: Biliary strictures affect 4-12% of pediatric liver transplants (P-LT). Biliary strictures can contribute to graft loss if left untreated, however there remains no consensus on the best course of treatment. Study objectives included analyses of outcomes associated with biliary stricture management strategies via PTC, ERCP or surgery.

METHODS: We identified P-LT recipients (2011-2016) with biliary strictures from the Society of Pediatric Liver Transplantation (SPLIT) registry and retrieved imaging, procedural and operative reports from individual centers. Sub-analyses were performed to specifically evaluate PTC and ERCP for “Optimal Biliary Outcome” (OBO), defined as survival with stricture resolution without recurrence or surgery.

RESULTS: 113 children with median 3.9 years of follow-up had strictures diagnosed 100 days (IQR 30, 290) post LT; 81% were isolated anastomotic strictures. Stricture resolution was achieved in 92% within 101 days, more frequently with isolated anastomotic strictures (96%). 20% of strictures recurred, more commonly in association with hepatic artery thrombosis (32%). Patient and graft survival at 1- and 3-years were 99%, 98% and 94%, 92% respectively. In a subgroup analysis of 79 patients with extrahepatic strictures managed by PTC/ERCP: 59% achieved OBO following a median 4 PTC, and 75% following a median 3 ERCP (P=0.0003). Among patients with OBO, those with ERCP had longer time intervals between successive procedures (41, 47, 54, 62, 71 days) than for PTC (27, 31, 36, 41, 48 days; P=0.0006).

CONCLUSIONS: Allograft salvage was successful across all interventions. Stricture resolution was achieved in 92%, with 20% risk of recurrence. Resolution without recurrence was highest in patients with isolated anastomotic strictures and without HAT.

PMID:34837468 | DOI:10.1002/lt.26379