Category: Statistics

Andrology. 2022 Feb 18. doi: 10.1111/andr.13162. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate clinical outcomes, radiation exposure and procedural costs associated with percutaneous varicocele embolization using coils and sclerosing agents (SA) in a cohort of young-adult men.

MATERIALS AND METHODS: Data from consecutive men treated with percutaneous varicocele embolization using coils and SA between 2017 and 2021 were analyzed. The allocation was based on a change of policy occurred in June 2020 with the substitution of coils with SA (before and after study). Semen analysis values were based on 2010 WHO reference criteria. Anatomic variants of gonadal veins were categorized according to Jargiello et al. Intraoperative radiation dose and procedural costs were collected for each patient. Descriptive statistics and linear regression models were used to describe the association between clinical parameters with procedural costs and radiation exposure.

RESULTS: One hundred sixteen men were included, of whom 76 (65.5%) received coils and 40 (34.5%) received SA. Baseline characteristics of the two study groups did not differ. A type 3 Jargiello anatomic variation of left gonadal vein was found in 45.7% of cases. Radiation dose was lower in the SA group as compared to the coils one [13.2 (7-43) vs. 19.8 (12-57) Gy/cm² ; p<0.001]. Similarly, procedural costs were lower for the SA group [169.6 (169-199) € vs. 642.5 (561-775) €; p<0.001]. At follow up, pain and sperm variables significantly improved in both groups (p<0.01), without differences among the embolic materials. Linear regression model revealed that coils use was associated with higher radiation exposure (beta 8.8, p = 0.02) than SA after accounting for anatomic variation of gonadal vein, BMI and vascular access.

CONCLUSIONS: SA and coils for varicocele embolization are equally safe and effective. The use of SA was associated with lower radiation exposure and procedural costs than coils. These results should be considered in terms of public health cost and patient’s safety. This article is protected by copyright. All rights reserved.

PMID:35179316 | DOI:10.1111/andr.13162

Orthop Surg. 2022 Feb 18. doi: 10.1111/os.13188. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze the efficacy of modified Allgöwer-Donati suture (MADS) technique on cosmetic outcomes compared with vertical mattress suture (VMS) technique in spinal surgery wounds.

METHODS: This randomized controlled trial was conducted at the First Hospital of Lanzhou University (Gansu, China) from September 2019 to August 2020. The patients were randomly divided into two groups, a VMS group and a MADS group, by staff not involved in the treatment using a computer-based random number table program (no restrictions on age or sex). Both procedures were performed by the same group of physicians as well as assistants. All suture wounds were completed by the same person. The primary endpoint was the scar area, and the postoperative scar area was scored by the Patient and Observer Scar Scale Assessment (POSAS). The scar area was calculated by ImageJ software. The second outcome measure was wound complications, including poor wound healing, wound edge necrosis, and infection. The trial was recorded in the Chinese Clinical Trial Register on 18 August 2019 (ChiCTR1900024548).

RESULTS: A total of 143 patients were included: 72 in the VMS group and 71 in the MADS group. There was no significant difference in their demographics in terms of age (49.71 ± 8.91 vs 50.15 ± 6.79 years, P = 0.737), sex (M/F, 30/41 vs 31/41, P = 0.923), suture time (3.39 ± 0.22 vs 3.47 ± 0.25 s/mm, P = 0.057), or body mass index (BMI, 23.88 ± 3.50 vs 24.05 ± 3.50, P = 0.765) for MADS to VMS. The postoperative scar area was compared between the two groups transversely on day 12, the MADS wound scars decreased by 58.95% (75,133.24/127,452.58). In the POSAS evaluation, after MADS treatment, surface area score decreased from 5 (4, 5) to 2 (2, 3) (P < 0.0001), observer’s overall opinion from 5 (4, 5) to 3 (2, 3) (P < 0.0001), itching from 3 (3, 4) to 3 (2, 3) (P = 0.001), color from 4 (4, 5) to 3 (2-4) (P < 0.0001), stiffness 4 (3-4.75) to 3 (3, 4) (P < 0.0001), or thickness from 4 (3-5) to 4 (3, 4) (P = 0.004). In terms of overall opinion evaluation, the MADS showed a significant difference in observer’s overall opinion to the VMS (5 (4, 5) vs 3 (2, 3), P < 0.0001) and in patient’s overall opinion 5 (5, 6) to 3 (3, 4), (P < 0.0001). There was no significant statistical difference in poor wound healing (3 vs 0, P = 0.245), wound edge necrosis (3 vs 0, P = 0.245), and infection (1 vs 0, P = 1.000) with the MADS to the VMS.

CONCLUSION: The results of this study show that the MADS effectively reduced the surgical scar area to 58.95% with no additional adverse events compared with that of the VMS in spine surgery.

PMID:35179312 | DOI:10.1111/os.13188

Cancer Med. 2022 Feb 18. doi: 10.1002/cam4.4607. Online ahead of print.

ABSTRACT

BACKGROUND: More than a third of thyroid carcinoma (TC) patients require treatment with radioactive iodine (RAI), but the timing of initial RAI therapy after thyroidectomy remains controversial.

METHODS: We included 1224 differentiated thyroid carcinoma (DTC) patients during 2015-2019, divided them into the early (≤3 months) and the delayed (>3 months) groups based on the interval between surgery and the initial RAI. Clinical outcomes were assessed within 6-8 months of treatment with RAI, including excellent response (ER), indeterminate response (IDR), biochemical incomplete (BIR) and structural incomplete response (SIR). Further transformed them into dichotomous outcomes, we therefore introduced the ordered/binary logistic regression to assess the relation of time interval and quaternary/dichotomous outcomes, respectively. Finally, we conducted a meta-analysis for cohort study to investigate the effect of timing of RAI therapy on the prognosis of TC.

RESULTS: Delay RAI therapy beyond 3 months reduced the IR (BIR + SIR) rate in the present cohort study (RR = 0.67, 95% CI: 0.49-91). Following meta-analysis including 38,688 DTC patients confirmed these results (RR = 0.77, 95% CI: 0.66-0.91), further revealed the duration of treatment does not influence OS (pooled RR = 1.05, 95% CI: 0.83-1.33).

CONCLUSION: Delayed initial RAI therapy beyond 3 months but no later than 6 months did not impair the prognosis of TC.

PMID:35179295 | DOI:10.1002/cam4.4607

Cancer Med. 2022 Feb 18. doi: 10.1002/cam4.4611. Online ahead of print.

ABSTRACT

BACKGROUND: Case reports of bladder carcinosarcoma (BCS) indicate high rates of recurrence and metastasis and poor prognosis. However, the differences in clinicopathologic characteristics and prognosis between BCS and conventional bladder cancer histologies (transitional cell carcinoma [TCC], squamous cell carcinoma [SCC] and adenocarcinoma [AC]) have not been fully clarified in a large study. Therefore, we conducted a large population-based study to further investigate these differences.

PATIENTS AND METHODS: Information on patients with BCS and conventional bladder cancer (TCC, SCC or AC) was extracted from the Surveillance, Epidemiology, and End Results database. Categorical variables were compared using Pearson’s chi-squared test or Fisher’s exact test. Survival analysis was carried out using the Kaplan-Meier method, and differences in survival were assessed using the log-rank test. Propensity score matching analysis was conducted to calibrate the differences between the baseline characteristics, after which Cox regression analysis was applied to calculate the hazard ratios and 95% confidence intervals of BCS compared to other subtypes. Subgroup analysis and related interaction were tested to evaluate the consistency and heterogeneity of results.

RESULTS: We enrolled 152 patients with BCS and 180,196 patients with TCC, SCC or AC. Our results showed that BCS was associated with poor differentiation, advanced stage and an unfavourable overall survival and cancer-specific survival. BCS had a worse prognosis than TCC and AC, but no statistically significant difference in survival was noted between BCS and SCC.

CONCLUSIONS: BCS is a more aggressive bladder cancer than TCC and AC but is comparable to SCC. These findings broaden our understanding of BCS and may be helpful in clinical practice.

PMID:35179304 | DOI:10.1002/cam4.4611

Laryngoscope. 2022 Feb 18. doi: 10.1002/lary.30069. Online ahead of print.

ABSTRACT

OBJECTIVES: With the increase in dental implants for tooth loss, odontogenic sinusitis following maxillary dental implants is frequently encountered in otorhinolaryngology practice. The authors aimed to reveal the association between implant extrusion into maxillary sinus, along with implant-related complications in patients diagnosed with implant-related odontogenic sinusitis (IR-ODS).

STUDY DESIGN: Case-control study.

METHODS: This study enrolled 60 patients who received functional endoscopic sinus surgery due to IR-ODS. The preoperative sinus computed tomography was retrospectively reviewed. Among the 120 maxillary sinuses of the 60 patients, 68 sides were diagnosed with IR-ODS sides, whereas 27 sides showed no clinical or radiological evidence of this condition after the implant insertion and were defined as the control sides. Statistical analysis between these two groups was conducted, in addition to odds ratio (OR) calculations for associations with IR-ODS.

RESULTS: The mean age of the IR-ODS subjects was 59.5 ± 19.1, with a male to female ratio of 32/28 (53.3%/46.7%). Implants extruding by more than 4 mm into the maxillary sinus, peri-implantitis, bone graft disruption-extrusion were associated with a significantly higher incidence in the IR-ODS (p = 0.035, p = 0.003, p = 0.011, respectively). The IR-ODS sides showed an adjusted-OR (95% confidence interval) of 27.4 (2.7-276.5) for extrusion length >4 mm, 11.8 (3.0-46.5) for peri-implantitis, and 34.1 (3.3-347.8) for bone graft disruption (p = 0.005, p < 0.001, and p = 0.003, respectively).

CONCLUSION: Maxillary dental implants extruding more than 4 mm into the maxillary sinus, peri-implantitis, and disrupted-extruded bone grafts show significant association with IR-ODS.

LEVEL OF EVIDENCE: 4 Laryngoscope, 2022.

PMID:35179239 | DOI:10.1002/lary.30069

Int J Geriatr Psychiatry. 2022 Mar;37(3). doi: 10.1002/gps.5696.

ABSTRACT

BACKGROUND: Older age is a substantial risk factor for serious illness from COVID-19. Moreover, isolation and quarantine are more likely to cause physical, mental and social deprivation in older age. Information and Communication Tools are means to prevent such consequences.

OBJECTIVE: This study aimed therefore to investigate the impact of the COVID-19 lockdown measures on the usage of an innovative technical support system deployed in Austria (AT) and Luxembourg (LU) consisting of several tools that allow independent living in older age.

METHODS: Thirty-nine older adults (11 male; 28 female) with a mean age of 74.3 (SD 7.3) years were included in the study. In total, 18 older people were recruited in AT and 21 in LU. Descriptive statistics were computed, and longitudinal models were fitted for technology use and self-reported mood.

RESULTS: The number of older adults using the system significantly decreased from the time before lockdown (39 [100%]) to during lockdown (26 [67%]) and thereafter (23 [59%]; p < 0.001). Multiple comparisons revealed a significant reduction in the average number of events for calendar and medication tools, but a substantial increase in communication and messaging events. Self-reported well-being declined during the lockdown and increased afterwards back to baseline levels.

CONCLUSION: Communication was the main reason for using the support system. In addition, strategies and interventions are essential to support older adults when using information technology in the prolonged phases of the pandemic to sustain independent living.

CLINICAL TRIAL REGISTRATION: The DAPAS protocol was published at www.researchgate.net. DOI: 10.13140/RG.2.2.24233.34401.

PMID:35179240 | DOI:10.1002/gps.5696

Epilepsia. 2022 Feb 18. doi: 10.1111/epi.17173. Online ahead of print.

ABSTRACT

OBJECTIVE: Epilepsy is common in patients with PIGN diseases due to biallelic variants; however, limited epilepsy phenotyping data have been reported. We describe the epileptology of PIGN encephalopathy.

METHODS: We recruited patients with epilepsy due to biallelic PIGN variants and obtained clinical data regarding age at seizure onset/offset and semiology, development, medical history, examination, electroencephalogram, neuroimaging, and treatment. Seizure and epilepsy types were classified.

RESULTS: Twenty six patients (13 female) from 26 families were identified, with mean age 7 years (range = 1 month to 21 years; three deceased). Abnormal development at seizure onset was present in 25 of 26. Developmental outcome was most frequently profound (14/26) or severe (11/26). Patients presented with focal motor (12/26), unknown onset motor (5/26), focal impaired awareness (1/26), absence (2/26), myoclonic (2/26), myoclonic-atonic (1/26), and generalized tonic-clonic (2/26) seizures. Twenty of 26 were classified as developmental and epileptic encephalopathy (DEE): 55% (11/20) focal DEE, 30% (6/20) generalized DEE, and 15% (3/20) combined DEE. Six had intellectual disability and epilepsy (ID+E): two generalized and four focal epilepsy. Mean age at seizure onset was 13 months (birth to 10 years), with a lower mean onset in DEE (7 months) compared with ID+E (33 months). Patients with DEE had drug-resistant epilepsy, compared to 4/6 ID+E patients, who were seizure-free. Hyperkinetic movement disorder occurred in 13 of 26 patients. Twenty-seven of 34 variants were novel. Variants were truncating (n = 7), intronic and predicted to affect splicing (n = 7), and missense or inframe indels (n = 20, of which 11 were predicted to affect splicing). Seven variants were recurrent, including p.Leu311Trp in 10 unrelated patients, nine with generalized seizures, accounting for nine of the 11 patients in this cohort with generalized seizures.

SIGNIFICANCE: PIGN encephalopathy is a complex autosomal recessive disorder associated with a wide spectrum of epilepsy phenotypes, typically with substantial profound to severe developmental impairment.

PMID:35179230 | DOI:10.1111/epi.17173

BJS Open. 2021 May 7;5(3):zrab010. doi: 10.1093/bjsopen/zrab010.

ABSTRACT

BACKGROUND: The Esophagectomy Complications Consensus Group (ECCG) and the Dutch Upper Gastrointestinal Cancer Audit (DUCA) have set standards in reporting outcomes after oesophagectomy. Reporting outcomes from selected high-volume centres or centralized national cancer programmes may not, however, be reflective of the true global prevalence of complications. This study aimed to compare complication rates after oesophagectomy from these existing sources with those of an unselected international cohort from the Oesophago-Gastric Anastomosis Audit (OGAA).

METHODS: The OGAA was a prospective multicentre cohort study coordinated by the West Midlands Research Collaborative, and included patients undergoing oesophagectomy for oesophageal cancer between April and December 2018, with 90 days of follow-up.

RESULTS: The OGAA study included 2247 oesophagectomies across 137 hospitals in 41 countries. Comparisons with the ECCG and DUCA found differences in baseline demographics between the three cohorts, including age, ASA grade, and rates of chronic pulmonary disease. The OGAA had the lowest rates of neoadjuvant treatment (OGAA 75.1 per cent, ECCG 78.9 per cent, DUCA 93.5 per cent; P < 0.001). DUCA exhibited the highest rates of minimally invasive surgery (OGAA 57.2 per cent, ECCG 47.9 per cent, DUCA 85.8 per cent; P < 0.001). Overall complication rates were similar in the three cohorts (OGAA 63.6 per cent, ECCG 59.0 per cent, DUCA 62.2 per cent), with no statistically significant difference in Clavien-Dindo grades (P = 0.752). However, a significant difference in 30-day mortality was observed, with DUCA reporting the lowest rate (OGAA 3.2 per cent, ECCG 2.4 per cent, DUCA 1.7 per cent; P = 0.013).

CONCLUSION: Despite differences in rates of co-morbidities, oncological treatment strategies, and access to minimal-access surgery, overall complication rates were similar in the three cohorts.

PMID:35179183 | DOI:10.1093/bjsopen/zrab010

Mol Omics. 2022 Feb 18. doi: 10.1039/d1mo00377a. Online ahead of print.

ABSTRACT

Bacteria are amongst the leading causes of mortality worldwide. Although several studies have proposed the possible therapeutic role of vitamin D in bacterial infection, the exact mechanism through which vitamin D functions in antibacterial immunity remains elusive. The metabolic reconfigurations induced by vitamin D in bacterial infection can therefore be explored through metabolomics, a multidisciplinary ‘omics’ science that evaluates the metabolic changes of a biological system by identifying and quantifying metabolites under specific conditions. In the present study, cultured U937 macrophages were treated with Pam₃CSK₄/mL, 1,25(OH)₂D₃ and a combination of Pam₃CSK₄/mL and 1,25(OH)₂D₃. These treatment/stimulated U937 cells were compared to untreated cells in order to measure the metabolic effect of vitamin D (1,25(OH)₂D₃). Intracellular metabolomics was performed using nuclear magnetic resonance. The obtained data were subjected to chemometric modelling and statistical analyses, which revealed a clear distinction between the metabolic profiles of Pam₃CSK₄ stimulated cells, 1.25(OH)₂D₃ supplemented cells and cells supplemented with a combination of Pam₃CSK₄/1.25(OH)₂D₃ as compared to the untreated cells. Significant differences (p < 0.05) were identified in 32 metabolites linked to bioenergy production, redox reaction regulation, inflammation and protein synthesis. The generated results illustrate that 1.25(OH)₂D₃ reprogrammes the metabolic profile of U937 cells stimulated with Pam₃CSK₄.

PMID:35179165 | DOI:10.1039/d1mo00377a

Ugeskr Laeger. 2022 Feb 7;184(6):V02210146.

ABSTRACT

To directly relate tissue abnormalities to dysfunctional voicing, it is decisive to temporally resolve the vocal fold movement during phonation on the microscopic level. High-speed video (HSV) can record the vocal folds with 2,000-4,000 fps. Ultra-high resolution optical coherence tomography can distinguish cellular layers with a resolution better than 5 μm within a tissue depth of 1 mm. In this review, we propose combining the two technologies and apply deep learning-based image segmentation to establish statistical evident and reproducible documentation for voice-related diseases.

PMID:35179120