Category: Statistics

Knee Surg Sports Traumatol Arthrosc. 2021 Jun 5. doi: 10.1007/s00167-021-06613-9. Online ahead of print.

ABSTRACT

PURPOSE: Current treatment recommendations emphasize early loading, with preservation of tendon length and physiologic tension. The objective of this systematic review and network meta-analysis was to compare failure load and elongation after cyclic loading of Achilles tendon repair techniques at time-zero.

METHODS: The databases PubMed, CENTRAL and Web of Science were searched for all published in-vitro studies comparing Achilles tendon repair techniques, or augmentation with autografts/biomaterials, and reports of failure load or elongation after cyclic loading. Only studies using human cadaveric Achilles tendons and matched pairs, or randomized specimen allocation, were selected for quantitative synthesis. A network meta-analysis per primary outcome was performed. Results were summarized as P score rankings and their validity was assessed using statistical methods.

RESULTS: Sixteen studies, comprising 367 tendon repairs, were included. The following repair techniques were used (n = number of studies): Krackow (n = 8), Achillon (n = 4), double Krackow (n = 3), Bunnell (n = 3), Percutaneous Achilles Repair System (n = 3), Percutaneous Achilles Repair System Midsubstance (n = 2), Kessler (n = 3), double Kessler (n = 1), modified triple Kessler (n = 1), triple bundle (n = 1), a multifilament stainless steel cable-crimp technique (n = 1) and a double loop knot stitch (n = 1). Five studies assessed augmentation with autografts/biomaterials. Regarding the failure load, biomaterial augmented Krackow repairs occupied the first four positions in the ranking, followed by the multifilament stainless steel cable-crimp and Percutaneous Achilles Repair System Midsubstance techniques. Concerning elongation after cyclic loading, the triple Kessler was ranked first, followed by the Achillon and Percutaneous Achilles Repair System Midsubstance techniques. A negligible correlation between ranks was found (r_s = 0.11; p = 0.75n.s.), meaning that a higher repair tensile strength is not necessarily related to improved performance in regard to avoidance of elongation.

CONCLUSION: In the failure load network meta-analysis, biomaterial augmented Krackow repairs ranked highest, but noticeable statistical heterogeneity was found. Regarding elongation with cyclic loading, the modified triple Kessler stitch showed the highest probability of ranking first.

LEVEL OF EVIDENCE: Level IV.

PMID:34089335 | DOI:10.1007/s00167-021-06613-9

Int Arch Occup Environ Health. 2021 Jun 5. doi: 10.1007/s00420-021-01721-y. Online ahead of print.

ABSTRACT

PURPOSE: Over the last few decades, a global increase in both cold and heat extremes has been observed with significant impacts on human mortality. Although it is well-identified that older individuals (> 65 years) are most prone to temperature-related mortality, there is no consensus on the effect of sex. The current study investigated if sex differences in temperature-related mortality exist in the Netherlands.

METHODS: Twenty-three-year ambient temperature data of the Netherlands were combined with daily mortality data which were subdivided into sex and three age classes (< 65 years, 65-80 years, ≥ 80 years). Distributed lag non-linear models were used to analyze the effect of ambient temperature on mortality and determine sex differences in mortality attributable to the cold and heat, which is defined as mean daily temperatures below and above the Minimum Mortality Temperature, respectively.

RESULTS: Attributable fractions in the heat were higher in females, especially in the oldest group under extreme heat (≥ 97.5th percentile), whilst no sex differences were found in the cold. Cold- and heat-related mortality was most prominent in the oldest age group (≥ 80 years) and to a smaller extent in the age group between 65-80 years. In the age group < 65 years temperature-related mortality was only significant for males in the heat.

CONCLUSION: Mortality in the Netherlands represents the typical V- or hockey-stick shaped curve with a higher daily mortality in the cold and heat than at milder temperatures in both males and females, especially in the age group ≥ 80 years. Heat-related mortality was higher in females than in males, especially in the oldest age group (≥ 80 years) under extreme heat, whilst in the cold no sex differences were found. The underlying cause may be of physiological or behavioral nature, but more research is necessary.

PMID:34089351 | DOI:10.1007/s00420-021-01721-y

J Cosmet Dermatol. 2021 Jun 5. doi: 10.1111/jocd.14278. Online ahead of print.

ABSTRACT

BACKGROUND: Auricular melanomas are rare malignancies, and conflicting reports regarding their clinical behaviors have been published so far.

OBJECTIVE: In this study, we investigated the clinical features of the auricular melanomas and compared them with periauricular skin melanomas.

METHODS: The data of 53 primary melanomas arising in auricular (n=25) and periauricular regions (n=28) were analyzed retrospectively.

RESULTS: Demographic, histopathological and clinical characteristics were found similar in auricular and periauricular melanomas (p>0.05). Likewise, the recurrence rates for each group were found to be similar (30%) (p=0.9). The 5-year relapse-free survival rate of all patients was 57.4% and no statistical difference was observed between two groups; 63.9% for auricular melanomas and 51.7% for periauricular melanomas (p=0.5). Moreover, 5-year overall survival rate of all melanomas was 46.9%; and there was no statistical significance between two groups, 56.1% and 37.4% for auricular and periauricalar melanomas, respectively (p=0.4).

CONCLUSION: Auricular and periauricular melanomas share similar clinicopathological features and outcomes.

PMID:34089217 | DOI:10.1111/jocd.14278

Lipids. 2021 Jun 5. doi: 10.1002/lipd.12314. Online ahead of print.

ABSTRACT

Dyslipidemia is nephrotoxic and can result in the development of chronic kidney disease (CKD). The ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) (TG/HDL-C ratio) is well-correlated with insulin resistance and cardiovascular events. The aim of this study is to examine the association between the TG/HDL-C ratio and CKD in Korean adults. This study was retrospectively designed based on the National Health Insurance Service-National Health Screening cohort. Seventy three thousand and fifty-two participants aged between 40 and 79 years old at baseline (2009-2010) were included in the final analyses. The study population was classified into three tertile groups (T₁ , T₂ , and T₃ ) according to the TG/HDL-C ratio by sex. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for CKD were calculated using Cox proportional hazard regression models. The median follow-up duration was 5.9 years. Higher tertile groups of the TG/HDL-C ratio had lower estimated glomerular filtration rates in both sexes. The cumulative incidence of CKD of T₁ , T₂ , and T₃ was 11.89%, 12.90%, and 12.91%, respectively, in men and 10.17%, 10.61%, and 14.87%, respectively, in women (all p values < 0.001). Compared with T₁ of the TG/HDL-C ratio, the HRs (95% CIs) of T₂ and T₃ for CKD were 1.212 (1.118-1.315) and 1.183 (1.087-1.287), respectively, in men and 0.895 (0.806-0.994) and 1.038 (0.937-1.150), respectively, in women after being fully adjusted. Higher TG/HDL-C ratios were positively associated with CKD development in men, while middle levels of TG/HDL ratios reduced the CKD incidence in women.

PMID:34089267 | DOI:10.1002/lipd.12314

BJOG. 2021 Jun 5. doi: 10.1111/1471-0528.16747. Online ahead of print.

NO ABSTRACT

PMID:34089213 | DOI:10.1111/1471-0528.16747

Nephrology (Carlton). 2021 Jun 5. doi: 10.1111/nep.13910. Online ahead of print.

ABSTRACT

BACKGROUND: Albumin-adjusted calcium remains widely used in clinical practice with guidelines for chronic kidney disease (CKD) mineral bone disorder recommending the use of serum calcium for monitoring. This is despite ionised calcium being the biologically active fraction. This study aimed to investigate the ability of total calcium and albumin-adjusted calcium to correctly assign calcium status in stage 5/5D CKD across non-dialysis, haemodialysis and peritoneal dialysis patients.

METHODS: Over a 6-months, 352 paired serum and ionised calcium samples were collected from stage 5 (n = 58) and 5D (n = 294, 196 haemodialysis, 98 peritoneal dialysis) CKD patients in a tertiary-hospital setting. Albumin-adjusted calcium was calculated using the modified-Payne formula. Ionised calcium was the reference standard. The agreement between the two methods in assigning calcium status was assessed using Cohen’s weighted kappa (κ) statistic.

RESULTS: Albumin-adjusted calcium was a poor predictor of calcium status compared to ionised calcium in stage 5/5D CKD (observed agreement 0.42, weighted κ 0.20, 95% CI 0.15-0.26). Dialysis dependence was associated with worse agreement (observed agreement 0.38, weighted κ 0.14, 95% CI 0.09-0.19). Total calcium was more reliable however remained inaccurate. Calcium status was not more accurately classified in those with higher albumin levels ≥30 g/L (observed agreement 0.47, weighted κ 0.23, 95% CI 0.10-0.36).

CONCLUSION: Total calcium provides better approximation of calcium status than albumin-adjusted calcium in stage 5/5D CKD. Albumin-adjusted calcium tends to ‘overcorrect’ serum calcium upward. Clinicians should use ionised calcium where accurate measure of calcium is indicated, with total calcium used as the next best option where resources are limited.

PMID:34089212 | DOI:10.1111/nep.13910

J Cosmet Dermatol. 2021 Jun 4. doi: 10.1111/jocd.14272. Online ahead of print.

ABSTRACT

BACKGROUND: Acne vulgaris (AV) may affect external appearance and significantly deteriorate the quality of life of patients. Therefore, patients make various inquiries about their disease and seek treatment options.

AIMS: To investigate the social media usage habits of patients with AV concerning their diseases, and their recommendations for dermatologists related to social media use.

METHODS: A total of 1,609 patients with AV completed the survey prepared by the authors and the Cardiff Acne Disability Index questionnaire. The Food and Drug Administration severity scores and clinical information of the patients were noted by their physicians.

RESULTS: Of the 1,489 patients who stated that they used social media, 46.31% regularly and 28.77% sometimes referred to these sources to make inquiries about AV. Social media usage for AV was statistically significantly higher in women, participants with short-term and severe disease, those with a moderate income level, and those using topical treatment and cosmetics. They mostly used Google (67%), Instagram (54%), and YouTube (49%). While 76% of the participants stated that they did not share what they saw on the internet with their doctor. Of the respondents, 18.5% were trying to contact their dermatologists through the internet, and 69.73% would prefer experts such as dermatologists to post AV-related content.

CONCLUSIONS: Our study shows that patients frequently resort to social media to seek information about AV. In the changing digital world order, it is observed that there is a need for dermatologists to use social media more actively to share accurate information about AV.

PMID:34087036 | DOI:10.1111/jocd.14272

J Cosmet Dermatol. 2021 Jun 4. doi: 10.1111/jocd.14271. Online ahead of print.

ABSTRACT

BACKGROUND: Melasma is a common skin disorder characterized by alterations in normal skin pigmentation. The objective was to evaluate the efficacy and safety of a skin whitening serum containing niacinamide, hydroxyphenoxy propionic acid, dipotassium glycyrrhizate, glycolic acid and 4-n-butylresorcinol applied twice daily combined with a spot-preventing SPF50+ sunscreen for treatment of melasma.

METHODS: Twelve healthy Caucasian women with melasma (Fitzpatrick skin types II-IV) were enrolled in this pilot clinical study. Efficacy evaluations were performed at baseline and weeks 4, 8, and 12 of treatment, and included clinical and instrumental assessments.

RESULTS: All endpoints for melasma hyperpigmentation showed a statistically significant improvement from baseline to the end of the study. There was only one dropout. No signs of irritation or discomfort were observed at baseline, w4, w8 or w12. An overall improvement in melasma was observed both clinically and on reflectance confocal microscopy (RCM).

CONCLUSION: This topical skin whitening serum had favorable outcomes for the treatment of melasma hyperpigmentation in adult women, as demonstrated on investigator and instrumental assessments. The results of this pilot study need to be confirmed in randomized, controlled studies with a larger sample size.

PMID:34087055 | DOI:10.1111/jocd.14271

J Diabetes Investig. 2021 Jun 4. doi: 10.1111/jdi.13607. Online ahead of print.

ABSTRACT

AIMS/INTRODUCTION: This 6-month, single-center, prospective, open-labeled, randomized trial was designed to investigate whether physician’s diabetes self-management education (DSME) using an education tool developed by the Japan Association of Diabetes Education and Care (JADEC) and a self-monitoring of blood glucose (SMBG) analyzer improves glycemic control in individuals with type 2 diabetes receiving insulin and SMBG.

MATERIALS AND METHODS: Participants were randomized into intervention (I) and control (C) groups. Both groups received physician’s DSME at each hospital visit, while the JADEC education tool and the SMBG readings analyzer was used in Group I but not Group C. All participants filled out a diabetes treatment-related QOL (DTR-QOL) form and an original questionnaire on SMBG use with 5 questions (Q1-Q5) before and after the study period.

RESULTS: A total of 76 individuals were recruited and randomized. HbA1c was significantly improved during the study period in Group I, while no significant change was observed in Group C. Change in HbA1c was greater in Group I although it did not reach statistical significance. The DTR-QOL total score was not changed in either group. Interestingly, the score of Q1 (“How important is SMBG to you?”) in the SMBG questionnaire was unchanged in Group I, while it was significantly decreased in Group C. HbA1c change was independently associated with changes in insulin dose and SMBG Q1 score.

CONCLUSION: Greater HbA1c-lowering by physician’s DMSE using the JADEC education tool and SMBG analyzer in individuals with type 2 diabetes receiving insulin and SMBG was suggested but not confirmed.

PMID:34087060 | DOI:10.1111/jdi.13607

J Ultrasound Med. 2021 Jun 4. doi: 10.1002/jum.15761. Online ahead of print.

ABSTRACT

OBJECTIVES: Determine prevalence of increased signal intensity of the lateral collateral ligament (LCL) of the knee on MRI and decreased echogenicity on ultrasound, and compare with cadaveric histologic evaluation.

METHODS: After IRB approval of this prospective study with informed consent, patients having knee MRI were additionally evaluated with ultrasound. Signal intensities of LCL on MRI (low, intermediate, high), echogenicity at ultrasound (hyperechoic, hypoechoic, anechoic), and extent of findings were assessed. Descriptive statistics, Wilcoxon signed ranked test, and intraclass correlation coefficient (ICC) were calculated. Two cadaveric knees were imaged with MRI and ultrasound, including histologic LCL evaluation.

RESULTS: Seventy-three subjects were included (39 males, 34 females; mean age 48 ± 14 years) with 77 knee examinations. On MRI, low, intermediate, and high signals were present in 21% (16/77), 75% (58/77), and 4% (3/77), respectively. On ultrasound, echogenicity was assessed as hyperechoic, hypoechoic, and anechoic in 62% (48/77), 38% (29/77), and 0% (0/77), respectively. Mean length of increased signal was 8.6 mm (±4.9) on MRI, and 6.5 mm (±4.8) on ultrasound. The ICC showed a good to excellent intermodality reliability (0.735-0.899) without statistically significant difference for interreader measurements (P = .163-.795). Histology evaluation showed transition of ligament fibers to fibrocartilage at its insertion with increased connective tissue mucin corresponding to MRI and ultrasound findings.

CONCLUSIONS: Increased signal intensity of the proximal LCL on ultrasound and MRI is common and corresponds to normal connective tissue mucin.

PMID:34086999 | DOI:10.1002/jum.15761