Category: Statistics

Laryngoscope. 2022 Jan 17. doi: 10.1002/lary.30028. Online ahead of print.

ABSTRACT

OBJECTIVE: To quantify the effect of the COVID-19 pandemic upon the 2020-21 residency match for Otolaryngology-Head & Neck Surgery (OHNS).

METHODS: Residency match outcomes for all applicants to our institution during 2020-2021 were collected from the National Residency Matching Program (NRMP) including medical school of origin and matched program. Matches were categorized as to home-program, within-region, or out-of-region, and sorted by US geographic region. Matches from the 2020-2021 cycle were compared to those from 2019-2020, as well as averages and trends from match cycles 2016-2020. Statistical analysis included descriptive statistics and chi-square testing.

RESULTS: During 2020-2021, there were 436 applicants to our single OHNS program. From 2019-20 to 2020-21, the match rate decreased significantly for groups studied, including: All applicants (72.0% (268/372) to 64.7% (282/436); p = 0.025); All US MD Senior applicants (76.5% (254/332) to 68.9% 262/380); p = 0.024); and US MD Seniors specifically without a home program (77.5% (31/40) to 56.4% (22/39); p = 0.046). The match rate for US MD Seniors with a home program did not change significantly (76.4% (223/292) to 70.4% (240/341); p = 0.09). From 2019-20 to 2020-21, the proportion of US MD Seniors who matched to home-program increased significantly (22.0% (49/223) to 30.0% (72/240); p = 0.05).

CONCLUSION: The COVID-19 pandemic saw high volumes of OHNS applicants with an overall decreased rate of matching compared to previous years. These changes particularly affected applicants without home programs. Home-program matching increased significantly, likely as a consequence of the limitations placed on in-person away experiences including interviews.

PMID:35038190 | DOI:10.1002/lary.30028

J Magn Reson Imaging. 2022 Jan 17. doi: 10.1002/jmri.28061. Online ahead of print.

ABSTRACT

BACKGROUND: Currently, multi-parametric prostate MRI (mpMRI) consists of a qualitative T₂ , diffusion weighted, and dynamic contrast enhanced imaging. Quantification of T₂ imaging might further standardize PCa detection and support artificial intelligence solutions.

PURPOSE: To evaluate the value of T₂ mapping to detect prostate cancer (PCa) and to differentiate PCa aggressiveness.

STUDY TYPE: Retrospective single center cohort study.

POPULATION: Forty-four consecutive patients (mean age 67 years; median PSA 7.9 ng/mL) with mpMRI and verified PCa by subsequent targeted plus systematic MR/ultrasound (US)-fusion biopsy from February 2019 to December 2019.

FIELD STRENGTH/SEQUENCE: Standardized mpMRI at 3 T with an additionally acquired T₂ mapping sequence.

ASSESSMENT: Primary endpoint was the analysis of quantitative T₂ values and contrast differences/ratios (CD/CR) between PCa and benign tissue. Secondary objectives were the correlation between T₂ values, ISUP grade, apparent diffusion coefficient (ADC) value, and PI-RADS, and the evaluation of thresholds for differentiating PCa and clinically significant PCa (csPCa).

STATISTICAL TESTS: Mann-Whitney test, Spearman’s rank (r_s ) correlation, receiver operating curves, Youden’s index (J), and AUC were performed. Statistical significance was defined as P < 0.05.

RESULTS: Median quantitative T₂ values were significantly lower for PCa in PZ (85 msec) and PCa in TZ (75 msec) compared to benign PZ (141 msec) or TZ (97 msec) (P < 0.001). CD/CR between PCa and benign PZ (51.2/1.77), respectively TZ (19.8/1.29), differed significantly (P < 0.001). The best T₂ -mapping threshold for PCa/csPCa detection was for TZ 81/86 msec (J = 0.929/1.0), and for PZ 110 msec (J = 0.834/0.905). Quantitative T₂ values of PCa did not correlate significantly with the ISUP grade (r_s = 0.186; P = 0.226), ADC value (r_s = 0.138; P = 0.372), or PI-RADS (r_s = 0.132; P = 0.392).

DATA CONCLUSION: Quantitative T₂ values could differentiate PCa in TZ and PZ and might support standardization of mpMRI of the prostate. Different thresholds seem to apply for PZ and TZ lesions. However, in the present study quantitative T₂ values were not able to indicate PCa aggressiveness.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 2.

PMID:35038203 | DOI:10.1002/jmri.28061

J Clin Ultrasound. 2022 Jan 17. doi: 10.1002/jcu.23143. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate if an automatic classification of rheumatoid arthritis (RA) metacarpophalangeal joint conditions in ultrasound images is feasible by deep learning (DL) method, to provide a more objective, automated, and fast way of RA diagnosis in clinical setting.

MATERIALS AND METHODS: DenseNet-based DL model was used and both training and testing are implemented in TensorFlow 1.13.1 with Keras DL libraries. The area under curve (AUC), accuracy, sensitivity, and specificity values with 95% CIs were reported. The statistical analysis was performed by using scikit-learn libraries in Python 3.7.

RESULTS: A total of 1337 RA ultrasound images were acquired from 208 patients, the number of images is 313, 657, 178, and 189 in OESS Grade L0, L1, L2, and L3, respectively. In Classification Scenario 1 SP-no versus SP-yes, three experiments with region of interest of size 192 × 448 (Group 1), 96 × 224 (Group 2), and 96 × 224 stacked with pre-segmented annotated mask of SP area (Group 3) as input achieve an AUC of 0.863 (95% CI: 0.809, 0.917), 0.861 (95% CI: 0.805, 0.916), and 0.886 (95% CI: 0.836, 0.936), respectively. In Classification Scenario 2 Healthy versus Diseased, experiments in Group 1, Group 2 and Group 3 achieve an AUC of 0.848 (95% CI: 0.799, 0.896), 0.864 (95% CI: 0.819, 0.909), and 0.916 (95% CI: 0.883, 0.952), respectively.

CONCLUSION: We combined DenseNet model with ultrasound images for RA condition assessment. The feasibility of using DL to create an automatic RA condition classification system was also demonstrated. The proposed method can be an alternative to the initial screening of RA patients.

PMID:35038176 | DOI:10.1002/jcu.23143

Folia Histochem Cytobiol. 2022 Jan 17. doi: 10.5603/FHC.a2022.0003. Online ahead of print.

ABSTRACT

INTRODUCTION: . Apoptosis is a key process during normal trophoblastic development and, consequently, the whole gestation. However, in trophoblastic differentiation in spontaneous abortions apoptosis has been hardly investigated. Therefore, the aim of the study was to investigate the correlation between apoptotic frequency in trophoblast and spontaneous abortion incidences.

MATERIAL AND METHODS: A total of 72 trophoblastic tissue samples were immunohistochemically examined. 42 of 72 derived from first-trimester spontaneous abortions and the remaining 30 from elective terminations during the same trimester of pregnancy. TUNEL assay and M30 marker were used for apoptosis evaluation by immunohistochemistry.

RESULTS: Comparative study of tissues from spontaneous abortions and elective pregnancy terminations demonstrated increased expression of both apoptotic markers in tissues derived from spontaneous abortions compared to normal pregnancies. In addition, statistical analysis correlated maternal age and gravidity with increased spontaneous abortion incidences. Moreover, both M30 and TUNEL staining were significantly correlated with maternal age and primigravidity in spontaneous abortion cases.

CONCLUSIONS: Our data proved that elevated apoptotic activity during the first pregnancy trimester is clearly involved in spontaneous abortions. Moreover, two well-established apoptotic markers revealed high statistical significance in the evaluation of post-abortive tissues.

PMID:35038161 | DOI:10.5603/FHC.a2022.0003

Anaesthesia. 2022 Jan 17. doi: 10.1111/anae.15651. Online ahead of print.

ABSTRACT

Effective pain control enhances patient recovery after surgery. Laparoscopic techniques for major abdominal surgery are increasingly utilised to reduce surgical trauma. Intrathecal morphine is an attractive analgesic option that is gaining popularity. However, limited evidence guides its use in the setting of laparoscopic surgery. In addition, enhanced recovery after surgery pathways advocate opioid-sparing techniques. We conducted a feasibility trial to compare intrathecal morphine with non-neuraxial analgesia in laparoscopic or laparoscopic-assisted major abdominal surgery to inform the design of a future large clinical trial. This multicentre, double-blind, randomised controlled trial was conducted at two tertiary hospitals in Australia. Fifty-one patients were randomly allocated to receive either intrathecal morphine (intervention group) or a sham subcutaneous injection of normal saline in the lumbar area (control group) immediately before the induction of general anaesthesia. Co-primary outcomes were patient recruitment and successful adherence to treatment allocation as per the study protocol. The primary endpoints of feasibility and protocol adherence were met with a 46% recruitment rate (51 of 110 eligible patients) and 96% protocol adherence. There was only one patient with failed access to the intrathecal space. For secondary endpoints, fewer patients in the intrathecal morphine group required opioids in the post-anaesthesia care unit, their postoperative pain scores at rest were lower across the four time-points measured (p = 0.007), but not dynamic pain scores (p = 0.061), and pruritus was more common following intrathecal morphine (p = 0.007). Total oral morphine equivalents until postoperative day 3 were less in the intrathecal morphine group (median (95%CI) difference 82 (-13 to 168) mg), but this reduction was not statistically significant (p = 0.10). These findings support conducting a definitive clinical trial.

PMID:35038165 | DOI:10.1111/anae.15651

Spine Deform. 2022 Jan 17. doi: 10.1007/s43390-021-00470-9. Online ahead of print.

ABSTRACT

PURPOSE: Pulmonary function and quality of life (QOL) are important outcome measures for patients with early-onset scoliosis (EOS) undergoing rib-based growing system (RBGS) implantation. The Assisted Ventilation Rating (AVR) measures ventilator requirements in this population. A higher, more severe, score implies negative changes in QOL. The EOS Questionnaire (EOSQ) is a validated outcome measure. Paired measurements for both ratings were compared to clarify correlation between ventilator status and QOL. Secondary analysis aimed at defining QOL between more broad subgroups defined by ventilator use.

METHODS: AVR and EOSQ scores were extracted from the Pediatric Spine Study Group database for patients 10 years of age and under. Instances were excluded if the time between AVR and EOSQ assessment was greater than 6 months. Scores were compared using Spearman correlation coefficient. Subgroup analysis included control for age, gender, and etiology. Secondary analysis was performed for broad functional grouping using ranked analysis of variance for repeated measures using median scores.

RESULTS: Two thousand five hundred and forty-two instances of paired EOSQ and AVR in 329 patients were analyzed. A statistically significant weak correlation between AVR and EOSQ was identified in Child’s Health Related QOL and Family Impact sections, in nine subsets. Subgroup analysis showed little variation, except increased correlation in female patients to near moderate level. Analysis of variance for demonstrated decreased medians for all subdomains when comparing those mechanically ventilated to patients who did not require ventilation.

CONCLUSION: Ventilator status tracks with QOL were measured by EOSQ. A more severe AVR is negatively correlated with most domains of the EOSQ for patients with EOS who have undergone RBGS implantation. The strength of this correlation is weak, and so AVR alone may be insufficient to precisely determine QOL in this population.

LEVEL OF EVIDENCE: Level-III, Retrospective.

PMID:35038135 | DOI:10.1007/s43390-021-00470-9

Environ Sci Pollut Res Int. 2022 Jan 17. doi: 10.1007/s11356-021-18371-9. Online ahead of print.

ABSTRACT

The goal of this research is to investigate the impact of tourism on sustainable development in the 10 most visited countries. For this purpose, following the STIRPAT model, the impact of urbanization, energy intensity, and tourism on the newly designed sustainable development index is examined for the period 1995-2015. In doing so, tourism is represented by two different indicators, the number of tourists and tourism receipts. In addition, the impact of tourism on economic growth is analyzed to compare the effects of tourism development on economic growth and sustainable development. While doing this, second-generation panel data methods are used to take into account the possible inter-country dependency. According to the findings obtained in the study, tourism, energy intensity, and urbanization have positive effects on economic growth. On the other hand, the effects of all three factors on the sustainable development index are negative and statistically significant. These findings indicate that the harmful effects of tourism on other dimensions of sustainable development are greater than the beneficial effects of tourism on economic growth.

PMID:35038088 | DOI:10.1007/s11356-021-18371-9

Geroscience. 2022 Jan 17. doi: 10.1007/s11357-022-00515-5. Online ahead of print.

ABSTRACT

Unconventional T cells show distinct and unique features during antigen recognition as well as other immune responses. Their decrease in frequency is associated with various autoimmune disorders, allergy, inflammation, and cancer. The landscape frequency of the unconventional T cells altogether (iNKT, γδ T, and MAIT) is largely unestablished leading to various challenges affecting diagnosis and research in this field. In this study, we have established the age group-wise frequency of iNKT, γδ T, and MAIT cells altogether on a total of 203 healthy adult samples of the Caucasian population. The results revealed that iNKT cells were 0.095%, γδ T cells were 2.175%, and MAIT cells were 2.99% of the total T cell population. γδ and MAIT cell frequency is higher in younger age groups than elderly; however, there is no statistically significant difference in the frequency of iNKT cells. Furthermore, γδ and MAIT cells were negatively correlating with age, supporting immunosenescence, unlike iNKT cells. Our finding could be used for further age-wise investigation of various pathological conditions such as cancer and their prognosis, autoimmune diseases and their pathogenicity.

PMID:35038082 | DOI:10.1007/s11357-022-00515-5

Strahlenther Onkol. 2022 Jan 17. doi: 10.1007/s00066-021-01890-2. Online ahead of print.

ABSTRACT

PURPOSE: About one fifth of patients with head and neck cancer are aged 70 years and older at the time of diagnosis. In these patients, risk factors (R1 status or extracapsular extension of lymph node metastases, ECE) often lead to a need for combined chemoradiotherapy (CRT) in the postoperative setting. However, there is considerable concern about the toxicity of such therapy in this age group.

METHODS: Retrospective evaluation of the data of 53 patients ≥ 70 years of age who underwent surgery in our hospital between 1999 and 2015 for tumors of the oral cavity, the oropharynx, the hypopharynx, or the larynx, who subsequently received adjuvant radiation therapy. Two younger patients (< 70 years) were assigned to each of the elderly patients in a matching procedure based on anatomic sublocalization and tumor stage. The total cohort was comprised of 154 patients.

RESULTS: Univariate analyses revealed a statistically significant influence of many factors on overall survival (OS) and progression-free survival (PFS), including Karnofsky performance score (KPS), alcohol consumption, smoking, R status, ECE, chemotherapy, and discontinuation of RT. Younger patients had better OS and PFS compared to the elderly (p = 0.013 and 0.012, respectively). In a multivariate Cox regression, no independent influence of age on OS and PFS was found. Survival was primarily dependent on the addition of chemotherapy to radiotherapy (RT), application of the full course of RT, continued alcohol abuse, KPS, and the presence of ECE. Toxicity analysis showed a higher incidence of chronic renal failure but, generally, side effects for elderly patients were not substantially greater.

CONCLUSION: Performance status and behavioral risk factors but not chronological age are crucial for the prognosis of patients who require adjuvant chemoradiation.

PMID:35037950 | DOI:10.1007/s00066-021-01890-2

Schmerz. 2022 Jan 17. doi: 10.1007/s00482-021-00619-5. Online ahead of print.

ABSTRACT

BACKGROUND: The present study aimed to assess the postoperative pain experience in cognitive deficit patients with special reference to sensory or affective pain quality.

METHODS: Nineteen patients with normal cognition up to cognitive impairments according to the DemTect screening-tool were studied regarding their postoperative pain experience after proximal femur fracture. The numerical rating scale (NRS), the cognitive DemTect questionnaire, the pain sensation questionnaire (SES), and a quantitative sensory test (QST) were used as examination instruments.

RESULTS: The mean ± SD age of the patients was 83.8 ± 10.0 years. Of the 19 patients, 6 (31.6%) had normal cognitive abilities. In 4 patients (21.1%) there were indications of mild cognitive impairments, and in 9 patients (47.4%) the suspicions of the presence of dementia arose. The mean postoperative pain intensity (NRS) was 4.0 (1.6). With comparable analgesic therapy, the reported pain intensities did not differ between the three patient groups with different cognitive impairments and the first three postoperative treatment days. There were no statistically significant differences between the groups for the sensory or affective total scores of the pain sensation scale. The QST parameters deep pain (PPT), superficial mechanical pain after needle stimulation (MPT), and the superficial sensitivity to light touch stimuli (MDT) showed a significantly increased sensitivity of the operated side. For the sensation of vibration (VDT) no differences between operated and healthy extremities could be proven.

DISCUSSION: The postoperative pain experience does not differ between patients with normal and limited cognition. The quantitative sensory testing showed mechanical hyperalgesia in the operated area. The study points to the importance of adequate postoperative pain management even in those with dementia.

PMID:35038009 | DOI:10.1007/s00482-021-00619-5