Category: Statistics

Microsurgery. 2023 Oct 17. doi: 10.1002/micr.31124. Online ahead of print.

ABSTRACT

BACKGROUND: Abdomen-based free flaps represent the gold standard option in the armamentarium of breast reconstruction. The natural evolution to more preservation with less invasive forms of these flaps has been driven by both patient and surgeon satisfaction. Nevertheless, obese patients are challenging due to the increased risk of compromised flap perfusion and donor site morbidity. This challenge is compounded by the prevalence of obesity worldwide, resulting in more free abdominal flaps being performed for breast reconstruction in obese patients. The authors present the outcomes of a modified supra-arcuate fascial muscle-sparing transverse rectus abdominus myocutaneous (FMS-TRAM) technique compared to standard muscle-sparing transverse rectus abdominus myocutaneous (MS-TRAM) technique to reduce the donor site morbidity while providing a well-vascularized large volume of autologous tissue.

METHODS: A retrospective comparative data analysis was conducted at two centers: Cairo University Hospitals, Egypt, and University Hospitals Birmingham, United Kingdom. Standard MS-TRAM was performed in 65 patients between 2008 and 2011 (Group 1) versus 275 patients between 2011 and 2020 (Group 2) who underwent FMS-TRAM. The modified technique involved limiting the fascial incision to above or at the level of the arcuate line to preserve the integrity of the anterior rectus sheath caudally. All patients included were of the obese population (BMI≥30 kg/m² ) and underwent unilateral post-mastectomy reconstruction. Patient demographics, comorbidities, operative details, and outcomes focusing on donor site morbidity and flap complications were recorded and compared between the two groups.

RESULTS: The median age and BMI for Group 1 were 43 and 32, respectively. While for Group 2, they were 47 and 33, respectively. Flap weight ranged from 560 to 1470 g (Mean 705) for Group 1, while Group 2 ranged from 510 to 1560 (mean 715). The majority (280/340 [82%]) of the patients in both groups received radiotherapy. 7.7% of Group 1 were smokers, while in Group 2 it was 4.7%. The percentage of delayed versus immediate reconstruction in Group 1 was 60%/40%, while in Group 2, it was 43%/56%. The incidence of fat necrosis, partial necrosis, and total necrosis was 7.6%.1.5%, and 3%, respectively, for Group 1 and 8%, 1.4%, and 2.6%, respectively, for Group 2. The two-tailed p-value demonstrated a significant statistical difference (p < 0.00001) in donor site morbidity between both groups, with more bulge 20% (13/65) and hernia 1.5% (2/65) occurrence in Group 1 versus 1.9% (5/275) and 0.7% (2/275) in Group 2 respectively, over a follow-up period ranging from 24 to 60 months (mean 32).

CONCLUSION: FMS-TRAM flaps are safe, robust, and reliable with less donor site morbidity while maintaining optimal flap perfusion for large volume flaps in obese patients with excellent, durable outcomes. It should be considered a valuable tool in the reconstructive armamentarium of breast reconstruction.

PMID:37846651 | DOI:10.1002/micr.31124

Int J Cancer. 2023 Oct 17. doi: 10.1002/ijc.34765. Online ahead of print.

ABSTRACT

The proportion of lung cancer in never smokers is rising, especially among Asian women, but there is no effective early detection tool. Here, we developed a polygenic risk score (PRS), which may help to identify the population with higher risk of lung cancer in never-smoking women. We first performed a large GWAS meta-analysis (8595 cases and 8275 controls) to systematically identify the susceptibility loci for lung cancer in never-smoking Asian women and then generated a PRS using GWAS datasets. Furthermore, we evaluated the utility and effectiveness of PRS in an independent Chinese prospective cohort comprising 55 266 individuals. The GWAS meta-analysis identified eight known loci and a novel locus (5q11.2) at the genome-wide statistical significance level of P < 5 × 10^-8 . Based on the summary statistics of GWAS, we derived a polygenic risk score including 21 variants (PRS-21) for lung cancer in never-smoking women. Furthermore, PRS-21 had a hazard ratio (HR) per SD of 1.29 (95% CI = 1.18-1.41) in the prospective cohort. Compared with participants who had a low genetic risk, those with an intermediate (HR = 1.32, 95% CI: 1.00-1.72) and high (HR = 2.09, 95% CI: 1.56-2.80) genetic risk had a significantly higher risk of incident lung cancer. The addition of PRS-21 to the conventional risk model yielded a modest significant improvement in AUC (0.697 to 0.711) and net reclassification improvement (24.2%). The GWAS-derived PRS-21 significantly improves the risk stratification and prediction accuracy for incident lung cancer in never-smoking Asian women, demonstrating the potential for identification of high-risk individuals and early screening.

PMID:37846649 | DOI:10.1002/ijc.34765

J Perinat Med. 2023 Oct 18. doi: 10.1515/jpm-2023-0280. Online ahead of print.

ABSTRACT

OBJECTIVES: Although the knowledge on SARS-CoV-2 infection in pregnancy has greatly improved, there is still a lack of information on its role in the later stages of gestation. The aim of this study is to investigate whether SARS-CoV-2 discovered at delivery is associated with any obstetric or neonatal complications.

METHODS: A retrospective case-control study was conducted at Department of Obstetrics, University Hospital Maggiore della Carità, Novara, Italy, from March 2020 to March 2023. Pregnant women admitted were tested for SARS-CoV-2. 168 women resulted positive at the time of delivery; the women were asymptomatic or paucisymptomatic. 170 negative women were selected as controls, selecting, for each SARS-CoV-2 positive patient, the patient who gave birth right before, if negative. Demographic and anamnestic characteristics, pregnancy, labor, and neonatal outcomes were evaluated.

RESULTS: SARS-CoV-2 positive patients were more likely to have gestational diabetes (13.7 vs. 5.3 %) and required less frequently intrapartum analgesia (11.3 vs. 27 %) and labor augmentation (7.3 vs. 16.5 %). Post-partum hemorrhage rate was lower (13.7 vs. 22.9 %) and a shorter length of first and second stage of labor occurred. There were no statistically significant differences between the two groups regarding the mode of delivery and neonatal outcomes.

CONCLUSIONS: SARS-CoV-2 positive patients have shorter labor length and a lower incidence of postpartum hemorrhage. Fewer obstetric interventions, as well as less use of intrapartum analgesia and oxytocin, could explain these findings. Moreover, gestational diabetes could increase susceptibility to infection. SARS-CoV-2 infection discovered at the time of delivery in asymptomatic or paucisymptomatic patients does not appear to increase the rate of cesarean delivery or other obstetric complications, and neonatal outcomes have not worsened.

PMID:37846639 | DOI:10.1515/jpm-2023-0280

Am J Hosp Palliat Care. 2023 Oct 17:10499091231206561. doi: 10.1177/10499091231206561. Online ahead of print.

ABSTRACT

Objectives: Concurrent care is a unique care delivery system that allows patients to receive disease modifying treatments and other supportive interventions while also receiving the traditional benefits of hospice care. The objectives of our observational study were to examine health care utilization, use of cancer-directed therapies and palliative interventions, and location of death in patients enrolled in concurrent care. Methods: 72 hematology-oncology patients at the Hines Veteran’s Affairs Medical Center (VAMC) who enrolled in concurrent care from 12/2018-4/2021 were reviewed. Data were summarized with descriptive statistics including medians and percentages. Results: A minority of patients received cytotoxic chemotherapy (27.8%), immunotherapy (20.8%), palliative radiation (20.9%), blood products (11.1%), or invasive pain procedures (4.2%). Patients also used fewer cancer-directed treatments as they approached end of life (24.4% within 30 days of death compared to 13.3% within 14 days of death). Most patients died at home (62.9%) or in inpatient hospice (12.9%) as opposed to the hospital (2.9%). Conclusions: A minority of concurrent care patients received cancer-directed therapies or additional types of health care interventions despite the option to do so. Cancer-directed treatment utilization also decreased as patients approached end of life. Patients enrolled in concurrent care were able to appreciate its benefits for longer, as the average length of stay on concurrent care was nearly 3 months.

PMID:37846638 | DOI:10.1177/10499091231206561

Zhonghua Nan Ke Xue. 2022 Dec;28(12):1113-1118.

ABSTRACT

OBJECTIVE: To investigate the effect of pricking-reinforcing -reducing therapy (PRRT) on the semen quality and seminal plasma biochemical indexes of varicocele (VC) infertility patients.

METHODS: We randomly and equally assigned 160 patients with VC infertility into a PRRT and a control group, the former treated by PRRT and the latter with oral ShengjingCapsules. Before and after treatment, we obtained the semen parameters, sperm morphology, sperm survival rate, sperm acrosin activity, seminal plasma neutral α glucosidase and seminal plasma zinc in the patients and compared them between the two groups.

RESULTS: Before treatment, there were no statistically significant differences between the PRRT and control groups in sperm concentration (［16.81 ± 7.83］ vs ［16.80 ± 7.54］ ×106 /ml, P > 0.05), total sperm count (［42.01 ± 19.57］ vs ［41.99 ± 18.84］ ×106, P > 0.05), percentages of progressively motile sperm (PMS) (［15.37 ± 11.03］% vs ［14.68 ± 10.27］%, P > 0.05) and morphologically normal sperm ( MNS) (1.62 ± 1.51］% vs ［1.62 ± 1.13］%, P > 0.05), sperm survival rate (［28.11 ± 18.95］% vs ［28.23±18.38］%, P > 0.05) and sperm acrosin activity (［28.11 ± 14.64］ vs ［27.19 ± 14.07］ U/L, P > 0.05). After three months of treatment, all the patients showed evident increases in the above parameters (P < 0.05), even higher in the PRRT than in the control group, more significantly in sperm concentration (［38.88 ± 30.54］ vs ［25.60 ± 14.71］ ×106 /ml, P < 0.05), PMS (［32.60 ± 12.46］% vs ［27.67 ± 12.27］%, P < 0.05) and sperm acrosin activity (［65.74±31.81］ vs ［67.94±17.95］ U/L, P < 0.05), though not significantly in total sperm count (97.20 ± 76.35］ vs ［88.19 ± 39.56］ ×106, P > 0.05), MNS (［2.35 ± 1.83］% vs ［1.87 ± 1.20］%, P > 0.05) and sperm survival rate (［61.44 ± 20.02］% vs ［59.12 ± 22.48］%, P > 0.05). Compared with the baseline, after treatment, the patients in the PRRT group also exhibited elevated levels of neutral α-glucosidase (［14.42 ± 5.90］ vs ［28.43 ± 19.76］ U/L, P < 0.05) and seminal plasma zinc (［2.11 ± 1.22］ vs ［2.89 ± 1.23］ mmol/L, P < 0.05), and so did the controls (［14.44 ± 5.61］ vs ［26.66 ± 17.69］ U/L , P < 0.05) and (［2.09 ± 1.10］ vs ［2.82±1.08］ mmol/L, P < 0.05). No statistically significant difference, however, was observed between the two groups after treatment (P > 0.05).

CONCLUSION: PRRT can significantly improve semen quality in patients with VC infertility, even more effective than ShengjingCapsules in improving sperm concentration, PMS, sperm survival rate, and sperm acrosin activity, which may be related to its effect of elevating the levels of seminal plasma neutral-α glucosidase and zinc providing sufficient energy for basic sperm metabolism, maturation, energy acquisition and motility.

PMID:37846632

Zhonghua Nan Ke Xue. 2022 Dec;28(12):1107-1112.

ABSTRACT

OBJECTIVE: To study the clinical value of accelerated rehabilitation nursing (ARN) in improving the symptoms of PCa patients after surgery.

METHODS: This study included 80 cases of PCa treated surgically in our hospital from October 2020 to October 2021. We randomly divided the patients into two groups of an equal number to receive ARN and routine nursing care (the control group), respectively. We obtained the scores of the patients on IPSS, TCM syndromes, quality of life (QOL) and pain, incidence of postoperative complications, satisfaction with nursing care and Gleason scores, and compared them between the two groups.

RESULTS: The IPSS and TCM syndrome scores were significantly lower (P < 0.05 ), and the physical and psychological function score remarkably higher in the ARN than in the control group (P < 0.05), but there was no statistically significant difference in the social function scores between the two groups (P > 0.05). The postoperative pain score was also significantly lower in the ARN than in the control group (P < 0.05), and so was the incidence rate of postoperative complications (10% vs 37.5%, P < 0.05). The patients’ satisfaction with nursing care was markedly higher in the former than in the latter group (90% vs 80%, P < 0.05). No statistically significant difference was observed in the Gleason scores between the two groups of patients.

CONCLUSION: Accelerated rehabilitation nursing can effectively improve the symptoms of PCa patients after surgery and therefore deserves clinical application.

PMID:37846631

Zhonghua Nan Ke Xue. 2022 Dec;28(12):1089-1095.

ABSTRACT

OBJECTIVE: To investigate the value of combined detection of tPSA, fPSA and peripheral blood neutrophil count (Neut#) in the diagnosis of PCa.

METHODS: This study included 238 cases of PCa, 328 cases of BPH and 303 normal men as healthy controls present at our hospital for medical or physical examination from August 2018 to December 2021. We detected the levels of serum tPSA and fPSA and Neut# of the subjects, and assessed the value of the combined detection in the diagnosis of PCa using logistic regression analysis, ROC curves, Pearman correlation analysis and nonparametric test.

RESULTS: There were significant differences in the tPSA and fPSA levels and Neut# between any two of the PCa, BPH and healthy control groups (P < 0.05). The index N of the combined detection of tPSA, fPSA and Neut# showed an evidently higher diagnostic value than that of any single-item detection. The Gleason scores of the subjects were correlated positively with the tPSA and fPSA levels and index N, with the correlation coefficients of 0.184, 0.245 and 0.166 respectively, P < 0.05), and negatively with the Neut#, with the correlation coefficient of －0.168, P < 0.05). Statistically significant differences were observed in the tPSA and fPSA levels, Neut# and index N in those with different Gleason scores (P < 0.05).

CONCLUSION: The combined detection of tPSA, fPSA and Neut# improves the diagnosis of PCa and can be applied clinically as an auxiliary diagnostic method.

PMID:37846628

Zhonghua Nan Ke Xue. 2022 Dec;28(12):1080-1088.

ABSTRACT

OBJECTIVE: To analyze the clinicopathological and imaging features of primary squamous cell carcinoma of the prostate (PSCC) and provide some new ideas for exploring suitable diagnostic and treatment strategies for the disease.

METHODS: We retrieved and analyzed the studies published at home and abroad between 1976 and 2022 and reviewed the clinical data of our Department of Medical Oncology on 70 cases of PSCC, as well as the survival statistics of another 58 cases.

RESULTS: Clinically, PSCC was characterized by normal PSA and increased squamous cell carcinoma antigen. Overall survival of the patients was evidently correlated to the PSCC stage, chemotherapy and radiotherapy, significantly longer in those treated by chemotherapy with platinum than in those without platinum (P = 0.001). Univariate analysis suggested that the overall survival of the patients was significantly correlated with chemotherapy.

CONCLUSION: PSCC has a poor prognosis. A deep insight into the clinical characteristics of PSCC is important for timely detection and suitable treatment of the malignancy.

PMID:37846627

J Ultrasound Med. 2023 Oct 17. doi: 10.1002/jum.16352. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate the biomechanical properties of porcine oral tissues with in vivo ultrasonography and to compare the difference between oral alveolar mucosa and gingival tissue concerning compressional and tensile mechanical strain.

MATERIALS AND METHODS: Sinclair minipigs (6 females and 4 males, 6 to 18 months of age) were anesthetized for ultrasonography. In vivo high-frequency tissue harmonic ultrasound (12/24 MHz) cine-loops were obtained while inducing mechanical tissue stress (0 to 1 N). Post-processing strain analysis was performed in a cardiac speckle tracking software (EchoInsight®). Region of interest (ROI) was placed for gingival and alveolar mucosa tissues for longitudinal (compressional) and tensile strain analyses. A calibrated gel pad was employed to determine the absolute force (pressure) for the measured tissue strain response function. The resulting elasticity data was statistically analyzed using custom Matlab scripts.

RESULTS: In total, 38 sonography cine-loops around the third premolars were included in the investigation. The longitudinal strain of alveolar mucosa ε AM L $$ {varepsilon}_{AM}^L $$ was found to be significantly (P < .05) larger than that of gingiva ε G L $$ {varepsilon}_G^L $$ . Across the measured force range, ε AM L $$ {varepsilon}_{AM}^L $$ ~ 1.7 × ε G L $$ {varepsilon}_G^L $$ . Significant differences between alveolar mucosa and gingiva tissues were found for all forces. The tensile strain of the alveolar mucosa ε AM T $$ {varepsilon}_{AM}^T $$ was found to be ~2 × ε G T $$ {varepsilon}_G^T $$ (on the epithelial surface of the gingiva). Both were statistically significantly different for forces exceeding ~0.08 N. At depth, that is, 500 and 1000 μm below the epithelial surface, the gingiva was found to have less ability to stretch contrary to the alveolar mucosa. Gingival tissue at 500 μm depth has significantly less tensile strain than at its surface and more than at 1000 μm depth. In contrast, the tensile strain of alveolar mucosa is largely independent of depth.

CONCLUSION: Ultrasonography can reveal significant differences in oral alveolar mucosal and gingival elastic properties, such as compressional and tensile strain. Under minute forces equivalent to 10 to 40 g, these differences can be observed. As dental ultrasound is a chairside, and noninvasive modality, obtaining real-time images might soon find clinical utility as a new diagnostic tool for the objective and quantitative assessment of periodontal and peri-implant soft tissues in clinical and research realms. As ultrasound is a safe modality with no known bioeffects, longitudinal monitoring of areas of concern would be particularly attractive.

PMID:37846622 | DOI:10.1002/jum.16352

J Gerontol B Psychol Sci Soc Sci. 2023 Oct 17:gbad154. doi: 10.1093/geronb/gbad154. Online ahead of print.

ABSTRACT

OBJECTIVES: The experience of being sandwiched between support obligations towards both aging parents and adult offspring is likely to become more common and more relevant. We aim at assessing the effect of demographic and social sandwiching on the psychological health and subjective well-being of individuals experiencing these transitions, and to what extent, these effects vary across welfare regimes.

METHODS: Data are from 63,585 individuals aged 50-75 participating in the Survey of Health, Ageing and Retirement in Europe (SHARE). We estimate within- and between-individual effects using hybrid regression models to predict depressive symptoms (EURO-D) and subjective well-being (CASP).

RESULTS: Among demographically sandwiched women, transitioning into social sandwiching and into supporting only parents were associated with a moderate but statistically significant increase in EURO-D and decline in CASP scores. The same association is not observed for male respondents. The pattern of variation among women living in countries characterized by different welfare regimes suggests that social sandwiching is less detrimental in the Nordic regimes than in other welfare contexts.

DISCUSSION: Results from the between-individuals part of the model indicate that there is a selection into social sandwiching of more healthy individuals into support roles. However, the within-individuals part of the model indicates that the transition into social sandwiching has a detrimental effect on women’s (but not men’s) psychological health and well-being. The explanations for this gendered effect of social sandwiching may be found in the “invisible” support provided by women and the gendered division of specific care tasks.

PMID:37846581 | DOI:10.1093/geronb/gbad154