Category: Statistics

J Ophthalmol. 2020 Nov 18;2020:5217645. doi: 10.1155/2020/5217645. eCollection 2020.

ABSTRACT

AIM: To investigate the changes in the retinal nerve fiber layer (RNFL) following pars plana vitrectomy (PPV) with surgically induced posterior vitreous detachment (PVD) and idiopathic epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling.

METHODS: Patients with unilateral ERM with vitreomacular traction were included in this prospective, randomized, and controlled clinical trial. The control group (Group 1) was formed with the nonoperated fellow eyes of the patients, and the study group (Group 2) was formed with the eyes that underwent PPV including idiopathic ERM and ILM peeling. In the preoperative and postoperative periods (1^st, 2^nd, 3^rd, 6^th, and 12^th months), complete ophthalmological examination of the eyes was performed and RNFL measurements were examined in 4 different quadrants (superior, temporal, inferior, and nasal) with the help of spectral domain optical coherence tomography (OCT).

RESULTS: There was no statistically significant change in Group 1 during the follow-up period in all quadrants (p > 0.05). The mean RNFL thickness in Group 2 was statistically significantly higher than in Group 1 in superior, inferior, and temporal quadrants (p < 0.01), preoperatively. The mean RNFL in Group 2 was higher in the 1^st, 2^nd, 3^rd, and 6^th months and lower in the 12^th month in superior, inferior, and temporal quadrants (p < 0.01) when compared to the preoperative period. The mean RNFL thickness in the nasal quadrant in Group 2 was higher in the 1^st, 2^nd, and 3^rd (p < 0.01) months, same in the 6^th month (p > 0.05), and lower in the 12^th (p < 0.01) month when compared to the preoperative period.

CONCLUSION: Idiopathic ERM may cause an increase in RNFL thickness in superior, inferior, and temporal quadrants with possible tractional effect. PPV with PVD induction and ERM and ILM peeling may cause these RNFL changes.

PMID:33824761 | PMC:PMC8006755 | DOI:10.1155/2020/5217645

Thromb Haemost. 2021 Apr 6. doi: 10.1055/a-1475-2263. Online ahead of print.

ABSTRACT

BACKGROUND: The 2019 European Society of Cardiology (ESC) guidelines recommend evaluation for right ventricular dysfunction in all normotensive patients with acute pulmonary embolism (PE). We compared the predictive performance of the 2019 and 2014 ESC risk stratification algorithms and the Pulmonary Embolism Severity Index (PESI).

METHODS: We performed a post-hoc analysis of normotensive patients aged ≥65 years with acute PE from a prospective cohort. The primary outcome was overall mortality; secondary outcomes were PE-related mortality and adverse outcomes (PE-related death, cardiopulmonary resuscitation, intubation, catecholamine use, recurrent venous thromboembolism) at 30 days. We assessed outcomes in intermediate-high, intermediate-low, and low risk groups according to the 2019 and 2014 ESC algorithms and the PESI. Discriminative power was compared using the area under the receiver operating curve (AUC).

RESULTS: Among 419 patients, 14 (3.3%) died (7 from PE) and 16 (3.8%) had adverse outcomes within 30 days. The 2019 ESC algorithm classified more patients as intermediate-high risk (45%) than the 2014 ESC algorithm (24%) or PESI (37%), and only 19% as low risk (32% with 2014 ESC or PESI). Discriminatory power for overall mortality was lower with the 2019 ESC algorithm (AUC 63.6%), compared to the 2014 ESC algorithm (AUC 71.5%) or PESI (AUC 75.2%), although the difference did not reach statistical significance (p=0.063). Discrimination for PE-related mortality and adverse outcomes was similar.

CONCLUSIONS: While categorizing more patients in higher-risk groups, the 2019 ESC algorithm for PE did not improve prediction of short-term outcomes compared to the 2014 ESC algorithm or the PESI.

PMID:33823559 | DOI:10.1055/a-1475-2263

Gerontology. 2021 Apr 6:1-11. doi: 10.1159/000514449. Online ahead of print.

ABSTRACT

BACKGROUND: The evidence supporting the use of antiresorptive and anabolic agents for fracture prevention in elderly patients is still inconclusive. Whether it is too late to alter the course of the disease in this age-group has remained uncertain.

OBJECTIVES: The objective of this study was to determine the efficacy and safety of antiresorptive and anabolic agents in elderly patients.

METHODS: PubMed, Web of Science, MEDLINE, and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials (RCTs) and post hoc analyses of RCTs reporting efficacy outcomes or adverse events of antiresorptive and anabolic agents in elderly patients. Statistical heterogeneity was assessed with the Cochran Q χ2 test and I2 statistic. All results were expressed as relative risk (RR) with 95% confidence intervals (CIs).

RESULTS: The meta-analysis included 1 RCT and 11 post hoc analyses of data from 10 double-blind placebo-controlled RCTs. Antiresorptive therapy significantly reduced the pooled incidence of vertebral fractures (RR = 0.43; 95% CI = 0.35-0.53; and p < 0.001). It was also associated with lower risk of nonvertebral and hip fractures (RR = 0.84; 95% CI = 0.74-0.96; and p = 0.009 and RR = 0.75; 95% CI = 0.58-0.97; and p = 0.028, respectively). For any adverse events, no difference was observed between antiresorptive agents and placebo groups (RR = 1.01; 95% CI = 1.00-1.02; and p = 0.23).

CONCLUSIONS: Both antiresorptive and anabolic agents represented potentially important osteoporosis treatments, showing significant effects on reducing vertebral, nonvertebral, or hip fracture risk, and were well-tolerated by elderly patients. Even in the elderly, maybe it is not too late to alter the course of the disease.

PMID:33823511 | DOI:10.1159/000514449

Fetal Diagn Ther. 2021 Apr 6:1-11. doi: 10.1159/000514504. Online ahead of print.

ABSTRACT

INTRODUCTION: This paper aimed to assess the knowledge of healthcare professionals (obstetric and gynecology residents, specialists, and midwives) in the field of perinatal medicine regarding fetal growth diagnosis and management.

METHODS: A questionnaire was created consisting of a set of questions regarding demographic data, methods of growth assessment, and management. It was a handout survey. The results were analyzed with the use of descriptive statistics and χ2 analysis using the program Statistica.

RESULTS: 190 medical professionals have participated in the questionnaire. 86.3% of respondents agreed that pregnancy dating should be modified based on first-trimester ultrasound. 90.9% agreed that III trimester ultrasound has a ±15% margin of error. When asked which growth charts are best fit for assessing growth in a studied population, 10.7% marked standard, 37.4% reference, 26.2% customized, and 26.2% did not know the difference between the three choices. 60.3% stated that they use a growth chart to assess growth and qualify fetuses for monitoring. 70.2% used the 10th centile as a cutoff, 20.1% 5th centile, and 9.7% 3rd centile. Only 40.9% would diagnose fetal growth restriction based on fetal weight only. 28.7% using the 10th centile cutoff, 16.1% 5th centile, and 54.0% 3rd centile. Only a quarter of the respondents were able to name the growth chart or tool that they use for assessment. The most common responses were Yudkin, Hadlock, and online calculators of Fetal Medicina Barcelona and the Fetal Medicine Foundation.

DISCUSSION: A lot of confusion is observed primarily in the aspect of cutoff values for identification, subsequent monitoring, and management of fetal growth restriction. There is a need for extensive training and education in this field and uniform national recommendations.

PMID:33823513 | DOI:10.1159/000514504

Eur J Prev Cardiol. 2020 Nov 5:zwaa049. doi: 10.1093/eurjpc/zwaa049. Online ahead of print.

ABSTRACT

AIMS: Heart failure (HF) is associated with obesity, but the relationship between weight change and HF is inconsistent. We examined the relationship between weight change and the incidence of HF in the Korean population.

DESIGN: Retrospective cohort study design.

METHODS AND RESULTS: A total of 11 210 394 subjects (6 198 542 men and 5 011 852 women) >20 years of age were enrolled in this study. Weight change over 4 years divided into seven categories from weight loss ≥15% to weight gain ≥15%. The hazard ratios (HRs) and 95% confidence intervals for the incidence of HF were analysed. The HR of HF showed a slightly reverse J-shaped curve by increasing weight change in total and >15% weight loss shows the highest HR (HR 1.647) followed by -15 to -10% weight loss (HR = 1.444). When using normal body mass index with stable weight group as a reference, HR of HF decreased as weight increased in underweight subjects and weight gain ≥15% in obesity Stage II showed the highest HR (HR = 2.97). Sustained weight for 4 years in the underweight and obesity Stages I and II increased the incidence of HF (HR = 1.402, 1.092, and 1.566, respectively).

CONCLUSION: Both weight loss and weight gain increased HR for HF. Sustained weight in the obesity or underweight categories increased the incidence of HF.

PMID:33823535 | DOI:10.1093/eurjpc/zwaa049

Phys Med Biol. 2021 Apr 6. doi: 10.1088/1361-6560/abf51f. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to investigate the feasibility of different acquisition methods for time-resolved magnetic resonance fingerprinting (TR-MRF) in computer simulation.

METHODS: Extended cardiac-torso (XCAT) phantom is used to generate abdominal T1, T2, and proton density (PD) maps for MRF simulation. The simulated MRF technique consists of an IR-FISP MRF sequence with spiral trajectory acquisition. MRF maps were simulated with different number of repetitions from 1 to 15. Three different methods were used to generate TR-MRF maps: 1) continuous acquisition without delay between MRF repetitions; 2) continuous acquisition with 5 seconds delay between MRF repetitions; 3) triggered acquisition with variable delay between MRF repetitions to allow the next acquisition to start at different respiration phase. After the generation of TR-MRF maps, the image quality indexes including absolute T1 and T2 value, signal-to-noise-ratio (SNR), tumor-to-liver contrast-to-noise ratio (CNR), error in the amplitude of diaphragm motion and tumor volume error were used to evaluate the reconstructed parameter maps. Three volunteers were recruited to test the feasibility of the selected acquisition method.

RESULTS: Dynamic MR parametric maps using three different acquisition methods were estimated. The overall and liver T1 value error, liver SNR in T1 and T2 maps, and tumor SNR from T1 maps from triggered method is statistically significantly better than the other two methods (p-value < 0.05). The other image quality indexes have no significant difference between the triggered method and the other two continuous acquisition methods. All image quality indexes exhibit no significant difference between the acquisition methods with 0 second and 5 seconds delay. The triggered method was successfully performed in three healthy volunteers.

CONCLUSION: TR-MRF technique was investigated using three different acquisition methods in computer simulation where the triggered method showed better performance than the other two methods. The triggered method has been tested successfully in healthy volunteers.

PMID:33823496 | DOI:10.1088/1361-6560/abf51f

Int J Pediatr Otorhinolaryngol. 2021 Jan 27;144:110606. doi: 10.1016/j.ijporl.2020.110606. Online ahead of print.

ABSTRACT

INTRODUCTION: Cochlear implantation is a safe surgery for restoration of hearing in profoundly deaf children. Following cochlear implantation, children undergo rehabilitation (or ‘habilitation’ for those without previous hearing). The device is programmed after the surgery, so that the user can hear sounds through it and through rehabilitation training, the heard sounds are made to understand.

OBJECTIVE: Our study was aimed at analysing the role of satellite habilitation centres following cochlear implantation by analysing the outcomes following habilitation and comparing it with the outcomes of the main centre and correlating it with the percentage of attendance of classes. Our study also aims to compare the attendance of implant patients from outside the geographical area of the main centre before and after starting the satellite centre.

MATERIALS AND METHODS: 1004 profoundly deaf children (6 years and below) who had undergone cochlear implantation and completed 12months of habilitation in our institution from July 2013 to December 2019 were retrospectively analysed. The outcomes of all the centres were assessed by comparing the baseline CAP with CAP scores at 12 months and baseline SIR with SIR scores at 12 months. The outcomes of the main centre and satellite centres were also compared. The outcomes were correlated with percentage of attendance of classes.

OBSERVATION: The overall attendance in all the centres was between 75 and 80%. Both main and satellite centres showed statistically significant good outcomes and this correlates with percentage of attendance.

CONCLUSION: Satellite centres for habilitation across the state has greatly helped to improve the attendance of these patients and outcomes. Reduced drop-out rates and improved speech language outcomes can be achieved by starting satellite centres for habilitation post cochlear implantation in developing countries like India.

PMID:33823468 | DOI:10.1016/j.ijporl.2020.110606

J Surg Res. 2021 Apr 3;264:138-148. doi: 10.1016/j.jss.2021.02.020. Online ahead of print.

ABSTRACT

BACKGROUND: Signet ring cell breast carcinoma (SRCBC) is a rare variant of invasive lobular carcinoma and there are no large series characterizing its long-term prognosis.

MATERIALS AND METHODS: The NCDB was queried from 2004-2016 to identify SRCBC patients. Patients were excluded if they had non-invasive tumors, multiple malignancies, or incomplete surgical data. Univariate analysis was performed utilizing chi-squared and Fischer’s Exact tests. Kaplan-Meier and Cox proportional hazard models were used for survival analysis.

RESULTS: 324 patients met inclusion criteria. Patients were mostly White (75.3%), ≥50 years of age (88.2%), female (98.5%), and had a low Charlson-Deyo score (82.7%). 34.5% had Stage IV disease and 78.1% had ER+ tumors. In patients with non-Stage IV disease, 91.5% received surgery: 49.5% had lumpectomy and 50.5% underwent mastectomy. Radiation therapy was used in 40.7% (71.4% with lumpectomy and 35.8% with mastectomy) and 50% received chemotherapy. Significant differences in unadjusted overall survival were seen at 5 and 10 years based on stage (P < 0.001). On multivariate analysis, ER+ patients showed an improved survival (HR 0.5, P < 0.01) but there was no difference in survival if ER+ patients received endocrine therapy (ET) (HR 0.9, P = 0.57). Non-metastatic patients who underwent surgery had improved overall survival compared to those that did not (HR 0.5, P = 0.02), but there was no survival difference based upon type of breast operation (P = 0.8).

CONCLUSION: SRCBC frequently presents at an advanced stage. While ER+ patients appear to have improved survival, there was no clear survival benefit to receiving ET in ER+ patients.

PMID:33823490 | DOI:10.1016/j.jss.2021.02.020

J Environ Manage. 2021 Mar 30;288:112403. doi: 10.1016/j.jenvman.2021.112403. Online ahead of print.

ABSTRACT

Water end-use studies disaggregate the quantity and frequency of water uses for various household purposes. Water end-use studies are available but none for India, which is gradually approaching a water-scarce condition from being a water-stressed country at present. This implies a need for incorporating water end-use understanding for augmenting urban recycling plans and strategies. To identify socio-demographic determinants of water end-use consumption for use in targeted urban water management, we focused on the indoor micro-components of bathing, dish-washing, laundering, and cleaning at households across the twin cities of Gujarat, a water-scarce province of India. A mixed-method approach was used for data collection in which questionnaire surveys (estimated or indirect measurements) were coupled with water meters (direct measurements) at households. The twin cities of Gujrat represent a spatial variation in greywater production at homes even at a distance of 30-40 km. Direct measurement showed less total average water consumption in Ahmedabad (83 L/HH/d) than Gandhinagar (105 L/HH/d), while indirect measurement showed indoor average consumption of 427 and 497 L/HH/d in the respective cities. Statistical significance of income, family size, and education was noticed on the water consumption pattern of a household. Besides, the study provides the attitude and practice of users towards water conservation behavior. We present new insights and recommendations for future urban water sustainability that are specific to India and applicable to several south-Asian countries.

PMID:33823433 | DOI:10.1016/j.jenvman.2021.112403

J Environ Manage. 2021 Mar 30;288:112412. doi: 10.1016/j.jenvman.2021.112412. Online ahead of print.

ABSTRACT

This study evaluated the impact of a 50% reduction of filter media depth in Household Slow Sand Filters (HSSFs) on continuous flow to remove physicochemical and microbiological parameters from river water. Furthermore, simple pre-treatment and disinfection processes were evaluated as additional treatments. Two filter models with different filtration layer depths were evaluated: a traditional one with 50 cm media depth (T-HSSF) and a compact one (C-HSSF) with 25 cm. HSSFs were fed with pre-treated river water (24-h water sedimentation followed by synthetic fabric filtration) for 436 days at a constant filtration rate of 0.90 m³ m^-2 day^-1 with a daily production of 48 L day^-1. Sodium hypochlorite (2.0 mg L^-1 of NaOCl 2.5% for 30 min) was used to disinfect the filtered water. Water samples were analysed weekly for parameters such as turbidity, organic matter, colour and E. coli, among others. Removal of protozoan cysts and oocysts by the HSSFs were also evaluated. After pretreatment, turbidity from the HSSF river water was reduced to 13.2 ± 14.6 NTU, allowing the filters to operate. Statistical analysis indicated no significant difference (p > 0.05) between T-HSSF and C-HSSF efficiencies in all evaluated parameters throughout operation time. Hence, media depth reduction did not hinder continuous HSSF performance for almost all the evaluated parameters. However, it may have affected Giardia cysts retaining, which passed through the thinner media on one evaluation day. Disinfection was effective in reducing remaining bacteria from filtered water; however, it was ineffective to inactivate protozoa. The reduction in the filtration layer did not affect the overall filtered water quality or quantity showing that a compact HSSF model may be a viable option for decentralized water treatment.

PMID:33823447 | DOI:10.1016/j.jenvman.2021.112412