Tag: statistics

J Orthop Surg Res. 2024 Dec 31;19(1):895. doi: 10.1186/s13018-024-05420-5.

ABSTRACT

OBJECTIVE: Ankle osteoarthritis is a debilitating condition that significantly impairs patients’ quality of life. Platelet-rich plasma has emerged as a novel cellular therapy in clinical practice. This study evaluates the clinical efficacy of platelet-rich plasma (PRP) after intervention in ankle disorders, so as to provide strong evidence in support of clinical treatment.

METHODS: A comprehensive and systematic search of PubMed, the Cochrane Library, Embase and web of science databases was performed, and studies that met the requirements according to the inclusion criteria were analyzed using Review Manager and STATA version 14.0. Quality assessment was performed using the Cochrane Collaboration Risk of Bias 2.0 tool. The outcome indicators were the American Orthopaedic Foot and Ankle Society Rating Scale (AOFAS) and Visual Analog Scale (VAS) scores used to evaluate the efficacy of platelet-rich plasma.

RESULTS: A total of 10 studies met the inclusion criteria. Regarding the AOFAS score, a meta-analysis that included five randomized controlled trials (each study extracted the score results at the last follow-up time) showed no statistically significant differences between the platelet-rich plasma intervention group and the control group, and there was a great deal of heterogeneity in the results, with subgroup analyses based on disease type. (Mean Difference = 4.14, 95% CI=-0.60-8.87, p = 0.09, I² = 86%). Subgroup analysis showed a more significant effect in patients with talar cartilage injuries (Mean Difference = 8.66, 95%CI = 6.61-10.71, p < 0.00001, I² = 0%). And the treatment effect of PRP remained effective in long-term follow-up (Mean Difference = 7.83, 95% CI = 5.57-10.09, p = 0.46, I² = 0%). For VAS scores, PRP relieved patients’ pain (Standardized Mean Difference=-0.62, 95%CI=-1.13-0.10, p = 0.02, I² = 77%) but showed a greater advantage in patients with cartilage injuries of the talus (Standardized Mean Difference=-1.24, 95%CI=-1.68-0.81, p < 0.00001, I² = 0%). Subgroup analyses according to different disease types and different follow-up times showed that PRP had significant efficacy in talar cartilage injuries in both the short and long term. A meta-analysis of single-arm studies showed that PRP was helpful in improving patients’ pain before and after the intervention (Standardized Mean Difference = -1.76, 95% CI = -2.85 to -0.67, p = 0.002, I^2 = 87%).However, the high level of heterogeneity may be due to the large differences between the inclusion criteria of the single-arm studies.

CONCLUSION: More clinical studies are needed to further confirm the efficacy of platelet-rich plasma in ankle disorders, and the current study only suggests that platelet-rich plasma may be more effective in talus cartilage injuries than in other types of ankle disorders.

PMID:39741342 | DOI:10.1186/s13018-024-05420-5

J Intensive Care. 2024 Dec 31;12(1):55. doi: 10.1186/s40560-024-00772-w.

ABSTRACT

BACKGROUND: Fluid balance gap (FBgap-prescribed vs. achieved) is associated with hospital mortality. Downtime is an important quality indicator for the delivery of continuous renal replacement therapy (CRRT). We examined the association of CRRT downtime with FBgap and clinical outcomes including mortality.

METHODS: This is a retrospective cohort study of critically ill adults receiving CRRT utilizing both electronic health records (EHR) and CRRT machine data. FBgap was calculated as achieved minus prescribed fluid balance. Downtime, or percent treatment time loss (%TTL), was defined as CRRT downtime in relation to the total CRRT time. Data collection stopped upon transition to intermittent hemodialysis when applicable. Linear and logistic regression models were used to analyze the association of %TTL with FBgap and hospital mortality, respectively. Covariates included demographics, Sequential Organ Failure Assessment (SOFA) score at CRRT initiation, use of organ support devices, and the interaction between %TTL and machine alarms.

RESULTS: We included 3630 CRRT patient-days from 500 patients with a median age of 59.5 years (IQR 50-67). Patients had a median SOFA score at CRRT initiation of 13 (IQR 10-16). Median %TTL was 8.1% (IQR 4.3-12.5) and median FBgap was 17.4 mL/kg/day (IQR 8.2-30.4). In adjusted models, there was a significant positive relationship between FBgap and %TTL only in the subgroup with higher alarm frequency (6 + alarms per CRRT-day) (β = 0.87 per 1% increase, 95%CI 0.48-1.26). No association was found in the subgroups with lower alarm frequency (0-2 and 3-5 alarms). There was no statistical evidence for an association between %TTL and hospital mortality in the adjusted model with the interaction term of alarm frequency.

CONCLUSIONS: In critically ill adult patients undergoing CRRT, %TTL was associated with FBgap only in the subgroup with higher alarm frequency, but not in the other subgroups with lower alarms. No association between %TTL and mortality was observed. More frequent alarms, possibly indicating unexpected downtime, may suggest compromised CRRT delivery and could negatively impact FBgap.

PMID:39741337 | DOI:10.1186/s40560-024-00772-w

Eur J Med Res. 2024 Dec 31;29(1):639. doi: 10.1186/s40001-024-02242-3.

ABSTRACT

BACKGROUND: There are limited and controversial findings concerning ovulation induction using intrauterine and intramuscular human chorionic gonadotropin (hCG) injection compared to intramuscular hCG alone. The study aimed to examine the impact of intrauterine hCG injection, which is used to induce ovulation, on the efficacy of the intrauterine insemination (IUI) technique in patients with unexplained infertility.

METHODS: A randomized controlled clinical trial was conducted involving 80 subjects with unexplained primary infertility at the infertility clinic of Al-Zahra Hospital in northwest Iran. Patients were randomly allocated into two groups: control and intervention. Both groups received initial treatment with letrozole and Recombinant follicle-stimulating hormone (r-FSH). After confirmation of at least one follicle measuring 18 mm or larger through ultrasonography, in the control group, two ampoules of 5000 units of hCG were administered intramuscularly. The intervention group received 500 units of hCG diluted in 0.5 cc of normal saline and was injected into the uterine cavity along with the two intramuscular ampoules. Primary outcomes were clinical and chemical pregnancy rates and the secondary outcome was any adverse pregnancy outcomes. Multiple logistic regression analysis was used to estimate crude and adjusted odds ratios (AORs) of the pregnancy rates with 95% confidence intervals (CIs).

RESULTS: No significant differences were found between the two groups regarding baseline characteristics (p > 0.05). Chemical and clinical pregnancy rates in the control and intervention groups were (32.5 vs. 40%) (32.5% vs. 35%), respectively. In the final analysis after adjusting the potential confounders, intrauterine and intramuscular hCG injection increased the likelihood of chemical pregnancy by 1.39 times AOR = 1.42 (1.31-4.12; p = 0.036), and clinical pregnancy by AOR = 1.25 (1.03-3.74; p = 0.048) compared to intramuscular hCG alone. There were no statistical differences regarding adverse pregnancy outcomes between the study groups (p value > 0.05).

CONCLUSIONS: It seems that ovulation induction through intrauterine and intramuscular hCG injection increased the odds of both chemical and clinical pregnancy rates compared with intramuscular hCG alone. Multicenter clinical trials and meta-analysis studies are needed for decision making in clinical settings.

PMID:39741322 | DOI:10.1186/s40001-024-02242-3

J Orthop Surg Res. 2024 Dec 31;19(1):898. doi: 10.1186/s13018-024-05367-7.

ABSTRACT

OBJECTIVE: This study aims to explore the predictive value of endplate morphology and pedicle screw bone quality score on screw loosening after single-level lumbar spinal fusion surgery.

METHODS: A retrospective analysis was conducted on the clinical data of 207 patients who underwent single-level lumbar spinal fusion (34 in the screw loosening group and 173 in the non-screw loosening group). Univariate analysis and binary logistic regression model analysis were performed using SPSS 27.0. MedCalc 23 was used to plot the receiver operating characteristic (ROC) curve to evaluate diagnostic efficacy.

RESULTS: Through comparative analysis of clinical data, we found statistically significant differences between the two groups in terms of endplate morphology, lumbar CT values, and PBQ scores(P<0.05). The results of the binary logistic regression analysis indicated that endplate morphology (OR = 17.088, 95% CI: 3.886-75.142; p < 0.001) and PBQ score (OR = 3.347, 95% CI: 1.473-7.603; p = 0.004) are independent risk factors for screw loosening after single-level lumbar spinal fusion surgery. The ROC analysis showed that the area under the curve (AUC) for endplate morphology was 0.731 (95% confidence interval [CI]: 0.665-0.790), with the optimal threshold representing irregular endplate morphology (sensitivity: 94.1%, specificity: 52.0%). The AUC for the PBQ score was 0.791 (95% CI: 0.729-0.844), with an optimal threshold of 3.198 (sensitivity: 91.2%, specificity: 61.8%). Furthermore, the predictive model constructed using both endplate morphology and PBQ score had an AUC of 0.870 (95% confidence interval: 0.817-0.913), with a maximum Youden index of 0.668, yielding a diagnostic sensitivity of 88.2% and specificity of 78.6%.

CONCLUSION: Endplate morphology and pedicle screw bone quality score have significant reference value for diagnosing screw loosening after single-level lumbar spinal fusion surgery.

PMID:39741319 | DOI:10.1186/s13018-024-05367-7

BMC Oral Health. 2024 Dec 31;24(1):1574. doi: 10.1186/s12903-024-05377-1.

ABSTRACT

OBJECTIVE: Based on the critical role of implant length and placement timing in treatment success, this study aimed to compare clinical outcomes (implant failure, marginal bone loss, biological and mechanical complications) between short implants (4-8 mm) versus long implants (≥ 8 mm) with sinus floor elevation, and between delayed versus immediate placement of long implants in the posterior maxilla.

METHODS: This network meta-analysis was prospectively registered in the PROSPERO database (CRD42023495027). Adhering to PRISMA-NMA guidelines, we systematically reviewed eligible studies from January 2014 to November 2024 was conducted across major databases, such as the Cochrane Library, PubMed, Embase, Scopus and Web of Science. The main focus of this NMA was to determine the rate of implant failure, as well as to assess marginal bone loss and the occurrence of biological and mechanical complications related to the implants.

RESULTS: Data from 17 studies, involving 1,076 patients and 1,751 implants, was collected and examined. Long implants have lower failure rates (OR = 1.26; 95% CI = 0.53, 3.00) and short dental implants showed a trend towards lower biological (OR = 0.47; 95% CI = 0.19, 1.18) and mechanical (OR = 0.94; 95% CI = 0.45, 1.94) complications rates, although this trend was not statistically significant. Additionally, compared to longer implants, short implants resulted in a significant reduction in marginal bone loss, regardless of whether long implants were immediately (MD=-0.17; 95%CI: -0.29, -0.05) or delayed (MD = 0.35; 95%CI: 0.05, 0.64) placed following sinus floor elevation. The analysis of cumulative ranking probabilities revealed that delayed placement of long implants with SFE demonstrated the highest efficacy in reducing implant failure (73.9%). SIs were found to excel in reducing marginal bone loss (88.7%) and biological complications (88.2%%), while short implants with SFE proved to be the most effective in preventing mechanical complications (66.0%%).

CONCLUSION: Short implants achieved comparable clinical outcomes to long implants with sinus floor elevation in posterior maxilla with limited vertical bone height. Given the limitations of the network meta-analysis and included studies, treatment selection should be individualized based on specific patient conditions.

PMID:39741292 | DOI:10.1186/s12903-024-05377-1

J Orthop Surg Res. 2024 Dec 31;19(1):896. doi: 10.1186/s13018-024-05339-x.

ABSTRACT

BACKGROUND: Anterior cervical corpectomy and fusion (ACCF) is a standard surgical procedure for cervical spondylosis with spinal cord compression (CSWSCC), especially in patients with intensity on T2-weighted imaging high signal (T2WIHS). The titanium mesh cage (TMC) utilized in this procedure is essential in stabilizing the spine; however, the optimal slotting width of the TMC remains unclear.

OBJECTIVE: This study aimed to investigate the impact of TMC slotting width on the clinical and radiological outcomes of ACCF in patients with spinal cord compression type cervical spondylosis with intensity on T2WIHS (CST2WIHS).

METHODS: We retrospectively analyzed 69 patients who underwent single-level ACCF between December 2010 and October 2021. The patients were divided into narrower (< 2 mm) and wider (> 2 mm) groups based on the slotting width of the TMC. The Neck Disability Index (NDI) and Japanese Orthopedic Association (JOA) scores were used to assess clinical outcomes. Radiological outcomes included cervical lordosis (CL), functional spinal unit (FSU) height, transverse decompression range (TDR), spinal canal area (SCA), TMC alignment, and subsidence and fusion rates.

RESULTS: Patients in both groups exhibited significant postoperative improvement in NDI and JOA scores (P < 0.05). Radiologically, patients in the wider slotting group exhibited better decompression, evidenced by a larger TDR (P < 0.01) and smaller postoperative SCA (P < 0.01) than the narrow group. Regarding CL, FSU height, TMC alignment, subsidence, or fusion rates, the groups did not differ significantly. Although statistically non-significant, patients in the wider group exhibited a trend towards improvement in spinal cord signal intensity than those in the narrower group.

CONCLUSION: The study demonstrated that a wider TMC slotting width offers superior decompression and may improve postoperative spinal cord signal; it does not compromise spinal stability or fusion outcomes. These findings indicate that slotting width should be carefully considered in ACCF procedures to optimize decompression and spinal cord recovery.

PMID:39741291 | DOI:10.1186/s13018-024-05339-x

BMC Gastroenterol. 2024 Dec 31;24(1):482. doi: 10.1186/s12876-024-03574-4.

ABSTRACT

BACKGROUND: Percutaneous Endoscopic Gastrostomy (PEG) tube insertion, a routine procedure for long-term enteral nutrition, serves as a crucial intervention for patients who are incapable of tolerating oral intake or meeting adequate nutritional requirements. PEG tube placement carries complications like bleeding and infection. Impact of PEG tubes on the 30-day and long-term mortality in HIV patients is unknown. Despite the ongoing utilization of PEG tubes in HIV patients, a comprehensive exploration of its outcomes is yet to be explored. We intended to study the impact of HIV positive status on post-PEG mortality and review other PEG tube related complications.

METHODS: Our study comprised a total of 639 PEG tubes placed on 461 unique patients, from which 85 patients (n = 18%) were HIV positive. We reviewed all these PEG tube patients at our institution and compared their complications and mortality outcome between the two groups of HIV positive as against HIV negative.

RESULTS: Our findings reveal a statistically significant increase (p-value 0.001) in post-PEG insertion site bleeding in the HIV group (15.3%) compared to the non-HIV group (4.5%). This difference occurred despite no notable variations in laboratory parameters such as platelet count and (international normalized ratio), as well as similar usage of anticoagulant or antiplatelet medications between the two groups. Notably, the 1-year mortality rate in the HIV group stands at 37.6% (p < 0.001), contrasting sharply with the non-HIV group’s rate of 17.8%.

CONCLUSION: This study underscores the need for heightened vigilance and tailored management strategies when considering PEG tube procedures in the context of HIV, given the observed elevated bleeding risks and increased 1-year mortality rates in this patient population. Further research is warranted to elucidate the underlying factors contributing to these outcomes, facilitating the development of targeted interventions to optimize the care of HIV patients undergoing PEG placement.

PMID:39741264 | DOI:10.1186/s12876-024-03574-4

BMC Psychiatry. 2024 Dec 31;24(1):962. doi: 10.1186/s12888-024-06434-3.

ABSTRACT

BACKGROUND: Major depressive disorder (MDD) is a highly prevalent mental disorder with devastating consequences that often first manifest during adolescence. Anhedonia has emerged as one of the most promising symptoms of adolescent MDD, which means a longer time to remission， fewer depression-free days, and also increased risk of suicide ideas or actions. Research has shown that at least two-thirds of depressed adolescents have significant sleep-onset or sleep-maintenance problems. However, the association between sleep disorder and anhedonia, and the potential mediators are less understood.

METHODS: This is a cross-sectional study that includes 200 adolescents suffered from MDD between the ages of 12-17. We use Spearman’s test to explore the relationship among main variables. To evaluate the mediating effects of stress, we applied regression models and used bootstrap method to validate the significance of effects.

RESULTS: Significant correlation exists among sleep disorder, stress, and anhedonia (P<0.05).The direct effect of sleep disorder on anhedonia was 0.214 (95% CI: 1.5235, 6.2073), while the total effect was 0.295 (95% CI: 2.9683, 7.6924). The indirect effect of sleep disorder on anhedonia mediated by stress was 0.081 (95% CI: 0.5842, 2.5268). Robustness of the regression analysis results has been verified by bootstrap test.

CONCLUSIONS: Our finding suggested a positive correlation between sleep disturbance and anhedonia in adMDD. Stress partially mediated the relationship between sleep disorder and anhedonia. Due to the deleterious effects of anhedonia on depressed adolescents, these findings provide impetus to investigate further the causal relationship between sleep problems and anhedonia.

TRIAL REGISTRATION: ChiCTR2200060176(Registration Date: 21/05/2022).

PMID:39741263 | DOI:10.1186/s12888-024-06434-3

BMC Oral Health. 2024 Dec 31;24(1):1577. doi: 10.1186/s12903-024-05379-z.

ABSTRACT

BACKGROUND: Orthodontic treatment involves manipulation of tooth position that can temporarily lead to occlusal interferences capable of inducing bruxism. The objectives of this study were to determine the self-reported incidence of bruxism and its association with factors such as facial type, divergence, skeletal and dental malocclusions in orthodontic patients.

MATERIALS AND METHODS: 80 patients who underwent a minimum of six months of orthodontic treatment were surveyed using a validated self-reported bruxism questionnaire for the presence or absence of bruxism. Data regarding patients’ facial type, divergence, skeletal and dental malocclusions were measured and collected from the patients’ orthodontic records. Binomial logistic regression analysis was used to assess the association of these factors with bruxism.

RESULTS: About 45% of the orthodontic patients reported bruxism after the commencement of orthodontic treatment. The median age of the sample was 19.8 (17.7, 24.3) years and 60% of them were women. Binomial logistic regression analysis showed an insignificant association of gender and age with bruxism. When analyzing the association with facial type, divergence, skeletal and dental malocclusion no statistically significant association was found. However, patients with hypodivergent face [odds ratio (OR) = 2.4; 95% confidence interval (CI) = 0.7-8.5] and dental class III [OR = 4.0; 95% CI = 0.3-51.0] were more likely to report bruxism after the initiation of orthodontic treatment. A statistically significant association was found with jaw fatigue or soreness upon awakening (28.7%), clenching (27.5%) and grinding (25%) in the bruxism group (p-value ≤ 0.001). Teeth and gum soreness were also significantly associated with bruxism, affecting 25% of the orthodontic patients (p-value ≤ 0.001). On the contrary, nocturnal grinding (10%) and temporal headaches (21.3%) were negatively correlated with bruxism.

CONCLUSIONS: There is a risk of bruxism among orthodontic patients, with 45% of them reporting bruxism following the initiation of treatment. Patients with bruxism commonly reported jaw fatigue or soreness upon awakening, clenching, grinding, teeth and gum soreness. Factors such as facial type, facial divergence, skeletal and dental malocclusions have no impact on the onset of bruxism during orthodontic treatment.

PMID:39741259 | DOI:10.1186/s12903-024-05379-z

BMC Psychiatry. 2024 Dec 31;24(1):960. doi: 10.1186/s12888-024-06390-y.

ABSTRACT

BACKGROUND: Problematic Internet use (PIU) is a growing concern in modern society. There is a limitation of epidemiologic data related to PIU. This is due to a lack of consensus on the definition and variability of assessment tools of PIU. PIU has been linked to a range of negative outcomes including depression, anxiety, social isolation, and poor academic or work performance. Resident physicians are at risk of exhibiting problematic internet use due to the high stress of academic demands, social isolation, long working hours, busy schedules, and internet access. There is limited research on this topic and targeting resident physicians in Ethiopia. This study aimed to determine the PIU prevalence and associated factors among resident physicians in SPHMMC, Ethiopia.

METHODS: An institutional-based cross-sectional study was conducted from September 1, 2023, to November 25, 2023, at St. Paul’s Hospital Millennium Medical College (SPHMMC). This study included 417 physician residents who were selected using multistage sampling techniques, and Young’s Internet addiction test was used to assess PIU. To look for associations, logistic regression analysis, both binary and multivariable, was performed, and a p-value of < 0.05 was used to determine statistical significance.

RESULTS: 414 participants were included in this study, with a response rate of 99.3%. The prevalence of PIU was 46.6%, with a 95% CI of 41.7-51.6%. The multivariable logistic regression model revealed that using the Internet for five or more hours per day (AOR: 1.84, 95% CI = 1.14, 2.99), having less than 7 h of actual sleep per night (AOR: 2.16, 95% CI = 1.03, 4.53), and having depression (AOR: 7.98, 95% CI = 2.47, 25.78) were significantly positively associated with PIU. In addition, factors such as being married (AOR: 0.42, 95% CI = 0.19, 0.91) and residents of the obstetrics and gynecology department (AOR: 0.32, 95% CI = 0.13, 0.81) were negatively associated with PIU.

CONCLUSION: This study revealed high PIU use among resident physicians at SPHMMC. Factors such as using the Internet for five or more hours per day, having less than seven hours of actual sleep per night, and having depression were found to be risk factors for PIU. On the other hand, being married and residents of the obstetrics and gynecology department were protective factors. Thus, creating awareness among medical residents about healthy tech habits and involving policymakers to develop guidelines for healthy internet use and awareness campaigns to reduce the impact of PIU is recommended.

PMID:39741254 | DOI:10.1186/s12888-024-06390-y