Tag: statistics

Eur J Neurol. 2023 Aug 11. doi: 10.1111/ene.16034. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence-based recommendations for treatment of Lyme neuroborreliosis (LNB) should rely on the available literature. As new data emerges, close review and evaluation of the recent literature is needed to build evidence-based recommendations to inform clinical practice and management of LNB. We performed an update of a previous systematic review on treatment of LNB.

METHODS: A systematic literature search of Medline and CENTRAL was performed for published studies from 2015-2023 to update a previous systematic review. Randomized controlled trials (RCTs) and non-randomized studies (NRS) were evaluated. Risk of bias was assessed using the Cochrane risk of bias tools for RCTs, NRS were assessed using the ROBINS-I-tool. Quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Data was integrated in existing meta-analysis of the available literature.

RESULTS: After screening 1530 records, 2 RCTs and 5 NRS with new and relevant data were additionally identified. Meta-analysis showed no statistically significant difference between doxycycline and beta-lactam antibiotics regarding residual neurological symptoms after 12 months. Meta-analysis showed no benefit of extended antibiotic treatment of LNB. Three NRS show no benefit for additional steroid use in LNB with facial palsy.

DISCUSSION: Additional incorporated recent research corroborates existing guideline recommendations for treatment of LNB. New RCTs add to the certainty of previous analysis showing similar efficacy for doxycycline and beta-lactam antibiotics in LNB. Available evidence shows no benefit for extended antibiotic treatment in LNB. NRS do not suggest a role for steroids in facial palsy due to LNB.

PMID:37565386 | DOI:10.1111/ene.16034

Clin Oral Implants Res. 2023 Aug 11. doi: 10.1111/clr.14157. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze the influence of titanium-base (straight [SSC]/angulated-screw-channel [ASC]) on failure-loads and bending-moments of two-piece ceramic and titanium-zirconium implants restored with monolithic-zirconia crowns after fatigue.

MATERIALS AND METHODS: Thirty-two anterior monolithic-screw-retained zirconia crowns were divided into four groups (n = 8/group) according to the factors: (1) type of implant material: two-piece titanium-zirconium implant (Ti-Zr; control-group) versus two-piece ceramic implant (CI; test-group) and (2) type of titanium-base: SSC (0° angle) versus ASC (25°). An intact implant was used for field emission gun-scanning electronic microscopy (FEG-SEM) characterization and Raman spectroscopy for phase analyses and residual stress quantification. All samples were exposed to fatigue with thermodynamic loading (1.2-million-cycles, 49 N, 1.6 Hz, 5-55°C) at a 30° angle. Surviving specimens were loaded until failure (SLF) and bending moments were recorded. Failed samples were examined using light microscope and SEM. Statistical analyses included ANOVA and Mann-Whitney U-test.

RESULTS: Raman-spectroscopy revealed the presence of residual compressive stresses. FEG-SEM revealed a roughened surface between threads and polished surface at the cervical-collar of the ceramic implant. All samples survived fatigue and were free of complications. Mean bending-moments (±SD) were: Ti-Zr-0: 241 ± 45 N cm, Ti-Zr-25: 303 ± 86 N cm, CI-0: 326 ± 58 N cm, CI-25: 434 ± 71 N cm. Titanium-base and implant-material had significant effects in favor of ASC titanium bases (p = .001) and ceramic-implants (p < .001). Failure analysis after SLF revealed severe fractures in ceramic implants, whereas titanium implants were restricted to plastic deformation.

CONCLUSIONS: Ceramic and titanium implants exhibited high reliability after fatigue, with no failures. From a mechanical perspective, titanium bases with ASC can be recommended for both ceramic and titanium implants and are safe for clinical application.

PMID:37565379 | DOI:10.1111/clr.14157

Eur J Heart Fail. 2023 Aug 10. doi: 10.1002/ejhf.2995. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Pulmonary capillary wedge pressure (PAWP) ≥25mmHg during bicycle ergometry is recommended to uncover occult heart failure with preserved ejection fraction. We hypothesized that PAWP increase would differ in available diastolic stress tests and that the margin of PAWP≥25mmHg would only be reliably achieved through ergometry.

METHODS: We conducted a prospective, single-arm study in patients with an intermediate risk for heart failure with preserved ejection fraction according to the ESC Heart Failure Association score. 19 patients underwent four stress test modalities in randomized order: leg raise, fluid challenge, handgrip, and bicycle ergometry. The primary outcome was the difference (Δ) between resting and exercise PAWP in each modality. Secondary outcomes were differences (Δ) in mean pulmonary artery pressure (mPAP), cardiac output (CO), as well as the ratios between mPAP and PAWP to CO.

RESULTS: Compared to resting values, passive leg raise (Δ7.7±8.0mmHg, p=0.030), fluid challenge (Δ9.2±6.4mmHg, p=0.003), dynamic handgrip (Δ9.6±7.5mmHg, p=.002), and bicycle ergometry (Δ22.3±5.0mmHg, p<.001), uncovered increased PAWP during exercise. Amongst these, bicycle ergometry also demonstrated the highest ΔmPAP (27.2±7.1mmHg, p<.001), ΔCO (3.3± 2.6L/min, p<.001), ΔmPAP/CO ratio (2.3±2.0mmHg/L/min, p<.001), and ΔPAWP/CO ratio (2.2±1.4mmHg/L/min, p<.001) compared to other modalities. PAWP≥25mmHg was only reliably achieved in bicycle ergometry (31.1±3.9mmHg). In all other modalities only 10.5% of patients achieved PAWP≥25mmHg (handgrip 18.4±6.6mmHg, fluid 18.1±5.6mmHg, leg raise 16.5±7.0mmHg).

CONCLUSIONS: We demonstrate that bicycle ergometry exhibits a distinct hemodynamic response with higher increase of PAWP compared to other modalities. This finding needs to be considered for valid detection of exercise PAWP ≥25mmHg when non-bicycle tests remain inconclusive. NCT04970953. https://clinicaltrials.gov/ct2/show/NCT04970953. This article is protected by copyright. All rights reserved.

PMID:37565370 | DOI:10.1002/ejhf.2995

J Biomol Struct Dyn. 2023 Aug 11:1-11. doi: 10.1080/07391102.2023.2245045. Online ahead of print.

ABSTRACT

Cholesterol is one of the essential component of lipid in membrane. We present a polarizable atomic multipole force field (FF) for the molecular dynamic simulation of cholesterol. The FF building process follows the computational framework as the atomic multipole optimized energetics for biomolecular applications (AMOEBA) model. In this framework, the electronics parameters, including atomic monopole moments, dipole moments, and quadrupole moments calculated from ab initio calculations in the gas phase, are applied to represent the charge distribution. Furthermore, the many-body polarization is modeled by following the same pattern of distributed atomic polarizabilities. Then, the bilayers composed of two typical phospholipid molecules, 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC), and 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine (POPC), in a range of different cholesterol concentrations are built and implemented by molecular dynamics (MD) simulations based on the proposed polarizable FF. The simulation results are statistically analyzed to validate the feasibility of the proposed FF. The structural properties of the bilayers are calculated to compare with the related experimental values. The MD values show the same trend of experimental values changes.Communicated by Ramaswamy H. Sarma.

PMID:37565356 | DOI:10.1080/07391102.2023.2245045

Acta Orthop. 2023 Aug 9;94:416-425. doi: 10.2340/17453674.2023.17737.

ABSTRACT

BACKGROUND AND PURPOSE: Antibiotic-loaded bone cement (ALBC) and systemic antibiotic prophylaxis (SAP) have been used to reduce periprosthetic joint infection (PJI) rates. We investigated the use of ALBC and SAP in primary total knee arthroplasty (TKA).

PATIENTS AND METHODS: This observational study is based on 2,971,357 primary TKAs reported in 2010-2020 to national/regional joint arthroplasty registries in Australia, Denmark, Finland, Germany, Italy, the Netherlands, New Zealand, Norway, Romania, South Africa, Sweden, Switzerland, the UK, and the USA. Aggregate-level data on trends and types of bone cement, antibiotic agents, and doses and duration of SAP used was extracted from participating registries.

RESULTS: ALBC was used in 77% of the TKAs with variation ranging from 100% in Norway to 31% in the USA. Palacos R+G was the most common (62%) ALBC type used. The primary antibiotic used in ALBC was gentamicin (94%). Use of ALBC in combination with SAP was common practice (77%). Cefazolin was the most common (32%) SAP agent. The doses and duration of SAP used varied from one single preoperative dosage as standard practice in Bolzano, Italy (98%) to 1-day 4 doses in Norway (83% of the 40,709 TKAs reported to the Norwegian arthroplasty register).

CONCLUSION: The proportion of ALBC usage in primary TKA varies internationally, with gentamicin being the most common antibiotic. ALBC in combination with SAP was common practice, with cefazolin the most common SAP agent. The type of ALBC and type, dose, and duration of SAP varied among participating countries.

PMID:37565339 | DOI:10.2340/17453674.2023.17737

J Clin Endocrinol Metab. 2023 Aug 11:dgad448. doi: 10.1210/clinem/dgad448. Online ahead of print.

ABSTRACT

BACKGROUND: Atrial fibrillation (AF) has been linked to increased hyperthyroidism risk, but contributing factors are unclear.

METHODS: This retrospective cohort study was conducted in a tertiary medical institution and included patients aged 18 years or older with AF but without hyperthyroidism at diagnosis. The endpoint was defined as newly diagnosed hyperthyroidism during follow-up.

RESULTS: The study cohort included 8,552 participants. Patients who developed new hyperthyroidism were younger and had a higher proportion of females. They had fewer comorbidities, including diabetes (26% vs 29%, p = 0.121), hypertension (51% vs 58%, p < 0.001), coronary artery disease (17% vs 25%, p < 0.001), stroke (16% vs 22%, p < 0.001), and end-stage renal disease (ESRD) (6% vs 10%, p = 0.001). The CHADS2 score was lower in patients with hyperthyroidism (1.74 vs 2.05, p = 0.031), but there was no statistically significant difference in the CHA2DS2-VAsc and HAS-BLED score. Cox regression analysis identified younger age, female gender, history of congestive heart failure, hypertension, diabetes, non-ESRD status, and lower CHADS2 score but not CHA2DS2-VASc as independent predictors of incident hyperthyroidism during follow-up. We also propose a novel, simple risk stratification score (SAD HEC2 score) with excellent predictive power for incident hyperthyroidism during follow-up.

CONCLUSIONS: Our results provide insight into clinical risk factors for the development of hyperthyroidism in AF patients, as identified by the novel SAD HEC2 score. AF appears to be a common precursor of hyperthyroidism.

PMID:37565329 | DOI:10.1210/clinem/dgad448

Int J Cosmet Sci. 2023 Aug 11. doi: 10.1111/ics.12893. Online ahead of print.

ABSTRACT

OBJECTIVE: Barrier creams (BCs) are marketed as locally-applied medical devices or cosmetic products to protect the skin from exposure to chemicals and irritants. Generally, the mechanism of action of such products is mainly due to the formation of a superficial thin film between the skin and the irritant or sensitizer, thus reducing or totally blocking the cutaneous penetration of such agents. Specifically, studies focusing on the effectiveness of commercial protective creams to prevent nickel cutaneous penetration are extremely scarce. The aim of the current work, therefore, is to evaluate the protective role of a commercially available barrier cream for nickel and compare the results with a simple moisturizing, following exposure to Ni powder.

METHODS: Marketed BCs were evaluated and tested. Human skin absorption of Ni was studied in vitro using static Franz diffusion cells.

RESULTS: Our results demonstrate that the application of both formulations caused a reduction of Ni inside the skin (8.00 ± 3.35 μg·cm^-2 for the barrier cream and 22.6 ± 12.6 μg·cm^-2 for the general moisturizing product), with the specialized barrier cream being statistically (p = 0.015) more efficient on forming a protective barrier, thus evidencing the importance of some ingredients of such formulations on the nickel dermal accumulation.

CONCLUSIONS: The composition of the formulations based on film forming or chelating agents may play an imperative role to reduce the cutaneous penetration of Ni.

PMID:37565324 | DOI:10.1111/ics.12893

Int J Cosmet Sci. 2023 Aug 11. doi: 10.1111/ics.12890. Online ahead of print.

ABSTRACT

OBJETIVE: Sisal is a common stiff fiber produced around the world, corresponding to approximately 70% of commercial production of all fibers of this type. The fibers are extracted from the leaves of Agave sisalana, from which approximately 4% of its weight is obtained, with the remaining 96% considered to be residues from the process of the sisal industry. The objective of this work was to obtain a polyphenols-enriched extract from the A. sisalana residue by ultrasonically assisted extraction (UAE), characterize it chemically, evaluate in vitro antioxidant activity, and develop safe and stable photoprotective formulations for future application in cosmetic preparations.

METHODS: Ultrasonic extraction of solid plant material was performed using 50% ethanol/water (v/v). The extract was chemically characterized by high-performance liquid chromatography (HPLC) equipment associated with classical molecular networking (MN) and evaluated for in vitro antioxidant activity by different methodologies. Ten formulations were prepared varying the component concentrations and the shear time. The 1.0% sisal extract was incorporated into the most stable formulations and preliminary and accelerated stability was evaluated. The emulsions were investigated for safety by assessment of primary accumulated dermal irritability and sensitization and dermatological clinical study of phototoxicity and photosensitization. The photoprotective formulations containing or not the extract that were stable after 90 days, had their in vivo Sun Protection Factor, UVA Protection Factor, critical wavelength, and protection against visible and blue light determined.

RESULTS: Ultrasound extraction using 50% ethanol/water (EH 50) as an extractor vehicle showed the best yield. The extract exhibited a concentration of phenolic compounds (77.93 mg of EAG/g) and showed in vitro antioxidant activity. Emulsions without and with 1.0% sisal extract remained stable and safe. The addition of the extract to the photoprotective formulation statistically increased the SPF when compared to the formulation without the extract and offered protection against UVA radiation, critical wavelength, and absorption of visible and blue light.

CONCLUSION: Based on the findings, the solid residue of A. sisalana may be indicated as a component of photoprotective and antioxidant cosmetic formulations.

PMID:37565318 | DOI:10.1111/ics.12890

Clin Psychol Psychother. 2023 Aug 11. doi: 10.1002/cpp.2897. Online ahead of print.

ABSTRACT

INTRODUCTION: This work aims to demonstrate, through the International Affective Picture System (IAPS) responses, an altered emotional pattern in borderline personality disorder (BPD) patients and to find a specific emotional response pattern by understanding their relationship with traumatic experiences and attachment bonds towards their primary caregivers.

METHOD: A total of 50 BPD patients and 39 control patients were evaluated using the IAPS, and its assessment was carried out through the Self-Assessment Manikin (SAM). Paternal and maternal attachment bonds as well as traumatic experiences in BPD patients were evaluated. Statistical associations were analysed in the different variables.

RESULTS: Significant differences between BPD and control patients were found in all emotional response components for pleasant, unpleasant and neutral images (p < .01), with one exception, the arousal in pleasant images. Patients’ experience of traumatic experiences was positively related to scores on the happiness component of pleasant imagery (p = .057) and on the arousal component of unpleasant imagery (p = .058). Poorer maternal bonding in BPD patients was significantly related to lower scores on happiness (p < .01) and dominance (p < .05) components of pleasant imagery and all emotional response components for unpleasant imagery (p < .01).

CONCLUSIONS: The results of the study confirm an impaired emotional response pattern in patients with borderline personality disorder (BPD), showing an emotional response to pleasant images similar to that of depression, while the pattern found to unpleasant images could be related to the complex trauma observed in these patients, which includes PTSD experiences such as sexual abuse and attachment trauma experiences.

PMID:37565308 | DOI:10.1002/cpp.2897

Orthod Craniofac Res. 2023 Aug 11. doi: 10.1111/ocr.12693. Online ahead of print.

ABSTRACT

OBJECTIVE: Mandibular condylar cartilage (MCC) of the rat was examined with the Fourier-transform infrared (FITR) spectroscopic imaging to study the effects of ageing, oestrogen level and altered dietary loading on the structure of MCC.

MATERIALS AND METHODS: The Sprague-Dawley rats (n = 96) aged 5 and 14 months were divided into 12 subgroups according to age, oestrogen status (ovariectomized [OVX], non-ovariectomized [non-OVX)]) and diet (hard, normal, soft). Specimens of the MCC were examined with FTIR spectroscopic imaging to quantify the distribution of collagens and proteoglycans. MCC was divided sagittally into three segments: anterior, most superior and posterior. From each segment, the collagen and proteoglycan contents at different depths of cartilage were statistically compared between the groups using an N-way analysis of variance (ANOVA).

RESULTS: The amount of collagen content was significantly associated with old age in the deep layer of the anterior segment and in the middle layer of the posterior segment of MCC. In the deep layer of the most superior segment, the collagen content also increased with ageing. The amount of proteoglycan content increased significantly when dietary loading increased, and the oestrogen level decreased in the deep layer of the most superior segment of MCC.

CONCLUSION: Ageing, oestrogen level and altered dietary loading have a significant effect on the location and content of collagens and proteoglycans of rat MCC. Ageing significantly increased the amount of collagen content in the superior and posterior segments, being highest in the older soft-diet rats. Decreased oestrogen levels and increased dietary loading increased the amount of proteoglycan content.

PMID:37565299 | DOI:10.1111/ocr.12693