Tag: statistics

Environ Anal Health Toxicol. 2023 Mar;38(1):e2023006-0. doi: 10.5620/eaht.2023006. Epub 2023 Mar 23.

ABSTRACT

Recent studies reported bisphenol A (BPA) and propyl paraben (PrP) are found in human urine, blood, and breast milk samples as well as in food, packaging, socks, and clothes. This means that the two chemicals co-exist in consumer products, and humans are exposed simultaneously to the mixture chemicals. However, the studies on the mixture effects of the two chemicals on human health are not enough. This study was designed to elucidate the effects of orally administered PrP, BPA, and their mixture effects on the uterotrophic response using ovariectomized rats. In addition, the correlation between the uterotrophic response and tissue concentrations of the two chemicals was studied to investigate whether one chemical has any effect on the absorption, distribution, or excretion of the other chemical. Histopathology, hematology, and plasma biochemistry analysis were also performed to evaluate the chemicals’ toxicological effects in the treated rats. Although a significant increase in uterus weight (absolute and relative) was observed in the positive chemical (17β-estradiol) treated group, there were no statistical differences in the uterus weight between the vehicle control and the chemical-treated groups. However, a slight increase in the endometrial glands and a change in the cuboidal to columnar epithelium of the endometrial epithelium were observed in the mixture-treated group. There was no significant toxicity in all treated groups by the hematology and plasma biochemistry analysis results. The results of tissue distribution showed that BPA was mostly detected in the liver while PrP was not detected in most tissues, and the BPA level was higher when the rats were treated with PrP than without PrP, suggesting that PrP may increase the absorption of BPA after oral administration.

PMID:37100401 | DOI:10.5620/eaht.2023006

Curr Probl Cardiol. 2023 Apr 24:101746. doi: 10.1016/j.cpcardiol.2023.101746. Online ahead of print.

ABSTRACT

AIM: This study aimed to assess the association between aortic valve calcification and lipoprotein (a).

METHODS: We searched PUBMED, WOS, and SCOPUS databases. Inclusion criteria were any controlled clinical trials or observational studies that reported the level of Lipoprotein A in patients with aortic valve calcifications, excluding case reports, editorials and animal studies. RevMan software (5.4) was used to perform the meta-analysis.

RESULTS: After complete screening, 7 studies were included with a total number of 446179 patients included in the analysis. The pooled analysis showed a statistically significant association between the incidence of aortic valve calcium and increased levels of lipoprotein (a) compared with controls (SMD = 1.71, 95% CI = 1.04 to 2.38, p-value < 0.00001).

CONCLUSION: This meta-analysis showed a statistically significant association between the incidence of aortic valve calcium and increased levels of lipoprotein (a) compared with controls. Patients with high levels of lipoprotein (a) are at increased risk of developing aortic valve calcification. Medications targeting lipoprotein (a) in future clinical trials may be useful in primary prevention of aortic valve calcification in high risk patients.

PMID:37100357 | DOI:10.1016/j.cpcardiol.2023.101746

Am J Infect Control. 2023 Apr 24:S0196-6553(23)00335-8. doi: 10.1016/j.ajic.2023.04.165. Online ahead of print.

ABSTRACT

BACKGROUND: Surgical site infection (SSI) surveillance is a labor-intensive endeavor. We present the design and validation of an algorithm for SSI detection after hip replacement surgery, and a report of its successful implementation in four public hospitals in Madrid, Spain.

METHODS: We designed a multivariable algorithm, AI-HPRO, using natural language processing (NLP) and extreme gradient-boosting to screen for SSI in patients undergoing hip replacement surgery. The development and validation cohorts included data from 19661 healthcare episodes from four hospitals in Madrid, Spain.

RESULTS: Positive microbiological cultures, the text variable “infection”, and prescription of clindamycin were strong markers of SSI. Statistical analysis of the final model indicated high sensitivity (99.18%) and specificity (91.01%) with a F1-score of 0.32, AUC of 0.989, accuracy of 91.27% and NPV of 99.98%.

DISCUSSION: Implementation of the AI-HPRO algorithm has reduced surveillance time from 975 person/hours to 63.5 person/hours and has permitted an 88.95% reduction in total volume of clinical records to be reviewed manually. The model presents a higher NPV (99.98%) than algorithms relying on NLP alone (94%) or NLP and logistic regression (97%).

CONCLUSIONS: This is the first report of an algorithm combining NLP and extreme gradient-boosting to permit accurate, real-time orthopedic SSI surveillance.

PMID:37100291 | DOI:10.1016/j.ajic.2023.04.165

Spine J. 2023 Apr 24:S1529-9430(23)00171-7. doi: 10.1016/j.spinee.2023.04.013. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Surgical invasiveness indices have been established for general spine surgery (surgical invasiveness index [SII]), spine deformity, and metastatic spine tumors; however, a specific index for thoracic spinal stenosis (TSS) has not been developed.

PURPOSE: To develop and validate a novel invasiveness index incorporating TSS-specific factors for open posterior TSS surgery, which may facilitate the prediction of operative duration and intraoperative blood loss, and the stratification of surgical risk.

STUDY DESIGN: A retrospective observational study.

PATIENT SAMPLE: Overall, 989 patients who underwent open posterior TSS surgeries at our institution during the past 5 years were included.

OUTCOME MEASURES: The operation duration, estimated blood loss, transfusion status, major surgical complications, length of hospital stay, and medical expenses.

METHODS: We retrospectively analyzed the data of 989 consecutive patients who underwent posterior surgery for TSS between March 2017 and February 2022. Among them, 70% (n = 692) were randomly placed in a training cohort, and the remaining 30% (n = 297) automatically constituted the validation cohort. Multivariate linear regression models of operative time and log-transformed estimated blood loss were created using TSS-specific factors. Beta coefficients derived from these models were used to construct a TSS invasiveness index (TII). The ability of the TII to predict surgical invasiveness was compared with that of the SII and assessed in a validation cohort.

RESULTS: The TII was more strongly correlated with operative time and estimated blood loss (P < 0.05) and explained more variability in operative time and estimated blood loss than the SII (P < 0.05). The TII explained 64.2% of operative time and 34.6% of estimated blood loss variation, whereas the SII explained 38.7% and 22.5%, respectively. In further verification, the TII was more strongly associated with transfusion rate, drainage time, and length of hospital stay than SII (P < 0.05).

CONCLUSION: By incorporating TSS-specific components, the newly developed TII more accurately predicts the invasiveness of open posterior TSS surgery than the previous index.

PMID:37100245 | DOI:10.1016/j.spinee.2023.04.013

Arthroscopy. 2023 Apr 24:S0749-8063(23)00304-3. doi: 10.1016/j.arthro.2023.03.028. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate symptom duration and its relationship to patient reported outcomes and survivorship following hip arthroscopy in adolescents.

METHODS: Patients ≤18 at time of primary hip arthroscopy for FAI between January 2011 and September 2018 were included. Exclusion criteria consisted of history of previous ipsilateral hip surgery, presence of osteoarthritis or dysplasia on preoperative radiographs, previous hip fracture, or history of slipped capital femoral epiphysis or Legg-Calve-Perthes disease. Minimum 2-year patient-reported outcomes (modified Harris Hip Score (mHHS), Hip Outcome Score (HOS)-Activities of Daily Living (ADL), HOS-Sport Scale (SSS), Short Forms 12 (SF-12)), minimum clinically significant difference (MCID) and patient acceptable symptom state (PASS) rates, and revision surgery rates, were compared based on symptom duration.

RESULTS: Two-year minimal follow-up was obtained for 111 patients (134 hips) (80%), including 74 females and 37 males with mean age of 16.4±1.1 (range: 13.0-18.0). The mean symptom duration was 17.2±15.2 months (range: 43 days to 6.0 years). Ten patients (11 hips), 6 females (7 hips) and 4 males, required revision surgery at an average of 2.3±1.0 years (range, 0.9 to 4.3 years). At a mean follow-up of 4.8±2.2 years (range, 2 to 10 years), there were statistically significant improvements in all PROs (p<.05 for all). Symptom duration showed no significant correlation to post-operative scores (correlation coefficient range: -0.162 to -.078, p>0.05 for all). Symptom duration <12 months versus >12 months or as a continuous variable was not a predictor for requiring revision surgery or achieving MCID/PASS (95% Confidence Interval crosses 1 for all).

CONCLUSION: In an adolescent cohort of symptomatic FAI patients who underwent hip arthroscopy, there is no difference in patient reported outcome measures when analyzing symptom duration by arbitrary time intervals or as a continuous variable.

PMID:37100216 | DOI:10.1016/j.arthro.2023.03.028

Arthroscopy. 2023 Apr 24:S0749-8063(23)00303-1. doi: 10.1016/j.arthro.2023.03.027. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study is to 1) report on trends in immediate procedure reimbursement, patient out-of-pocket expenditures, and surgeon reimbursement in hip arthroscopy 2) compare trends in ambulatory surgery centers (ASC) versus outpatient hospitals (OH) utilization, 3) quantify the cost differences (if any) associated with ASC versus OH settings, and 4) determine the factors that predict ASC utilization for hip arthroscopy.

METHODS: The cohort for this descriptive epidemiology study was any patient over 18 years identified in the IBM MarketScan Commercial Claims Encounter database who underwent an outpatient hip arthroscopy, identified by Current Procedural Terminology codes, in the U.S. from 2013 to 2017. Immediate procedure reimbursement, patient out-of-pocket expenditure, and surgeon reimbursement were calculated, and a multivariable model was utilized to determine the influence of specific factors on these outcome variables. Statistically significant p-values were less than 0.05 and significant standardized differences were more than 0.1.

RESULTS: The cohort included 20,335 patients. An increasing trend in ASC utilization was observed (p=0.001), and ASC utilization for hip arthroscopy was 32.4% in 2017. Patient out-of-pocket expenditures for femoroacetabular impingement surgery increased 24.3% over the study period (p=0.003), which was higher than the rate for immediate procedure reimbursement (4.2%, p=0.007). ASCs were associated with $3310 (28.8%, p=0.001) reduction in immediate procedure reimbursement and $47 (6.2%, p=0.001) reduction in patient out-of-pocket expenditure per hip arthroscopy.

CONCLUSION: ASCs provide a significant cost difference for hip arthroscopy. While there is an increasing trend towards ASC utilization, it remains relatively low at 32.4% in 2017. Thus, there are opportunities for expanded ASC utilization, which is associated with significant immediate procedure reimbursement difference of $3,310 and patient out-of-pocket expenditure difference of $47 per hip arthroscopy case, ultimately benefiting healthcare systems, surgeons and patients alike.

PMID:37100212 | DOI:10.1016/j.arthro.2023.03.027

J Stomatol Oral Maxillofac Surg. 2023 Apr 24:101483. doi: 10.1016/j.jormas.2023.101483. Online ahead of print.

ABSTRACT

INTRODUCTION: The present study evaluated the effect of two protocols of Pulsed Electromagnetic Field (PEMF) therapy on bone neoformation on calvaria critical defects in rats.

MATERIAL & METHODS: 96 rats were randomly divided into 3 groups: Control Group (CG; n=32); Test Group – PEMF 1 hour (TG1h; n=32) and Test Group – PEMF 3 hour (TG3h; n=32). A Critical-size Bone Defect (CSD) was surgically created in the calvaria of rats. The animals in the test groups were exposure to PEMF for 5 days a week. The animals were euthanized at 14, 21, 45 and 60 days. The specimens were processed for volume and texture (TAn) analysis, by Cone Beam Computed Tomography (CBCT) and histomorphometric analysis, RESULTS: Histomorphometric and volume analyses revealed that there was no statistically significant difference in the repair of bone defects between groups receiving PEMF therapy and CG. TAn revealed a statistically significant difference between the groups only for the entropy parameter, in which TG1h group presented a higher value compared to CG on 21 days. TG1h and TG3h did not accelerate bone repair in calvarial critical size defect and the parameters of PEMF should be considered.

DISCUSSION: This study showed that PEMF application on CSD in rats does not accelerate bone repair. Although literature showed a positive association in biostimulation on bone tissue with the parameters applied, studies with other PEMF parameters are essential to verify improving this study design.

PMID:37100171 | DOI:10.1016/j.jormas.2023.101483

J Surg Res. 2023 Apr 24;289:121-128. doi: 10.1016/j.jss.2023.03.027. Online ahead of print.

ABSTRACT

BACKGROUND: The topics of healthcare for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) patients and inclusion of LGBTQ+ health providers remain overlooked. Some specialties may be perceived as less inclusive to LGBTQ+ trainees. This study aimed to describe the perspectives of current medical students regarding LGBTQ+ education and the acceptance of LGBTQ+ trainees among different specialties.

MATERIALS AND METHODS: A cross-sectional voluntary and anonymous online survey was distributed through REDCap to all medical students (n = 495) at a state medical school. Medical students’ sexuality and gender identity were queried. A descriptive statistical analysis was performed, and the responses were classified into two groups: LGBTQ+ and non-LGBTQ+.

RESULTS: A total of 212 responses were queried. Of the respondents who agreed that certain specialties are less welcoming to LGBTQ+ trainees (n = 69, 39%), orthopedic surgery, general surgery and neurosurgery were identified most frequently (84%, 76%, and 55%, respectively). After analyzing sexual orientation as an influence on choosing a future specialty for residency, only 1% of non-LGBTQ+ students indicated that their sexual orientation influences their specialty of choice in comparison with 30% of LGBTQ+ students (P < 0.001). Finally, more non-LGBTQ+ students indicated that they believe they are receiving appropriate education on caring for LGBTQ+ patients as compared to LGBTQ+ students (71% and 55%, respectively, P < 0.05).

CONCLUSIONS: LGBTQ+ students are still hesitant to pursue careers in General Surgery as compared to their non-LGBTQ+ peers. The perception that surgical specialties are the least welcoming to LGBTQ+ students continues to be a concern for all students. Further strategies of inclusivity and their effectiveness need to be studied.

PMID:37099822 | DOI:10.1016/j.jss.2023.03.027

Pancreas. 2022 Nov-Dec 01;51(10):1427-1433. doi: 10.1097/MPA.0000000000002183. Epub 2023 Mar 7.

ABSTRACT

OBJECTIVES: RING finger protein 26 (RNF26) plays an essential role in determining malignant tumor growth, whereas the role of which in pancreatic cancer (PC) has not been reported. This study aimed to investigate the role of RNF26 in PC cells.

METHODS: The Gene Expression Profiling Interactive Analysis was applied to study the role of RNF26 in malignant tumors. The in vitro or in vivo cell proliferation assays were used to investigate the role of RNF26 on the PC. The protein-protein interaction network analysis was used to search the binding partner of RNF26. The Western blot was used to reveal whether RNF26 promoted RNA binding motif protein-38 (RBM38) degradation in PC cells.

RESULTS: The Gene Expression Profiling Interactive Analysis tool showed that RNF26 was overexpressed in PC. Repressing RNF26 expression decreased PC cells growth, but overexpression of RNF26 increased PC proliferation. Furthermore, we demonstrated RNF26 degraded RBM38 to promote PC cell proliferation.

CONCLUSIONS: RNF26 was abnormally increased in PC, and upregulated RNF26 was correlated with a poor prognosis. RNF26 enhanced PC proliferation by inducing RBM38 degradation. We identified a novel RNF26-RBM28 axis involved in the progression of PC.

PMID:37099788 | DOI:10.1097/MPA.0000000000002183

Pancreas. 2022 Nov-Dec 01;51(10):1292-1299. doi: 10.1097/MPA.0000000000002208.

ABSTRACT

OBJECTIVES: For population databases, multivariable regressions are established analytical standards. The utilization of machine learning (ML) in population databases is novel. We compared conventional statistical methods and ML for predicting mortality in biliary acute pancreatitis (biliary AP).

METHODS: Using the Nationwide Readmission Database (2010-2014), we identified patients (age ≥18 years) with admissions for biliary AP. These data were randomly divided into a training (70%) and test set (30%), stratified by the outcome of mortality. The accuracy of ML and logistic regression models in predicting mortality was compared using 3 different assessments.

RESULTS: Among 97,027 hospitalizations for biliary AP, mortality rate was 0.97% (n = 944). Predictors of mortality included severe AP, sepsis, increasing age, and nonperformance of cholecystectomy. Assessment metrics for predicting the outcome of mortality, the scaled Brier score (odds ratio [OR], 0.24; 95% confidence interval [CI], 0.16-0.33 vs 0.18; 95% CI, 0.09-0.27), F-measure (OR, 43.4; 95% CI, 38.3-48.6 vs 40.6; 95% CI, 35.7-45.5), and the area under the receiver operating characteristic (OR, 0.96; 95% CI, 0.94-0.97 vs 0.95; 95% CI, 0.94-0.96) were comparable between the ML and logistic regression models, respectively.

CONCLUSIONS: For population databases, traditional multivariable analysis is noninferior to ML-based algorithms in predictive modeling of hospital outcomes for biliary AP.

PMID:37099769 | DOI:10.1097/MPA.0000000000002208