Tag: statistics

Acta Chir Orthop Traumatol Cech. 2023;90(1):47-52.

ABSTRACT

PURPOSE OF THE STUDY Increased tibial slope facilitates anterior translation of tibia relative to the femur, thereby increasing the load on both the native and replaced anterior cruciate ligament. This study aims to retrospectively review the posterior tibial slope in a cohort of our patients after the ACL reconstruction and revision ACL reconstruction. Based on the results obtained by measurements, we aimed to confirm or disprove the claim that the increased posterior tibial slope is one of the risk factors of the ACL reconstruction failure. Another aim of the study was to assess whether there are any correlations between the posterior tibial slope and basic somatic parameters (height, weight, BMI) or the patient s age. MATERIAL AND METHODS The posterior tibial slope was measured retrospectively on lateral X-rays of 375 patients. There were 83 revision reconstructions and 292 primary reconstructions performed. The patient s age at the time of injury, height and weight were recorded and the BMI was calculated. The findings were then statistically analysed. RESULTS The mean posterior tibial slope in 292 primary reconstructions was 8.6 degrees, whereas the mean posterior tibial slope in 83 revision reconstructions was 12.3 degrees. The difference between the studied groups was statistically (p<0.0001) and substantively significant (d=1.35). In the breakdown into men and women, the mean tibial slope was 8.6 degrees in the group of men with primary reconstruction and 12.4 degrees in the group of men with revision reconstruction (p < 0.0001, d = 1.38). A similar result was achieved in women where in the group with primary reconstruction the mean tibial slope was 8.4 degrees, while in the group with revision reconstruction it was 12.3 degrees (p < 0.0001, d = 1.41). Furthermore, a higher age in men at the time of revision surgery (p = 0.009; d = 0.46) and a lower BMI in women at the time of revision surgery (p = 0.0342; d = 0.12) were observed. Conversely, neither height nor weight were different, both when comparing the whole groups and the groups in a breakdown by sex. DISCUSSION As regards the main aim, our results are in line with the results reported by majority of other authors, and they are substantively significant. The posterior tibial slope is a significant risk factor in anterior cruciate ligament replacements, with tibial slope above 12 degrees increasing the risk of ligament failure, namely both in men and women. On the other hand, this is obviously not the sole cause of the ACL reconstruction failure since there are also other risk parameters. It is not yet clear whether it makes sense to indicate correction osteotomy before the ACL replacement in all patients with an increased posterior tibial slope. CONCLUSIONS Our study confirmed a greater posterior tibial slope in the revision reconstruction group compared to the primary reconstruction group. Thus, we confirmed that greater posterior tibial slope may be a factor leading to the ACL reconstruction failure. Since the posterior tibial slope is easily measured on the baseline X-rays, we recommend to perform this measurement routinely before each ACL reconstruction. In the case of a high posterior tibial slope, slope correction should be considered to prevent potential ACL reconstruction failure. Key words: anterior cruciate ligament reconstruction, ACL graft failure, morphological risk factors, posterior tibial slope.

PMID:36907583

Acta Chir Orthop Traumatol Cech. 2023;90(1):17-21.

ABSTRACT

PURPOSE OF THE STUDY In treatment algorithm of developmental dysplasia of the hip, posteromedial limited surgery is placed between closed reduction and medial open articular reduction. The aim of the present study was to assess the functional and radiologic results of this method. MATERIAL AND METHODS This retrospective study was performed in 37 Tönnis grade II and III dysplastic hips of 30 patients. The mean age of the patients at operation was 12.4 months. The mean follow-up time was 24.5 months. Posteromedial limited surgery was applied when sufficient stable concentric reduction was not achieved by closed technique. No pre-operative traction was applied. Postoperatively, human position hip spica cast was applied for 3 months. Outcomes were evaluated regarding modified McKay functional results, acetabular index and presences of residual acetabular dysplasia or avascular necrosis. RESULTS Thirty-six hips had satisfactory and one hip had poor functional result. The mean pre-operative acetabular index was 34.5 degrees. It improved to 27.7 and 23.1 degrees at the postoperative 6th month and the last control X-Rays. The change in acetabular index was statistically significant (p<0.05). At the last control, 3 hips had findings of residual acetabular dysplasia and 2 hips had avascular necrosis. CONCLUSIONS Posteromedial limited surgery for developmental dysplasia of the hip is indicated when closed reduction remains insufficient and medial open articular reduction remains unnecessarily invasive. This study, in line with the literature, provides evidences that this method might decrease the incidences of residual acetabular dysplasia and avascular necrosis of the femoral head. Key words: developmental dysplasia of the hip, posteromedial limited surgery, closed reduction, medial open reduction.

PMID:36907578

Am J Obstet Gynecol. 2023 Mar 10:S0002-9378(23)00150-3. doi: 10.1016/j.ajog.2023.02.030. Online ahead of print.

ABSTRACT

BACKGROUND: It is a matter of debate whether one universal standard such as Intergrowth-21^st (IG-21) can be applied to all populations.

OBJECTIVE: We therefore aimed to establish a Danish Newborn Standard by the principles of the IG-21 Standard in order to compare the centiles of these two standards. A secondary objective was to compare the prevalence and the risk of fetal and neonatal death related to small-for-gestational-age (SGA) defined by the two standards when used in the Danish Reference Population.

STUDY DESIGN: Register-based nation-wide cohort study.The Danish Reference Population included 375,318 singletons born at 33-42 week’s gestation in Denmark between January 1 2008 and December 31 2015. The Danish Standard Cohort included those 37,811 newborns who fulfilled the IG-21 Standard criterion. Birthweight centiles were estimated using smoothed quantiles for each gestational week. Outcomes were birthweight centiles, small for gestational age (SGA) defined by the 3^rd centile, and adverse outcomes defined by either fetal or neonatal death.

RESULTS: At all gestational ages, the Danish Standard medians were higher than the IG-21 medians; at term by 295g for females and 320g for males. This resulted in different estimates of SGA prevalence within the entire population; 3.9% (n=14,698) using Danish Standard vs. 0.7% (n=2,640) using IG-21 Standard. Accordingly, the relative risk of fetal and neonatal death among SGA fetuses differed between SGA defined by different standards; RR=4.4 (Danish Standard) vs. RR=9.6 (Intergrowth-21^st).

CONCLUSION: This finding does not support the hypothesis that one universal standard BW curve fits all populations.

PMID:36907534 | DOI:10.1016/j.ajog.2023.02.030

Am J Obstet Gynecol. 2023 Mar 10:S0002-9378(23)00148-5. doi: 10.1016/j.ajog.2023.02.029. Online ahead of print.

ABSTRACT

BACKGROUND: The optimal treatment of recurrent ovarian granulosa cell tumors is not known. Pre-clinical studies and small case series have suggested direct anti-tumor activity of gonadotropin-releasing hormone agonists in the treatment of this disease, but little is known about the efficacy and safety of this approach.

OBJECTIVE: To describe patterns of use and clinical outcomes of leuprolide acetate in a cohort of patients with recurrent granulosa cell tumors.

STUDY DESIGN: This was a retrospective cohort study of patients enrolled in the Rare Gynecologic Malignancy Registry at a large cancer referral center and affiliated county hospital. Patients meeting inclusion criteria had a diagnosis of recurrent granulosa cell tumor and received either leuprolide acetate or traditional chemotherapy as cancer treatment. Outcomes were separately examined for leuprolide acetate used as adjuvant treatment, maintenance therapy, and the treatment of gross disease. Demographic and clinical data were summarized using descriptive statistics. Progression-free survival was calculated from the initiation of treatment to the date of disease progression or death, and compared between groups with the log-rank test. The 6-month clinical benefit rate was defined as the percentage of patients without disease progression 6 months after starting therapy.

RESULTS: Sixty-two patients received a total of 78 leuprolide acetate-containing therapy courses, owing to 16 instances of retreatment. Of these 78 courses, 57 (73%) were for treatment of gross disease, 10 (13%) were adjuvant to tumor reductive surgery, and 11 (14%) were for maintenance therapy. Patients had received a median of two (IQR, 1-3) systemic therapy regimens prior to their first leuprolide acetate treatment. Tumor reductive surgery (100% [62/62]) and platinum-based chemotherapy (81% [50/62]) were common prior to first leuprolide acetate exposure. The median duration of leuprolide acetate therapy was 9.6 months (IQR, 4.8-16.5 months). Nearly half of the therapy courses were single-agent leuprolide acetate (49% [38/78]). Combination regimens most often included an aromatase inhibitor (23% [18/78]). Disease progression was the most common cause of discontinuation (77% [60/78]); only one patient (1%) discontinued leuprolide acetate because of adverse events. In the treatment of gross disease, the 6-month clinical benefit rate for first use of leuprolide acetate was 66% (95% CI, 54-82%). Median progression-free survival was not statistically different compared to that which followed chemotherapy (10.3 months [95% CI, 8.0-16.0 months] vs. 8.0 months [95% CI, 5.0-15.3 months], p=0.3).

CONCLUSION: In a large cohort of patients with recurrent granulosa cell tumors, the 6-month clinical benefit rate of first-time leuprolide acetate treatment of gross disease was 66% and progression-free survival was comparable to patients treated with chemotherapy. Leuprolide acetate regimens were heterogeneous, but significant toxicity was rare. These results support leuprolide acetate as safe and effective for the treatment of relapsed adult granulosa cell tumors in the second line and beyond.

PMID:36907533 | DOI:10.1016/j.ajog.2023.02.029

ANZ J Surg. 2023 Mar 12. doi: 10.1111/ans.18363. Online ahead of print.

ABSTRACT

BACKGROUNDS: This study aims to identify the objective findings of haemoglobin (Hb) drift in patients that had a Whipple’s procedure in the last 10 years, their transfusion status intraoperatively and post-operatively, the potential factors affecting Hb drift, and the outcomes following Hb drift.

METHODS: A retrospective study was conducted at Northern Health, Melbourne. All adult patients who were admitted for a Whipple’s procedure from 2010 to 2020 were included and information collected retrospectively for demographics, pre-operative, operative and post-operative details.

RESULTS: A total of 103 patients were identified. The median Hb drift calculated from a Hb level at the end of operation was 27.0 g/L (IQR 18.0-34.0), and 21.4% of patients received a packed red blood cell (PRBC) transfusion during the post-operative period. Patients received a large amount of intraoperative fluid with a median of 4500 mL (IQR 3400-5600). Hb drift was statistically associated with intraoperative and post-operative fluid infusion leading to concurrent issues with electrolyte imbalance and diuresis.

CONCLUSION: Hb drift is a phenomenon that does happen in major operations such as a Whipple’s procedure, likely secondary to fluid over-resuscitation. Considering the risk of fluid overload and blood transfusion, Hb drift in the setting of fluid over-resuscitation needs to be kept in mind prior to blood transfusion to avoid unnecessary complications and wasting of other precious resources.

PMID:36906924 | DOI:10.1111/ans.18363

Clin Oral Implants Res. 2023 Mar 12. doi: 10.1111/clr.14063. Online ahead of print.

ABSTRACT

OBJECTIVES: To develop and assess the performance of a novel artificial intelligence (AI)-driven convolutional neural network (CNN)-based tool for automated three-dimensional (3D) maxillary alveolar bone segmentation on cone-beam computed tomography (CBCT) images.

MATERIAL AND METHODS: A total of 141 CBCT scans were collected for performing training (n=99), validation (n=12) and testing (n=30) of the CNN model for automated segmentation of the maxillary alveolar bone and its crestal contour. Following automated segmentation, the 3D models with under- or over-estimated segmentations were refined by an expert for generating a refined-AI (R-AI) segmentation. The overall performance of CNN model was assessed. Also, 30% of the testing sample was randomly selected and manually segmented to compare the accuracy of AI and manual segmentation. Additionally, the time required to generate a 3D model was recorded in seconds (s).

RESULTS: The accuracy metrics of automated segmentation showed an excellent range of values for all accuracy metrics. However, the manual method (95% HD: 0.20±0.05 mm; IoU: 95%±3.0; DSC: 97%±2.0) showed slightly better performance than the AI segmentation (95% HD: 0.27±0.03 mm; IoU: 92%±1.0; DSC: 96%±1.0). There was a statistically significant difference of the time-consumed amongst the segmentation methods (p<0.001). The AI-driven segmentation (51.5±10.9s) was 116 times faster than the manual segmentation (5973.3±623.6s). The R-AI method showed intermediate time-consumed (1666.7±588.5s).

CONCLUSION: Although the manual segmentation showed slightly better performance, the novel CNN-based tool also provided a highly accurate segmentation of the maxillary alveolar bone and its crestal contour consuming 116 times less than the manual approach.

PMID:36906917 | DOI:10.1111/clr.14063

Vet Rec. 2023 Mar 12:e2787. doi: 10.1002/vetr.2787. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to identify complications associated with cerebrospinal fluid (CSF) collection in dogs.

METHODS: This was a prospective, observational multicentre study using data collected from 102 dogs undergoing CSF collection for the investigation of neurological disease. CSF was collected from the cerebellomedullary cistern (CMC), lumbar subarachnoid space (LSAS) or both sites. Pre-, intra- and postprocedural data were collected. Descriptive statistics were performed to outline complications associated with CSF collection.

RESULTS: CSF sampling was attempted on 108 occasions, and CSF was acquired on 100 occasions (92.6%). Collection from the CMC was more likely to be successful than that from the LSAS. No dogs exhibited neurologic deterioration following CSF collection. There was no significant difference between pre- and post-CSF collection short-form Glasgow composite measure pain scores in ambulatory dogs (p = 0.13).

LIMITATIONS: The scarcity of complications limited the ability to quantify the incidence of some potential complications reported elsewhere.

CONCLUSIONS: Our results may be used to inform clinicians and owners that CSF sampling is associated with a low frequency of complications when performed by trained personnel.

PMID:36906911 | DOI:10.1002/vetr.2787

J Phys Chem B. 2023 Mar 12. doi: 10.1021/acs.jpcb.2c08976. Online ahead of print.

ABSTRACT

Following a recently reformulated Gibbs’ statistical chemical thermodynamic theory on discrete state space, we present a treatment on statistical measurements of random mechanical motions in continuous space. In particular, we show how the concept of temperature and an ideal gas/solution law arise from a statistical analysis of a collection of independent and identically distributed complex particles without relying on Newtonian mechanics, nor the very concept of mechanical energy. When sampling from an ergodic system, the data ad infinitum limit elucidates how the entropy function characterizes randomness among measurements with the emergence of a novel energetic representation for the statistics and an internal energy additivity. This generalization of Gibbs’ theory is applicable to statistical measurements on single living cells and other complex biological organisms, one individual at a time.

PMID:36906869 | DOI:10.1021/acs.jpcb.2c08976

Eur Arch Paediatr Dent. 2023 Mar 12. doi: 10.1007/s40368-023-00790-6. Online ahead of print.

ABSTRACT

PURPOSE: We compared the effect of an educational pamphlet and a mobile application regarding prevention and emergency management of sport-related traumatic dental injuries (TDIs) on knowledge and self-reported preventive practice of 11-17-year-old Karate and Taekwondo athletes.

METHODS: Participants were invited through an online link published by the Public Relations of the corresponding federations. They completed an anonymous questionnaire consisting of demographics, self-reported experience of TDIs, knowledge of emergency management of TDIs, self-reported preventive practice of TDIs, and the reason for not using mouthguard. The respondents were randomly allocated to pamphlet or mobile application group with the same content. Three months after the intervention, the questionnaire was completed by the athletes again. Repeated measures ANOVA and a linear regression model served for statistical analysis.

RESULTS: In pamphlet group, 51 athletes and in mobile application group 57 athletes completed both baseline and follow-up questionnaires. At baseline, the mean score was 1.98 ± 1.20 and 1.82 ± 1.24 (out of 7) for the knowledge and 3.70 ± 1.64 and 3.33 ± 1.95 (out of 7) for practice in the pamphlet and application group, respectively. In 3-month follow-up, the mean score of knowledge and self-reported practice was significantly higher compared to baseline in both groups (p < 0.001) with no statistically significant difference between the two groups (p = 0.83 and p = 0.58, respectively). Most of the athletes were very satisfied or satisfied with both types of the educational intervention.

CONCLUSION: Both pamphlet and mobile application seem to be useful to improve awareness and practice regarding TDI prevention in adolescent athletes.

PMID:36906868 | DOI:10.1007/s40368-023-00790-6

Nutr Clin Pract. 2023 Mar 12. doi: 10.1002/ncp.10976. Online ahead of print.

ABSTRACT

We conducted an umbrella review to summarize the existing evidence on the effect of early enteral nutrition (EEN) compared with other approaches, including delayed enteral nutrition (DEN), parenteral nutrition (PN), and oral feeding (OF) on clinical outcomes in hospitalized patients. We performed a systematic search up to December 2021, in MEDLINE (via PubMed), Scopus, and Institute for Scientific Information Web of Science. We included systematic reviews with meta-analyses (SRMAs) of randomized trials investigating EEN compared with DEN, PN, or OF for any clinical outcomes in hospitalized patients. We used “A Measurement Tool to Assess Systematic Reviews” (AMSTAR2) and the Cochrane risk-of-bias tool for assessing the methodological quality of the systematic reviews and their included trial, respectively. The certainty of the evidence was rated using the “Grading of Recommendations Assessment, Development, and Evaluation” (GRADE) approach. We included 45 eligible SRMAs contributing with a total of 103 randomized controlled trials. The overall meta-analyses showed that patients who received EEN had statistically significant beneficial effects on most outcomes compared with any control (ie, DEN, PN, or OF), including mortality, sepsis, overall complications, infection complications, multiorgan failure, anastomotic leakage, length of hospital stay, time to flatus, and serum albumin levels. No statistically significant beneficial effects were found for risk of pneumonia, noninfectious complications, vomiting, wound infection, as well as number of days of ventilation, intensive care unit days, serum protein, and pre-serum albumin levels. Our results indicate that EEN may be preferred over DEN, PN, and OF because of the beneficial effects on many clinical outcomes.

PMID:36906848 | DOI:10.1002/ncp.10976