Tag: statistics

Schmerz. 2023 Feb 7. doi: 10.1007/s00482-023-00698-6. Online ahead of print.

ABSTRACT

BACKGROUND: Patient-controlled analgesia (PCA) is a well-established form of postoperative pain management. One form of administration is patient-controlled regional analgesia (PCRA), where local anesthetics are administered via peripheral regional catheters; however, a prerequisite is that the patients are instructed on its use. A multitude of sources recommend that these instructions are given before surgery as preoperative training on pain management procedures has been shown to significantly reduce patients’ postoperative pain and increase their well-being.

OBJECTIVE: The aim was to assess the effect of guideline-assisted preoperative patient education for PCRA on postoperative pain in patients undergoing orthopedic surgery compared to unstructured postoperative standard instructions.

MATERIAL AND METHODS: A controlled study with two randomized samples and a postinterventional survey was conducted. Overall, 73 patients with PCRA catheters for orthopedic surgery were enrolled in the study. The 37 participants in the interventional group (IG) received guideline-based structured instructions on PCRA use as well as a handout immediately before the surgical intervention. The 36 patients in the control group (CG) received postoperative instructions in the anesthesia recovery room. Pain was documented according to the numerical rating scale (NRS) at 2h (t1), 6h (t2), and 24h (t3) after surgery.

RESULTS: There were no statistically significant differences in the average pain scores between the two groups; however, there were lower mean pain scores in the IG at t1 and t3.

CONCLUSION: A significant reduction of pain in the IG could not be shown. Further studies concerning this topic with larger samples and adapted points in time are recommended.

PMID:36749413 | DOI:10.1007/s00482-023-00698-6

Clin Oral Investig. 2023 Feb 7. doi: 10.1007/s00784-023-04899-2. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to compare 3 reciprocating systems regarding design, metallurgy, mechanical properties, and shaping ability.

MATERIALS AND METHODS: New Reciproc Blue R25, WaveOne Gold Primary, and REX 25 instruments (n=41 per group) were analyzed regarding design, metallurgy, and mechanical performance, while shaping ability (untouched canal walls, volume of removed dentin, and hard tissue debris) was tested in 36 anatomically matched root canals of mandibular molars. Results were compared using one-way ANOVA post hoc Tukey and Kruskal-Wallis tests with a significant level set at 5%.

RESULTS: All instruments showed symmetrical cross sections with asymmetrical blades, no radial lands, no major defects, and an almost equiatomic nickel and titanium ratio. The highest R-phase start temperatures were observed with WaveOne Gold (46.1°C) and REX (44.8°C), while Reciproc Blue had the lowest R-phase start (34.5°C) and finish (20°C) temperatures. WaveOne Gold had the lowest time to fracture (169 s) and the highest maximum load (301.6 gf) (P <0.05). The maximum torque of Reciproc Blue (2.2 N.cm) and WaveOne Gold (2.1 N.cm) were similar (P >0.05), but lower than REX (2.6 N.cm) (P <0.05). No statistical differences were observed among instruments in the angle of rotation (P >0.05) and in the shaping ability in both mesial and distal canals (P >0.05).

CONCLUSION: Although the overall design, temperature transition phases and mechanical behavior parameters were different among tested instruments, they were similar in terms of shaping ability.

CLINICAL RELEVANCE: All tested heat-treated NiTi reciprocating systems showed similar shaping ability, without clinically significant errors.

PMID:36749411 | DOI:10.1007/s00784-023-04899-2

J Med Microbiol. 2022 Dec;71(12). doi: 10.1099/jmm.0.001612.

ABSTRACT

Introduction. Aggregatibacter are Gram-negative, facultatively anaerobic rods or coccobacilli that are infrequently encountered as pathogens causing infection.Hypothesis/Gap Statement. The range of invasive infection that Aggregatibacter cause is poorly described. The pathogenicity of species such as Aggregatibacter segnis is debated.Aim. To identify invasive infection due to Aggregatibacter species in a large healthcare organization and to characterize clinical syndromes, co-morbidities and risk factors.Methodology. All microbiological samples positive for Aggregatibacter species were identified by conventional culture or 16S rRNA PCR between October 2017 and March 2021. Electronic records for all patients with positive samples were reviewed and the infection syndrome classified for patients with invasive disease.Results. Twenty-seven patients with invasive infection were identified, with a statistically significant difference in species-specific patterns of invasive infection (P=0.02) and a statistically significant association with residence in the 30 % most deprived households in the UK by postcode (P<0.01). The three most common co-morbidities were periodontitis or recent dental work (29.6%), cardiovascular disease (25.9%) and diabetes (18.5 %).Conclusion. We describe a novel association of Aggregatibacter segnis with skin and soft tissue infection. The propensity of the Aggregatibacter species to cause invasive infection at different body sites and be associated with deprivation is reported. Aggregatibacter actinomycetemcomitans bacteraemia was associated with infective endocarditis, and Aggregatibacter aphrophilus was implicated in severe appendicitis and noted to cause brain abscess. Areas warranting future research include exploring the risk-factors required for invasive infection and those that may determine the species-specific differences in patterns of invasive disease.

PMID:36748613 | DOI:10.1099/jmm.0.001612

Hum Vaccin Immunother. 2023 Feb 7:2167439. doi: 10.1080/21645515.2023.2167439. Online ahead of print.

ABSTRACT

Preventive health workers rather than general practitioners (GPs) are the principal providers of vaccines in China, which may be a determinant of the unmet demand for vaccination, especially for adults, in recent years. GPs’ preferences had a significant influence on alternative approaches to adult vaccination delivery. To better understand GP’s preferences for adult vaccination services, we employed a discrete choice experiment with seven attributes: income, setting, information system, workshop, workload, performance measurement, and managerial support. Mixed logit models and latent class models were used for statistical analyses. In general, support from primary healthcare managers was the strongest driver of choice, followed by a 10% increase in workload, separate adult vaccination clinic, 5% increase in workload, and independent information system. Monthly income was significantly associated with provision of adult vaccination services. Based on the influence of latent factors, GPs fell into three classes that were correlated with GPs’ years of practice, workload, income satisfaction, and knowledge-attitude-practicescore. Classes 1 and 2 valued the service setting and performance measurement differently, while Class 3 valued the service setting only (preferred separate adult vaccination clinics to provide service). This study generated actionable information to guide innovation in the adult vaccination delivery system in China.

PMID:36748594 | DOI:10.1080/21645515.2023.2167439

J Med Microbiol. 2023 Jan;72(1). doi: 10.1099/jmm.0.001650.

ABSTRACT

Introduction. Coccidiosis, caused by protozoan parasites of genus Eimeria, is a disease with large impact on poultry production worldwide. It is well known that Eimeria immunity is dependent on Th1-type responses.Gap Statement. In vitro assessment of Eimeria-specific T-cell activity would therefore be a valuable research tool but has so far proven difficult to establish.Aim. The present study aimed to evaluate in vitro induced blast transformation and CD25 expression in defined chicken T-cell populations as a measure of Eimeria immunity.Methodology. Three E. tenella infection experiments were performed and PBMC and/or spleen cells were collected between 6 and 16 days after infection of chickens. Cells were stimulated in vitro with E. tenella antigens and T-cell activation was assessed by immunofluorescence labelling and flow cytometry.Results. The results consistently showed statistically significant E. tenella specific activation of TCRα/β+T cells within a ‘window’ from 8 to 14 days after infection for both spleen cells and PBMC. Responding T-cells were identified as CD4+CD8-, CD4+CD8αα+ and CD4-CD8αβ+ where the CD4+CD8αα+ cells generally showed the highest responses. All three of these TCRα/βT-cell subsets showed significant E. tenella induced blast transformation and/or CD25 expression albeit not always in concert on the same days after infection indicating complex kinetics of T-cell responses. In general, responses were higher for spleen cells compared to PBMC for all responding T-cell populations.Conclusions. This methodology shows promise to study Eimeria-specific T-cells, e.g. to evaluate vaccine responses. Results indicated that a Th1-type response was induced and suggested a role for CD4+CD8αα+ cells in Eimeria immunity.

PMID:36748566 | DOI:10.1099/jmm.0.001650

Microb Genom. 2022 Dec;8(12). doi: 10.1099/mgen.0.000906.

ABSTRACT

The White-Kauffmann-Le Minor (WKL) scheme is the most widely used Salmonella typing scheme for reporting the disease prevalence of the enteric pathogen. With the advent of whole-genome sequencing (WGS), in silico methods have increasingly replaced traditional serotyping due to reproducibility, speed and coverage. However, despite integrating genomic-based typing by in silico serotyping tools such as SISTR, in silico serotyping in certain contexts remains ambiguous and insufficiently informative. Specifically, in silico serotyping does not attempt to resolve polyphyly. Furthermore, in spite of the widespread acknowledgement of polyphyly from genomic studies, the prevalence of polyphyletic serovars is not well characterized. Here, we applied a genomics approach to acquire the necessary resolution to classify genetically discordant serovars and propose an alternative typing scheme that consistently reflect natural Salmonella populations. By accessing the unprecedented volume of bacterial genomic data publicly available in GenomeTrakr and PubMLST databases (>180 000 genomes representing 723 serovars), we characterized the global Salmonella population structure and systematically identified putative non-monophyletic serovars. The proportion of putative non-monophyletic serovars was estimated higher than previous reports, reinforcing the inability of antigenic determinants to depict the complexity of Salmonella evolutionary history. We explored the extent of genetic diversity masked by serotyping labels and found significant intra-serovar molecular differences across many clinically important serovars. To avoid false discovery due to incorrect in silico serotyping calls, we cross-referenced reported serovar labels and concluded a low error rate in in silico serotyping. The combined application of clustering statistics and genome-wide association methods demonstrated effective characterization of stable bacterial populations and explained functional differences. The collective methods adopted in our study have practical values in establishing genomic-based typing nomenclatures for an entire microbial species or closely related subpopulations. Ultimately, we foresee an improved typing scheme to be a hybrid that integrates both genomic and antigenic information such that the resolution from WGS is leveraged to improve the precision of subpopulation classification while preserving the common names defined by the WKL scheme.

PMID:36748524 | DOI:10.1099/mgen.0.000906

Eur Endod J. 2023 Jan;8(1):37-46. doi: 10.14744/eej.2022.18894.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the survival from fractures and risk factors of VPT-treated permanent molars restored with direct resin composites in young patients.

METHODS: The dental records of patients aged 6 to 18 years with VPT-treated permanent molars restored with resin composites were retrospectively evaluated for the presence of fractures on these teeth. Kaplan-Meier methods were used to estimate the survival probabilities. The potential risk factors were assessed using the multivariable Cox proportional hazard model.

RESULTS: A total of 234 treated molars from 189 patients were included. An overall average follow-up time was 33.34+-20.54 months (ranging from 6 to 83 months). At the end of the study, 21.8% of molars had fractures with the majority of them (92.2%) were restorable. Radiographically, only 3.9% of the fractured molars had periapical lesions and considered VPT failures. The percentages of the fracture types are as follows: 54.9% natural tooth structure fracture, 27.5% restoration fracture, and 17.6% combination fracture. The most common fracture location among the 37 molars with natural tooth fracture (either alone or in combination with restoration fracture) was at the marginal ridge (59.5%), followed by the marginal ridge extending to cusp (21.6%), and the cusp itself (18.9%). The cumulative survival probabilities of these teeth decreased over time, reaching 66.02% (95% CI: 55.89-74.36) after 5 years. VPT-treated molars in the mandible had a 2.1 times higher risk of fracture than those in the maxilla. Furthermore, the molars treated with partial and coronal pulpotomy had 2.4 times and 4.6 times higher risks of fracture when compared to those with indirect pulp capping, respectively.

CONCLUSION: In VPT-treated permanent molars in young patients, more fractures were seen in mandibular teeth and in teeth with pulp roof removal (partial and coronal pulpotomy). Clinicians should plan for proper restoration on these teeth. (EEJ-2022-08-097).

PMID:36748448 | DOI:10.14744/eej.2022.18894

Eur Endod J. 2023 Jan;8(1):65-71. doi: 10.14744/eej.2022.96720.

ABSTRACT

OBJECTIVE: To test the hypothesis that the (i) presence of non-carious cervical lesions (NCCLs) and (ii) type of post system have no effect on the fracture resistance and pattern in endodontically treated maxillary premolars.

METHODS: Human maxillary first premolars (n=60) with two root canals were randomly allocated into four groups (n=15). Buccal wedge-shaped NCCLs were prepared in 45 teeth specimens. Following root canal treatment, the specimens were randomly divided into (i) composite resin core (CRC); (ii) NCCLs + composite resin core (NCCL+CRC); (iii) NCCLs+prefabricated fibre-reinforced composite post + composite resin core (NCCL+PFRC+CRC); (iv) NCCLs+custom fibre posts + composite resin core (NCCL+CFP+CRC). All specimens were subjected to thermocycling (5°C to 55°C/5000 cycles). The compressive load was applied non-axially to the palatal cusp with a universal testing machine at a crosshead speed of 0.5 mm/min at a 30° angle until fracture. Fracture patterns were examined using a loupe magnification (2.5×) under transillumination. Statistical analyses were performed using non-parametric tests and pairwise comparisons of the load-to-fracture among the groups. Chi-square test was used to analyse the fracture patterns (P=0.05).

RESULTS: Fracture resistance of NCCL+PFRC+CRC was significantly higher than NCCL+CRC (P=0.011), while NCCL+CFP+CRC did not show any significant difference when compared to NCCL+CRC (P=0.089). No statistical difference was found between CRC, NCCL+PFRC+CRC and NCCL+CFP+CRC (P=1.000). The frequencies of favourable fracture patterns in descending orders were as follows: CRC (80%), NCCL+CFP+CRC (73%), NCCL+PFRC+CRC (60%), and NCCL+CRC (40%). Chi-square test did not show significant differences in fracture patterns among all groups (P=0.110).

CONCLUSION: Restoration of the endodontically treated maxillary premolars with NCCLs, with or without post, resulted in similar fracture resistance as their counterparts without NCCLs. Placement of a prefabricated fibre-reinforced composite post exhibited greater fracture resistance to the maxillary premolars with restored NCCLs than those without a post. (EEJ-2022-06-077).

PMID:36748446 | DOI:10.14744/eej.2022.96720

Eur Endod J. 2023 Jan;8(1):79-89. doi: 10.14744/eej.2022.86094.

ABSTRACT

OBJECTIVE: According to the American Association of Endodontists (AAE), 22 million endodontic procedures have been performed annually. Root canal treatment is needed to prevent infection and restore function when a tooth is severely infected or decayed. This procedure is the only way to preserve the natural tooth and avoid artificial replacement (implant, denture, etc.). The current study aims to develop an electrochemical reamer (EC-Reamer or EC-R) that can help to disinfect the canal system and thus improve the success rate of root canal treatment.

METHODS: The COMSOL Multiphysics software was utilized to simulate the experimental setup and confirm the current flow in the electrolyte. The benchtop experimental approach follows a specific electrochemical protocol, (i) open circuit potential to monitor the electrochemical stabilization and (ii) potentiostatic scan at -9.0 V as the treatment stage. Identification of feasible reference electrode (RE) and insulation material for the exploratory benchtop studies considered platinum (Pt) and gold (Au) wire as the REs and hot melt adhesive (HMA) and liquid tape as the insulation materials. The antimicrobial effects of EC-R were analysed using Enterococcus faecalis (E. faecalis). One-way ANOVA with the Tukey post hoc test and a significance level of P<0.05 is used to compare the groups with an experimental duration of 60 seconds.

RESULTS: The findings showed that magnitude and current fluctuations created by Pt wire are promising when compared to Au wire, while Pt-HMA pair is chosen considering Pt’s good electrochemical inertness and HMA’s easy handling, availability, and non-hazardous features. The use of potentiostatic duration of 1 s and 3 s resulted in >99.99% E. faecalis reduction. Duration at 5 s and above resulted in a total bacterial kill. Statistical analysis confirmed a significant difference among the groups tested with commercial and custom-built potentiostats.

CONCLUSION: The outcome provided preliminary data for developing an EC-R prototype to enhance the antimicrobial effect during root canal treatment potentially. (EEJ-2022-01-04).

PMID:36748441 | DOI:10.14744/eej.2022.86094

Cancer Control. 2022 Jan-Dec;29:10732748221140694. doi: 10.1177/10732748221140694.

ABSTRACT

BACKGROUND: The clinical efficacy of immune checkpoint inhibitors (CPIs) has been proven; however, it is also known that their efficacy as monotherapy is limited, with a response rate of 20% or less in solid tumors. The combination of CPIs and anticancer agents has been actively attempted in solid tumors area. In this systematic review and meta-analysis, we aimed to find favorable combination therapies of programmed death 1 (PD-1) or programmed death ligand 1 (PD-L1) inhibitors in terms of anti-tumor efficacy in clinical settings.

METHODS: An electronic database search was performed using ClinicalTrials.gov, PubMed, and ASCO/ESMO annual meeting libraries. We included randomized or non-randomized trials designed to evaluate the efficacy and safety of combination therapies of PD-1/PD-L1 inhibitors and other anticancer drug-containing therapies. All clinical studies selected were solid tumors with objective response rate (ORR) data. The quality of the evidence was assessed with the Cochrane risk of bias tool or the Newcastle-Ottawa Scale. Meta-analysis used random effects models to pool results.

RESULTS: Sixteen studies involving 3793 patients were included in the primary analysis. These studies have a monotherapy group with PD-1/PD-L1 inhibitors as the control group or the in-study arm/cohort (1863 patients in the combination group with PD-1/PD-L1 inhibitors and 1930 patients in PD-1/PD-L1 inhibitor monotherapy). The pooled results showed that the combination of PD-1/PD-L1 inhibitors and other anticancer drugs significantly improved the ORR (relative risk [RR] = 1.79, 95% confidence interval [CI] 1.46, 2.20). In the subgroup analysis, PD-1/PD-L1 inhibitor plus DNA-synthesis or microtubule inhibitor led to a statistically significant improvement in the ORR compared to PD-1/PD-L1 inhibitor alone.

CONCLUSIONS: It was suggested that combinations of PD-1/PD-L1 inhibitors and potential immunogenic cell death (ICD) inducers improve the clinical anti-tumor efficacy, although updated meta-analyses based on the results of ongoing clinical trials are further needed.

PMID:36748438 | DOI:10.1177/10732748221140694