Tag: statistics

J Orthop Trauma. 2023 Mar 6. doi: 10.1097/BOT.0000000000002595. Online ahead of print.

ABSTRACT

OBJECTIVE: Evaluate the species distribution and resistance patterns of bacterial pathogens causing surgical site infection (SSI) after operative fracture repair, with and without the use of intrawound powdered antibiotic (IPA) prophylaxis during the index surgery.

DESIGN: Retrospective cohort study.

SETTING: Academic, level 1 trauma center, 2018-2020.Patients/Participants: 59 deep SSIs were identified in a sample of 734 patients with 846 fractures (IPA [n=320], control [n=526]; open [n=157], closed fractures [n=689]) who underwent orthopaedic fracture care. Among SSIs, 28 (48%) patients received IPA prophylaxis and 25 (42%) of the fractures were open.

INTERVENTION: Intrawound powdered vancomycin and tobramycin.

MAIN OUTCOME MEASUREMENTS: Distribution of bacterial species and resistance patterns causing deep surgical site infections requiring operative debridement.

RESULTS: Zero patients developed infections caused by resistant strains of streptococci, enterococci, gram-negative enterics, Pseudomonas, or Cutibacterium species. The only resistant strains isolated were MRSA (19%) and oxacillin-resistant coagulase-negative staphylococci (16%). There was no associated statistical difference in the proportion of bacterial species isolated, their resistance profiles, or rate of polymicrobial infections between the IPA and control group. The vast majority (93%) of cases using IPAs included both vancomycin and tobramycin powders. There were 59 SSIs; 28 (9%) in the IPA cohort and 31 (6%) in the control cohort (p=0.13).

CONCLUSION: The use of local antibiotic prophylaxis resulted in no measurable increase in the proportion of infections caused by resistant bacterial pathogens after operative treatment of fractures. However, the small sample size and limited time frame of these preliminary data require continued investigation into their role as an adjunct to SSI prophylaxis.

PMID:36920373 | DOI:10.1097/BOT.0000000000002595

JAMA Dermatol. 2023 Mar 15. doi: 10.1001/jamadermatol.2023.0061. Online ahead of print.

ABSTRACT

IMPORTANCE: Racial and ethnic differences in skin cancer outcomes are understudied. Delineating these differences in Merkel cell carcinoma (MCC) is needed to better understand this rare disease.

OBJECTIVE: To determine how MCC presentation and outcomes differ across racial and ethnic groups.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included patients diagnosed with MCC and followed up from 2000 through 2018 in the 18 population-based cancer registries of the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. Patients without follow-up data were excluded. Data analysis occurred from March 12 to November 30, 2022.

MAIN OUTCOMES AND MEASURES: A Cox proportional hazards regression was conducted to determine associations between demographic variables (race and ethnicity, age, sex, and income) and clinical variables (stage at diagnosis, primary site, and diagnosis year) with MCC-specific survival.

RESULTS: Of the 9557 patients with MCC identified (6758 [70.7%] aged ≥70 years; 6008 [62.9%] male), 222 (2.3%) were Asian American or Pacific Islander, 146 (1.5%) Black, 541 (5.7%) Hispanic, and 8590 (89.9%) White. Hispanic patients had improved MCC-specific survival compared with White patients (hazard ratio, 0.82; 95% CI, 0.67-0.99; P = .04). Black patients had the lowest MCC-specific survival, but it was not statistically different from White patients (hazard ratio, 1.19; 95% CI, 0.86-1.60; P = .28). Hispanic and Black patients were less likely to present with a primary site of the head and neck than White patients (183 of 541 [33.8%] Hispanic patients and 45 of 146 [30.8%] Black patients vs 3736 of 8590 [43.5%] White patients; P < .001 and P = .002, respectively). Black patients presented more often than White patients with advanced disease at diagnosis (59 of 146 [40.4%] vs 2510 of 8590 [29.2%]; P = .004).

CONCLUSIONS AND RELEVANCE: In this cohort study, there were differences between racial and ethnic groups in observed MCC outcomes and disease characteristics. Further investigations are warranted into the findings that, compared with White patients, Hispanic patients with MCC had improved outcomes and Black patients did not have worse outcomes despite presenting with more advanced disease.

PMID:36920369 | DOI:10.1001/jamadermatol.2023.0061

Expert Opin Drug Metab Toxicol. 2023 Mar 15. doi: 10.1080/17425255.2023.2192401. Online ahead of print.

ABSTRACT

INTRODUCTION: Antipsychotics (APs), during treatment or overdose, may be associated with respiratory aspiration.

AREAS COVERED: A PubMed search on September 30, 2022, provided 3 cases of respiratory aspiration during clozapine therapy and 1 case during an AP overdose. VigiBase records of respiratory aspiration associated with APs from inception until September 5, 2021, were reviewed. VigiBase, the World Health Organization’s global pharmacovigilance database, uses a statistical signal for associations called the information component (IC).

EXPERT OPINION: The ICs (and IC₀₂₅) were 2.1 (and 2.0) for APs, 3.2 (and 3.0) for clozapine, 2.6 (and 2.4) for quetiapine, and 2.5 (and 2.2) for olanzapine. Cases of respiratory aspiration associated with APs included: 137 overdose/suicide cases (64 fatal) and 609 cases during treatment (385 fatal) including 333 taking clozapine (238 fatal). In logistic regression models of fatal outcomes, the odds ratios, OR, and (95% confidence intervals, CI) of significant independent variables were: a) 2.3 – 2.6 for clozapine in 3 samples of AP treatment of varying size, b) 1.9 (CI 1.0 to 3.5) for geriatric age in 284 patients on clozapine treatment, and c) 1.8 (CI 1.1 – 3.2) for antidepressant co-medication in 276 patients on non-clozapine APs. Multiple AP pharmacological mechanisms may explain respiratory aspiration.

PMID:36920343 | DOI:10.1080/17425255.2023.2192401

Eur J Transl Myol. 2023 Mar 15. doi: 10.4081/ejtm.2023.11113. Online ahead of print.

ABSTRACT

Active Points Test on auricle was renamed Needle Contact Test (or NCT), considered an extremely effective method to select most efficient auricle acupoint for Auricular Acupuncture (or AA) therapy. Our aims were to evaluate NCT efficiency as viable diagnostic option to identify the most appropriate AA acupoints to be selected for SupraSpinatus Tendinopathy (SST) associated shoulder pain treatment and to evaluate which auricle area has greater concentration of NCT positive acupoints in subjects with SST shoulder pain, comparing results with available AA ear maps. 45 subjects with SST diagnosis were enrolled. On 30 subjects in treatment group, NCT was performed on acupoints of the auricle shoulder representation areas (i.e., Scaphoid Fossa), while in 15 subjects of control group, NCT was performed on auricle areas not shoulder associated. Statistically significant lower Numeric Pain Rating Scale scores were seen for study group over time and compared to control. A small sample showed statistically significant increase of SST shoulder maximum abduction range of Movements. NCT identified best SST shoulder pain AA acupoints in Scaphoid Fossa (or SF1 and SF2). In conclusion NCT is a viable tool to efficiently identify the best AA acupoints in SST shoulder pain treatment.

PMID:36920326 | DOI:10.4081/ejtm.2023.11113

Clin Oral Implants Res. 2023 Mar 15. doi: 10.1111/clr.14064. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the effect of aging on the changes in implant stability over time following implant placement.

MATERIAL AND METHODS: A total of 104 patients in four age ranges (group 1: <60 years, group 2: 61-70 years, group 3: 71-80 years, and group 4: >80 years) were included. Bone level-tapered implants were placed without implementing any bone augmentation procedure. The final torque value displayed on the implant engine during implant insertion was recorded. Cone-beam computed tomography (CBCT) was performed immediately after surgery to analyze the bone quality around the implant. Implant stability was measured immediately after surgery and 2, 4, and 8 weeks after surgery.

RESULTS: In the CBCT image, higher grayscale values were observed in the order of group 1, group 2, and groups 3/4, with statistical significance (p<0.05). There was no significant difference in the insertion torque values between age groups (p≥0.05). Groups 1 and 2 showed lower implant stability values after 2 and 4 weeks compared to immediately and 8 weeks after surgery (p<0.05); however, groups 3 and 4 showed no significant difference between the results measured at different timepoints (p≥0.05).

CONCLUSIONS: Implant treatment in elderly patients is successful showing a settled implant stability over time following implant placement when the implant is appropriately engaged in the alveolar bone in the absence of bone augmentation.

PMID:36920314 | DOI:10.1111/clr.14064

J Exp Med. 2023 Jun 5;220(6):e20221392. doi: 10.1084/jem.20221392. Epub 2023 Mar 15.

ABSTRACT

The hallmark of tuberculosis (TB) is the formation of immune cell-enriched aggregates called granulomas. While granulomas are pathologically diverse, their tissue-wide heterogeneity has not been spatially resolved at the single-cell level in human tissues. By spatially mapping individual immune cells in every lesion across entire tissue sections, we report that in addition to necrotizing granulomas, the human TB lung contains abundant non-necrotizing leukocyte aggregates surrounding areas of necrotizing tissue. These cellular lesions were more diverse in composition than necrotizing lesions and could be stratified into four general classes based on cellular composition and spatial distribution of B cells and macrophages. The cellular composition of non-necrotizing structures also correlates with their proximity to necrotizing lesions, indicating these are foci of distinct immune reactions adjacent to necrotizing granulomas. Together, we show that during TB, diseased lung tissue develops a histopathological superstructure comprising at least four different types of non-necrotizing cellular aggregates organized as satellites of necrotizing granulomas.

PMID:36920308 | DOI:10.1084/jem.20221392

J Exp Med. 2023 Jun 5;220(6):e20212383. doi: 10.1084/jem.20212383. Epub 2023 Mar 15.

ABSTRACT

Cell competition has recently emerged as an important tumor suppressor mechanism in the thymus that inhibits autonomous thymic maintenance. Here, we show that the oncogenic transcription factor Lmo2 causes autonomous thymic maintenance in transgenic mice by inhibiting early T cell differentiation. This autonomous thymic maintenance results in the development of self-renewing preleukemic stem cells (pre-LSCs) and subsequent leukemogenesis, both of which are profoundly inhibited by restoration of thymic competition or expression of the antiapoptotic factor BCL2. Genomic analyses revealed the presence of Notch1 mutations in pre-LSCs before subsequent loss of tumor suppressors promotes the transition to overt leukemogenesis. These studies demonstrate a critical role for impaired cell competition in the development of pre-LSCs in a transgenic mouse model of T cell acute lymphoblastic leukemia (T-ALL), implying that this process plays a role in the ontogeny of human T-ALL.

PMID:36920307 | DOI:10.1084/jem.20212383

Adv Clin Exp Med. 2023 Mar 15. doi: 10.17219/acem/159756. Online ahead of print.

ABSTRACT

BACKGROUND: Carotid artery stenosis is often considered a stable clinical condition, and the underlying atherosclerosis is thought to have an inflammatory background.

OBJECTIVES: The aim of the study was to assess the value of different parameters obtained from whole blood counts for the prediction of advanced carotid artery atherosclerosis, including vessel occlusion, irrespective of symptom occurrence.

MATERIAL AND METHODS: The study group comprised 290 patients (84 (29%) females and 206 (71%) males) with a mean age of 68 ±8 years, who were admitted to the Vascular Surgery Department due to significant carotid artery disease. Patients were retrospectively divided into 2 subgroups regarding the presence or absence of artery occlusion. The demographic, clinical and laboratory preoperative data were compared between both groups.

RESULTS: We found significant differences in preoperative large unstained cell (LUC) counts between patients with and without carotid artery occlusion (p = 0.003), when analyzed with the Mann-Whitney test for independent samples. The receiver operating characteristic (ROC) curve showed that LUC count has prognostic properties for carotid artery occlusion, with an area under the curve (AUC) of 0.637 (p = 0.033), yielding a 69.70% sensitivity and a 51.75% specificity.

CONCLUSIONS: Large unstained cells represent an acute inflammatory state related to artery occlusion. An LUC count below the cutoff value of 0.16×109/L may be a predictor of carotid artery occlusion. Therefore, carotid artery occlusion should not be regarded as a chronic state, but as a clinical challenge being promoted by active inflammatory processes.

PMID:36920263 | DOI:10.17219/acem/159756

Oral Health Prev Dent. 2023 Mar 15;21(1):83-92. doi: 10.3290/j.ohpd.b3957085.

ABSTRACT

PURPOSE: To assess the levels of oral health-related quality of life (OHRQoL) in orthodontic patients both during the suspension of dental services caused by COVID-19 and after a year of dental service reinstatement, and to evaluate the associated factors for OHRQoL in those patients during the suspension period.

MATERIALS AND METHODS: A cross-sectional online study was conducted both during the suspension of dental service due to COVID-19 (T1) and after a year of dental service reinstatement (T2). The questionnaire – consisting of personal information, subjective complaints, OHIP-14 and oral health conditions – was completed by the participants at T1 and T2. Data were evaluated by the Χ2 test, the Wilcoxon rank-sum test, and multivariate logistic regression analysis.

RESULTS: 324 participants were ultimately included in the study sample. The participants reported higher OHIP-14 total scores at T1 than T2 (p < 0.001). Statistically significant differences were detected in the domains psychological discomfort, psychological disability, social disability and handicap (p < 0.001). The multivariate logistic regression analysis showed that wearing fixed appliances, being over 18 years old, having delayed orthodontic treatment and poor oral hygiene habits were statistically significantly associated with higher OHIP-14 total scores at T1 (p < 0.05).

CONCLUSION: The OHRQoL in orthodontic patients was negatively impacted by the suspension of dental services during COVID-19, which was reflected in all the psychosocial domains. Types of appliances, ages, delays in follow-up visits and oral hygiene habits seemed to be the factors associated with OHRQoL in orthodontic patients during the suspension.

PMID:36920256 | DOI:10.3290/j.ohpd.b3957085

J Adhes Dent. 2023 Mar 15;25(1):63-70. doi: 10.3290/j.jad.b3956401.

ABSTRACT

PURPOSE: This study investigated the effect of different surface treatments and the effect of silane heat treatment with laser on the shear bond strength (SBS) of a nanoceramic composite to repaired hybrid CAD/CAM blocks.

MATERIALS AND METHODS: 60 hybrid CAD/CAM specimens (Cerasmart, GC) were prepared and randomly divided into six groups according to the different surface treatments (n = 10): group ER: Er:YAG laser+silane (Monobond Plus, Ivoclar Vivadent); group ER+SHT: Er:YAG laser+silane heat treatment; group B: bur+silane; group B+SHT: bur+silane heat treatment; group HF: hydrofluoric acid+silane; group HF+SHT: hydrofluoric acid+silane heat treatment. Afterwards, a universal adhesive (Universal Bond Quick, Kuraray) was applied, and nanoceramic resin composite (Zenit, President) cylinders were bonded to the Cerasmart specimens. They were thermocycled for 10,000 cycles (5-55°C) and subjected to SBS testing using a universal testing machine. Failure modes were examined with a stereomicroscope (15X). Scanning electron microscopy (SEM) was used to evaluate the surface topography (n = 2). The data were statistically analyzed using the Mann-Whitney U-test and the Kruskal-Wallis test (p < 0.05).

RESULTS: Regarding the surface treatments, group ER showed significantly lower SBS than groups B and HF (p < 0.05). Regarding the presence of silane heat treatment by laser, groups ER+SHT and B+SHT showed significantly lower SBS than group HF+SHT(p < 0.05). In addition, group B+SHT showed significantly lower SBS than did group B (p < 0.05).

CONCLUSION: Er:YAG laser treatment for repairing hybrid CAD/CAM blocks was not as effective as bur roughening or hydrofluoric acid etching. Silane heated by Er:YAG laser was incapable of significantly increasing the bond strength to repaired hybrid CAD/CAM blocks.

PMID:36920254 | DOI:10.3290/j.jad.b3956401