Tag: statistics

Nutr Metab Cardiovasc Dis. 2023 Jan 5:S0939-4753(23)00002-9. doi: 10.1016/j.numecd.2022.12.025. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Cardio-metabolic diseases has been shown to be strongly associated with obesity. The aim of this study was to compare the predictive value of traditional and novel anthropometric measurement indices for cardio-metabolic diseases risk and evaluate whether new indicators can provide important information in addition to traditional indicators.

METHODS AND RESULTS: China Health and Nutrition Survey (CHNS) data were obtained for this study. Baseline information for healthy participants was gathered from 1997 to 2004. The incidence of cardio-metabolic diseases was collected from 2009 to 2015 for cohort analysis. The predictive ability of each index for the risk of cardio-metabolic diseases was evaluated with time-dependent ROC analysis. Body mass index (BMI) showed the greatest predictive ability for cardio-metabolic disease incidence among all traditional and novel indices (Harrell’s C statistic (95% CI): 0.7386 (0.7266-0.7507) for hypertension, 0.7496 (0.7285-0.7706) for diabetes, 0.7895 (0.7593-0.8196) for stroke and 0.7581 (0.7193-0.7969) for myocardial infarction). The addition of novel indices separately into the BMI model did not improve the predictive ability. Novel anthropometric measurement indices such as a body shape index (ABSI), abdominal volume index (AVI) and triponderal mass index (TMI), had a certain prediction ability for adults with BMI <24 kg/m² compared to those with BMI ≥24 kg/m².

CONCLUSION: No strong evidence supports novel anthropometric measurement indices were better than BMI in the prediction of cardio-metabolic diseases incidence among Chinese adults. Novel anthropometric measurement indices, mainly for abdominal obesity, may have a high predictive effect for adults with BMI <24 kg/m².

PMID:36842959 | DOI:10.1016/j.numecd.2022.12.025

Nutr Metab Cardiovasc Dis. 2023 Jan 5:S0939-4753(23)00003-0. doi: 10.1016/j.numecd.2022.12.028. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Chronic exposure to hyperglycemia is a significant risk factor for cardiovascular disease (CVD). Advanced glycation end products (AGES) result from multiple sugar-dependent reactions interacting with proteins and their receptors, generating endothelial dysfunction and CVD. However, there is little epidemiological data about its impact on CVD risk. We aimed to assess the association between circulating AGES and CVD risk in the Mexican population.

METHODS AND RESULTS: We used longitudinal data from waves 2004-2006 and 2010-2012 of 1195 participants from the Health Workers Cohort Study. Circulating AGES were assessed by radioimmunoassay, and cardiovascular risk (CVR) was computed with the Framingham risk score. Linear and logistic fixed-effects regression models were used to assess the interest association, adjusting for confounding factors. An increase in 200 μU/ml of AGES was associated with a 0.18% increased risk of CVD (95% CI 0.05-0.31%). After adjusting for physical activity and smoking status, individuals who increased their AGES category had higher odds of middle-high CVR (low to medium AGES: OR 1.83, 95% CI 1.11-3.20; low to high AGES: OR 2.61, 95% CI 1.51-4.50). The associations remained statistically significant when we further adjusted for insulin resistance, dietary intake of AGES, and total daily calorie intake.

CONCLUSION: Our data show that circulating AGES are associated with the Framingham CVD risk score, independently of other major risk factors for CVD in the Mexican population.

PMID:36842957 | DOI:10.1016/j.numecd.2022.12.028

J Prosthet Dent. 2023 Feb 24:S0022-3913(23)00072-0. doi: 10.1016/j.prosdent.2022.11.029. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: Dental cobalt-chromium (Co-Cr) alloy manufactured by selective laser melting (SLM) is not recommended for clinical applications before annealing because of excessive residual stress. However, limited information is available regarding the relationship between annealing temperature and the metal-ceramic bond properties of SLM Co-Cr alloys.

PURPOSE: The purpose of this in vitro study was to investigate the effects of annealing temperature on the metal-ceramic bond properties of SLM Co-Cr alloys.

MATERIAL AND METHODS: Four groups with different annealing temperatures (850 °C; 950 °C; 1050 °C; 1150 °C) were prepared by using SLM techniques. Bond strengths were measured by using a 3-point bend test; subsequently, debonded surface morphologies and elements were assessed by using a scanning electron microscopy (SEM) coupled with energy-dispersive X-ray spectroscopy (EDS). The area fraction of adherence porcelain (AFAP) value was introduced to analyze fracture characteristics. Microstructural and interfacial characteristics were characterized by SEM/EDS and X-ray diffraction analysis. The coefficient of thermal expansion (CTE) test was used to analyze thermal matching. A 1-way ANOVA and the Tukey honestly significant difference tests were used to analyze bond strengths and AFAP values statistically (α=.05).

RESULTS: The mean ±standard deviation values of the metal-ceramic bond strengths were 40.68 ±4.34 MPa for the 850 °C group, 37.54 ±5.34 MPa for the 950 °C group, 45.97 ±2.18 MPa for the 1050 °C group, and 50.79 ±1.79 MPa for the 1150 °C group. Significant differences (P<.05) were observed among all groups. Debonded surfaces and AFAP analysis displayed a mixed fracture mode of adhesive and cohesive fracture, and 1150 °C-annealing specimens exhibited better fracture characteristics close to cohesive fractures. As the temperature increased, native oxide film thicknesses remained unchanged; the 850 °C group had the thinnest diffusion layer, while the other 3 groups had similar thicknesses. Although the 1050 °C and 1150 °C groups displayed higher CTE values, their microstructures were more conducive to atomic diffusion and improved chemical bonding. Microstructure analysis found that ε phase and second-phase precipitates jointly affected metal-ceramic bond strength.

CONCLUSIONS: Annealing temperatures affected the metal-ceramic bond strengths of SLM Co-Cr porcelain specimens. 1150 °C annealing SLM Co-Cr specimens displayed higher bond strengths and improved fracture and interface characteristics among the 4 groups.

PMID:36842952 | DOI:10.1016/j.prosdent.2022.11.029

Am J Orthod Dentofacial Orthop. 2023 Feb 24:S0889-5406(23)00066-5. doi: 10.1016/j.ajodo.2022.11.012. Online ahead of print.

ABSTRACT

INTRODUCTION: Regarding the key role of the maxillary canine in dynamic occlusion and smile esthetics, this study investigated the relation between smile esthetics and maxillary canine torque and vertical position from the viewpoint of orthodontists, general dentists, and laypersons.

METHODS: In this descriptive cross-sectional study, the close-up smile images have been changed using Adobe Photoshop (Adobe Systems, San Jose, Calif). Then, groups of 21 orthodontists, 20 general dentists, and 33 laypersons evaluated the smile attractiveness of the images using a digital version of a visual analog scale. Statistical analysis was performed using SPSS software (version 25; IBM, Armonk, Calif) and Shapiro-Wilk, analysis of variance, and Tukey post-hoc statistical tests. The significance level was set at 0.05.

RESULTS: There was no significant difference in the mean score between the 3 groups of observers regarding the changes in the canine vertical position in none of the variations (P >0.05). Regarding variations in torque, there was a significant difference between the 3 groups of observers in the bilateral 5° torque change. (P = 0.020).

CONCLUSIONS: Unilateral changes in the vertical position had lower scores, which shows that symmetry is very important in smile esthetics. In addition, laypersons did not find torque changes ranging between -15° to 15° a significant factor in smile esthetics. Overall, some adherence to these values will be acceptable in dental treatments.

PMID:36842948 | DOI:10.1016/j.ajodo.2022.11.012

Eur Urol Oncol. 2023 Feb 24:S2588-9311(23)00031-7. doi: 10.1016/j.euo.2023.01.012. Online ahead of print.

ABSTRACT

BACKGROUND: The comparative efficacy and health-related quality of life (HRQoL) outcomes of nivolumab plus cabozantinib versus pembrolizumab plus axitinib as first-line treatments for advanced renal cell carcinoma (aRCC) have not been assessed in head-to-head trials.

OBJECTIVE: To assess the efficacy and HRQoL outcomes of nivolumab plus cabozantinib versus pembrolizumab plus axitinib.

DESIGN, SETTING, AND PARTICIPANTS: Patient-level data for nivolumab plus cabozantinib from the CheckMate 9ER trial and published data for pembrolizumab plus axitinib from the KEYNOTE-426 trial were used. CheckMate 9ER data were reweighted to match the key baseline characteristics as reported in KEYNOTE-426.

INTERVENTION: Nivolumab (240 mg every 2 wk) plus cabozantinib (40 mg once daily) and pembrolizumab (200 mg every 3 wk) plus axitinib (5 mg twice daily, initially).

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Hazard ratios (HRs) for progression-free survival (PFS), duration of response, overall survival (OS), and deterioration in HRQoL were assessed using weighted Cox proportional-hazard models, with sunitinib as a common anchor. Objective response rates (ORRs) and changes in HRQoL scores from baseline were assessed as difference-in-differences for the two treatments relative to sunitinib.

RESULTS AND LIMITATIONS: After balancing patient characteristics between the trials, nivolumab plus cabozantinib was associated with significantly improved PFS (HR [95% confidence interval {CI}] 0.70 [0.53-0.93]; p = 0.01) and a significantly decreased risk of confirmed deterioration in HRQoL (Functional Assessment of Cancer Therapy-Kidney Symptom Index-Disease-related Symptoms: HR [95% CI] 0.48 [0.34-0.69]) versus pembrolizumab plus axitinib. OS was similar between treatments (HR [95% CI] 0.99 [0.67-1.44]; p = 0.94). Nivolumab plus cabozantinib was associated with numerically greater ORRs (difference-in-difference [95% CI] 8.4% [-1.7 to 18.4]; p = 0.10) and longer duration of response (HR [95% CI] 0.79 [0.47-1.31]; p = 0.36) than pembrolizumab plus axitinib. Comparative studies using data with a longer duration of follow-up are warranted.

CONCLUSIONS: Nivolumab plus cabozantinib significantly improved PFS and HRQoL compared with pembrolizumab plus axitinib as first-line treatment for aRCC.

PATIENT SUMMARY: This study was conducted to indirectly compare the results of two immunotherapy-based combinations-nivolumab plus cabozantinib versus pembrolizumab plus axitinib-for patients who have not received any treatment for advanced renal cell carcinoma. Patients who received nivolumab plus cabozantinib had a significant improvement in the length of time without worsening of their disease and in their perceived physical and mental health compared with pembrolizumab plus axitinib; patients remained alive for a similar length of time from the start of either treatment. This analysis further adds to our current knowledge of the relative benefits of these two treatment regimens and will help with physician and patient treatment decisions.

PMID:36842942 | DOI:10.1016/j.euo.2023.01.012

Surgeon. 2023 Feb 24:S1479-666X(23)00021-5. doi: 10.1016/j.surge.2023.02.002. Online ahead of print.

ABSTRACT

BACKGROUND: MRCS examiners are the face of the Royal College of Surgeons for early-career surgeons and should therefore represent the workforce they are examining as not to marginalise or negatively impact on the assessment experience of candidates from minoritised groups. This study aimed to explore the diversity of MRCS examiners and whether they represent the demographics of the MRCS candidates.

METHODS: A retrospective observational study including all active examiners and examination candidates who attempted MRCS Part A or Part B between January 2020 and July 2021. Self-declared demographic data collected by the Intercollegiate Committee for Basic Surgical Examinations (ICBSE) included gender, sexual orientation, disability status and ethnicity. Following data anonymisation, total group response frequencies were made available to the research team for statistical analysis.

RESULTS: Chi-squared analyses showed statistically significant differences in the representation of gender, disability and ethnicity between candidates and examiners (all p < 0.001). Men (83.9% (n = 1121) vs 70.9% (n = 6017) respectively), individuals without disability (98.7% (n = 917) vs 96.1% (n = 6847)) and individuals of White ethnicity (36.6% (n = 346) vs 20.4% (n = 1223)) were significantly overrepresented in the examiners compared to the examination candidates. There was no statistically significant difference in sexual orientation between examiners and candidates (p = 0.712).

CONCLUSIONS: Broadly speaking, the socio-demographic profile of MRCS examiners reflects that seen in senior and leadership positions in surgery in the UK – that is, predominantly male and White – but not that seen in early-career surgeons. Positive action is now required in examiner recruitment by the Royal Colleges to ensure that the cohort of MRCS examiners reflects the modern surgical workforce.

PMID:36842928 | DOI:10.1016/j.surge.2023.02.002

Prog Urol. 2023 Feb 24:S1166-7087(23)00044-1. doi: 10.1016/j.purol.2023.02.002. Online ahead of print.

ABSTRACT

PURPOSE: Bladder infusion, which involves filling the bladder with saline prior to catheter removal, has been associated with reduced time-to-discharge and increased success rates in trials without catheter (TWOCs) in perioperative setting. The objective of this study was to evaluate the applicability of this protocol in patients with acute urinary retention (AUR) related to benign prostatic hyperplasia (BPH).

METHODS: We conducted a retrospective single-center study comparing bladder infusion with at least 150mL of warm saline vs. standard catheter removal during TWOC in patients with BPH-related AUR between January and December 2021. The primary outcome was time to discharge. Secondary outcomes included: TWOC success, and early recurrence of urinary retention defined as recurrence within three months of successful TWOC.

RESULTS: A total of 75 men were included: 35 in the bladder infusion protocol and 40 in the standard protocol. Baseline characteristics were well balanced between groups. Overall, 35 patients (46.7%) had a successful TWOC without statistically significant difference between groups (P=0.10). Bladder infusion protocol was associated with a shorter median time to discharge (200 vs. 240min, P=0.003). However, patients in the bladder infusion group were associated with a higher risk of early recurrence of urinary retention (30% vs. 0%, P=0.02).

CONCLUSION: In patients with BPH-related AUR, the saline bladder infusion method reduced time-to-discharge with similar TWOC success rates. Larger studies are needed to properly analyze the risk of early recurrence of urinary retention before any clinical application.

LEVEL OF EVIDENCE: III.

PMID:36842924 | DOI:10.1016/j.purol.2023.02.002

J Pediatr Urol. 2023 Feb 11:S1477-5131(23)00053-0. doi: 10.1016/j.jpurol.2023.02.004. Online ahead of print.

ABSTRACT

INTRODUCTION: There is controversy surrounding the association between caudal block and complication rates after hypospadias repair. Conflicting results have been reported mostly from single-center, low volume studies and those that did not include relevant variables.

OBJECTIVES: We hypothesized that caudal block is not associated with increased rates of reoperation after primary repair and is associated with more complex hypospadias surgery.

STUDY DESIGN: The Clinical Practice Solutions Center database was queried to identify patients who received a primary hypospadias repair between 2009 and 2010. Primary hypospadias repair was further categorized as meatal advancement and glanduloplasty, distal, one-stage proximal, or one-stage perineal repair. Anesthesia coding was evaluated to identify those who received a caudal block. Any revision surgery was captured between 2009 and 2019 and the types of revision surgeries were identified. Variables such as caudal block, age, insurance type, surgeon volume, and surgeon years in practice were analyzed with mixed effects multiple logistic regression models.

RESULTS: The dataset query identified 3343 pediatric males who had primary hypospadias repair. The procedures were performed by 50 surgeons at 27 hospitals. Primary surgeries included meatal advancement and glanduloplasty (23%), distal (69%), proximal (6.9%), and perineal repairs (1%). Caudal block was administered to 42% of patients. Utilization of caudal block was not associated with type of primary surgery (p = 0.21). Adjusting for all other variables, increased patient age was associated with decreased usage of caudal block (p < 0.001). Analysis did not demonstrate a statistically significant association between utilization of caudal block with rates of revision surgery.

CONCLUSIONS: This large, multi-institution study demonstrates that the use of caudal block was not associated with more complex hypospadias surgery nor statistically significantly associated with increased rates of revision surgery after primary hypospadias repair.

PMID:36842912 | DOI:10.1016/j.jpurol.2023.02.004

Enferm Infecc Microbiol Clin (Engl Ed). 2023 Feb 24:S2529-993X(23)00058-8. doi: 10.1016/j.eimce.2022.12.015. Online ahead of print.

ABSTRACT

INTRODUCTION: The role of Aeromonas species in gastrointestinal disease is controversial. The aim was to analyze not only the virulence genes between different species of Aeromonas isolated from feces, but the distribution of these virulence genes between enterotoxigenic strains and co-pathogen strains.

METHODS: Retrospective study of isolates of Aeromonas spp. in feces (2016-2021). The protocol included coproculture, identification by MALDI-TOF and confirmation by multiplex PCR. SPSS Statistics program was used.

RESULTS: A total of 288 strains were studied for the virulence genes between different species of Aeromonas. To compare virulence genes between Aeromonas as co-pathogen and those isolated alone, 218 strains of the global set were used; 52 as co-pathogens compared with 166 Aeromonas without associated pathogen as controls.

CONCLUSIONS: We found no significant differences in the distribution of virulence genes versus co-existence of co-pathogens or not. A. hydrophila is the potentially most virulent species of our set.

PMID:36842908 | DOI:10.1016/j.eimce.2022.12.015

Ultrasound Med Biol. 2023 Feb 24:S0301-5629(23)00027-3. doi: 10.1016/j.ultrasmedbio.2023.01.013. Online ahead of print.

ABSTRACT

OBJECTIVE: Modelling ultrasound speckle to characterise tissue properties has generated considerable interest. As speckle is dependent on the underlying tissue architecture, modelling it may aid in tasks such as segmentation or disease detection. For the transplanted kidney, where ultrasound is used to investigate dysfunction, it is unknown which statistical distribution best characterises such speckle. This applies to the regions of the transplanted kidney: the cortex, the medulla and the central echogenic complex. Furthermore, it is unclear how these distributions vary by patient variables such as age, sex, body mass index, primary disease or donor type. These traits may influence speckle modelling given their influence on kidney anatomy. We investigate these two aims.

METHODS: B-mode images from n = 821 kidney transplant recipients (one image per recipient) were automatically segmented into the cortex, medulla and central echogenic complex using a neural network. Seven distinct probability distributions were fitted to each region’s histogram, and statistical analysis was performed.

DISCUSSION: The Rayleigh and Nakagami distributions had model parameters that differed significantly between the three regions (p ≤ 0.05). Although both had excellent goodness of fit, the Nakagami had higher Kullbeck-Leibler divergence. Recipient age correlated weakly with scale in the cortex (Ω: ρ = 0.11, p = 0.004), while body mass index correlated weakly with shape in the medulla (m: ρ = 0.08, p = 0.04). Neither sex, primary disease nor donor type exhibited any correlation.

CONCLUSION: We propose the Nakagami distribution be used to characterize transplanted kidneys regionally independent of disease etiology and most patient characteristics.

PMID:36842904 | DOI:10.1016/j.ultrasmedbio.2023.01.013