Tag: statistics

Graefes Arch Clin Exp Ophthalmol. 2022 Dec 28. doi: 10.1007/s00417-022-05940-y. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study is to investigate the clinical and morphological characteristics of epiretinal membrane (ERM)-Foveoschisis.

METHODS: Medical charts of 2088 patients diagnosed with idiopathic ERM were screened and eyes with ERM-Foveoschisis were included. All eyes underwent a complete ophthalmological examination including spectral domain optical coherence tomography (SD-OCT). OCT features and best corrected visual acuity (BCVA) were analysed. ERM-Foveoschisis was defined as open, closed, elevated or flat based on the OCT features. Ellipsoidal zone (EZ) abnormality, intraretinal cystoid spaces, central foveal thickness (CFT), posterior vitreous detachment (PVD) and lens status were assessed.

RESULTS: One hundred-sixty-six patients (175 eyes) (72% female, mean age 70.46 years) were included. Incidence of ERM-Foveoschisis was 6.7%. Open type was seen in 86.8% and had a significantly better mean BCVA than closed type (p = 0.01). No statistically significant difference of mean BCVA was noted between the elevated and flat types. Mean BCVA was significantly lower in eyes with EZ abnormality (p = 0.03) and eyes with intraretinal cystoid spaces (p = 0.02). Patients with ‘closed’ ERM-Foveoschisis showed a significant higher median CFT than ‘open’ ERM-Foveoschisis (respectively, 364 µm and 176 µm, p < 0.001). A total of 81.9% eyes had PVD.

CONCLUSION: We differentiated four morphological types of ERM-Foveoschisis based on the OCT examination. Closed ERM-Foveoschisis presented with a higher CFT and lower BCVA than the open type. ERM-Foveoschisis with cystoid intraretinal spaces presented with a lower BCVA. The impact of the morphological types of the ERM-Foveoschisis on the clinical course and for therapy decision requires further long-term studies.

PMID:36576570 | DOI:10.1007/s00417-022-05940-y

Foot Ankle Int. 2022 Dec 28:10711007221140868. doi: 10.1177/10711007221140868. Online ahead of print.

ABSTRACT

BACKGROUND: Recurrence of the hallux valgus deformity has various causes, and the incomplete reduction of sesamoids may be one of the important issues. However, we have seen several patients with postoperative lateral sesamoid displacement on anteroposterior (AP) standing radiographs who did not experience hallux valgus recurrence. Therefore, we hypothesized that lateral displacement of the sesamoid on AP standing radiographs does not cause hallux valgus recurrence.

METHODS: The study included 269 feet (185 patients) with hallux valgus treated with distal chevron metatarsal osteotomy. Mean patient age was 64.26 (range, 15-80) years. Patients were followed up for an average of 33.85 (range, 12-228) months between April 2002 and December 2019. The patients were divided into 4 groups, according to the presence or absence of hallux valgus recurrence and sesamoid reduction.

RESULTS: During outpatient follow-up, we discovered 99 feet (42.1%) in which hallux valgus did not recur despite lateral sesamoid displacement (grade IV-VII) on AP standing radiographs. Hallux valgus angle (HVA, 2.7 to 7.9 degrees), intermetatarsal angle (IMA, 4.6 to 6.2 degrees), and sesamoid grades (2.1 to 3.5) all deteriorated over time after surgery, and each indicator was statistically significantly altered, and changes in the 3 indicators had a statistically significant positive correlation. Changes in HVA and IMA between feet with and without sesamoid reduction on AP standing radiographs increased over time, with the differences in HVA (2.9 degrees) and IMA (0.9 degrees) being significant at final follow-up (P < .05 for each). Regardless of whether sesamoid reduction was achieved on AP standing radiographs, the final analysis showed that HVA and IMA in both groups worsened over time. Further, there were no differences between the 2 groups in the patterns of change over time.

CONCLUSION: In our cohort, postoperative sesamoid position on AP standing radiographs was not associated with hallux valgus recurrence based on radiographic criteria.

LEVEL OF EVIDENCE: Level III, retrospective comparative study.

PMID:36576025 | DOI:10.1177/10711007221140868

Foot Ankle Int. 2022 Dec 28:10711007221140841. doi: 10.1177/10711007221140841. Online ahead of print.

ABSTRACT

BACKGROUND: Enhanced recovery after surgery programs, also called fast-track protocols, were developed and successfully applied in the last decade for hip and knee reconstruction. Specific fast-track protocols have not yet been applied to ankle prostheses. The aim of the study was to develop and validate an enhanced recovery protocol for total ankle replacement (TAR) evaluating the clinical and radiographic results. We hypothesize that on the basis of well-defined pre- and postoperative characteristics, the current knowledge on ankle replacement, and referring to hip and knee reconstruction, it is possible to identify a “patient type” to be safely eligible to a Fast-Track Protocol with at least comparable results and without increasing the complications risk.

METHODS: We identified 8 predictive variables that might affect the outcome of TAR. Those variables were the body mass index, the state of anxiety or depression, the functional preoperative status, ankle equinus, the coronal malalignment, the surgical time, the surgical accessory procedures, and the bone quality. These characteristics were evaluated for each patient with almost validated outcome tools attributing a specific score. Based on the score obtained, the patients were divided into 2 groups: the Standard Protocol group (Control Group) and the Fast-Track Protocol group (Study Group). The main difference between treatment of the 2 groups relates to the use of postoperative plaster casts: in the Fast-Track group the cast was removed the first day after surgery and walking was allowed in sports shoes assisted with crutches, whereas in the Standard Protocol group, the cast was removed after 3 weeks. Clinical and radiographic evaluation was performed for all patients preoperatively and postoperatively every 6 months.

RESULTS: A total of 163 patients received a score between 1 and 5 and were included in the control group (Standard Protocol); 47 patients received a score of 0 and were allocated to the study group (Fast-Track Protocol). Clinically, except for the preoperative American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale score, no statistically significant differences were recorded in the multiple comparisons between the 2 groups. No significant differences were found regarding complications.

CONCLUSION: In selected patients, it is possible to apply an enhanced recovery protocol of rehabilitation, focused on immediate weightbearing and mobilization without any plaster or boot.

LEVEL OF EVIDENCE: Level II, prospective comparative study.

PMID:36576024 | DOI:10.1177/10711007221140841

Circ Res. 2022 Dec 28. doi: 10.1161/CIRCRESAHA.122.321975. Online ahead of print.

ABSTRACT

BACKGROUND: Dysbiosis of gut microbiota plays a pivotal role in vascular dysfunction and microbial diversity was reported to be inversely correlated with arterial stiffness. However, the causal role of gut microbiota in the progression of arterial stiffness and the specific species along with the molecular mechanisms underlying this change remain largely unknown.

METHODS: Participants with elevated arterial stiffness and normal controls free of medication were matched for age and sex. The microbial composition and metabolic capacities between the 2 groups were compared with the integration of metagenomics and metabolomics. Subsequently, AngII (angiotensin II)-induced and humanized mouse model were employed to evaluate the protective effect of Flavonifractor plautii (F. plautii) and its main effector cis-aconitic acid.

RESULTS: Human fecal metagenomic sequencing revealed a significantly high abundance and centrality of F. plautii in normal controls, which was absent in the microbial community of subjects with elevated arterial stiffness. Moreover, blood pressure only mediated part of the effect of F. plautii on lower arterial stiffness. The microbiome of normal controls exhibited an enhanced capacity for glycolysis and polysaccharide degradation, whereas, those of subjects with increased arterial stiffness were characterized by increased biosynthesis of fatty acids and aromatic amino acids. Integrative analysis with metabolomics profiling further suggested that increased cis-aconitic acid served as the main effector for the protective effect of F. plautii against arterial stiffness. Replenishment with F. plautii and cis-aconitic acid improved elastic fiber network and reversed increased pulse wave velocity through the suppression of MMP-2 (matrix metalloproteinase-2) and inhibition of MCP-1 (monocyte chemoattractant protein-1) and NF-κB (nuclear factor kappa-B) activation in both AngII-induced and humanized model of arterial stiffness.

CONCLUSIONS: Our translational study identifies a novel link between F. plautii and arterial function and raises the possibility of sustaining vascular health by targeting gut microbiota.

PMID:36575982 | DOI:10.1161/CIRCRESAHA.122.321975

Neurorehabil Neural Repair. 2022 Dec 28:15459683221143461. doi: 10.1177/15459683221143461. Online ahead of print.

ABSTRACT

The Critical Periods After Stroke Study (CPASS, n = 72) showed that, compared to controls, an additional 20 hours of intensive upper limb therapy led to variable gains on the Action Research Arm Test depending on when therapy was started post-stroke: the subacute group (2-3 months) improved beyond the minimal clinically important difference and the acute group (0-1 month) showed smaller but statistically significant improvement, but the chronic group (6-9 months) did not demonstrate improvement that reached significance. Some have misinterpreted CPASS results to indicate that all inpatient motor therapy should be shifted to outpatient therapy delivered 2 to 3 months post-stroke. Instead, however, CPASS argues for a large dose of motor therapy delivered continuously and cumulatively during the acute and subacute phases. When interpreting trials like CPASS, one must consider the substantial dose of early usual customary care (UCC) motor therapy that all participants received. CPASS participants averaged 27.9 hours of UCC occupational therapy (OT) during the first 2 months and 9.8 hours of UCC OT during the third and fourth months post-stroke. Any recovery experienced would therefore result not just from CPASS intensive motor therapy but the combined effects of experimental therapy plus UCC. Statistical limitations also did not allow direct comparisons of the acute and subacute group outcomes in CPASS. Instead of shifting inpatient therapy hours to the subacute phase, CPASS argues for preserving inpatient UCC. We also recommend conducting multi-site dosing trials to determine whether additional intensive motor therapy delivered in the first 2 to 3 months following inpatient rehabilitation can further improve outcomes.

PMID:36575958 | DOI:10.1177/15459683221143461

J Appl Lab Med. 2022 Dec 28:jfac089. doi: 10.1093/jalm/jfac089. Online ahead of print.

ABSTRACT

BACKGROUND: Kidney stones are a highly prevalent disease worldwide. Additionally, both environmental and occupational exposure to Pb and Cd continue to be prevalent globally and can result in renal toxicity. The objective of this study was to examine the potential presence of Pb and Cd in kidney stones, and to assess for correlation with demographic factors including smoking, gender, age, and kidney stone matrix composition.

METHODS: Patient kidney stones (n = 96) were analyzed using Fourier transform infrared spectroscopy to identify the stone constituents. Cd and Pb concentrations (µg/g) were determined by inductively coupled plasma mass spectrometry. Cd and Pb concentrations were correlated using bivariable and multivariable statistical analysis with demographic factors (age, gender, smoking status), and kidney stone composition.

RESULTS: Kidney stone Cd (median 0.092 µg/g, range 0.014 to 2.46) and Pb concentrations (median 0.95 µg/g, range 0.060 to 15.4) were moderately correlated (r = 0.56, P < 0.0001). Cd concentrations were positively associated with patient history of smoking, patient age, and calcium oxalate monohydrate levels while negatively associated with struvite and uric acid/uric acid dihydrate. Pb concentrations were positively associated with females and apatite levels while negatively associated with uric acid/uric acid dihydrate. After holding constant other stone type composition levels, smoking status, and age, both Pb and Cd were positively associated with apatite and negatively associated with uric acid/uric acid dihydrate, struvite, and calcium carbonate.

CONCLUSIONS: Cd and Pb kidney stone concentrations are associated with specific kidney stone types. Cd and Pb kidney stone concentrations are both associated with smoking.

PMID:36575923 | DOI:10.1093/jalm/jfac089

Pediatrics. 2022 Dec 28:e2022059540. doi: 10.1542/peds.2022-059540. Online ahead of print.

NO ABSTRACT

PMID:36575920 | DOI:10.1542/peds.2022-059540

J Periodontal Res. 2022 Dec 27. doi: 10.1111/jre.13087. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the level of ADMA (asymmetric dimethylarginine), SDMA (symmetric dimethylarginine), and IL-1β (Interleukin-1β) in gingival crevicular fluid (GCF) from periodontitis patients and control subjects.

BACKGROUND: ADMA and SDMA are potentially hazardous non-proteinogenic amino acids that limit nitric oxide (NO) synthesis and have many functions in various human disorders. ADMA causes a structural change in nitric oxide synthase, while SDMA blocks arginine cell uptake. Increased plasma ADMA has been widely recognized as a “trigger” initiating impaired NO bioavailability and vascular dysfunction, which ultimately leads to oxidative stress.

METHODS: Twenty-five patients with periodontitis (P) (Stage III, Grade C, n = 25) and 20 control (C) subjects were included in the study. The IL-1β level of GCF was measured by enzyme immunoassay (ELISA) and ADMA and SDMA by liquid chromatography-mass spectrometry (LC-MS/MS).

RESULTS: Periodontitis patients had higher clinical parameters than controls (p < .001). Levels of IL-1β, ADMA and SDMA GCF were statistically significantly higher in group P than in group C (respectively; p = .003, p < .0001, p < .0001). There was no difference in the ADMA/SDMA ratio (p = .312) between the groups. There were significant positive correlations between clinical periodontal parameters and IL-1β, ADMA, and SDMA levels (p < .05). ADMA and SDMA levels were significantly correlated with IL-1β (p < .05).

CONCLUSIONS: These findings suggest that ADMA and SDMA may be involved in the pathogenesis of the periodontal disease.

PMID:36575915 | DOI:10.1111/jre.13087

Biotechnol Appl Biochem. 2022 Dec 27. doi: 10.1002/bab.2433. Online ahead of print.

ABSTRACT

Invasive infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are associated with high mortality and morbidity. The sooner the pathogen is determined, the better it is beneficial to patient. However, routine laboratory inspections are time-consuming and laborious. A thorough research was conducted in PubMed, Web of Science (until June 2021) to identify studies evaluating the accuracy of MRSA identification by MALDI-TOF-MS. STATA 15.0 software was used to analyze the pooled results of sensitivity, specificity and 95% confidence intervals (CI). The summary receiver operating characteristic curves (SROC) and area under the curve (AUC) were utilized to show the overall performance of MALDI-TOF-MS. Fifteen studies involving 2,471 isolates were included in this study after the final selection in this meta-analysis. Using the random effects model forest plot to summarize the overall statistics, the sensitivity of MALDI-TOF MS for identifying MRSA was 92% (95% CI, 81%-97%), and the specificity was 97% (95% CI, 89%-99%). In the SROC curve, the AUC reached 0.99 (95% CI, 97%-99%). Deeks’ test showed no significant publication bias in this meta-analysis. Compared with clinical reference methods, MALDI-TOF MS identification of MRSA shows a higher degree of sensitivity and specificity. This article is protected by copyright. All rights reserved.

PMID:36575908 | DOI:10.1002/bab.2433

J Adv Nurs. 2022 Dec 27. doi: 10.1111/jan.15557. Online ahead of print.

ABSTRACT

AIM: To develop an emotional intelligence (EI) test and evaluate its psychometrics for social and healthcare student selection.

DESIGN: A cross-sectional methodological design.

METHODS: The test was developed based on a systematic review and focus group interviews. Content validity was evaluated with expert panels, and preliminary psychometrics with two pilot studies. Descriptive statistics, correlations and item response theory were used.

DATA SOURCES: Search was conducted in six databases 2018. Focus group interviews were conducted with educators and professionals in 2019. Expert panels with doctoral students, researchers and educators were conducted in 2020. Pilot tests with students were conducted 2020-2021. The developed test was administered to 4808 applicants 2021.

RESULTS: The test included four subscales. Correlations support the test’s theoretical structure. The items were mainly easy.

CONCLUSION: The test assesses EI objectively and comprehensively. The item-level distractor analysis can be used for further test development.

IMPACTS: Social care and healthcare students engage in clinical practice early in their studies, and these environments can be emotionally challenging. Assessing EI in student selection with adequate test can help the institutions of higher education to select the students with required abilities to succeed in the studies. The assessment of EI during student selection also provides information higher education institutions could use to develop and provide support interventions. The results may also encourage practice placements to include EI elements as learning objective. The results of this study and especially the use of IRT and detailed distractor analysis to evaluate the psychometric properties of EMI-T can benefit researchers and educators that develop or evaluate objective assessment tools with multiple choice questions.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Emotional intelligence is important for students to enable professional interaction.

PMID:36575904 | DOI:10.1111/jan.15557