Tag: statistics

Knee Surg Sports Traumatol Arthrosc. 2022 Jun 16. doi: 10.1007/s00167-022-07027-x. Online ahead of print.

ABSTRACT

PURPOSE: Fluoroscopic knee kinematics have historically been quantified at least 1 year after total knee arthroplasty (TKA). The purpose of this study was to longitudinally assess knee kinematics at 6-12 weeks, 6 months, and 1 year after TKA to determine if earlier evaluation may be justified.

METHODS: Twenty-one patients participated after undergoing TKA with a posterior cruciate ligament-retaining fixed-bearing prosthesis. Fluoroscopic examinations of lunge, kneel, and step-up activities were performed at 12 ± 4 weeks (V1), 7 ± 2 months (V2), and 13 ± 2 months (V3) postoperatively. Images were analyzed using a three-dimensional to two-dimensional image registration technique. Maximum flexion poses for lunging and kneeling were compared between visits with repeated-measures statistical tests. For the step-up activity, mixed-effects linear models were constructed for condylar anteroposterior (AP) contact points and tibial internal rotation throughout flexion. Estimated marginal means of fitted values were plotted with 95% confidence intervals and used to compare mean kinematics between visits.

RESULTS: There were no significant changes in maximum lunging flexion over time (p = 0.405), though significant increases in maximum kneeling flexion were observed between V1 (106 ± 8°) and V2 (110 ± 9°) (p = 0.006), and V1 and V3 (113 ± 9°) (p = 0.0003). While statistical differences were calculated for lunging medial condyle AP translation and kneeling tibial internal rotation, absolute differences in condylar AP contact locations were less than ~ 2 mm between all visits during both movements. For the step-up activity, tibial internal rotation increased with flexion, and there were pair-wise significant differences at all flexion angles between V1-V2 (p < 0.001) and V1-V3 (p < 0.001). Anterior medial condylar translation was observed with flexion, with pair-wise significant differences present for V1-V3 (p = 0.005) and V2-V3 (p < 0.001). The lateral condyle exhibited initial posterior translation followed by anterior translation with increasing flexion, with pair-wise differences between all visits (p < 0.005 for all comparisons).

CONCLUSION: Though statistical differences were observed between visits for all activities, variations in estimated mean condylar positions were within ~ 2 mm from ~ 12 weeks to 1 year. Considering measurement error averages approximately 1 mm for sagittal plane translations, these results indicate that knee kinematics during kneel, lunge, and step-up activities may be sustained from as early as 12 weeks after TKA.

PMID:35708746 | DOI:10.1007/s00167-022-07027-x

Eur J Trauma Emerg Surg. 2022 Jun 16. doi: 10.1007/s00068-022-02015-9. Online ahead of print.

ABSTRACT

PURPOSE: To analyze if perioperative and oncologic outcomes with stenting as a bridge to surgery (SEMS-BS) and interval colectomy performed by acute care surgeons for left-sided occlusive colonic neoplasms (LSCON) are non-inferior to those obtained by colorectal surgeons for non-occlusive tumors of the same location in the full-elective context.

METHODS: From January 2011 to January 2021, patients with LSCON at University Regional Hospital in Málaga (Spain) were directed to a SEMS-BS strategy with an interval colectomy performed by acute care surgeons and included in the study group (SEMS-BS). The control group was formed with patients from the Colorectal Division elective surgical activity dataset, matching by ASA, stage, location and year of surgery on a ratio 1:2. Stages IV or palliative stenting were excluded. Software SPSS 23.0 was used to analyze perioperative and oncologic (defined by overall -OS- and disease free -DFS-survival) outcomes.

RESULTS: SEMS-BS and control group included 56 and 98 patients, respectively. In SEMS-BS group, rates of technical/clinical failure and perforation were 5.35% (3/56), 3.57% (2/56) and 3.57% (2/56). Surgery was performed with a median interval time of 11 days (9-16). No differences between groups were observed in perioperative outcomes (laparoscopic approach, primary anastomosis rate, morbidity or mortality). As well, no statistically significant differences were observed in OS and DFS between groups, both compared globally (OS:p < 0.94; DFS:p < 0.67, respectively) or by stages I-II (OS:p < 0.78; DFS:p < 0.17) and III (OS:p < 0.86; DFS:p < 0.70).

CONCLUSION: Perioperative and oncologic outcomes of a strategy with SEMS-BS for LSCON are non-inferior to those obtained in the elective setting for non-occlusive neoplasms in the same location. Technical and oncologic safety of interval colectomy performed on a semi-scheduled situation by acute care surgeons is absolutely warranted.

PMID:35708740 | DOI:10.1007/s00068-022-02015-9

J Periodontol. 2022 Jun 16. doi: 10.1002/JPER.22-0129. Online ahead of print.

ABSTRACT

BACKGROUND: Plasminogen Activator Inhibitor-1 (PAI-1) is significantly enhanced in insulin resistance and inflammation and ascribed as a pro-inflammatory marker. This study aimed to compare and correlate salivary and serum PAI-1 and alpha 2-macroglobulin (α2MG) in patients with periodontitis with and without type 2 diabetes mellitus (T2DM) and also appraise the consequence of periodontal treatment on these biomarkers.

METHODS: 60 subjects enlisted were split into two groups; Group 1 consisted of 30 systemically healthy subjects with Stage II and III, generalised, Grade B, C periodontitis while Group 2 consisted of 30 patients with periodontitis and well-controlled T2DM (PDM). Salivary and serum PAI-1 and α2MG levels were estimated by enzyme-linked immunosorbent assay and allied with clinical parameters before and 3 months post non-surgical periodontal therapy (NSPT). Data was statistically analysed using student t test and Spearman’s correlation.

RESULTS: Analogous improvements in clinical periodontal markers were experienced in both groups after initial periodontal treatment. Estimates of salivary and serum PAI-1 and α2MG were higher among the PDM group compared to periodontitis alone at baseline. Significant diminution in estimates of biomarkers was noted 3 months after NSPT. In the PDM group, there was also an improvement in glycaemic control.

CONCLUSION: NSPT positively impacted both groups. Noteworthy expression of salivary and serum PAI-1 in periodontitis and diabetes patients insinuates a possible role of the adipokine in periodontal inflammation and glucose level regulation. Salivary PAI-1 could thus be used as a diagnostic biomarker to detect disease activity and to track periodontal therapy response. This article is protected by copyright. All rights reserved.

PMID:35708712 | DOI:10.1002/JPER.22-0129

JAMA Netw Open. 2022 Jun 1;5(6):e2216784. doi: 10.1001/jamanetworkopen.2022.16784.

ABSTRACT

IMPORTANCE: Whether the benefits of notifying women about breast density outweigh the potential harms to inform current and future mammogram screening practice remains unknown.

OBJECTIVE: To assess the effect of mammographic breast density notification and information provision on women’s intention to seek supplemental screening and psychological outcomes.

DESIGN, SETTING, AND PARTICIPANTS: A 3-arm online randomized clinical trial was conducted from August 10 to 31, 2021. Data analysis was conducted from September 1 to October 20, 2021. Participants included Australian residents identifying as female, aged between 40 and 74 years, with no history of breast cancer who were residing in jurisdictions without existing breast density notification with screening mammograms.

INTERVENTIONS: Women were randomized to receive 1 of the following hypothetical breast screening test result letters: screening mammogram result letter without breast density messaging (control), screening mammogram result letter with breast density messaging and an existing density information letter taken from a screening service in Australia (intervention 1), and screening mammogram result letter with breast density messaging and a health literacy-sensitive version of the letter adapted for people with lower health literacy (intervention 2).

MAIN OUTCOMES AND MEASURES: Primary outcomes were intention to seek supplemental screening; feeling anxious (uneasy, worried, or nervous), informed, or confused; and having breast cancer worry.

RESULTS: A total of 1420 Australian women were randomized and included in the final analysis. The largest group consisted of 603 women aged 60 to 74 years (42.5%). Compared with the control cohort (n = 480), women who received density notification via intervention 1 (n = 470) and intervention 2 (n = 470) reported a significantly higher intention to seek supplemental screening (0.8% vs 15.6% and 14.2%; P < .001) and feeling anxious (14.2% vs 49.4% and 48.5%; P < .001), confusion (7.8% vs 24.0% and 23.6%; P < .001), and worry about breast cancer (quite/very worried: 6.9% vs 17.2% and 15.5%; P < .001). There were no statistically significant differences in these outcomes between the 2 intervention groups.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, breast density notification and information integrated with screening mammogram results increased women’s intention to seek supplemental screening and made women feel anxious, confused, or worried about breast cancer. These findings have relevance and implications for mammogram screening services and policy makers considering whether and, if so, how best to implement widespread notification of breast density as part of mammography screening.

TRIAL REGISTRATION: ACTRN12621000253808.

PMID:35708691 | DOI:10.1001/jamanetworkopen.2022.16784

Pain Med. 2022 Jun 16:pnac094. doi: 10.1093/pm/pnac094. Online ahead of print.

ABSTRACT

OBJECTIVES: Recurrent, severely painful episodes, known as vaso-occlusive crises (VOCs) are the hallmark of sickle cell disease (SCD) and the primary reason for hospitalization. Opioids have been the gold standard for VOC treatment without significant improvement pain outcomes. To aid analgesia and combat opioid related adverse effects (ORAEs), some SCD clinicians have trialed infusions of sub-anesthetic ketamine along with opioids to treat VOCs. In this retrospective analysis, we compared adult SCD patients who received early versus late adjunctive sub-anesthetic ketamine infusions for VOCs.

METHODS: We identified adult SCD patients (age 18-50 years) who presented to Duke University with a VOC and received sub-anesthetic ketamine infusions from July 2015 to June 2019. We assessed both daily opioid consumption (measured as oral morphine milligram equivalents (MME)) and self-reported 0-10 numeric pain ratings (NPR) at one, two, and three days after infusion initiation, as well as one day after discontinuation.

RESULTS: A total of 56 patients were identified with a median age of 30 years. Compared to late administration, early infusion of sub-anesthetic ketamine was associated with a 24.5% (p = 0.0003) and 25.9% (p = 0.0006) reduction, respectively, in median NPR at one day and two days after infusion initiation but did not persist at three days following initiation of the infusion. A statistically significant reduction in MME was not observed.

CONCLUSION: In a non-randomized study of sickle cell patients with VOCs, early sub-anesthetic ketamine infusion led to greater reduction in subjective pain intensity than late initiation of the infusion. Randomized studies should further explore whether early versus late ketamine infusion improves management of acute SCD pain.

PMID:35708641 | DOI:10.1093/pm/pnac094

Syst Biol. 2022 Jun 16:syac043. doi: 10.1093/sysbio/syac043. Online ahead of print.

ABSTRACT

Contamination of a genetic sample with DNA from one or more non-target species is a continuing concern of molecular phylogenetic studies, both Sanger sequencing studies and Next-Generation Sequencing (NGS) studies. We developed an automated pipeline for identifying and excluding likely cross-contaminated loci based on detection of bimodal distributions of patristic distances across gene trees. When the contamination occurs between samples within a dataset, comparisons between a contaminated sample and its contaminant taxon will yield bimodal distributions with one peak close to zero patristic distance. This new method does not rely on a priori knowledge of taxon relatedness nor does it determine the causes(s) of the contamination. Exclusion of putatively contaminated loci from a dataset generated for the insect family Cicadidae showed that these sequences were affecting some topological patterns and branch supports, although the effects were sometimes subtle, with some contamination-influenced relationships exhibiting strong bootstrap support. Long tip branches and outlier values for one anchored phylogenomic pipeline statistic (AvgNHomologs) were correlated with the presence of contamination. While the AHE markers used here, which target hemipteroid taxa, proved effective in resolving deep and shallow level Cicadidae relationships in aggregate, individual markers contained inadequate phylogenetic signal, in part probably due to short length. The cleaned dataset, consisting of 429 loci, from 90 genera representing 44 of 56 current Cicadidae tribes, supported three of the four sampled Cicadidae subfamilies in concatenated-matrix maximum likelihood (ML) and multispecies coalescent-based species tree analyses, with the fourth subfamily weakly supported in the ML trees. No well-supported patterns from previous family-level Sanger sequencing studies of Cicadidae phylogeny were contradicted. One taxon (Aragualna plenalinea) did not fall with its current subfamily in the genetic tree, and this genus and its tribe Aragualnini is reclassified to Tibicininae following morphological re-examination. Only subtle differences were observed in trees after removal of loci for which divergent base frequencies were detected. Greater success may be achieved by increased taxon sampling and developing a probe set targeting a more recent common ancestor and longer loci. Searches for contamination are an essential step in phylogenomic analyses of all kinds and our pipeline is an effective solution.

PMID:35708660 | DOI:10.1093/sysbio/syac043

Rheumatology (Oxford). 2022 Jun 16:keac311. doi: 10.1093/rheumatology/keac311. Online ahead of print.

ABSTRACT

OBJECTIVES: Lung vascular and parenchymal changes can be recently assessed quantitatively in thoracic computed tomography (CT) images using automated software tools. We investigated the vessel parameters of patients with Systemic Sclerosis (SSc), quantified by CT imaging, and correlated them with the interstitial lung disease (ILD) features.

METHODS: SSc patients undergoing standard of care pulmonary function testing and CT evaluation were retrospectively evaluated. CT images were analyzed for ILD patterns and total pulmonary vascular volume (PVV) extents with Imbio LTA. Vascular analysis (volumes, numbers, and densities of vessels, separating arteries and veins) was performed with an in-house developed software. A threshold of 5% ILD extent was chosen to define the presence of ILD, and commonly used cut-offs of lung function were adopted.

RESULTS: 79 patients (52 women, 40 ILD, age 56.2 ± 14.2 years, total ILD extent 9.5 ± 10.7%, PVV/LV% 2.8%) were enrolled. Vascular parameters for total and separated PVV significantly correlated with functional parameters and ILD pattern extents. SSc-ILD patients presented with an increased number and volume of arterial vessels, in particular those between 2-4 mm of diameter, and with a higher density of arteries and veins of < 8 mm in diameter. Considering radiological and functional criteria concomitantly, as well as the descriptive trends from the longitudinal evaluations, the normalized PVVs, vessel numbers and densities increased progressively with the increase/worsening of ILD extent and functional impairment.

CONCLUSION: In SSc patients CT vessel parameters increase in parallel with ILD extent and functional impairment and may represent a biomarker of SSc-ILD severity.

PMID:35708639 | DOI:10.1093/rheumatology/keac311

J Med Food. 2022 Jun;25(6):636-644. doi: 10.1089/jmf.2022.K.0007.

ABSTRACT

There is a lack of studies on the effects of Korean ginseng (Panax ginseng C.A. Meyer) on face or body temperature. Therefore, in this study, we evaluated the effects of a black ginseng extract, KGR-BG1, on head and face temperatures and compared them with those of red ginseng extract and a placebo. We assessed their safety and tolerability and examined changes in the serum levels of biomarkers associated with immune responses, as well as with glucose and lipid metabolism. A randomized, double-blind, placebo-controlled study was conducted with 180 participants. The participants were randomly assigned to the KGR-BG1, red ginseng extract, or placebo group. Each group received a 1500 mg oral dose of their respective substances containing 1000 mg of the active component or placebo twice daily for 6 weeks. After treatment, changes in the head, face, and body temperature were measured, and serum biomarkers were evaluated. A total of 172 participants completed the evaluation after 6 weeks of treatment. No significant differences were observed in the head, face, and body temperatures among the treatment groups. After 6 weeks of treatment, the serum levels of biomarkers associated with inflammation, glucose metabolism, and lipid metabolism were similar to the baseline levels in all treatment groups. KGR-BG1 was well-tolerated compared with red ginseng extract and placebo. KGR-BG1 did not significantly alter head, face, or body temperature, or serum biomarker levels, and it was well tolerated in healthy volunteers over 6 weeks of treatment. Study Registration: Registered at Clinical Research Information Service (CRIS; https://cris.nih.go.kr) as KCT0003126.

PMID:35708631 | DOI:10.1089/jmf.2022.K.0007

Phys Sportsmed. 2022 Jun 16. doi: 10.1080/00913847.2022.2090869. Online ahead of print.

ABSTRACT

OBJECTIVES: Certain occupations are associated with greater risk of triggering a sudden cardiac event because of high levels of physical exertion and extreme thermal environments in which they occur. The extent to which sports officials-particularly high school (HS) American football referees-experience these conditions is unknown. Forty-six male HS officials (72% White/Caucasian; age=48±12 y, body mass index=31.7±6.6 kg·m^-2) were studied to quantify the physiological strain and physical demands of officiating.

METHODS: Referee demographics (e.g., experience, habitual exercise), pre-game urine specific gravity (U_SG), thermal (peak core temperature [T_core]) and cardiovascular (average heart rate [HR]) strain, kinematic activity (e.g., total distance, speed, mechanical intensity), and environmental conditions were measured during 10 regular season varsity HS football games (≈2.5 h each) in the Southeastern United States (average wet bulb globe temperature and relative humidity: 18.9±6.0 °C and 78.2±12.1%). Analyses included descriptive statistics, bivariate correlations, and linear regression.

RESULTS: Referees covered 5.2±1.2 km per game, eliciting average HR and peak T_core of 71.5%±8.0% HR_max and 38.3±0.5 °C, respectively; 38% began games dehydrated (U_SG=1.026±0.004). Multiple regression analyses revealed that obesity (β=0.34), not participating in regular exercise (β=-0.36), and officiating at lower mechanical intensity (β=-0.33) predicted greater cardiovascular strain (all p≤0.03). White/Caucasian race/ethnicity (β=0.59), younger age (β=-0.46), and obesity (β=0.28) predicted greater thermal strain (all p≤0.01).

CONCLUSION: HS football referees experienced elevated levels of physiological strain while officiating, with individual factors modulating the magnitude of strain. Strategies aimed at reducing obesity, increasing exercise participation, and improving cardiovascular health should be emphasized to mitigate strain and prevent cardiac events.

PMID:35708121 | DOI:10.1080/00913847.2022.2090869

Haematologica. 2022 Jun 16. doi: 10.3324/haematol.2021.280027. Online ahead of print.

ABSTRACT

Achievement of complete remission (CR) signifies a crucial milestone in the therapy of acute myeloid leukemia (AML) while refractory disease is associated with dismal outcomes. Hence, accurately identifying patients at risk is essential to individually tailor treatment concepts to disease biology. We used nine machine learning (ML) models to predict CR and 2-year overall survival (OS) in a large multi-center cohort of 1383 AML patients who received intensive induction therapy using clinical, laboratory, cytogenetic and molecular genetic data and validated our results on an external multicenter cohort. Our ML models autonomously selected predictive features both including established markers of favorable or adverse risk as well as identifying markers of so-far controversial relevance. De novo AML, extramedullary AML, double-mutated (dm) CEBPA, mutations of CEBPA-bZIP, NPM1, FLT3-ITD, ASXL1, RUNX1, SF3B1, IKZF1, TP53, U2AF1, t(8;21), inv(16)/t(16;16), del(5)/del(5q), del(17)/del(17p), normal or complex karyotypes, age and hemoglobin at initial diagnosis were statistically significant markers predictive of CR, while t(8;21), del(5)/del(5q), inv(16)/t(16;16), del(17)/del(17p), dmCEBPA, CEBPA-bZIP, NPM1, FLT3-ITD, DNMT3A, SF3B1, U2AF1, TP53, age, white blood cell count, peripheral blast count, serum LDH and Hb at initial diagnosis as well as extramedullary manifestations were predictive for 2-year OS. For prediction of CR and 2-year OS, AUROCs ranged between 0.77 – 0.86 and 0.63 and 0.74, respectively in our test set and 0.71 – 0.80 and 0.65 – 0.75 in the external validation cohort. We demonstrate the feasibility of ML for risk stratification in AML as a model disease for hematologic neoplasms using a scalable and reusable ML framework. Our study illustrates the clinical applicability of ML as a decision support system in hematology.

PMID:35708137 | DOI:10.3324/haematol.2021.280027