Tag: statistics

J Korean Neurosurg Soc. 2022 Nov 3. doi: 10.3340/jkns.2022.0200. Online ahead of print.

ABSTRACT

OBJECTIVE: Chronic subdural hematoma (CSDH) is a common neurosurgical disease and generally treated with burr-hole surgery alone. Tranexamic acid (TXA) is an antifibrinolytic agent that potentially reduces recurrence rates and the residual hematoma volume. However, the role of postoperative TXA medication remains unclear to date. This study aimed to verify the effectiveness of adjunctive TXA in the view of early hematoma resolution.

METHODS: Between January 2018 and September 2021, patients with CSDH who underwent burr-hole trephination in a single tertiary institute were reviewed. The study population was divided into three groups, TXA, non-TXA and antithrombotics (AT) groups, according to the medical history of cardio-cerebrovascular disease and TXA administration. The primary endpoint was CSDH recurrence, defined as re-appearance or re-accumulation of CSDH requiring neurosurgical interventions. The secondary outcome was CSDH resolution, defined as complete or near-complete resorption of the CSDH. The CSDH resolution time and serial changes of hematoma thickness were also investigated.

RESULTS: A total of 240 patients was included in the analysis consisting of 185 male and 55 female, with a median age of 74 years. During the median imaging follow-up period of 75 days, 222 patients were reached to the primary or secondary endpoint. TXA was administered as an adjunctive therapy in 41 patients (TXA group, 16.9%) while 114 patients were included in the non-TXA group (47.9%) and 85 were in the AT group. The recurrence rate was the lowest in the TXA group (2.4%), followed by non-TXA (7.0%) and AT (8.2%) groups. However, there was no statistical significance due to the small number of patients with recurrence. CSDH resolution was achieved in 206 patients, and the median estimated time to resolution was significantly faster in the TXA group (p < 0.001). Adjunctive TXA administration was a significant positive factor for achieving CSDH resolution (p < 0.001). The hematoma thickness was comparable among the three groups at the initial time and after surgery. However, CSDH thickness in the TXA group decreased abruptly in a month and showed a significant difference from that in the other groups (p < 0.001). There was no TXA-related adverse event.

CONCLUSION: The adjunctive use of TXA after CSDH surgery significantly facilitated the resorption of residual CSDH and resulted in the early CSDH resolution. Adjunctive TXA may be an effective treatment option to reduce recurrence by enhancing CSDH resolution in the selective patients.

PMID:36325752 | DOI:10.3340/jkns.2022.0200

J Appl Clin Med Phys. 2022 Nov 3:e13820. doi: 10.1002/acm2.13820. Online ahead of print.

ABSTRACT

PURPOSE: To develop an independent log file-based intensity-modulated radiation therapy (IMRT) quality assurance (QA) tool for the 0.35 T magnetic resonance-linac (MR-linac) and investigate the ability of various IMRT plan complexity metrics to predict the QA results. Complexity metrics related to tissue heterogeneity were also introduced.

METHODS: The tool for particle simulation (TOPAS) Monte Carlo code was utilized with a previously validated linac head model. A cohort of 29 treatment plans was selected for IMRT QA using the developed QA tool and the vendor-supplied adaptive QA (AQA) tool. For 27 independent patient cases, various IMRT plan complexity metrics were calculated to assess the deliverability of these plans. A correlation between the gamma pass rates (GPRs) from the AQA results and calculated IMRT complexity metrics was determined using the Pearson correlation coefficients. Tissue heterogeneity complexity metrics were calculated based on the gradient of the Hounsfield units.

RESULTS: The median and interquartile range for the TOPAS GPRs (3%/3 mm criteria) were 97.24% and 3.75%, respectively, and were 99.54% and 0.36% for the AQA tool, respectively. The computational time for TOPAS ranged from 4 to 8 h to achieve a statistical uncertainty of <1.5%, whereas the AQA tool had an average calculation time of a few minutes. Of the 23 calculated IMRT plan complexity metrics, the AQA GPRs had correlations with 7 out of 23 of the calculated metrics. Strong correlations (|r| > 0.7) were found between the GPRs and the heterogeneity complexity metrics introduced in this work.

CONCLUSIONS: An independent MC and log file-based IMRT QA tool was successfully developed and can be clinically deployed for offline QA. The complexity metrics will supplement QA reports and provide information regarding plan complexity.

PMID:36325743 | DOI:10.1002/acm2.13820

Hosp Pract (1995). 2022 Nov 3. doi: 10.1080/21548331.2022.2144066. Online ahead of print.

ABSTRACT

OBJECTIVES: In the United States, approximately 18-25 percent of carotid duplex ultrasound (CUS) studies are ordered to assess patients with non-lateralizing neurological complaints such as syncope, blurry vision, lightheadedness, headache, and altered mental status. The purpose of this study is to evaluate the benefit of CUS in the evaluation of patients presenting with non-lateralizing signs or symptoms.

MATERIALS AND METHODS: We conducted a retrospective analysis to assess the degree and laterality of carotid stenosis among patients with non-lateralizing neurological complaints who underwent CUS interpreted by certified vascular neurologists over a period of three years. The primary endpoint was to identify the prevalence of moderate to severe carotid artery stenosis among 280 patients who met inclusion criteria.

RESULTS: 17.7% of CUS studies were ordered for non-lateralizing symptoms. 261 patients (93.21%) had either normal imaging or mild carotid stenosis of <50%. 19 patients (6.79%) were found to have stenosis of ≥50%. In this subgroup, age and known pre-existing carotid artery atherosclerotic disease were the only variables found to have a statistically significant association with the level of stenosis found on CUS. Two patients with asymptomatic stenosis of >70% underwent a revascularization procedure.

CONCLUSION: At least 17.7% of CUS studies were completed for non-lateralizing symptoms. The study is of low-yield with the prevalence of moderate to severe stenosis being comparable to that in the general asymptomatic population. We conclude that there is minimal clinical value in the use of CUS to investigate non-lateralizing neurological complaints, resulting in unnecessary healthcare costs.

PMID:36325737 | DOI:10.1080/21548331.2022.2144066

J Hum Nutr Diet. 2022 Nov 3. doi: 10.1111/jhn.13110. Online ahead of print.

ABSTRACT

This article reports the development and validation of a measure of parents’ use of baby-led weaning (BLW). Baby-led weaning is a child-centered approach to complementary feeding where the infant is allowed to eat whole foods (rather than purees) and explore a variety of foods and textures.^2,3,5,6 To date, parents’ use of baby-led weaning has been assessed using either single items or a wide variety of measures. In this study, exploratory and confirmatory factor analyses on independent samples supported three BLW subscales: independence, exploration, and family. The final thirteen-item scale showed adequate fit statistics and good reliability (χ2(62) = 115.02, p < .001; CFI = 0.98; TLI = .98; RMSEA = 0.05; SRMR = 0.06; exploration a=.738; family a=.715; independence a=.809). In addition, the scale demonstrated good external validity and related in theoretically expected ways to an infant feeding style measure and parent report of complementary feeding approach. This study was limited as it was mostly white parents, and the scale should be validated on a more diverse sample. Future research can use this scale to examine if BLW relates to infant taste preferences, parenting styles, and child eating behaviors to improve child nutrition and health outcomes. This article is protected by copyright. All rights reserved.

PMID:36325736 | DOI:10.1111/jhn.13110

Eur J Ophthalmol. 2022 Nov 3:11206721221136989. doi: 10.1177/11206721221136989. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the average retinal layer thicknesses in eyes with unilateral acute central serous chorioretinopathy (CSC) (with subretinal fluid (SRF)) and after complete resolution of SRF in these eyes and to compare the results with those obtained in healthy eyes.

METHODS: Fifty-four eyes of 27 patients with unilateral acute CSC (CSC in active phase) who had complete resolution of SRF and 25 eyes of 25 healthy control subjects enrolled in this retrospective study. The average thicknesses of the retinal layers were measured by segmentation analysis of optical coherence tomography at baseline and 6 months after complete resolution of SRF.

RESULTS: The mean outer nuclear layer (ONL) thickness was significantly lower in eyes with CSC than in fellow eyes (p < 0.001). The mean ONL thickness was increased after resolution of SRF, but still low compared to unaffected fellow eye and the increment was not statistically significant (p > 0.05). There were significant strong inverse correlations between visual acuity and ONL thicknesses at baseline and 6 months after complete resolution of SRF (p < 0.001, r = – 0.810; p < 0.001, r = – 0.705, respectively).

CONCLUSION: ONL thickness was thinned in cases with acute CSC, and although there was some increment in ONL thickness 6 months after complete resolution of SRF, it was still thinner compared to unaffected fellow eyes.

PMID:36325684 | DOI:10.1177/11206721221136989

Am J Health Promot. 2022 Nov 2:8901171221137056. doi: 10.1177/08901171221137056. Online ahead of print.

ABSTRACT

PURPOSE: To estimate the percentage of United States adults who accurately assessed their diet quality (DQ).

DESIGN: Observational, cross-sectional, nationally representative.

SETTING: National Health and Nutrition Examination Survey, 2015-2018.

SAMPLE: 9757 (86%) of 11 288 adults aged ≥20 years.

MEASURES: Perceived DQ was assessed by asking participants, how healthy is your diet? The five responses included excellent, very good, good, fair, and poor. Measured DQ was assessed using 24-hours dietary recalls scored with 2015 Healthy Eating Index; scores were categorized using a 10-point grading scale.

ANALYSIS: Matches between perceived and measured DQ that were classified as accurate included: excellent = A, very good = A or B, good = B or C, fair = C or D, and poor = D or F. All others were classified as inaccurate. Analyses included descriptive statistics and multivariable logistic regression for complex survey designs.

RESULTS: 63% of adults perceived their DQ as very good or good while 70% scored DQ grades of F. Overall, 15% of adults accurately assessed their DQ with 96% accuracy in the poor perception group and <23% in the other 4 groups. Overall, 75% of adults overrated their DQ. Females, adults with lower educational attainment, and those with low food security were more likely to accurately assess their DQ.

CONCLUSION: Adults cannot accurately assess their DQ except for those perceiving their DQ as poor, and the majority overrate their DQ.

PMID:36325649 | DOI:10.1177/08901171221137056

Schweiz Arch Tierheilkd. 2022 Nov;164(11):777-788. doi: 10.17236/sat00374.

ABSTRACT

The hay producing plants, concentrate, straw and meadows could be contaminated by the aerosols of glyphosate based herbicide during spraying process of crops and pre-harvest desiccation treatment of cereals. The aim of this study is to investigate the concentration of glyphosate in the duodenal fluid of horses with gastric ulcer syndrome. The stomach and duodenum of referred untreated horse patients (n=92) with colic, weight loss, diarrhoea, anemia or performance intolerance were endoscopically examined right after the admission. Duodenal fluid (40 ml) was collected from the duodenal region where the papilla duodeni major is located. Hematology and clinical chemistry data were examined. The concentration of glyphosate in serum and duodenal fluid samples were analysed using a competitive ELISA and control analysis had also been done with HPLC. Statistical differences between groups were determined by the non-parametric Mann-Whitney-test using a significant level of p≤0,05. Glyphosate was detected in all duodenal fluid (median 12,2 ng/ml; 1st quartile 4,0 ng/ml; 3rd quartile 19,3 ng/ml; min 0,6 ng/ml; max. 192,9 ng/ml) and blood samples (1,79 ng/ml; 1,0 ng/ml; 2,8 ng/ml; 0,2 ng/ml; 3,7 ng/ml) of all horses. Glyphosate concentrations of duodenal fluid samples are significantly higher than in blood samples (Mann Whitney U-test, p≤0,05). The concentration of glyphosate in the duodenal fluid was significantly higher in horses with squamous gastric disease (grade 4/4; n=11/92) compared to horses with normal squamous mucosa (grade 0/4, n=10/92) (median: 19,8 ng/ml versus 8,4 ng/ml). Horses with glandular gastric disease and a grade 4/4 (n=9/92) had higher concentrations of glyphosate in the duodenal fluid than horses with normal glandular mucosa (grade 0/4; n=9/92) (median: 19,2 versus 11,1). The Gamma-Glutamyltransferase (GGT) enzyme activity is significantly higher in the group of horses with lower concentration of glyphosate in the duodenal fluid (≤12,2 ng/ml) compared with the group with higher concentration of glyphosate (>12,2 ng/ml) (median 279,5 versus 101,9 U/L). During autumn the horses had higher concentrations of glyphosate in duodenal fluid (n=18; median 14,3) compared with lower concentrations in spring time (n=34; median 8,1 ng/ml). Horses kept around big cities had significantly higher concentrations of glyphosate in the duodenal fluid in comparison to horses living in the countryside (medians 17,8 ng/ml versus 7,5 ng/ml).

PMID:36325641 | DOI:10.17236/sat00374

Biophys J. 2022 Nov 1:S0006-3495(22)00892-X. doi: 10.1016/j.bpj.2022.10.038. Online ahead of print.

ABSTRACT

Blood coagulation is a self-repair process regulated by activated platelet surfaces, clotting factors, and inhibitors. Antithrombin (AT) is one such inhibitor that impedes coagulation by targeting and inactivating several key coagulation enzymes. The effect of AT is greatly enhanced in the presence of heparin, a common anticoagulant drug. When heparin binds to AT and either bridges with the target enzyme or induces allosteric changes in AT leading to more favorable binding with the target enzyme. Antithrombin inhibition of fluid-phase enzymes caused little suppression of thrombin generation in our previous mathematical models of blood coagulation under flow. This is because in that model, flow itself was a greater inhibitor of the fluid-phase enzymes than AT. From clinical observations, it is clear that AT and heparin should have strong inhibitory effects on thrombin generation, and thus we hypothesized that AT could be inhibiting enzymes bound to activated platelet surfaces that are not subject to being washed away by flow. We extended our mathematical model to include the relevant reactions of AT inhibition at the activated platelet surfaces as well as those for unfractionated heparin and a low molecular weight heparin. Our results show that antithrombin alone is only an effective inhibitor at low tissue factor densities, but in the presence of heparin, it can greatly alter and in some cases shut down thrombin generation. Additionally, we studied each target enzyme separately and found that inactivation of no single enzyme could substantially suppress thrombin generation.

PMID:36325617 | DOI:10.1016/j.bpj.2022.10.038

Disabil Rehabil. 2022 Nov 2:1-15. doi: 10.1080/09638288.2022.2140844. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the effectiveness of mobile health applications (mHealth apps) containing a physical training component on physical function and physical activity in stroke rehabilitation.

MATERIALS AND METHODS: A systematic literature search was conducted in three databases for studies published from inception to 12 July 2022. Clinical trials including mHealth apps with a physical training component were included using outcomes of physical function and physical activity. Quality of life was extracted as a secondary outcome.

RESULTS: Five RCTs, two non-RCTs, and four uncontrolled clinical trials were included with a total of 264 stroke survivors. Eleven apps were identified with a physical training component using features of gamification (six apps), exercise prescription (three apps), and physical activity (two apps). Six out of seven studies reported statistically significant improvements in physical function in favor of the experimental group, with the most robust findings for upper extremity function. For physical activity, statistically significant improvements were seen in the experimental groups. Only one study showed significant improvement in quality of life. Overall study quality was fair.

CONCLUSIONS: mHealth apps containing a physical training component are promising for physical function and physical activity in stroke rehabilitation. Further research is warranted to confirm these conclusions.Implications for rehabilitationDesign content of mobile apps with a physical training component were focused on gamification, exercise prescription, and physical activityUsing mobile app-delivered therapy seem promising for improving upper extremity function in stroke rehabilitationUsing mobile apps also supported an increase of physical activity in people with strokeStudies using mobile apps should report more specifically the dosage of physical training and adherenceUsing mobile apps seems promising as an additional tool for clinical work, however, more studies are required to understand their effectiveness in stroke rehabilitation.

PMID:36325613 | DOI:10.1080/09638288.2022.2140844

J Korean Med Sci. 2022 Oct 31;37(42):e304. doi: 10.3346/jkms.2022.37.e304.

ABSTRACT

BACKGROUND: In Korea, the birth rate is declining at an alarming pace. This study aimed to investigate the changes and trends in the population count, number of births, and birth rate in Korea, in the past and future.

METHODS: Data regarding the total number of births, crude birth rate, and total fertility rate were collected from the “Statistics Korea Census” of the national statistical portal, census report, and Statistics Korea’s “2020 Population Trend Survey for 1981-2020, provisional results of birth and death statistics.” We used the Organisation for Economic Co-operation and Development 2019 Family Database for the TFR. To develop a better understanding of the data in this study, we classified it according to the modern history of Korea.

RESULTS: The changes and trends in the number of births and fertility rate in Korea, after liberation, were due to the birth control policy that restricted births. In Korea’s low fertility society, which began in the mid-2000s, the fertility rate dropped to below 0.84 in 2020, despite policies to improve the quality of the population. The death toll has reached 300,000, entering an era of population decline.

CONCLUSION: As we enter the era of population decline, we are in a direction that will cause various socioeconomic problems, from demographic problems to future population decline.

PMID:36325608 | DOI:10.3346/jkms.2022.37.e304