Tag: statistics

Breast. 2022 Mar 12;63:29-36. doi: 10.1016/j.breast.2022.03.006. Online ahead of print.

ABSTRACT

PURPOSE: Young age is associated with poor prognosis in ductal carcinoma in situ (DCIS) of female breast and controversy exists regarding the optimal treatment modality for young patients. We aimed to compare treatment outcomes among breast conserving surgery (BCS), BCS with adjuvant radiotherapy (BCS + RT), and total mastectomy (MT) for young DCIS women.

METHODS: PubMed, Cochrane, and Embase were searched for studies reporting comparative results among BCS, BCS + RT, or MT in ≤50 years old (y/o) DCIS females. Study quality was assessed and meta-analysis with subgroup analysis was performed to pool the effect sizes of the outcomes-of-interest.

RESULTS: We included 3 randomized control trials and 18 observational studies. For DCIS women ≤50 y/o, RT following BCS significantly reduced the risk for ipsilateral breast tumor recurrence (IBTR) (HR = 0.66, 95% CI 0.50-0.87). However, the benefit was less robust in extremely young patients and with long follow-ups. RT revealed no statistically significant preventive effect on ipsilateral invasive recurrence (HR = 1.38, 95% CI 0.98-1.94). On the other hand, MT yielded the lowest IBTR (BCS + RT vs MT: HR = 4.4, 95% CI 2.06-9.40), both in ipsilateral DCIS recurrence and ipsilateral invasive recurrence. There was great heterogeneity and could not reach an evident conclusion concerning survival outcomes.

CONCLUSION: This study highlighted the varying effect of RT for young DCIS females. The local control benefit of MT was definite without survival differences observed. Our study provided a moderate certainty of evidence to guide the treatment for young DCIS women. Further age-specific prospective trial is warranted.

PMID:35299032 | DOI:10.1016/j.breast.2022.03.006

J Biomech. 2022 Mar 10;135:111035. doi: 10.1016/j.jbiomech.2022.111035. Online ahead of print.

ABSTRACT

Exercise encourages active and healthy aging, maintaining functional and physical capabilities. This study aimed to assess the effects of a long-term moderate aerobic exercise protocol on bone microarchitecture and fragility associated with chronic inflammation and oxidative stress in aging. Male BALB/c mice (n = 10 per group) underwent a moderate exercise protocol from 13 weeks to 27 (adulthood age) or 108 weeks of age (elderly age) and were then sacrificed. Age-match sedentary mice were included as a control group. Serum cortisol concentrations were determined by chemiluminescent immunoassay, C-reactive protein (CRP) by a turbidimetric assay, advanced glycation end-products (AGEs) and malondialdehyde (MDA) by fluorescent spectroscopy, and total glutathione (GSH) by colorimetric method. The right femur was dissected formorphometric and densitometricanalysis bycomputerized microtomography (µCT),and biomechanical properties were assessed usinga three-point bending device. Musclefrom the same extremitywas obtained to determine relative mRNA expression ofpro-inflammatory cytokines (TNF-α and IL-6) by RT-qPCR.Statistical differences were evaluated by two-way ANOVA and Holm-Sidak method post hoc with P < 0.05. In elderly mice, moderate exercise increased glutathione levels and microarchitecture complexity but decreased bone fragility and oxidative stress markers, cortisol, and pro-inflammatory cytokines. In conclusion, these results suggest a strong link between a pro-inflammatory state and age-conditioned oxidative stress on bone quality. Thus, on a human scale, moderate aerobic exercise may improve bone quality during aging.

PMID:35298960 | DOI:10.1016/j.jbiomech.2022.111035

Water Res. 2022 Mar 8;215:118272. doi: 10.1016/j.watres.2022.118272. Online ahead of print.

ABSTRACT

Water governing systems are twisted with complex interplays among levels and scales which embody their structures. Typically, the mismatch between human-generated and natural systems produces externalities and inefficiencies reflectable in spatial scales. The largely known problem of fit in water governance is investigated to detect the issues of fit between administrative/institutional scales and the hydrological one in a lake basin. To implement the idea, constraining the level of analysis interlinked to the concentrated levels of administration in spatial scales, the fit of the governing system was analyzed by means of statistical mechanics. Modeling the structure of water demand/supply governing system in a given region through the Curie-Weiss Mean Field approximation, the system cost in relation to its structure and fit was appraised and compared with two other conceptual structures in the Urmia Lake Basin in Iran. The methodology articulated an analysis framework for exploring the effectiveness of the formulated water demand/supply governing system and its fit to the relevant hydrological system. The findings of this study may help developing strategies to encourage adaptations, rescaling/reforms for effective watershed management.

PMID:35298993 | DOI:10.1016/j.watres.2022.118272

Res Dev Disabil. 2022 Mar 14;124:104215. doi: 10.1016/j.ridd.2022.104215. Online ahead of print.

ABSTRACT

BACKGROUND: Children with Developmental Language Disorder (DLD) have been found to demonstrate low performance in Executive Functions (EFs). However, the evidence-based data is so far scarce, especially for 4-5-year-old children. Most of the existing research involves English-speaking populations, while very few studies have been carried out with non-English-speaking populations. Nevertheless, it is documented that possible differences in the language-cognition relations may exist due to the specific characteristics of each language, and studies across different languages could contribute to the above.

AIMS: The present study aimed to systematically investigate the profile of oral language and EF skills (verbal and nonverbal) and the way these skills are related with each other in 4-5-year-old Greek-speaking children with and without DLD.

METHODS AND PROCEDURES: Fifty-three 4-5-year-old children (age range: 51- 57 months) with DLD, and 62 Typically Developing (TD) peers (age range: 51- 57 months) were assessed on a standardized psychometric battery for oral language skills (phonological and morphological awareness, oral language comprehension, vocabulary knowledge, narrative speech and pragmatics) and on a series of verbal (v) and nonverbal (nv) tasks tapping EFs skills (updating-accuracy, inhibition -accuracy and reaction time-, and cognitive flexibility).

OUTCOMES AND RESULTS: Children with DLD demonstrated statistically significant lower performance across all oral language measures in comparison to their TD peers. Additionally, they performed significantly lower in the updating (nv) task, as well as in cognitive flexibility (v & nv) in comparison to the TD group. Further regression analyses demonstrated that updating (nv), inhibition (nv) and cognitive flexibility (v) predicted oral language comprehension in children with DLD while updating (v & nv), inhibition-reaction time (nv) and cognitive flexibility (v & nv) predicted phonological and morphological awareness, oral language comprehension, narrative speech as well as total language score in TD children.

CONCLUSIONS AND IMPLICATIONS: These results provide important information about the profile of oral language and EF skills in children with DLD compared to their TD peers as well as on the relationship of these skills in both groups. The findings also suggest that improving EFs skills may be a possible way for improving oral language skills in young children with DLD. Our findings are discussed in terms of their theoretical as well as practical implications regarding the diagnostic and intervention procedures for children with DLD.

PMID:35298958 | DOI:10.1016/j.ridd.2022.104215

Minerva Dent Oral Sci. 2022 Feb;71(1):25-30. doi: 10.23736/S2724-6329.21.04544-7.

ABSTRACT

BACKGROUND: Over the years, numerous studies and advanced technologies about dental implants have been evolved from the traditional two-stage procedure to immediate loading. Implants located in the posterior maxillary region allow to achieve an appropriate prosthetic support. The aim of this work was to solve the atrophied posterior maxilla, through monophasic implants with flapless technique and intraoral electro-welding.

METHODS: In this study were enrolled 120 patients between 20 and 68 years old (mean age of 34.2 years), where females predominate with 53.1% compared to 46.9% males. The patients were presented at the Oral Surgery Clinic of the Aldent University (Tirana, Albania), for a period 2009-2019. Briefly, 310 monophasic implants were placed, TRAMONTE type (Milan, Italy), to the posterior maxilla thus avoiding the sinus, with dense and wide threads, of different lengths and widths. The surgical technique was minimally invasive, flapless one. Data were expressed as mean + standard error (SEM) of all the radiographic outcomes obtained; and as statistical analysis was used the Student’s t-test. P<0.5 and P<0.05, were considered significant.

RESULTS: A part of the patients were hypertensive and type 2 diabetic, then a negligible part were smokers, also a lack of oral hygiene was observed in 40% of cases. After 5 years of observation, it appeared that 95.9% of the implants were successful. Furthermore, the mesial and distal bone loss during the first three years was 0.1 mm, while after 5 years no continuation of bone loss was observed.

CONCLUSIONS: The application of monophasic implants must be performed according to approved protocols, considering the conditions of the posterior maxillary region, obtaining in this way a safe dental implantation.

PMID:35289541 | DOI:10.23736/S2724-6329.21.04544-7

Intern Med J. 2022 Mar 15. doi: 10.1111/imj.15750. Online ahead of print.

ABSTRACT

BACKGROUND: Telehealth was widely adopted in health services during the Covid-19 pandemic. It is unknown what the attitudes and ongoing needs of healthcare staff are after a rapid implementation of telehealth.

AIMS: To evaluate staff attitudes to telehealth utilisation after a rapid implementation.

METHODS: A health service-wide bespoke survey was sent to all clinicians, managers, and administration staff in June-July 2021. We evaluated attitudes to (i) telehealth application in the model of care and (ii) the barriers and enablers to use of telehealth. Descriptive statistics were used for quantitative data, and content analysis for the textual data.

RESULTS: A hundred and thirty-four respondents completed the survey (response rate = 22.5% of healthdirect users (71/315), and = 3.2% of total healthcare staff population). Most commonly, telehealth was identified as being important (78%) and safe (79%) by clinicians; important (100%) and encouraged (88%) by managers. In contrast, telehealth was identified as not the same as face-to-face (56%, 50%); but easy to add to usual work arrangements (43%, 44%) by clinicians and managers, respectively. The most common enablers of telehealth were: (i) having others use the same telehealth platform (74.3%, 100%), and (ii) completing training (68.9%, 72.7%) by clinicians and managers, respectively. The most common barriers were having (i) reliable internet connectivity (39.2%, 45.5%) by clinicians and managers respectively, (ii) the right equipment (clinician 37.8%), and (iii) a private area (managers 36.3%).

CONCLUSIONS: Despite training and having support from colleagues to implement telehealth, ongoing needs were identified that may promote uptake in specific health settings. This article is protected by copyright. All rights reserved.

PMID:35289486 | DOI:10.1111/imj.15750

J Magn Reson Imaging. 2022 Mar 15. doi: 10.1002/jmri.28151. Online ahead of print.

ABSTRACT

BACKGROUND: Magnetic resonance elastography (MRE) is an imaging technique that can noninvasively assess the shear properties of the intervertebral disc (IVD). Unlike the standard gradient recalled echo (GRE) MRE technique, a spin-echo echo-planar imaging (SE-EPI) sequence has the potential to improve imaging efficiency and patient compliance.

PURPOSE: To validate the use of an SE-EPI sequence for MRE of the IVD compared against the standard GRE sequence.

STUDY TYPE: Cross-over.

SUBJECTS: Twenty-eight healthy volunteers (15 males and 13 females, age range: 19-55).

FIELD STRENGTH/SEQUENCE: 3 T; GRE, SE-EPI with breath holds (SE-EPI-BH) and SE-EPI with free breathing (SE-EPI-FB) MRE sequences.

ASSESSMENT: MRE-derived shear stiffnesses were calculated via principal frequency analysis. SE-EPI derived shear stiffness and octahedral shear strain signal-to-noise ratios (OSS-SNR) were compared against those derived using the GRE sequence. The reproducibility and repeatability of SE-EPI stiffness measurements were determined. Shear stiffness was evaluated in the nucleus pulposus (NP) and annulus fibrosus (AF) regions of the disc. Scan times between sequences were compared.

STATISTICAL TESTS: Linear mixed models, Bland-Altman plots, and Lin’s concordance correlation coefficients (CCCs) were used with P < 0.05 considered statistically significant.

RESULTS: Good correlation was observed between shear stiffnesses derived from the SE-EPI sequences with those derived from the GRE sequence with CCC values greater than 0.73 and 0.78 for the NP and AF regions, respectively. OSS-SNR was not significantly different between GRE and SE-EPI sequences (P > 0.05). SE-EPI sequences generated highly reproducible and repeatable stiffness measurements with CCC values greater than 0.97 in the NP and AF regions and reduced scan time by at least 51% compared to GRE. SE-EPI-BH and SE-EPI-FB stiffness measurements were similar with CCC values greater than 0.98 for both regions.

DATA CONCLUSION: SE-EPI-based MRE-derived stiffnesses were highly reproducible and repeatable and correlated with current standard GRE MRE-derived stiffness estimates while reducing scan times.

LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 1.

PMID:35289470 | DOI:10.1002/jmri.28151

Catheter Cardiovasc Interv. 2022 Mar 15. doi: 10.1002/ccd.30154. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study is to investigate the viability of transcatheter aortic valve replacement (TAVR) for severe symptomatic aortic stenosis (AS) in patients with prior chest radiation therapy (cXRT).

BACKGROUND: Since patients with prior cXRT perform poorly with surgical aortic valve replacement, TAVR can be a viable alternative. However, clinical outcomes after TAVR in this patient population have not been well studied.

METHODS: From the pooled registry of the placement of aortic transcatheter valves II trial, we identified patients with and without prior cXRT who underwent TAVR (n = 64 and 3923, respectively). The primary outcome was a composite of all-cause death and any stroke at 2 years. Time to event analyses were shown as Kaplan-Meier event rates and compared by log-rank testing. Hazard ratios (HRs) were estimated and compared by Cox proportional hazards regression model.

RESULTS: There was no significant difference in the primary outcome between the patients with and without prior cXRT (30.7% vs. 27.0%; p = 0.75; HR, 1.08; 95% confidence interval, 0.66-1.77). Rates of myocardial infarction, vascular complications, acute kidney injury, or new pacemaker implant after TAVR were not statistically different between the two groups. The rate of immediate reintervention with a second valve for aortic regurgitation after TAVR was higher among the patients with prior cXRT. However, no further difference was observed during 2 years follow-up after discharge from the index-procedure hospitalization.

CONCLUSIONS: TAVR is a viable alternative for severe symptomatic AS in patients who had cXRT in the past.

PMID:35289473 | DOI:10.1002/ccd.30154

J Magn Reson Imaging. 2022 Mar 15. doi: 10.1002/jmri.28156. Online ahead of print.

ABSTRACT

BACKGROUND: Moyamoya is a progressive intracranial vasculopathy, primarily affecting distal segments of the internal carotid and middle cerebral arteries. Treatment may comprise angiogenesis-inducing surgical revascularization; however, lack of randomized trials often results in subjective treatment decisions.

HYPOTHESIS: Compensatory presurgical posterior vertebrobasilar artery (VBA) flow-territory reactivity, including greater cerebrovascular reactivity (CVR) and reduced vascular delay time, portends greater neoangiogenic response verified on digital subtraction angiography (DSA) at 1-year follow-up.

STUDY TYPE: Prospective intervention cohort.

SUBJECTS: Thirty-one patients with moyamoya (26 females; age = 45 ± 13 years; 41 revascularized hemispheres).

METHODS: Anatomical MRI, hypercapnic CVR MRI, and DSA acquired presurgically in adult moyamoya participants scheduled for clinically indicated surgical revascularization. One-year postsurgery, DSA was repeated to evaluate collateralization.

FIELD STRENGTH: 3 T.

SEQUENCE: Hypercapnic T2* -weighted gradient-echo blood-oxygenation-level-dependent, T₂ -weighted turbo-spin-echo fluid-attenuated-inversion-recovery, T₁ -weighted magnetization-prepared-rapid-gradient-echo, and T₂ -weighted diffusion-weighted-imaging.

ASSESSMENT: Presurgical maximum CVR and response times were evaluated in VBA flow-territories. Revascularization success was determined using an ordinal scoring system of neoangiogenic collateralization from postsurgical DSA by two cerebrovascular neurosurgeons (R.V.C. with 8 years of experience; M.R.F. with 9 years of experience) and one neuroradiologist (L.T.D. with 8 years of experience). Stroke risk factors (age, sex, race, vasculopathy, and diabetes) were recorded.

STATISTICAL TESTS: Fisher’s exact and Wilcoxon rank-sum tests were applied to compare presurgical variables between cohorts with angiographically confirmed good (>1/3 middle cerebral artery [MCA] territory revascularized) vs. poor (<1/3 MCA territory revascularized) outcomes.

SIGNIFICANCE: two-sided P < 0.05. Normalized odds ratios (ORs) were calculated.

RESULTS: Criteria for good collateralization were met in 25 of the 41 revascularized hemispheres. Presurgical normalized VBA flow-territory CVR was significantly higher in those with good (1.12 ± 0.13 unitless) vs. poor (1.04 ± 0.05 unitless) outcomes. Younger (OR = -0.60 ± 0.67) and White (OR = -1.81 ± 1.40) participants had highest revascularization success (good outcomes: age = 42 ± 14 years, race = 84% White; poor outcomes: age = 49 ± 11 years, race = 44% White).

DATA CONCLUSION: Presurgical MRI-measures of VBA flow-territory CVR are highest in moyamoya participants with better angiographic responses to surgical revascularization.

LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 4.

PMID:35289460 | DOI:10.1002/jmri.28156