Tag: statistics

Asian Cardiovasc Thorac Ann. 2022 Nov 13:2184923221138505. doi: 10.1177/02184923221138505. Online ahead of print.

ABSTRACT

INTRODUCTION: An abdominal aortic aneurysm (AAA) is a life-threatening abnormal dilation of the abdominal aorta that can be repaired either endovascularly or with open surgery. However, endovascular aortic repair (EVAR) has become the main treatment modality for AAA due to its more optimal results. EVAR devices can either be standard, fenestrated, or branched, with fenestrated EVAR (FEVAR) seemingly achieving superior prospects. Although EVAR is associated with excellent outcomes, it still carries a risk of certain complications requiring reintervention or ‘rescue’. Several commercial EVAR devices are available on the global market, nevertheless, the Fenestrated Anaconda developed by Terumo Aortic can be considered the superior device due to the wide range of endovascular solutions that it offers along with its unique custom-made approach, excellent results and its highly promising potential to be used as a ‘rescue’ device for failed competitor endografts.

MATERIALS AND METHODS: The current study represents a 9-year cross-sectional international analysis of a custom-made Fenestrated Anaconda™ device. For the statistical analysis, SPSS 28 for Windows and R were utilised. Pearson Chi-square analysis was used to assess differences in cumulative distribution frequencies between select variables. Statistical significance for all two-tailed tests was set at p < 0.05.

RESULTS: Out of 5058 EVARs performed using the Fenestrated Anaconda, 2987 (59%) were ‘rescue’ procedures for migrated Gore (n = 252) and Medtronic (n = 2735) devices. The Fenestrated Anaconda™ was indicated as the reintervention device either due to unsuitable/complex anatomy for the competitor (n = 2411) or based on surgeon preference (n = 576). Overall, the Fenestrated Anaconda was utilised to rescue 3466 (68.5%) failed previous EVARs using competitor devices. Yet, the primary endovascular solution offered by the Fenestrated Anaconda was FEVAR (91.3%), with 112 (2.2%) devices using custom-made iliac stents.

DISCUSSION: The use of the Fenestrated Anaconda endograft as a ‘rescue’ device to salvage failed competitor devices is well-established in the literature with excellent clinical outcomes achieved. The evidence in the literature also highlights the distinctive custom-made approach that the Fenestrated Anaconda offers which enables it to treat extremely complex aortic anatomy.

PMID:36373569 | DOI:10.1177/02184923221138505

Circ Heart Fail. 2022 Nov 14:e009772. doi: 10.1161/CIRCHEARTFAILURE.122.009772. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with cancer (patients with a history of cancer) with advanced heart failure are increasing, but unlikely to be transplanted, and left ventricular assist device (LVAD) is an alternative strategy. This study investigates the characteristics and outcomes of patients with cancer undergoing durable LVAD.

METHODS: Adult patients with a history of cancer who received LVADs were identified from INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) registry: 2008 and 2017. Characteristics and outcomes between patients with cancer and those without cancer were compared, and subgroup analyses of cancer therapy-induced cardiomyopathy (CCM) and non-CCM were also conducted.

RESULTS: Overall, 1273 (6.5%) patients had a history of cancer, including 289 (22.7%) with CCM and 984 (77.3%) with non-CCM as the primary reason for heart failure. Patients with cancer had shorter median survival (3.72 versus 3.97 years, log-rank P=0.002), and multivariable Cox and competing risk regressions revealed that a history of cancer was associated with reduced survival (hazard ratio, 1.14 [95% CI, 1.04-1.26]; P=0.005; subdistribution hazard ratio, 1.24 [95% CI, 1.13-1.36]; P<0.001) and decreased incidence of heart transplantation. There was no significant difference in mortality between patients with CCM-induced heart failure and patients without cancer. Patients with cancer experienced an increased risk of bleeding, and age, INTERMACS profile, albumin, dialysis, and blood urea nitrogen were associated with mortality in these patients.

CONCLUSIONS: A history of cancer is associated with mildly reduced survival, lower incidence of heart transplantation, and increased risk of bleeding after LVAD, whereas the survival in patients with cancer with CCM-induced heart failure is similar to those without cancer. LVAD implantation in patients with cancer is very well possible.

PMID:36373549 | DOI:10.1161/CIRCHEARTFAILURE.122.009772

Foot Ankle Int. 2022 Nov 14:10711007221128562. doi: 10.1177/10711007221128562. Online ahead of print.

ABSTRACT

BACKGROUND: Isolated Weber B, AO (Association for the Study of Internal Fixation) type 44B ankle fractures with no fracture to the medial side are the most common type of ankle fracture and may be treated with internal fixation or without surgery.This study aimed to determine if surgery is superior to nonsurgical management for the treatment of these fractures after a minimum 5-year follow-up.

METHODS: Design: A pragmatic, multicenter, single-masked, randomized controlled trial with minimum 5-year follow-up. Setting/participants/interventions: Participants between 18 and 65 years with AO type 44B ankle fracture and minimal talar shift were recruited from 22 hospitals in Australia and New Zealand. Participants willing to be randomized were randomly allocated to undergo surgical fixation followed by mobilization in a walking boot for 6 weeks. Those treated nonsurgically were managed in a walking boot for 6 weeks. Outcome assessors were masked for the treatment allocation. Primary outcomes: Patient-reported ankle function using the American Academy of Orthopaedic Surgeons Foot and Ankle Outcomes Questionnaire (FAOQ) and the physical component summary (PCS) of the SF-12v2 General Health Survey at 12 months postinjury and at minimum 5 years post injury. Primary analysis was intention-to-treat.

RESULTS: Of the 160 (80 surgical, 80 nonoperative) randomized patients included in the CROSSBAT analysis, 77 (40 surgical, 37 nonoperative) were followed up for repeat analysis at minimum 5-year follow-up (mean 7.3 years, range 5.1-8.9). This cohort demonstrated that surgery was not associated with clinically or statistically significant differences compared to nonoperative management for the FAOQ (51.7 vs 49.6; mean difference 2.1, 95% CI -2.1 to 6.2, P = .95), or the PCS (51.5 vs 49.1; mean difference 2.3, 95% CI -2.0 to 6.7, P = .54). The surgical cohort had a higher rate of any adverse events (odds ratio 3.7, 95% CI 1.2-11.6, P = .04).

CONCLUSION: The results of this study suggest that surgical management is not superior to nonsurgical management in type B ankle (fibula) fractures with minimal talar shift over a 5-year period and is associated with increased adverse events.

LEVEL OF EVIDENCE: Level II, randomized clinical trial.

PMID:36373545 | DOI:10.1177/10711007221128562

J Microsc. 2022 Nov 14. doi: 10.1111/jmi.13152. Online ahead of print.

ABSTRACT

Optical coherence tomography (OCT) has shown to be a valuable imaging tool in the field of ophthalmology, and it is becoming increasingly relevant in the field of neurology. Several OCT image segmentation methods have been developed previously to segment retinal images, however sophisticated speckle noises with low-intensity restrictions, complex retinal tissues, and inaccurate retinal layer structure remain a challenge to perform effective retinal segmentation. Hence, in this research, complicated speckle noises are removed by using a novel Far-flung ratio algorithm in which pre-processing has been done to treat the speckle noise thereby highly decreasing the speckle noise through new similarity and statistical measures. Additionally, a novel haphazard walk and inter-frame flattening algorithms have been presented to tackle the weak object boundaries in OCT images. These algorithms are effective at detecting edges and estimating minimal weighted paths to better diverge, which reduces the time complexity. In addition, the segmentation of OCT images is made simpler by using a novel N-ret layer segmentation approach that executes simultaneous segmentation of various surfaces, ensures unambiguous segmentation across neighboring layers, and improves segmentation accuracy by using two grey scale values to construct data. Consequently, the novel work outperformed the OCT image segmentation with 98.5% of accuracy. This article is protected by copyright. All rights reserved.

PMID:36373509 | DOI:10.1111/jmi.13152

ANZ J Surg. 2022 Nov 14. doi: 10.1111/ans.18146. Online ahead of print.

ABSTRACT

BACKGROUND: Native skin flap necrosis is a potentially devastating complication following skin-sparing or nipple-sparing mastectomy with a reported incidence of as high as 30%. Treatment depends on the depth and extent of tissue necrosis and can range from dressings to surgical debridement and further reconstruction. This can have implications on patient physical and psychological wellbeing as well as cost of treatment. This study aims to identify and appraise cost-effective non-surgical adjuncts for the prevention of native skin flap necrosis.

METHODS: A systematic review was performed using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and structured around existing recommended guidelines. A search of MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature and ClinicalTrials.gov was performed with the medical subject headings ‘mastectomy’ and ‘flap necrosis’. After exclusion, 12 articles were selected for review and analysed.

RESULTS: A total of 8439 mastectomies were performed on 7895 patients. Preventative non-surgical adjuncts that demonstrated statistically significant reduction in mastectomy flap necrosis included topical nitroglycerin ointment (P = 0.000), closed-Incision negative pressure wound therapy (P = 0.000), topical dimethylsulfoxide ointment (P = 0.03), oral cilostazol (P = 0.032), and local heat pre-conditioning (P = 0.047).

CONCLUSIONS: This study identifies multiple adjuncts that may aid in preventing mastectomy skin flap necrosis, especially in high-risk patients. Further studies could aim to define standardized protocols and compare the various adjuncts in different circumstances.

PMID:36373495 | DOI:10.1111/ans.18146

Nurs Open. 2022 Nov 14. doi: 10.1002/nop2.1472. Online ahead of print.

ABSTRACT

AIM: The aim of this study was to determine the digital detox programme’s impact on the electronic screen syndrome among preparatory school students.

DESIGN: A quasi-experimental pre- and posttest group was used.

METHODS: Two preparatory governmental schools.

SAMPLE: purposive sample consists of 105 students.

TOOLS: Two tools used for data collection: Student’s datasheet and Electronic Screen Addiction Scale. The data collection period took six months, from September 2021 to February 2022.

RESULTS: The high rate of screen addiction among students dropped to 14.3% in the posttest compared with 20.0% in the pre-test. Moreover, the students’ proportion with moderate screen addiction dropped from 65.7% on the pre-test to 43.8% on the posttest. Furthermore, screen addiction students with lower levels were about 41.9% in the posttest and 14.3% in the pre-test.

CONCLUSIONS: There was a highly statistically significant difference between school students’ total electronic screen scores in the pre- and posttest. A preventive care programme is recommended for high school children and helps raise screen addiction’s awareness and its negative consequences.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

PMID:36373487 | DOI:10.1002/nop2.1472

Emerg Microbes Infect. 2022 Nov 14:1-73. doi: 10.1080/22221751.2022.2146535. Online ahead of print.

ABSTRACT

How much the vaccine contributes to the induction and development of neutralizing antibodies (NAbs) of breakthrough cases relative to those unvaccinated-infected cases is not fully understood. We conducted a prospective cohort study and collected serum samples from 576 individuals who were diagnosed with SARS-CoV-2 Delta strain infection, including 245 breakthrough cases and 331 unvaccinated-infected cases. NAbs were analyzed by live virus microneutralization test and transformation of NAb titer. NAbs titers against SARS-CoV-2 ancestral and Delta variant in breakthrough cases were 7.8-fold and 4.0-fold higher than in unvaccinated-infected cases, respectively. NAbs titers in breakthrough cases peaked at the second week after onset/infection. However, the NAbs titers in the unvaccinated-infected cases reached their highest levels during the third week. Compared to those with higher levels of NAbs, those with lower levels of NAbs had no difference in viral clearance duration time (P>0.05), did exhibit higher viral load at the beginning of infection/maximum viral load of infection. NAb levels were statistically higher in the moderate cases than in the mild cases (P<0.0001). Notably, in breakthrough cases, NAb levels were highest longer than 4 months after vaccination (Delta strain: 53118.2 U/mL), and lowest in breakthrough cases shorter than 1 month (Delta strain: 7551.2 U/mL). Cross-neutralization against the ancestral strain and the current circulating isolate (Omicron BA.5) was significantly lower than against the Delta variant in both breakthrough cases and unvaccinated-infected cases. Our study demonstrated that vaccination could induce immune responses more rapidly and greater which could be effective in controlling SARS-CoV-2.

PMID:36373485 | DOI:10.1080/22221751.2022.2146535

J Urol. 2022 Nov 14:101097JU0000000000003049. doi: 10.1097/JU.0000000000003049. Online ahead of print.

ABSTRACT

PURPOSE: Adrenal 11-oxygenated androgens may support cancer progression in men with prostate cancer (PCa) owing to their abundance and androgenic potential. We hypothesized that preoperative circulating levels of 11-oxygenated androgens influence clinical outcomes in men with newly diagnosed localized PCa.

MATERIAL AND METHODS: We studied 1793 treatment-naïve patients and 155 patients who received preoperative treatment with 5α-reductase inhibitors (5-ARIs) in the prospective PROCURE cohort for which preoperative plasma samples were obtained prior to radical prostatectomy (RP). Adrenal 11-oxygenated precursors, potent 11-oxygenated androgens and their metabolites (n=7) were quantified using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Circulating levels were evaluated in relation to prognostic factors, disease-free survival (DFS), and metastasis-free survival (MFS), using multivariable Cox proportional hazards models.

RESULTS: At a median follow-up time of 93.8 months after surgery, 583 patients experienced biochemical recurrence, 104 developed metastatic disease and 168 diseased. Higher levels of 11-hydroxytestosterone (11OHT) and 11-ketotestosterone (11KT) were observed in men with prostatic specific antigen (PSA) >20 ng/ml and positive nodal status (P<.05). In multivariable analyses, no significant association between 11-oxygenated androgens and DFS was observed. Adrenal 11β-hydroxyandrostenedione (11OHA4), the predominant androgenic 11KT, and its metabolite 11-ketoandrosterone (11KAST), modeled as quartiles, were associated with MFS (P=.06, .03, and 0.008, respectively). A significant accumulation of 11-oxygenated androgen precursors and bioactive androgens, but reduced metabolite levels, was observed in 5-ARIs patients (P<.001).

CONCLUSIONS: Preoperative circulating 11-oxygenated androgen levels are associated with MFS in men with localized PCa undergoing RP and are affected by 5-ARI treatment.

PMID:36373402 | DOI:10.1097/JU.0000000000003049

J Appl Biomater Funct Mater. 2022 Jan-Dec;20:22808000221125870. doi: 10.1177/22808000221125870.

ABSTRACT

The nanoparticles are frequently used in biomedical science for the treatment of diseases like cancer and these nanoparticles are injected in blood which is transported in the cardiovascular system on the principle of peristalsis. This study elaborates the effects of Lorentz force and joule heating on the peristaltic flow of copper and iron oxide suspended blood based nanofluid in a complex wavy non-uniform curved channel. The Brinkman model is utilized for the temperature dependent viscosity and thermal conductivity. The problem is formulated using the fundamental laws in terms of coupled partial differential equations which are simplified using the creeping flow phenomenon. The graphical results for velocity, temperature, streamlines, and axial pressure are simulated numerically. The concluded observations deduce that the solid volume fraction of nanoparticles reduces the velocity and enhance the pressure gradient and accumulation of trapping bolus in the upper half of the curved channel is noticed for temperature dependent viscosity.

PMID:36373397 | DOI:10.1177/22808000221125870

Scand J Gastroenterol. 2022 Nov 14:1-8. doi: 10.1080/00365521.2022.2143724. Online ahead of print.

ABSTRACT

BACKGROUND: The role of laparoscopy in the treatment of intrahepatic cholangiocarcinoma (ICC) remains unclear. This multicenter study examined the outcomes of laparoscopic liver resection for ICC.

METHODS: Patients with ICC who had undergone laparoscopic or open liver resection between 2012 and 2019 at four European expert centers were included in the study. Laparoscopic and open approaches were compared in terms of surgical and oncological outcomes. Propensity score matching was used for minimizing treatment selection bias and adjusting for confounders (age, ASA grade, tumor size, location, number of tumors and underlying liver disease).

RESULTS: Of 136 patients, 50 (36.7%) underwent laparoscopic resection, whereas 86 (63.3%) had open surgery. Median tumor size was larger (73.6 vs 55.1 mm, p = 0.01) and the incidence of bi-lobar tumors was higher (36.6 vs 6%, p < 0.01) in patients undergoing open surgery. After propensity score matching baseline characteristics were comparable although open surgery was associated with a larger fraction of major liver resections (74 vs 38%, p < 0.01), lymphadenectomy (60 vs 20%, p < 0.01) and longer operative time (294 vs 209 min, p < 0.01). Tumor characteristics were similar. Laparoscopic resection resulted in less complications (30 vs 52%, p = 0.025), fewer reoperations (4 vs 16%, p = 0.046) and shorter hospital stay (5 vs 8 days, p < 0.01). No differences were found in terms of recurrence, recurrence-free and overall survival.

CONCLUSION: Laparoscopic resection seems to be associated with improved short-term and with similar long-term outcomes compared with open surgery in patients with ICC. However, possible selection criteria for laparoscopic surgery are yet to be defined.

PMID:36373379 | DOI:10.1080/00365521.2022.2143724