Tag: statistics

Pain Physician. 2022 Oct;25(7):E1039-E1045.

ABSTRACT

BACKGROUND: Recurrent LDH (rLDH) is one of the most common causes of unsatisfactory outcomes after discectomy, which usually needs secondary surgery and leads to physical and psychological suffering for patients and substantial costs for society.

OBJECTIVES: This study was conducted to analyze the risk factors of early rLDH (<= 6 months) and to reduce the incidence of early rLDH.

STUDY DESIGN: A clinical retrospective study.

METHODS: A total of 1,228 patients received percutaneous endoscopic lumbar discectomy surgery from January 2013 through December 2016; there was a minimum 5-year follow-up. Seventy-seven of them (6.27%) developed recurrences and were included in this study. According to the differences in recurrent time, patients were divided into 2 groups (<= 6 months and > 6 months). Clinical and radiological parameters were retrospectively collected through chart review and preoperative imaging. All related risk factors were collected and analyzed relative to the time of recurrent herniation.

RESULTS: Patients with rLDH at <= 6 months and > 6 months were 49 and 28, respectively. Recurrence most often occurred within 6 months postoperatively, which was 63.6% of the total patients with rLDH. Of those risk factors, Modic changes, disc height index (DHI), and facet orientation (FO) showed significant statistical differences P = 0.003, P = 0.036, and P = 0.007, respectively). A logistic regression analysis was performed and showed there was an independent significant relationship between Modic changes (P = 0.042) and FO (P = 0.005) and early rLDH.

LIMITATIONS: First, this was a retrospective nonrandomized study, and the number of patients with rLDH included in this study was relatively small. Second, limited risk factors were assessed in this study, and some relevant risk factors that were identified as significant independent predictors in other studies were not included in this study, such as canal diameter, annular defect size, migrated disc, and foraminoplasty. Third, this study compared the clinical and radiological parameters of patients with rLDH at different times, and one case-control study is needed for further study, especially in terms of standardized sampling and data classification.

CONCLUSION: This study demonstrated that the recurrence rate of LDH at 5-year follow-up was 6.27% and there was a significant statistical relationship between FO, DHI, and Modic changes and early rLDH. Surgeons should take FO angles, DHI, and Modic change into consideration before surgery to achieve a satisfactory postoperative outcome and a relatively lower early recurrence rate. More patients and further investigation should be taken to assess the risk factors for early rLDH.

PMID:36288589

Pain Physician. 2022 Oct;25(7):E1009-E1019.

ABSTRACT

BACKGROUND: Postoperative pain after colorectal cancer surgery has a significant impact on postoperative physical and mental health. Vitamin D deficiency has been correlated with both acute pain states, including postoperative and post-traumatic pain, and several chronic pain diseases. The effects of hypovitaminosis D on preoperative pain threshold and perioperative opioid use in colorectal cancer surgery still need to be studied.

OBJECTIVES: To find the relationship between hypovitaminosis D on pain threshold, perioperative opioid use, and postoperative complications in colorectal cancer surgery.

STUDY DESIGN: A total of 112 patients, who were enrolled in this prospective, observational trial, were divided into 2 groups based on their preoperative serum 25-hydroxyvitamin D (25 [OH] D3) levels: (1) group D: vitamin D-deficient group (< 20 ng/mL); and (2) group S: vitamin D-sufficient group (>= 20 ng/mL).

METHODS: Primary outcomes were pain threshold indexes, perioperative dosages of opioid use, and postoperative pain. Secondary outcomes were other postoperative complications.

RESULTS: Preoperative serum level of vitamin D was 14.94 ± 3.10 ng/mL in group D and 24.20 ± 4.80 ng/mL in group S. Significant differences were showed in the 3 indexes of pain threshold and analgesic consumption between the 2 groups (P < 0.05). A low 25 (OH) D3 level was associated with a higher opioid dose of sufentanil. There was an association between 25 (OH) D3 and pain enduring threshold (PET), beta coefficient beta = 0.532, 95% confidential interval (0.440, 0.623), P < 0.001. The history of diabetes mellitus (DM) and vitamin C and vitamin D levels may be risk factors of surgical site infections (SSI), and the binary logistics regression model is statistically significant, chi-squared = 35.028, P < 0.001.

LIMITATIONS: There is room for further expansion in the sample size. Our study lacked objective indicators to measure pain threshold. Intestinal recovery time and total hospital stay were not included in the final analysis. In the follow-up study, the vitamin D supplementation group should be set and the specific site of colorectal cancer surgery also needs to be divided more carefully.

CONCLUSIONS: On the basis of the study results, hypovitaminosis D is associated with increased perioperative opioid consumption in colorectal cancer surgery. Sensory perception and pain threshold of patients with insufficient 25 (OH) D3 concentration were more sensitive, and PET was lower. History of DM, vitamin D, and vitamin C may be factors related with SSI. Future studies are needed to investigate their relationship further and discover if postoperative pain and pain threshold can benefit from vitamin D supplementation in these patients.

PMID:36288586

Pain Physician. 2022 Oct;25(7):E999-E1008.

ABSTRACT

BACKGROUND: Laparoscopic cholecystectomy is the most common surgical procedure performed in the Western world. While it is performed with minimally invasive procedures, patients often complain of moderate to severe postoperative pain, and the role of the anesthesiologist for its effective management remains crucial. Modern anesthesiology practices have embraced trunk blocks which can contribute to perioperative, multimodal analgesia. There is emerging literature about the favorable effect of erector spinae plane block in the reduction of pain after laparoscopic cholecystectomy.

OBJECTIVE: The aim of this study was to explore the efficacy of preoperative bilateral erector spinae plane block when dexmedetomidine is added in the local anesthetic mixture in patients undergoing elective laparoscopic cholecystectomy.

STUDY DESIGN: This study is a double-blind, randomized, controlled, prospective study.

SETTING: Georgios Papanikolaou General Hospital of Thessaloniki, Greece.

METHODS: After Local Ethics Committee approval (No: 1146/7.10.2019, October 2019) and in accordance with the principles outlined in the Declaration of Helsinki, the study was submitted to clinicaltrials.gov with reference number: NCT04587973. Sixty patients were randomized into 3 equal groups. Erector spinae plane block was performed in Group C with normal saline (N/S) 0.9%, in Group DR with ropivacaine 0.375% and dexmedetomidine 1 mcg/kg, and in Group R with ropivacaine 0.375%. The perioperative opioid consumption, pain intensity, time of first mobilization, hospitalization days, and satisfaction score of patients were recorded. Statistical analysis was performed with ANOVA, Kruskal-Wallis and Spearman test, as appropriate.

RESULTS: The perioperative opioid consumption was significantly lower in Groups R and DR as compared to Group C (P < 0.001). The median numerical rating scale (NRS) scores of patients at all time points were statistically different between Groups C and DR, as well as between groups C and R. Satisfaction score was significantly higher in Group DR as compared to Group C (P < 0.001), and mobilization time was significantly shorter in group DR in comparison to Group C as well as in Group R as compared to Group C (P = 0.015 and P = 0.035, respectively). Intraoperative remifentanil consumption was lower in Group DR in comparison to Group R (P < 0.001). There was no difference in postoperative nausea and vomiting and duration of hospital stay of patients.

LIMITATIONS: The limitation of the study is the small sample size of the patients recruited, which may be the reason why no statistically significant differences were found in postoperative morphine consumption and postoperative NRS scores between Groups R and DR and in postoperative nausea and vomiting among the 3 groups.

CONCLUSION: Erector spinae plane block performed either with ropivacaine or with a combination of ropivacaine and dexmedetomidine is a novel and safe method, which was found to be more effective compared to standard analgesia protocols in patients undergoing laparoscopic cholecystectomy and thus, it can improve the quality of perioperative analgesia.

PMID:36288585

Pain Physician. 2022 Oct;25(7):E987-E998.

ABSTRACT

BACKGROUND: Ultrasound-guided Quadratus Lumborum block (QLB) is a regional analgesia approach that has been reported to provide effective post-operative pain relief for both abdominal and retroperitoneal surgery. Bupivacaine is the most often used and well documented local anesthetic medication in children. Dexamethasone is a systemic glucocorticoid that is often used to minimize postoperative nausea, vomiting, and pain to improve recovery quality after surgery.

OBJECTIVES: To evaluate postoperative analgesia of QLB in pediatric patients undergoing renal surgeries by the addition of dexamethasone to bupivacaine compared to intravenous administration.

STUDY DESIGN: A prospective, randomized, controlled clinical trial.

SETTING: Pediatric surgery unit in a university hospital.

METHODS: One hundred and five patients (6-12 years old) scheduled for renal surgeries were randomly allocated into 3 groups, with 35 patients in each group. Randomization was based on computer-generated codes. The groups were DEX1 (QLB with IV dexamethasone group), DEX2 (QLB dexamethasone group), and QLB CONTROL (QLB alone). The 1st time for rescue analgesia request, total morphine consumption, Pediatric Objective Pain Scale (POPS), and parents’ satisfaction score were measured in 24 hours follow-up to evaluate postoperative pain control.

RESULTS: The time to 1st rescue analgesics request (hours), total morphine consumption (mg), and the parents’ satisfaction scores were much better in groups DEX1 and DEX2 as compared to group CONTROL with statistical significance. However, group DEX2 was better than DEX1 in the previous outcomes but without statistical significance. In respect, the pediatric objective pain scale was much lower with a significant difference in groups DEX1and DEX2 in comparison with group CONTROL up to 18 hours postoperatively.

LIMITATIONS: Difficult to assess the block as all children were sedated, plus this was a unilateral surgical procedure with limited surgical incision, so the effect of QLB needed to be studied when there is a bilateral surgical procedure.

CONCLUSIONS: Dexamethasone may be more effective when added to bupivacaine than when given systemically in analgesic effects without any impact on the other secondary pain-related outcomes. Dexamethasone as an adjuvant to bupivacaine has a marked hand on prolongation of the postoperative duration of analgesia, less request for rescue analgesia, and fewer side effects as compared to bupivacaine if used as a sole agent in QLB.

PMID:36288584

Pain Physician. 2022 Oct;25(7):E977-E985.

ABSTRACT

BACKGROUND: Severe acute pain is a significant risk factor for postherpetic neuralgia (PHN). The importance of early management in alleviating zoster pain cannot be overstated.

OBJECTIVES: This study aimed to determine the efficiency and safety of one bolus injection thoracic paravertebral block (PVB) and erector spinae plane block (ESB) in individuals with acute thoracic herpes zoster (HZ) in preventing PHN.

STUDY DESIGN: A prospective randomized controlled trial.

SETTING: Tanta University Hospitals, Tanta, Egypt.

METHODS: Ninety participants over the age of 50 years with chest wall herpetic eruption, lasting shorter than a week along with moderate to severe pain, who got adequate antiviral medication. Patients were chosen at random and classified into 3 equal groups. Group C (control group) did not receive any intervention. Group ESB received US-guided ESB with 25 mg bupivacaine 0.5%, plus 8 mg dexamethasone (10 mL volume). Group PVB received US-guided PVB with 25 mg bupivacaine 0.5%, plus 8 mg dexamethasone (10 mL volume).

RESULTS: Numerical rating scale (NRS) showed insignificant differences at baseline. NRS for pain at 1, 3, 4, 12, and 24 weeks was significantly reduced in group ESB compared to group C and in group PVB than group C and insignificantly different between group ESB and group PVB. Doses of pregabalin and acetaminophen were comparable at 1 week among the studied groups. Doses of pregabalin and acetaminophen at 3, 4, 12, and 24 weeks were significantly lesser in group ESB compared to group C and in group PVB than group C and insignificantly different between group ESB and group PVB. After 3 months, the incidence of persistent herpetic pain was not significantly different between the study groups. After 6 months, the incidence of persistent herpetic pain was statistically significantly lower in groups ESB and PVB than in group C (P = 0.037 and 0.015, respectively) without significant difference between group ESB and group PVB.

LIMITATIONS: Small sample size, single center study.

CONCLUSIONS: Both ESB and PVB were effective in controlling acute pain and persistent herpetic pain after 6 months (which was evident by lower NRS for pain and doses of pregabalin and acetaminophen), but ESB is safer (no reported pneumothorax and hypotension).

PMID:36288583

Emerg Infect Dis. 2022 Oct 26;28(12). doi: 10.3201/eid2812.220215. Online ahead of print.

ABSTRACT

SARS-CoV-2 likely emerged from an animal reservoir. However, the frequency of and risk factors for interspecies transmission remain unclear. We conducted a community-based study in Idaho, USA, of pets in households that had >1 confirmed SARS-CoV-2 infections in humans. Among 119 dogs and 57 cats, clinical signs consistent with SARS-CoV-2 were reported for 20 dogs (21%) and 19 cats (39%). Of 81 dogs and 32 cats sampled, 40% of dogs and 43% of cats were seropositive, and 5% of dogs and 8% of cats were PCR positive. This discordance might be caused by delays in sampling. Respondents commonly reported close human‒animal contact and willingness to take measures to prevent transmission to their pets. Reported preventive measures showed a slightly protective but nonsignificant trend for both illness and seropositivity in pets. Sharing of beds and bowls had slight harmful effects, reaching statistical significance for sharing bowls and seropositivity.

PMID:36288573 | DOI:10.3201/eid2812.220215

J Clin Oncol. 2022 Oct 26:JCO2102371. doi: 10.1200/JCO.21.02371. Online ahead of print.

ABSTRACT

PURPOSE: Patients with progressive or recurrent meningiomas have limited systemic therapy options. Focal adhesion kinase (FAK) inhibition has a synthetic lethal relationship with NF2 loss. Given the predominance of NF2 mutations in meningiomas, we evaluated the efficacy of GSK2256098, a FAK inhibitor, as part of the first genomically driven phase II study in recurrent or progressive grade 1-3 meningiomas.

PATIENTS AND METHODS: Eligible patients whose tumors screened positively for NF2 mutations were treated with GSK2256098, 750 mg orally twice daily, until progressive disease. Efficacy was evaluated using two coprimary end points: progression-free survival at 6 months (PFS6) and response rate by Macdonald criteria, where PFS6 was evaluated separately within grade-based subgroups: grade 1 versus 2/3 meningiomas. Per study design, the FAK inhibitor would be considered promising in this patient population if either end point met the corresponding decision criteria for efficacy.

RESULTS: Of 322 patients screened for all mutation cohorts of the study, 36 eligible and evaluable patients with NF2 mutations were enrolled and treated: 12 grade 1 and 24 grade 2/3 patients. Across all grades, one patient had a partial response and 24 had stable disease as their best response to treatment. In grade 1 patients, the observed PFS6 rate was 83% (10/12 patients; 95% CI, 52 to 98). In grade 2/3 patients, the observed PFS6 rate was 33% (8/24 patients; 95% CI, 16 to 55). The study met the PFS6 efficacy end point both for the grade 1 and the grade 2/3 cohorts. Treatment was well tolerated; seven patients had a maximum grade 3 adverse event that was at least possibly related to treatment with no grade 4 or 5 events.

CONCLUSION: GSK2256098 was well tolerated and resulted in an improved PFS6 rate in patients with recurrent or progressive NF2-mutated meningiomas, compared with historical controls. The criteria for promising activity were met, and FAK inhibition warrants further evaluation for this patient population.

PMID:36288512 | DOI:10.1200/JCO.21.02371

Int J Prosthodont. 2022 Oct 21. doi: 10.11607/ijp.7984. Online ahead of print.

ABSTRACT

PURPOSE: To compare the accuracy of milled vs printed complete denture bases and teeth and to assess the position of the teeth on the corresponding denture bases.

MATERIALS AND METHODS: Two different manufacturing techniques were used in this study. In group A, 10 complete dentures were digitally designed and fabricated by milling prepolymerized blocks of polymethyl methacrylate. In group B, 10 complete dentures were digitally designed and fabricated using the 3D printing technique. The accuracy of the maxillary and mandibular denture bases and teeth and the position of the teeth on the corresponding denture bases were evaluated using Geomagic Control X software. Data were presented as mean and SD values. Statistical analysis of the resultant data was performed using Student t test. The significance level was set at P ≤ .05.

RESULTS: The results revealed lower surface deviations of the maxillary and mandibular milled denture bases (group A) with values of 0.158 ± 0.024 and 0.117 ± 0.022, respectively. Lower surface deviations of the printed teeth (group B) were found with values of 0.18 ± 0.016 for the maxillary teeth and 0.153 ± 0.02 for the mandibular teeth, and for position of teeth on the corresponding denture bases, the values were 0.4 ± 0.08 for the maxillary teeth and 1.003 ± 0.027 for the position of the mandibular teeth.

CONCLUSION: The milling technique yields complete denture bases with superior accuracy, while printing technology provides denture teeth with better accuracy and positioning on the corresponding denture bases.

PMID:36288493 | DOI:10.11607/ijp.7984

Environ Sci Technol. 2022 Oct 26. doi: 10.1021/acs.est.2c04150. Online ahead of print.

ABSTRACT

As the largest emission source in the Pan-Third Pole region, residential solid fuel combustion gains increasing public concern regarding air pollution-associated health impacts. This study firstly developed emission inventories by combining energy statistics, fuel-mix survey, and detailed emission factors considering different fuel types, stove types, and altitudes, and we achieved full regional coverage and increased spatial resolution from 9 × 9 km to 1 km × 1 km. Total CO₂, CO, PM_2.5, SO₂, and NO_x emissions (coefficient of variation) were estimated to be 823 Mt (24%), 53 Mt (28%), 4525 kt (48%), 1388 kt (55%), and 1275 kt (46%) in 2020. India, Pakistan, and Bangladesh combined contributed 73, 57, 65, 67, and 69% of total CO₂, CO, PM_2.5, SO₂, and NO_x emissions, respectively, due to the large population. The Qinghai-Tibet Plateau had the second-highest emission intensity, mainly due to the high fuel consumption per capita. Unlike the emissions of the Pan-Third Pole in existing Asian inventories, dung cake combustion dominated total PM_2.5, SO₂, and NO_x emissions rather than firewood combustion with proportions of 54, 70, and 67%, respectively. The effect of altitude on combustion efficiencies increased PM_2.5 emissions by about 21% from the region. The method and results can provide technical guidance for emission inventory refinement in the Pan-Third Pole and other regions.

PMID:36288504 | DOI:10.1021/acs.est.2c04150

Int J Prosthodont. 2022 Oct 21. doi: 10.11607/ijp.7332. Online ahead of print.

ABSTRACT

PURPOSE: To determine the effects of scanning protocol, number of implants, and implant splinting on the accuracy of digital scanning in the edentulous arch.

MATERIALS AND METHODS: A resin-based model of an edentulous mandible with six implants was scanned with a coordinate measurement machine as a reference and then with two intraoral scanner (IOS) systems (TRIOS 3 and Primescan). Ten scans were taken per IOS in three experiments, and each scan was compared to the reference to evaluate trueness and precision. Analysis involved using engineering software (GOM Inspect) to measure linear and angular discrepancies. In experiment 1, three scanning protocols were compared (linear, zigzag, and half-arch). In experiment 2, three clinical situations were simulated. In experiment 3, the effect of implant splinting with a suture thread was measured. Normal distribution of data was examined with Shapiro-Wilk test. Levene test was used for equality of variance (αα = .05). Statistical differences in distance and angular deviations were analyzed by Student t test or ANOVA with post hoc Tukey test (α = .05).

RESULTS: The best results in terms of trueness and precision were obtained with a linear scanning protocol and six implants: TRIOS 3 = trueness 52 µm/0.42 degrees, precision 40 µm/0.26 degrees; and Primescan = trueness 24 µm/0.28 degrees, precision 18 μm/0.27 degrees. The scanning protocol did not significantly affect distance or angular deviation accuracy. Trueness and precision significantly decreased with four implants using both Primescan and TRIOS 3. Splinting implants negatively affected accuracy with both scanners.

CONCLUSION: Both IOS systems achieved clinically satisfying accuracy in distance (< 100 μm) and angular (< 0.5 degrees) deviation with six implants and a linear scanning protocol. With four implants, angular deviations sometimes differed between implants within the same digital scan depending on the IOS and the clinical situation.

PMID:36288490 | DOI:10.11607/ijp.7332