Tag: statistics

Aging Clin Exp Res. 2022 Sep 3. doi: 10.1007/s40520-022-02241-6. Online ahead of print.

ABSTRACT

AIMS: Using the reliable change index (RCI), we aimed to examine the effect of a multicomponent exercise program on the individual level.

METHODS: Overall, 270 adults (mean age, 78 years) completed a multicomponent physical exercise program (strength, aerobic, gait, and balance) for 40 min, 1-2 times per week, continued up to 1 year at a daycare center. Effectiveness was assessed using grip, ankle, knee, and hip strength; Timed Up & Go (TUG); Berg Balance Scale (BBS); gait speed; and 6-min walking distance. These were measured at baseline and every 3 months thereafter. We calculated the RCI using the data between two-time points (baseline and at 3, 6, 9, or 12 months) in each participant and then calculated the mean RCI value across the participants. A paired t-test was also employed to evaluate the effect of the intervention as an average-based statistics.

RESULTS: The highest mean RCI values were on ankle plantar-flexion strength, followed by gait speed, hip abduction strength, BBS, knee extensor strength, 6-min walk distance, grip strength, and finally TUG. Paired t-test also revealed significant improvement with moderate effect sizes for ankle plantar-flexion strength (0.504), gait speed (0.413), hip abduction strength (0.374), BBS (0.334), knee extensor strength (0.264), and 6-min walk distance (0.248). Significant but small effect size was seen on TUG (0.183).

CONCLUSION: The RCI is a convenient method of comparing the effect between different assessments, especially at an individual level. This index can be applied to the use of personal feedback.

PMID:36057083 | DOI:10.1007/s40520-022-02241-6

J Neurosurg. 2022 Sep 2:1-11. doi: 10.3171/2022.7.JNS22524. Online ahead of print.

ABSTRACT

OBJECTIVE: Decompressive craniectomy (DC) is the definitive neurosurgical treatment for managing refractory malignant cerebral edema and intracranial hypertension due to combat-related severe traumatic brain injury (TBI). To date, the long-term outcomes and sequelae of this procedure on host-country national (HCN) populations during Operation Iraqi Freedom (Iraq, 2003-2011), Operation Enduring Freedom (Afghanistan, 2001-2014), and Operation Freedom’s Sentinel (Afghanistan, 2015-2021) have not been described, specifically the process and results of delayed custom synthetic cranioplasty. The Joint Trauma System’s Clinical Practice Guidelines (JTS-CPG) for severe head injury counsels surgeons to discard the cranial osseous explant when treating coalition service members. Ongoing political and healthcare system instabilities often preclude opportunities for delayed cranioplasty by host-country assets. Various surgical options (such as hinge craniectomy) are inadequate in the setting of complicated cranial comminution from blast or missile injuries, severe cerebral edema, grossly contaminated wounds, complex polytrauma, and tissue devitalization. Delayed cranioplasty with a custom synthetic implant is a viable but logistically challenging alternative. In this retrospective review, the authors present the first patient series describing delayed custom synthetic cranioplasty in an HCN population performed during active military conflict.

METHODS: Patients were identified through the Joint Trauma System/Theater Medical Data Store, and subgroup analyses were performed to include mechanisms of injury, surgical complications, and clinical outcomes.

RESULTS: Twenty-five patients underwent DC between 2012 and 2020 to treat penetrating, blast, and high-energy closed head injuries per JTS-CPG criteria. The average time from injury to surgery was 1.4 days, although 6 patients received delayed care (3-6 days) due to protracted evacuation from local hospitals. Delayed care correlated with an increased rate of intracranial abscess and empyema. The average time to cranioplasty was 134 days due to a lack of robust mechanisms for patient follow-up, tracking, and access to NATO hospitals. HCN patients who recovered from DC demonstrated overall benefit from custom synthetic cranioplasty, although formal statistical analysis was impeded by a lack of long-term follow-up.

CONCLUSIONS: This review demonstrates that cranioplasty with a custom synthetic implant is a safe and feasible treatment for vulnerable HCN patients who survive their index DC surgery. This unique paradigm of care highlights the capabilities of deployed neurosurgical healthcare teams working in partnership with the prosthetics laboratory at Walter Reed National Military Medical Center.

PMID:36057122 | DOI:10.3171/2022.7.JNS22524

Aging Clin Exp Res. 2022 Sep 3. doi: 10.1007/s40520-022-02225-6. Online ahead of print.

ABSTRACT

BACKGROUND: Osteoarthritis (OA) is a leading cause of disability in older adults. Most research has focused on minimizing pain and maximizing physical function so as to maintain patient mobility preceding joint arthroplasty. However, few studies have formally studied the relationship between OA and sleep trouble, although it is clinically recognized that OA may affect sleep.

METHODS: The study was based on the National Health and Nutrition Examination Survey (NHANES) database from 2011-2018. Participants were defined as adults aged 60 years or older with diagnoses of OA and self-reported sleep trouble. Multivariable regression analyses were applied to assess the association between OA and sleep trouble, adjusting for age, sex, body mass index, race/ethnicity, education level, marital status, income, depression level, etc. RESULTS: This study included 4154 participants, consisting of the control group (n = 2966) and the OA group (n = 1188). OA individuals were 2.11 (95% CI 1.79-2.47, p < 0.001) times more likely to have sleep trouble compared with those without OA. On subgroup analyses, there was lower odds ratio value of sleep trouble in men compared with women, and in the highest income group compared with the other income groups.

CONCLUSIONS: OA was positively associated with sleep trouble in older adults, with different odds ratio values among different subgroups. Our results suggest that older adults with OA should be aggressively screened for sleep problems.

PMID:36057081 | DOI:10.1007/s40520-022-02225-6

Curr Med Sci. 2022 Sep 3. doi: 10.1007/s11596-022-2620-6. Online ahead of print.

ABSTRACT

OBJECTIVE: Apatinib is a novel inhibitor of vascular endothelial growth factor receptor-2. The goal of this study was to evaluate overall survival (OS) after a combination of transarterial chemoembolization (TACE) and apatinib in patients with advanced hepatocellular carcinoma (HCC) and to identify the factors affecting patient survival.

METHODS: Fifty-one patients with advanced HCC who received TACE in combination with apatinib in our hospital from June 2015 to May 2017 were enrolled. The OS and progression-free survival (PFS) were calculated using the Kaplan-Meier method. The log-rank test and Cox regression model were used to determine the factors affecting OS.

RESULTS: The median OS and PFS of the patients were 15 months and 10 months, respectively. The 1-, 2-, and 3-year survival rates were 64.7%, 23.5%, and 1.8%, respectively. Univariate survival analysis showed that patients with Child-Pugh A (P=0.006), reduction rate of proper hepatic artery (P=0.016), hand-foot syndrome (P=0.005), secondary hypertension (P=0.050), and without ascites (P=0.010) had a better OS. Multivariate analysis showed that hand-foot syndrome (P=0.014), secondary hypertension (P=0.017), and reduction rate of proper hepatic artery (P=0.025) were independent predictors of better OS.

CONCLUSION: TACE combined with apatinib is a promising treatment for advanced HCC. Hand-foot syndrome, secondary hypertension, and the reduction rate of proper hepatic artery were associated with a better OS.

PMID:36057075 | DOI:10.1007/s11596-022-2620-6

Mycopathologia. 2022 Sep 3. doi: 10.1007/s11046-022-00660-7. Online ahead of print.

ABSTRACT

Onychomycosis is commonly studied in Africa but not in patients with diabetics despite having a significant number of her population living with diabetes mellitus (DM). Our review highlights a total of 15 studies with only two from Africa over the past two decades; 8 (53.3%) from Asia, 4 (26.7%) from Europe, 2 (13.3%) from Africa and 1 (6.7%) from North America. A total number of 4321 participants were involved with onychomycosis prevalence of 35.3% (1527/4321). Seven studies documented preponderance of onychomycosis in males, one showed preponderance in females, one showed no statistically significant difference in gender, while correlation with gender was unclear in the remainder. The risk factors identified were duration of diabetes, increasing age, occupation (agriculture), subclinical atherosclerosis, metabolic syndrome, obesity, triglyceride levels, and glycosylated haemoglobin. Three case control studies showed a statistically significant correlation between onychomycosis and individuals with DM. Diagnosis was mainly by microscopy and culture with Trichophyton (T) rubrum as the predominant isolate. Fungal nail infections are grossly underdiagnosed and/or underreported in Africa and hence the need for improved awareness and diagnosis especially in patients with DM. Although focused on Africa, this study also revealed paucity of data on onychomycosis in diabetic patients living in the Americas despite evidence from the literature showing a significant number of individuals from that region are living with diabetes. The need to evaluate this at-risk population for onychomycosis cannot be over emphasized.

PMID:36057068 | DOI:10.1007/s11046-022-00660-7

J Clin Monit Comput. 2022 Sep 3. doi: 10.1007/s10877-022-00908-z. Online ahead of print.

ABSTRACT

Accurate estimation of surgical risks is important for informing the process of shared decision making and informed consent. Postoperative reintubation (POR) is a severe complication that is associated with postoperative morbidity. Previous studies have divided POR into early POR (within 72 h of surgery) and late POR (within 30 days of surgery). Using data provided by American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP), machine learning classification models (logistic regression, random forest classification, and gradient boosting classification) were utilized to develop scoring systems for the prediction of combined, early, and late POR. The risk factors included in each scoring system were narrowed down from a set of 37 pre and perioperative factors. The scoring systems developed from the logistic regression models demonstrated strong performance in terms of both accuracy and discrimination across the different POR outcomes (Average Brier score, 0.172; Average c-statistic, 0.852). These results were only marginally worse than prediction using the full set of risk variables (Average Brier score, 0.145; Average c-statistic, 0.870). While more work needs to be done to identify clinically relevant differences between the early and late POR outcomes, the scoring systems provided here can be used by surgeons and patients to improve the quality of care overall.

PMID:36057069 | DOI:10.1007/s10877-022-00908-z

Environ Sci Pollut Res Int. 2022 Sep 3. doi: 10.1007/s11356-022-22804-4. Online ahead of print.

ABSTRACT

As a Chinese solution to build a community of human destiny, Belt and Road Initiative (BRI) has shown China’s international responsibility by promoting its green development. Based on the annual panel data of Chinese cities from 2004 to 2018, this paper systematically explores the effect of BRI on the Green Total Factor Productivity (GTFP) of cities along its domestic route using the difference-in-differences (DID) method. The results of the study show that (1) BRI significantly increases the GTFP of cities along its domestic route, and this finding holds after excluding a series of robustness tests such as endogeneity issues and other policy disturbances. (2) BRI promotes the growth of GTFP in the region mainly through improving science and technology innovation, increasing foreign direct investment and enhancing trade cooperation. (3) From the perspective of heterogeneity, the promotion effect of BRI on the GTFP of inland cities along the route is much higher than that of coastal cities, and cities along the route with stronger environmental concerns have a more significant enhancement effect. (4) Based on the policy context and the undertaking of role functions, there is a significant positive linkage effect between BRI Initiative and the Free Trade Zone (FTZ) construction in promoting GTFP growth. (5) From a spatial perspective, BRI has not only increased the GTFP of cities along the route, but also radiated the growth of GTFP in neighboring cities along the route. The conclusion of this paper provides a policy reference and theoretical basis for further building the green “Belt and Road” and promoting the sustainable development of China’s economy and high-quality transformation.

PMID:36057062 | DOI:10.1007/s11356-022-22804-4

J Interv Card Electrophysiol. 2022 Sep 3. doi: 10.1007/s10840-022-01258-1. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary vein isolation is the cornerstone of atrial fibrillation (AF) ablation. However, the recurrence rate of AF after pulmonary vein isolation (PVI) remains high. The efficacy and safety of low voltage area (LVA) ablation in the treatment of AF are uncertain.

METHODS: The studies comparing the efficacy and safety of LVA ablation and LVA non-ablation for AF were systematically reviewed and meta-analyzed. Outcomes of interest included recurrent event, procedure time, and fluoroscopy time. Continuous variables were evaluated with mean deviation (MD) and standard mean difference (SMD). Odds ratio (OR) values and its 95% confidence intervals (CI) were used in meta-analysis of binary variables.

RESULTS: Fourteen studies were eligible for inclusion. The AF recurrence was similar between the two groups, with no statistical difference (25.7% (67/346) vs. 28% (63/225), P = 0.49). LVA ablation did not increase the incidence of AT (8.7% (20/231) vs. 14.5% (28/193), P = 0.66). Fluoroscopy time was longer in the LVA ablation group (31.4 ± 8.4 min vs. 26.3 ± 7.8 min, P < 0.05). Complication rates were similar between the two groups (26.6% (17/64) vs. 21.7% (13/60), P = 0.53). Patients with LVA had higher AT/AF recurrence (32.9% (213/647) vs. 24.2% (229/948), P < 0.05).

CONCLUSIONS: Patients with left atrial LVA have a poor prognosis after catheter ablation. LVA ablation did not reduce the recurrence of AF nor did it increase the recurrence of atrial tachycardia.

PMID:36057055 | DOI:10.1007/s10840-022-01258-1

Int J Clin Oncol. 2022 Sep 3. doi: 10.1007/s10147-022-02240-7. Online ahead of print.

ABSTRACT

BACKGROUND: In Japan, HPV vaccination rates has dramaticaly declined since 2013. Since mothers are the ones making the decision to vaccinate their daughters against HPV, we probed the mothers’ intention to receive vaccinations for themselves and to vaccinate their daughters against HPV, and their reasoning.

METHODS: An internet survey was conducted in March of 2021. Through the screening, 1576 participants were extracted from a survey panel and divided into 3 groups based on their daughter’s birth fiscal year (Group 1: 1994 to 1999, Group 2: 2000 to 2003, Group3: 2004 to 2008). The chi-square test and residual analysis were used for the statistical analysis of comparison among the groups. Logistic regression analysis was used to identify independent variables with mothers intention to get their daughters vaccinated under specific situations.

RESULTS: The percentage of respondents without anxiety regarding their daughter’s general vaccination was significantly higher in Group 1 (p < 0.05). In the mothers of daughters born in or after 2000 when vaccination rates declined (Groups 2 and 3), a situation in which ‘The daughter’s best friends were vaccinated before her’ made the mothers think positively about HPV vaccination, and to the same degree as a situation in which ‘You received a notice from your local government recommending vaccination’ (Group 2: 41.6% (214/514) and 40.5% (208/514), Group 3: 48.5% (257/530) and 47.0% (249/530)).

CONCLUSION: If mothers who have had their daughters vaccinated were to recommend HPV vaccination to their close friends, ‘the best friend effect’ should promote others to be vaccinated.

PMID:36057048 | DOI:10.1007/s10147-022-02240-7

Updates Surg. 2022 Sep 3. doi: 10.1007/s13304-022-01369-4. Online ahead of print.

ABSTRACT

OBJECTIVE: We reviewed the available literature on patients with MPM undergoing either extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D).

METHODS: Original research studies that evaluated long-term outcomes of P/D versus EPP were identified, from January 1980 to February 2022. The 30-days and 90-day mortality, along with the 1-, 2-, 3-, 5-year survival, the median overall survival, the macroscopic complete resection (MCR) rate, and the complications were calculated according to both a fixed and a random effect model. The Q and I² statistic were used to test for heterogeneity among the studies. Sensitivity analysis was performed including only studies that incorporated the MCR concept.

RESULTS: Eighteen studies were included, incorporating a total of 4,852 patients treated with EPP and P/D. The 30-day mortality was significantly higher in the EPP group (OR: 2.79 [95% CI 1.30, 6.01]; p = 0.009). The median overall survival was higher in the P/D group (WMD:-4.55 [-6.05, -3.04]; p < 0.001). No differences were found regarding the 90-day mortality, MCR rate, and the 1-, 2-,3-, 5-year survival between the EPP and P/D groups. These findings were validated by the sensitivity analysis. The incidence of atrial fibrillation, hemorrhage, pulmonary embolism, air leak, and reoperation was significantly increased in the EPP group (p < 0.05).

CONCLUSIONS: The present meta-analysis indicates that P/D is associated with enhanced outcomes regarding 30-day mortality, median overall survival, and complications. The P/D approach should be preferred when technically feasible. However, the procedure of choice should be decided based on the goal of MCR in the safest approach for the patient.

PMID:36057027 | DOI:10.1007/s13304-022-01369-4