Tag: statistics

Acta Orthop Belg. 2021 Dec;87(4):713-721. doi: 10.52628/87.4.16.

ABSTRACT

To date, the use of biomarkers for assessing individual severity of osteoarthritis (OA) is limited, and the correlation of histological scores with biomarkers for individual animals in the destabilization of the medial meniscus (DMM) model of OA has not been well investigated. Accordingly, this study investigated how well representative biomarkers in the DMM model reflected specific changes in individual animals. Rats were randomly divided into the OA group and the sham group. OA model was established by destabilization of the medial meniscus (DMM). After 2,4,6,8,10 and 12 weeks (n=14, each week), the concentrations of CTXII, COMP, C2C, and OC in serum were measured, and cartilage degeneration, osteophytes, and synovial membrane inflammation, typical of OA, were scored using Osteoarthritis Research Society International (OARSI) scoring system. Additionally, the correlation between each biomarker and the specific changes in osteoarthritis was analyzed for individual animals using the Generalized Estimating Equation (GEE). Statistical analysis showed a low correlation between CTXII and osteophyte score of the medial femur (coefficient = -0.0088, p= 0.0103), COMP and osteophyte score of the medial tibia (coefficient = -0.0911, p= 0.0003), and C2C and synovial membrane inflammation scores of the medial femoral (coefficient = 0.054, p= 0.0131). These results suggest that representative OA bio- markers in individual animals in the DMM model did not reflect histological scores well.

PMID:35172438 | DOI:10.52628/87.4.16

Acta Orthop Belg. 2021 Dec;87(4):643-647. doi: 10.52628/87.4.09.

ABSTRACT

Ganz periacetabular osteotomy (PAO) is a technically demanding surgical procedure. It requires cutting around the acetabulum to mobilize it under fluoro- scopic control. The radiolucent table and good quality imaging are mandatory to perform this osteotomy in a safe way. Modification of Ganz osteotomy was developed a with minimal soft tissue exposure using intra-pelvic approach which allows direct visualization of the quadrilateral plate. The purpose of the present study was to review the early results in the initial group of patients who had this procedure. The Ganz PAO was performed on 8 cases painful dysplastic hips, using the intra-pelvic approach through the Pfannenstiel incision. All of the osteotomies were performed under fluoroscopic control and direct visualizing the osteotomy site from the same incision. The acetabular fragment was medialized and redirected anterolaterally then fixed with 3 screws. The pre-operative Harris hip score mean was 66.8 and improved to be 92.7 (p value <0.0005) and this was statistically significant. Radiologically the CEA improved in the pre-operative X-ray from mean of 13.12 degree to 28.37 degrees (p value <0.0005) and this was statistically significant. Painful dysplastic hips should be treated before function becomes seriously impaired. The Ganz osteotomy through an intra-pelvic approach, can be done with minimal exposure to radiation in a relatively short time.

PMID:35172431 | DOI:10.52628/87.4.09

Acta Orthop Belg. 2021 Dec;87(4):705-712. doi: 10.52628/87.4.15.

ABSTRACT

Repeated joint bleeding leads to chronic synovitis, cartilage damage and bone alterations which result in haemophilic arthropathy and are associated with pain, functional impairment and poor quality of life. There are evidence that Hyaluronic Acid (HA) and Platelet-rich Plasma (PRP) have different mechanisms of action in the treatment of arthropathy for this reason we decided to use both components. The aim of this study is to compare, the efficacy, safety and duration of a single intra-articular injection of PRP against PRP+HA for pain, bleeding episodes and joint health, in the same patient with bilateral hemophilic knee arthropathy. Twenty-one men patients (42 knee joints) were treated with intra- articular injections of PRP or PRP+HA. All of them were haemophilia type A severe. The mean age was 36.6 years (21-72). All patients were evaluated for: Haemophilia Joint Health Score (HJHS), pain (VAS), the number of bleeding episodes (BE) in the last 30 days, before treatment, at three and six months after treatment. Statistically significant improvement were shown for both knee joints at three and six months after treatment for VAS and BE (P < 0.00001). The HJHS score did not significantly improve for either knee in the 6-month period after injection. A single PRP or PRP+HA injection is safe and effective in treating haemophilic arthropathy of the knee for up to 6 months follow-up, reducing pain, bleeding episodes and delaying total knee arthroplasty.

PMID:35172437 | DOI:10.52628/87.4.15

Acta Orthop Belg. 2021 Dec;87(4):601-606. doi: 10.52628/87.4.04.

ABSTRACT

Fast track programs have been introduced to reduce perioperative complication rates and to quickly reintegrate the patient into everyday life. The aim of this retrospective case-control study was to identify patient characteristics and patient-independent factors that influence fast track programs in hip arthroplasty. A total of 1138 patients were examined. A hospital stay of more than seven days was used to define the case group. In addition to the causes for the longer hospitalisation, age, sex, BMI, chronic nicotine and alcohol abuse, ASA score, surgical duration, anaemia and blood transfusion as well as concomitant diseases were assessed. The statistical analysis included two-sample t-test, chi-square test and logistic regression analyses. An 95% confidence interval was calculated (p<0.05). 16.9% of patients could not leave the hospital on the seventh day. The main causes were delayed wound healing (69.4%), increased CRP (43.0%>100 mg/l), and internal complications (19.7%). At a mean of 69.2 ± 10.7 years, the age of the case group was significantly higher than that of the control group, which had a mean of 63.3 ± 10.3 years (p<0.001). Cardiac comorbidities (p<0.001), BMI (p=0.023), and alcohol consumption (p<0.001) increased the risk for longer hospitalisation. Significant patient-independent factors were duration of the surgery (p<0.001) and transfusion (p<0.001). Successful application of fast-track hip arthroplasty is possible for every patient. However, longer hospi- talisation and delayed discharge must be taken into account for patients with advanced age, cardiac comorbidities, alcohol consumption, and high BMI.

PMID:35172426 | DOI:10.52628/87.4.04

Cancer Sci. 2022 Feb 16. doi: 10.1111/cas.15289. Online ahead of print.

NO ABSTRACT

PMID:35172389 | DOI:10.1111/cas.15289

Acta Orthop Belg. 2021 Dec;87(4):587-592. doi: 10.52628/87.4.02.

ABSTRACT

D-dimer is a fibrin degradation product formed by the destruction of the cross-linked fibrin clot by activation of the coagulation system. Many studies have shown that systemic and local infections cause fibrinolytic activities. The purpose of this study was to determine the role of serum D-dimer in the diagnosis of periprosthetic joint infection (PJI) and the timing of reimplantation. The patients who underwent primary and revision knee or hip arthroplasty between July 2018 and May 2019 were prospectively evaluated. All surgeries were performed by the same surgeon. 60 of 71 patients who met our criteria were included in the study, comprising of 27 primary arthroplasties (PA), 21 two-stage septic revision (SR) and 12 aseptic revision (AR). We analyzed D-dimer, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels. The values of the septic group were evaluated as two groups; Group 1 (before the first stage) and Group 2 (before the second stage) to investigate the role of D-dimer in determining the timing of reimplantation. D-dimer level was significantly higher in the SR group compared to PA and AR groups (p<0.001 and p=0.045). CRP and ESR levels were significantly higher in the SR group compared to PA and AR groups. There was no statistically significant difference between preoperative D-dimer levels of Group 1 and Group 2 (p=0.2). Serum D-dimer level can be used as an easy and inexpensive test to support the diagnosis of PJI. But the D-dimer level is not useful to determine the timing of reimplantation.

PMID:35172424 | DOI:10.52628/87.4.02

Stat Med. 2022 Feb 16. doi: 10.1002/sim.9340. Online ahead of print.

ABSTRACT

Hepatitis B has been a well-documented risk factor of liver cancer and mortality. To what extent hepatitis B affects mortality through increasing liver cancer incidence is of research interest and remains to be studied. We formulate the research question as a hypothesis testing problem of causal mediation where both the mediator and the outcome are time-to-event variables. The problem is closely related to semicompeting risks because time to the intermediate event may be censored by an occurrence of the outcome. We propose two hypothesis testing methods: a weighted log-rank test (WLR) and an intersection-union test (IUT). A test statistic of the WLR is constructed by adapting a nonparametric estimator of the mediation effect; however, the test may be conservative regarding its Type I Error rate. To address this, we further propose the IUT, the test statistic of which is constructed under the composite null hypothesis. Asymptotic properties of the two tests are studied, showing that the IUT is a size α test with better statistical power than the WLR. The theoretical properties are supported by extensive simulation studies under finite samples. Applying the proposed methods to the motivating hepatitis study, both WLR and IUT provided strong evidence that hepatitis B had a significant mediation effect on mortality via liver cancer incidence.

PMID:35172384 | DOI:10.1002/sim.9340

Oncol Res Treat. 2022 Feb 16. doi: 10.1159/000522645. Online ahead of print.

ABSTRACT

Introduction The most common intracranial neoplasm diagnosed in adults are brain metastases (BrM). The benefit in terms of clinical control and toxicity for stereotactic radiotherapy (SRT)has been investigated for patients with low load of brain metastases. Aim of this single-institution experience was to investigate the best dose schedule for five-fraction stereotactic radiotherapy (FFSRT). Methods A retrospective analysis of patients treated for BrM with different dose schedules of FFSRT was performed. Local Control and clinical outcomes were evaluated with Magnetic resonance imaging (MRI) at 3, 6 and 9 months. Toxicity data were also collected. Results A total of 41 patients treated from November 2016 to September 2020 were enrolled in the analysis. Non Small Cell Lung cancer (51,2%) and breast cancer (24,3%) represented the most frequent primitive tumors. Treatment was performed on 5 consecutive days with prescribed dose ranging from 30 to 40 Gy, prescribed to the 95% isodose line that covered at least 98% of the GTV. Statistically significant differences (p=0.025) with higher LC control rates for dose schedules > 6Gy for fractions. Toxicity rates were not found to be higher than G1. Conclusion The results of this retrospective analysis suggest that FFSRT for BrM seems to be safe and feasible. Our results also underline that a total dose lower than 30 Gy in 5 fractions should not be used due to the expected minor LC.

PMID:35172322 | DOI:10.1159/000522645

Urol Int. 2022 Feb 16:1-5. doi: 10.1159/000522079. Online ahead of print.

ABSTRACT

INTRODUCTION AND OBJECTIVES: We report our experience with pediatric shock wave lithotripsy (SWL) using two types of lithotripters: Dornier HM3 (HM3) and Dornier Lithotripter SII (DLS).

STUDY DESIGN: We retrospectively reviewed the charts of children who underwent SWL between 2002 and 2016. Patients were divided into two groups based on the type of the lithotripter: during 2002-2009, we used the electrohydraulic HM3 lithotripter which was replaced in 2009 with the DLS electromagnetic lithotripter. Clinical and perioperative parameters were compared.

RESULTS: Our cohort included 107 children who underwent SWL. Average age was 11.5 ± 5.1 years. Average stone size was 10.6 ± 4.9 mm. HM3 was used in 38% of children and DLS2 in 62% (n = 41 and 66, respectively). There were no significant differences in age, gender, stone size, or location between the groups. The total SFR did not differ statistically between HM3 and DLS (83% vs. 74%, p = 0.35). SFR after one SWL was higher with the HM3 (78% vs. 62%, p = 0.093). Re-treatment rate was 22% and 17% (HM3 vs. DLS, p = 0.61). Complication rates were low, with renal colic being the most common (HM3 10%, DLS 20%, NS).

CONCLUSIONS: SWL in the pediatric population using the DLS showed good results with low complication rates that are equivalent to the gold standard HM3.

PMID:35172318 | DOI:10.1159/000522079

Neuroendocrinology. 2022 Feb 16. doi: 10.1159/000522643. Online ahead of print.

ABSTRACT

BACKGROUND: Family with sequence similarity 83, member A (FAM83A) has been reported to play an important role in cancer progression and metastasis. The purpose of this study was to clarify the role and mechanism of FAM83A in pancreatic neuroendocrine tumors (PanNETs).

METHODS: PanNET specimens and adjacent nontumor pancreatic tissues obtained from 68 patients who underwent curative surgery for PanNETs were assessed using immunochemical staining to identify FAM83A expression. The relationships between FAM83A expression, clinicopathological parameters and prognosis were statistically analyzed. PanNET cell lines were used to study the role of FAM83A in the progression and metastasis of PanNETs in vitro and in vivo.

RESULTS: FAM83A was overexpressed in PanNET specimens compared with adjacent nontumor tissues. Furthermore, FAM83A expression was closely associated with lymph node metastasis (P = 0.02), perineural invasion (P = 0.001), the WHO classification (P = 0.039), AJCC stage (P = 0.01) and shorter disease-free survival in patients with PanNETs (P < 0.001). Enforced expression of FAM83A effectively promoted PanNET cell proliferation, migration, invasion and growth both in vitro and in vivo, whereas FAM83A inhibition exerted the opposite effects. Subsequent mechanistic investigations revealed that FAM83A promoted the progression and metastasis of PanNETs by inducing epithelial-mesenchymal transition (EMT) via the PI3K/AKT and ERK pathways. More importantly, specific inhibition of either the AKT or ERK pathways partially rescued the effect of FAM83A overexpression on promoting PanNET progression and metastasis.

CONCLUSIONS: FAM83A plays an important role in the progression and metastasis of PanNET by inducing the EMT via the activation of the ERK and PI3K/AKT pathways and may serve as a valuable molecular target in PanNET treatment.

PMID:35172316 | DOI:10.1159/000522643