Tag: statistics

J Am Acad Orthop Surg. 2022 Mar 2. doi: 10.5435/JAAOS-D-21-00977. Online ahead of print.

ABSTRACT

INTRODUCTION: Limited literature is available about the effects of extended (>24 hours) antibiotic use after primary and aseptic revision total joint arthroplasty (TJA) on rates of periprosthetic joint infection (PJI). The purpose of this study was to systematically review the outcomes of extended prophylactic antibiotic use.

METHODS: A systematic search on PubMed and EMBASE databases was done in August 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles that met inclusion criteria were screened by two separate authors. Basic patient demographics, route of delivery, type, dose, frequency of the antibiotic, rates of PJI, and length of stay were extracted.

RESULTS: A total of 11 articles published from 1979 to 2021 were included in the final analysis. Two studies evaluated aseptic revisions, seven evaluated primary TJA, and two studies evaluated both. Five studies were randomized controlled trials, one multicenter nonrandomized trial, and five retrospective cohort studies. All 11 studies used a cephalosporin or a penicillin antibiotic in both the control and cohort groups. Five studies used intravenous (IV) antibiotics, one study used oral (PO) antibiotics, and the other five studies used both IV and PO antibiotics. Length of stay was reported in three studies, all using IV antibiotics. All 11 studies evaluated rates of PJI, while four studies evaluated included rates of superficial surgical site infections. Four studies showed a statistically significant decrease in PJI when compared with a control group, while seven studies showed no statistically significant difference.

CONCLUSION: There is conflicting evidence regarding the benefit of extended (>24 hours) antibiotics, IV or PO, after TJA. As of now, current guidelines do not support the use of extended antibiotics; future prospective clinical trials are needed to help support these claims.

PMID:35245256 | DOI:10.5435/JAAOS-D-21-00977

J Am Acad Orthop Surg Glob Res Rev. 2022 Mar 2;6(3). doi: 10.5435/JAAOSGlobal-D-21-00322.

ABSTRACT

INTRODUCTION: Cephalomedullary nail (CMN) length for intertrochanteric femur fractures without subtrochanteric extension has been an ongoing debate. The authors hypothesize that increasing nail length would result in increasing surgical time, greater incidence of acute kidney injury (AKI), postoperative anemia, and blood loss requiring transfusion due to increased intramedullary reaming and pressurization of the canal with nail insertion.

METHODS: A retrospective chart review of patients aged 65 years or older who underwent CMN for low-energy intertrochanteric femur fractures from 2010 to 2018 was undertaken. Patient demographic data, comorbidities, case duration, postoperative hospital length of stay (LOS), and laboratory data, including serum creatinine, hemoglobin, and hematocrit, were collected for analysis. The following outcome measures were compared: postoperative pneumonia, cardiac complications, sepsis, reintubation/intensive care unit stay, pulmonary embolism, stroke, postoperative AKI, 30-day hospital readmission, 30-day return to operating room, 30-day mortality, 1-year mortality, postoperative anemia (hemoglobin <7 g/dL), and blood transfusion.

RESULTS: A total of 247 patients were analyzed (short = 48, intermediate = 39, and long = 160). No notable difference was observed in postoperative pneumonia, cardiac complications, sepsis, reintubation/intensive care unit stay, pulmonary embolism, stroke, mean total hospital LOS, mean postoperative hospital LOS, rate of postoperative AKI, 30-day readmission, 30-day return to operating room, 30-day mortality, or 1-year mortality. Patients receiving long nails had significantly higher rates of postoperative anemia (P = 0.0491), blood transfusion (P = 0.0126), and mean procedure length (P = 0.0044) compared with the two other groups.

DISCUSSION: Patients receiving long nails had markedly higher rates of postoperative anemia and blood loss requiring blood transfusion with markedly longer mean procedure length than patients receiving short and intermediate CMNs. Long nails did not result in an increase in other complications evaluated.

PMID:35245250 | DOI:10.5435/JAAOSGlobal-D-21-00322

Fa Yi Xue Za Zhi. 2021 Dec 25;37(6):825-831. doi: 10.12116/j.issn.1004-5619.2020.500701.

ABSTRACT

OBJECTIVES: To evaluate the effects of different pretreatment methods and preservation time on RNA quality of peripheral blood samples, and to optimize the preservation method of peripheral blood samples.

METHODS: Eight pretreatment methods were used to preprocess the peripheral blood from 3 healthy unrelated individuals and the treated samples were stored at -80 ℃. Total RNA of samples was extracted using Quick-RNA^TM Miniprep Plus kit. DNA/RNA Shield^TM was added to peripheral blood and total RNA was extracted after preservation at -80 ℃ for 0, 5, 10, 15, 30 and 60 days, respectively. The concentration, purity and integrity of RNA were determined. Statistical analyses were performed by SPSS 22.0 software to compare the differences in RNA yield, purity and integrity among the eight pretreatment methods.

RESULTS: In terms of purity, leukocyte pretreated with RNAlater^TM and directly cryopreservation peripheral blood showed the worst purity. The other six methods showed better purity. In terms of yield, blood cells with DNA/RNA Shield^TM came out with the highest yield, followed by peripheral blood with DNA/RNA Shield^TM. In terms of integrity, peripheral blood preserved in PAXgene Blood RNA tube method had the best integrity. Except for peripheral blood pretreated with DNA/RNA Shield^TM and blood cells pretreated with DNA/RNA shield^TM, the other five methods had statistical differences when compared to the method by keeping peripheral blood in PAXgene Blood RNA tube. The purity of RNA stored at six-time gradients ranged from 1.815 to 1.952. With the increase of storage time, RNA yield decreased from 4.516 ng to 1.039 ng, and RNA integrity decreased from 8.533 to 7.150.

CONCLUSIONS: According to the results of total RNA’s yield, purity and integrity, peripheral blood pretreated with DNA/RNA Shield^TM was the best pretreatment method. After the pretreatment, samples can be preserved for up to 60 days in low temperature.

PMID:35243848 | DOI:10.12116/j.issn.1004-5619.2020.500701

Se Pu. 2022 Mar 8;40(3):281-288. doi: 10.3724/SP.J.1123.2021.10011.

ABSTRACT

Understanding the diffusion behavior of particles during chromatographic analysis is critical for optimizing the operation conditions, improving the chromatographic performance, and designing a new separation device. Most of the existing simulations focus on chromatographic thermodynamics, while very few consider the overall diffusion and separation process. Herein, a new simulation method for gas chromatography separation was developed based on the random diffusion theory in microscale restricted space. This method retained the key information for controlling the diffusion behavior, simplified the interaction between the particles to be separated, and enlarged the time scale of each step one molecule walks. Thus, the operational efficiency could be significantly improved due to reduced calculation, and the entire diffusion process in the gas chromatography capillary column could be simulated. In this model, the capillary column was represented by a two-dimensional long and narrow rectangle where the particles to be separated randomly diffused. Besides, a directional velocity along the axis of the chromatographic column exerted on the particle represented the driving force of the mobile phase. If a particle collided with the inner wall of the column, it would remain at the collision position even after some time lapsed. When desorption occured, the particle would flow along with the mobile phase until its next adsorption on the surface. The interaction between the particle and the inner wall was expressed by the equivalent adsorption time. By dynamically tracking the trajectories of particles, the statistical distribution of time for the residence of the particles in the chromatographic column could be obtained, that is, the detection signal (retention time). Based on the previous simulation studies on the separation of n-alkane homologues, combined with the Kovats Retention Index, the functional relationships between adsorption steps and temperature as well as carbon number were established. As a result, the separation parameter systems for various homologues at different temperatures were set up. The separation of alcohol homologues at different temperatures was considered as an example to verify the reliability of the simulation method. The relative errors between the measured and simulated values were within 5% for the retention time and 0.75%-60% for the peak width. The reasons for the large relative errors in the peak width are summarized as follows. On the one hand, parameterization of alcohol homologues was performed on the basis of a previous study on the separation law of n-alkane. Given the limitations of the current computing capability, the insufficient iteration in the parameterized process led to large errors. In addition, the errors at different temperatures further accumulated in extrapolated approximations. On the other hand, the strong hydrogen bond force between the alcohol molecules was simplified with the elastic collision, which increased the magnitude of the errors. Although the simulation method proposed in this paper can accurately predict the retention time and reasonably describe the morphological characteristics of chromatographic peaks, there is still room for improvement. In particular, the description of the detailed interactions between molecules must be improved. For example, the method of molecular mechanics may be assistant with the investigation of the functional relationship between interaction potential and adsorption steps. The interaction potential calculated on the basis of molecular mechanics replaces the parameterized adsorption steps, yielding more accurate simulation results. In general, the simulation method proposed in this study is a valuable reference for the optimization of chromatographic operating conditions and for the development of new chromatographic techniques.

PMID:35243838 | DOI:10.3724/SP.J.1123.2021.10011

Fa Yi Xue Za Zhi. 2021 Dec 25;37(6):813-816. doi: 10.12116/j.issn.1004-5619.2020.200913.

ABSTRACT

OBJECTIVES: To explore the relationship between the frequency characteristics and response threshold of auditory steady-state response (ASSR), auditory brainstem response (ABR) and 40 Hz auditory event related potential (40 Hz AERP), and their application values in forensic medicine.

METHODS: Thirty volunteers with normal hearing (60 ears) were selected to perform pure tone audiometry (PTA) threshold and ASSR, ABR and 40 Hz AERP response threshold tests in the standard sound insulation shielding room, and the results were statistically analyzed by SPSS 22.0 software.

RESULTS: At 0.5 kHz and 1.0 kHz frequencies, the correlation between 40 Hz AERP response threshold and PTA threshold was good, which was better than that of ASSR and ABR response threshold. At 2.0 kHz and 4.0 kHz frequencies, the correlation between ASSR and ABR response thresholds and PTA threshold was good, which was better than that of 40 Hz AERP response threshold.

CONCLUSIONS: To evaluate the hearing at 0.5 kHz and 1.0 kHz frequencies, it is recommended to use 40 Hz AERP and ASSR to comprehensively assess the PTA threshold of the subjects. To evaluate the hearing at 2.0 kHz and 4.0 kHz frequencies, ABR and ASSR are recommended to assess the PTA threshold of subjects comprehensively. The combination of ASSR, ABR and 40 Hz AERP can improve the accuracy of hearing function evaluation.

PMID:35243846 | DOI:10.12116/j.issn.1004-5619.2020.200913

Arthritis Rheumatol. 2022 Mar 3. doi: 10.1002/art.42104. Online ahead of print.

ABSTRACT

OBJECTIVES: Systemic juvenile idiopathic arthritis (sJIA) is a systemic inflammatory disease of childhood-onset. sJIA is associated with neutrophilia, including immature granulocytes, potentially driven by the growth factor granulocyte-colony stimulating factor (G-CSF). This study aimed to unravel the role of G-CSF in the pathology of sJIA.

METHODS: Injection of complete Freund’s adjuvant (CFA) in BALB/c mice induces mild inflammation and neutrophilia in wild-type (WT) mice and a more pronounced disease, reminiscent to patients, in interferon-γ (IFN-γ) knock-out (KO) mice. Extramedullary myelopoiesis was studied in CFA-immunised mice by single-cell RNA-sequencing and the effect of G-CSFR-blockage on neutrophil development and sJIA pathology was evaluated. Additionally, in patients, plasma G-CSF-levels were measured.

RESULTS: Both in sJIA patients and in a corresponding mouse model, plasma levels of G-CSF are increased. Using the model, we demonstrate that G-CSF is responsible for the observed neutrophilia and extramedullary myelopoiesis and the induction of immature neutrophils and myeloid-derived suppressor-like cells. Administration of a G-CSF-receptor antagonising antibody blocked the maturation and differentiation of neutrophils in CFA-immunised mice. In IFN-γ KO mice, treatment was associated with almost complete inhibition of arthritis due to its reduced neutrophilia and osteoclast formation. Disease symptoms were ameliorated although slight increases in IL-6, TNF-α and IL-17 were detected upon G-CSFR inhibition in the IFN-γ KO mice, associated with mild increases in weight loss, tail damage and immature RBCs.

CONCLUSION: We described the role of G-CSF in a sJIA-like mouse model and point towards an important role for G-CSF-induced myelopoiesis and neutrophilia, regulating the development of arthritis.

PMID:35243819 | DOI:10.1002/art.42104

J Med Imaging Radiat Oncol. 2022 Mar 3. doi: 10.1111/1754-9485.13398. Online ahead of print.

ABSTRACT

INTRODUCTION: We aimed to explore the prognostic value of albumin-bilirubin (ALBI) scores in unresectable hepatocellular carcinoma (HCC) treated with combined immune checkpoint inhibitors (ICIs) and radiotherapy (RT).

METHODS: Patients with unresectable HCC receiving combined ICI and RT (July 2018 to February 2021) were retrospectively enrolled and analysed. Cox regression modelling was implemented to identify prognostic factors. Survival analysis was performed using the Kaplan-Meier method. Survival was compared using log-rank tests.

RESULTS: A total of 38 patients were enrolled. The median follow-up was 16.5 months (range: 6.7-29.9). The objective response rate (ORR) was 28.9%, including complete response in three (7.9%) patients. The median progression-free survival (PFS) was 5.6 months (95% confidence interval (CI): 3.2-8.0), and the median overall survival (OS) was 12.9 months (95% CI: 8.3-17.6). In the multivariate Cox regression analysis, ALBI score and age were identified as independent prognostic factors for PFS and OS. Patients with grade 1 ALBI scores who were ≥53 years of age (the low-risk group) had statistically significantly higher ORRs (50.0% vs. 13.6%) and prolonged median PFS (15.3 vs. 2.7 months) and OS (not reached vs. 10.1 months). Grade 3 haematological toxicities and/or liver function abnormalities occurred in 15 (39.5%) patients; treatment was not interrupted. No grade 4 or higher side effects were observed.

CONCLUSION: Combined ICI and RT is an effective modality for treating unresectable HCC with moderate side effects. ALBI scores merits consideration when applying this combined treatment modality. These results should be validated within large cohort studies.

PMID:35243796 | DOI:10.1111/1754-9485.13398

Cancer Rep (Hoboken). 2022 Mar 3:e1612. doi: 10.1002/cnr2.1612. Online ahead of print.

ABSTRACT

BACKGROUND: Several lifestyle factors are associated with an increased risk of colorectal cancer (CRC). Although lifestyle factors co-occur, in most previous studies these factors have been studied focusing upon a single risk factor or assuming independent effects between risk factors.

AIM: To examine the pairwise effects and interactions of smoking, alcohol consumption, physical inactivity, and body mass index (BMI) with risk of subsequent colorectal cancer (CRC).

METHODS AND RESULTS: We used METCA cohort data (pooled data from seven population-based Finnish health behavior survey studies during years 1972-2015) consisting of 171 063 women and men. Participants’ smoking, alcohol consumption, physical inactivity and BMI measures were gathered, and participants were categorized into those exposed and those not exposed. The incidence of CRC was modeled by Poisson regression with main and interaction effects of key lifestyle factors. The cohort members were followed-up through register linkage to the Finnish Cancer Registry for first primary CRC case until the end of 2015. Follow-up time was 1715, 690 person years. The highest pairwise CRC risk was among male smokers who had overweight (BMI ≥ 25 kg/m² ) (HR 1.75, 95% CI 1.36-2.26) and women who had overweight and consumed alcohol (HR 1.45, 95% CI 1.14-1.85). Overall, among men the association of lifestyle factors and CRC risk was stronger than among women. In men, both having overweight and being a smoker combined with any other adverse lifestyle factor increased CRC risk. Among women, elevated CRC risks were observed for those who were physically inactive and who consumed alcohol or had overweight. No statistically significant interactions were detected between pairs of lifestyle factors.

CONCLUSIONS: This study strengthens the evidence of overweight, smoking, and alcohol consumption as CRC risk factors. Substantial protective benefits in CRC risk can be achieved by preventing smoking, maintaining BMI to <25 kg/m² and not consuming alcohol.

PMID:35243812 | DOI:10.1002/cnr2.1612

Emerg Med Australas. 2022 Mar 3. doi: 10.1111/1742-6723.13954. Online ahead of print.

ABSTRACT

OBJECTIVE: Paediatric trauma is a major cause of morbidity and mortality in those aged 0-14. Anatomical and physiological differences require a specialised approach to paediatric trauma care. Medical imaging, particularly computed tomography (CT) scans, requires specific consideration because of the consequences of radiation exposure in the paediatric population. The present study compares current practice of CT scan ordering in paediatric trauma patients at a regional Australian hospital against consensus guidelines published in the UK.

METHODS: A retrospective audit of paediatric trauma CT scans referred from the ED from May 2017 to May 2018 was completed. Details relating to CT scan ordering were reviewed and compliance with the Royal College of Radiologists Paediatric trauma protocols, was determined. Descriptive statistics and χ² tests comparing those that met and did not meet guidelines were performed.

RESULTS: A total of 71 CT scans were included with an overall compliance rate of 56.3%. Specific regional compliance was lowest with CT neck at 14%. Patients where a trauma call was initiated were more likely to receive a full body (pan) scan rather than region specific imaging. Compliance improved when paediatric team involvement was documented.

CONCLUSIONS: Evidence-based guidelines for CT imaging in paediatric trauma are essential to reduce unnecessary radiation exposure for children. The present study has demonstrated that current practice has the potential to be improved and that decisions should involve a multidisciplinary team.

PMID:35243766 | DOI:10.1111/1742-6723.13954

Obes Rev. 2022 Mar 3:e13438. doi: 10.1111/obr.13438. Online ahead of print.

ABSTRACT

The extent to which behavioral weight management interventions affect health inequalities is uncertain, as is whether trials of these interventions directly consider inequalities. We conducted a systematic review, synthesizing evidence on how different aspects of inequality impact uptake, adherence, and effectiveness in trials of behavioral weight management interventions. We included (cluster-) randomized controlled trials of primary care-applicable behavioral weight management interventions in adults with overweight or obesity published prior to March 2020. Data about trial uptake, intervention adherence, attrition, and weight change by PROGRESS-Plus criteria (place of residence, race/ethnicity, occupation, gender, religion, education, socioeconomic status, social capital, plus other discriminating factors) were extracted. Data were synthesized narratively and summarized in harvest plots. We identified 91 behavioral weight loss interventions and 12 behavioral weight loss maintenance interventions. Fifty-six of the 103 trials considered inequalities in relation to at least one of intervention or trial uptake (n = 15), intervention adherence (n = 15), trial attrition (n = 32), or weight outcome (n = 34). Most trials found no inequalities gradient. If a gradient was observed for trial uptake, intervention adherence, and trial attrition, those considered “more advantaged” did best. Alternative methods of data synthesis that enable data to be pooled and increase statistical power may enhance understanding of inequalities in behavioral weight management interventions.

PMID:35243743 | DOI:10.1111/obr.13438