Tag: statistics

Otol Neurotol. 2021 Jun 25. doi: 10.1097/MAO.0000000000003245. Online ahead of print.

ABSTRACT

HYPOTHESIS: We hypothesized that an anomalous change of Notch signaling might be involved in the pathophysiology of cholesteatoma.

BACKGROUND: The Notch signaling pathway regulates integrated growth and differentiation control of keratinocytes. Its involvement in cholesteatoma proliferation has not been elucidated.

METHODS: We obtained cholesteatoma and external auditory canal (EAC) skin samples from patients with middle ear cholesteatoma who underwent tympanomastoid surgery. We performed polymerase chain reaction using the RT2 Profiler™ PCR Array Human Notch Signaling Pathway (Qiagen) in the cholesteatoma and EAC skin samples (n = 6 each). This was followed by immunohistochemical staining of Notch1, enhancer of split-1 (HES1), and p53 in 41 and 8 cholesteatoma and EAC skin samples, respectively.

RESULTS: The fold change of Notch1 gene expression was lowest in cholesteatoma, with a statistically significant difference (p = 0.0424). Moreover, the fold change of HES1 expression decreased (p = 0.272). The positive rates of Notch1 and HES1 protein expressions in the cholesteatoma (48.5 ± 32.4% and 44.9 ± 17.8%, respectively) were significantly lower than in the EAC skin (83.4 ± 17.5% and 55.7 ± 7.1%, respectively) (p < 0.001 and p < 0.01). In contrast, the positive rate of p53 expression in the cholesteatoma (8.5 ± 11.4%) was significantly higher than in the EAC skin (0.5 ± 0.7%) (p < 0.001).

CONCLUSION: The decreases in Notch1 and HES1 protein expression might play an important role in the hyperproliferative character of the keratinizing squamous epithelium in cholesteatoma. An increase in p53 might reflect the reaction to cellular hyperproliferation.

PMID:34172659 | DOI:10.1097/MAO.0000000000003245

Otol Neurotol. 2021 Jun 25. doi: 10.1097/MAO.0000000000003251. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess outcomes after surgery for vestibular schwannoma in patients over 70 years of age.

STUDY DESIGN: Retrospective chart review.

SETTING: Two tertiary otology and neurotology centers.

PATIENTS AND INTERVENTIONS: Patients undergoing primary surgery for vestibular schwannoma between 2007 and 2018.

MAIN OUTCOME MEASURES: Postoperative complications and surgical outcomes.

RESULTS: A total of 452 patients met inclusion criteria, 31 of whom (6.9%) were over 70 years of age. Age ranged from 18 to 90 years with a mean of 53 years. Elderly patients were more likely to have pre-existing hypertension (58.1% versus 34.0%, p = 0.007) and diabetes mellitus (19.4% versus 7.4%, p = 0.02). Elderly patients were less likely to undergo gross total resections of their tumors (35.5% versus 60.6%, p = 0.05) although they were not statistically significantly more likely to undergo subtotal (<95%) resections (25.8% versus 14.7%, p > 0.05). Elderly patients were also less likely to undergo second stage procedures (0% versus 9.5%, p = 0.04). There were no significant differences between elderly and non-elderly patients in the rates of any complications, ultimate facial nerve function, or duration of surgery. No patients over 70 years of age expired within 1 year of surgery.

CONCLUSIONS: Conservative surgery for vestibular schwannoma in appropriately selected elderly patients is appropriate and safe, given adequate consideration to risk-benefit analysis and goals of care.

PMID:34172668 | DOI:10.1097/MAO.0000000000003251

J Strength Cond Res. 2021 Jun 22. doi: 10.1519/JSC.0000000000004089. Online ahead of print.

ABSTRACT

Gomez-Hixson, K, and Brown, ML. Implementation of an educational fueling station for a NCAA division III athletic program. J Strength Cond Res XX(X): 000-000, 2021-The purpose of this project was to evaluate the effectiveness and sustainability of an educational fueling station for National Collegiate Athletic Association (NCAA) Division III student-athletes. Subjects included student-athletes participating in the fall 2018 athletic season (n = 82). Once the mobile fueling station was established, the athletes were informed of the mobile fueling station policies and educated on the appropriate use and timing of the fueling station. The fueling station remained in operation until the end of the 2018 fall athletic season, after which the effectiveness and athlete acceptance of the mobile fueling station was assessed. An anonymous online survey was used as the assessment tool and was created by the authors based on the information pertinent to our institution and mobile fueling station goals and objectives. An itemized inventory usage tracking system was used to calculate actual costs. Data analysis was limited to basic descriptive statistics including the overall response rate and the frequency and percentage of responses to the survey questions. Outcome assessment indicated that 97% of athletes found that the foods provided helped their performance; 95% felt they were properly oriented to the fueling station, and 51% used the fueling station 1-2 times per week on game days. Furthermore, inventory tracking revealed that the operational costs came in under the projected budget. Overall, the mobile fueling station was successfully implemented for student-athletes within a NCAA Division III university and demonstrated feasibility and sustainability within a low-budget athletic program. Establishing proof of concept led to the permanent adoption of the mobile fueling station.

PMID:34172635 | DOI:10.1519/JSC.0000000000004089

J Strength Cond Res. 2021 Jun 22. doi: 10.1519/JSC.0000000000004081. Online ahead of print.

ABSTRACT

Hibbert, JE, Klawiter, DP, Schubert, MM, Nessler, JA, and Asakawa, DS. Strength, cardiovascular fitness, and blood lipid measures in law enforcement personnel after a 12-week health promotion program. J Strength Cond Res XX(X): 000-000, 2021-Law enforcement personnel often have high rates of cardiovascular disease and injury. Health promotion programs have been found to successfully encourage behavior change among law enforcement personnel, but these programs can often be intensive and expensive. Thus, the purpose of this study was to examine the efficacy of a health promotion program on body composition, metabolic health, muscle strength, and cardiovascular endurance in law enforcement personnel. Active duty officers from a local law enforcement agency were invited to participate in a 12-week health promotion program that included activity tracking and exercise and nutrition education. Eighteen subjects underwent measurements of body composition, V[Combining Dot Above]O2max through treadmill test, knee extensor strength, and blood lipids. An a priori alpha level for significance was set at 0.05, and comparisons were assessed using paired t-tests. Overall, subjects improved blood lipid levels evidenced by movement of mean values toward established healthy ranges. Although 8 subjects improved their V[Combining Dot Above]O2max (range: 1.3-30% change), there was large variability and no statistically significant differences in measures of V[Combining Dot Above]O2max (pre: 38.48 ± 5.86 ml·kg·min-1; post: 39.27 ± 5.26 ml·kg·min-1), body composition (pre: 26.52 ± 8.02% body fat; post: 26.44 ± 7.45% body fat), and strength normalized to body mass (isometric pre: 1.45 ± 0.45; post: 1.08 ± 0.36). Although no significant changes were noted, promising trends in these data suggest that health promotion programs with a modified focus may lead to positive changes in overall health.

PMID:34172638 | DOI:10.1519/JSC.0000000000004081

Otol Neurotol. 2021 Jun 25. doi: 10.1097/MAO.0000000000003163. Online ahead of print.

ABSTRACT

OBJECTIVE: To describe a new stapedotomy in which is removed only the stapes head not the entire stapes superstructure and its long-term results.

STUDY DESIGN: Prospective study.

PATIENTS: The study was started on January 2015 and ended on September 2020. Seventy patients with otosclerosis were included in the study. They underwent stapedotomy from January 2015 to April 2016. The main follow-up for the study group was (5.1 yrs). The study group was divided into two groups (A and B) according the short hearing results (1 yr) and long hearing results (5.1 yrs). Group A including short hearing results. Group B including long hearing results. For all patients in groups A and B, the surgeon (M.G.), microscope, the anesthesia (local), the approach (transcanal), the prostheses (piston-type), and the new stapedotomy (removal of the stapes head only and not of the entire stapes superstructure), were identical.

RESULTS: No patients exhibited postoperative dizziness or worsening of bone conduction. Cutting the stapes neck never caused bleeding or footplate complications. The average time to perform the new stapedotomy was 15 minutes. Air-bone gap (ABG) closure to within 10 dB was achieved in 66 of 70 (94.28%) cases in group A and in 65 of 70 (92.85%) cases in group B. This difference was not statistically significant.

CONCLUSION: The Malafronte’s stapedotomy is an easy, safety, minimally invasive, and fast surgical technique. Its hearing outcomes are good and stable over time.

PMID:34172650 | DOI:10.1097/MAO.0000000000003163

J Glaucoma. 2021 Jun 24. doi: 10.1097/IJG.0000000000001903. Online ahead of print.

ABSTRACT

PRECIS: A small increase in optic nerve head vessel density (VD), but not macular VD, in the evening compared to the morning is observed in healthy subjects.

PURPOSE: To evaluate the diurnal variation of the macular and optic nerve head (ONH) vessel density (VD) in healthy eyes as measured with optical coherence tomography angiography (OCT-A).

METHODS: In this prospective study of healthy individuals older than 18 years old, VD parameters, including macular whole image vessel density (wiVD), parafoveal vessel density (pfVD), ONH whole image vessel density (ONH-wiVD), ONH whole image capillary density (ONH-wiCD), circumpapillary vessel density (cpVD), and circumpapillary capillary density (cpCD), were measured with OCT-A at four time points throughout the day (8 AM, 12 PM, 4 PM, and 8 PM).

RESULTS: Twenty nine healthy eyes were included from 15 subjects (mean age: 30.9 years). After adjustment for age and mean ocular perfusion pressure (MOPP), a significant positive rate of change was found for cpVD (0.05%/hour; P=0.027). In contrast, macular VD changes were not significantly different. When comparing morning (8 AM and 12 PM) and evening (4 PM and 8 PM) measurements, there were small, but statistically significant, increases for all ONH measurements. The greatest increase was found for cpVD (0.58%; P=0.022). Significant but small increases in mean arterial pressure and MOPP were also observed.

CONCLUSIONS: There was a small increase in ONH VD, but not macular VD, in the evening compared to the morning in healthy human eyes. As the observed difference was within the measurement variability, our results suggest the timing of OCT-A examination does not affect retinal VD measurements.

PMID:34172629 | DOI:10.1097/IJG.0000000000001903

J Glaucoma. 2021 Jun 24. doi: 10.1097/IJG.0000000000001904. Online ahead of print.

ABSTRACT

PRECIS: We retrospectively reviewed records of patients prescribed latanoprostene bunod to assess its efficacy and safety in a real-world clinical setting. Latanoprostene bunod was efficacious in lowering intraocular pressure and had a favorable safety profile.

PURPOSE: To evaluate the usage of latanoprostene bunod 0.024%, the first topical nitric oxide donating prostaglandin analog for reducing intraocular pressure, in clinical practice.

PATIENTS AND METHODS: Retrospective review identified patients prescribed latanoprostene bunod by 5 glaucoma specialists at an academic center from 1/2018-11/2019. 56 patients (102 eyes) met inclusion criteria of an intraocular pressure measured at the visit latanoprostene bunod was prescribed and at 2 visits ≥7 days after beginning treatment, with no surgeries, lasers or medication changes during follow-up. Main outcome measures were intraocular pressure, number of ocular medications, and adverse effects.

RESULTS: Intraocular pressure (mean±standard deviation mmHg) at the visit latanoprostene bunod was prescribed was 16.2±4.3 on 3.2±1.5 glaucoma medications. IOP at most recent visit was 13.7±3.8 on 3.2±1.6 medications. Mean intraocular pressure reduction was 2.1±3.5 (P<0.0001) at first follow-up, after 38.7±36.5 days, and 2.5±3.3 (P<0.0001) at last follow-up, after 235.9±160.8 days. Pressure decreased ≥2▒mmHg in 60%, ≥3▒mmHg in 46%, and ≥4▒mmHg in 34% of eyes. All patients received latanoprostene bunod as replacement for a prostaglandin analog or latanoprost/netarsudil fixed-dose combination. 43 patients remained on latanoprostene bunod throughout the follow-up period. 7 were discontinued for insufficient pressure control, 4 for adverse effects including pain and itching, and 2 for financial reasons.

CONCLUSIONS: In two years of clinical use of latanoprostene bunod, patients exhibited intraocular pressure reductions that were statistically significant overall and clinically meaningful in 60% of patients. Latanoprostene bunod was well-tolerated and may be more efficacious than traditional prostaglandin analogs.

PMID:34172630 | DOI:10.1097/IJG.0000000000001904

Shock. 2021 Jun 24. doi: 10.1097/SHK.0000000000001827. Online ahead of print.

ABSTRACT

INTRODUCTION: Early diagnosis and treatment can reduce the risk of organ failure and mortality in systemic inflammatory conditions. Heart rate variability (HRV) has potential for early identification of the onset of systemic inflammation, as it may detect changes in sympathetic nervous system activity resulting from the developing inflammatory response before clinical signs appear. With the use of new methodologies, we investigated the onset and kinetics of HRV changes as well as several inflammatory parameters and symptoms during experimental human endotoxemia, a model of systemic inflammation in humans in vivo.

MATERIAL AND METHODS: Healthy volunteers were intravenously administered lipopolysaccharide (LPS, n = 15) or placebo (n = 15). HRV was determined using a wireless wearable device, and parameters low to high frequency (LF:HF) ratio, root mean square of the successive differences (RMSSD), and standard deviation of normal-to-normal R-R intervals (SDNN)were calculated through 1-min-rolling 6-minute windows. Plasma cytokine levels and flu-like symptoms and vital signs were serially assessed.

RESULTS: The increase in LF:HF ratio, reflecting sympathetic predominance, was more pronounced in the LPS group compared to the placebo group, with the difference becoming statistically significant 65 minutes following LPS administration (1.63 [1.42-1.83] vs. 1.28 [1.11-1.44], p = 0.005). Significant between-group differences in RMSSD and SDNN were observed from 127 and 140 minutes post-LPS administration onwards, respectively. Plasma cytokine levels showed significant between-group differences staring 60 minutes post-LPS. For symptom score, heart rate, temperature and diastolic blood pressure, significant differences compared with the placebo group were observed at 90, 118, 120, and 124 minutes post-LPS, respectively.

CONCLUSION: In a controlled human model of systemic inflammation, elevations in the LF:HF ratio followed very shortly after elevations in plasma cytokine levels and preceded onset of flu-like symptoms and alterations in vital signs. HRV may represent a promising non-invasive tool for early detection of a developing systemic inflammatory response.

PMID:34172613 | DOI:10.1097/SHK.0000000000001827

J Addict Med. 2021 Jun 24. doi: 10.1097/ADM.0000000000000874. Online ahead of print.

ABSTRACT

OBJECTIVE: During the COVID-19 pandemic, states have had to confront a drug overdose problem associated with the pandemic. The objective of this study was to identify the impact of the COVID-19 pandemic on the opioid epidemic in the state of Ohio by describing the changes in the quarterly opioid overdose deaths (OOD) over the last 10 years.

METHODS: This longitudinal study included OOD data from death records obtained through the Ohio Department of Health. Temporal trend analysis and visualizations were performed on the OOD death rate per 100,000 quarterly from 2010 to 2020. Age, sex, and ethnicity were also analyzed.

RESULTS: The OOD rate of 11.15 in Q2 of 2020 was statistically equivalent to the previous peak level of 10.87 in Q1 of 2017. There was a significant increase in the OOD rate from Q1 to Q2 of 2020 and a significant difference between the actual Q2 of 2020 OOD rate and the predicted OOD rate. The poisoning indicator fentanyl was present in 94% of OOD during Q2 of 2020. The total number of OOD remains highest in the White population. There was no significant difference between the actual and predicted OOD rates in the Black population of Q2 of 2020 based on the trend line. However, the OOD rate of 14.29 in Q2 of 2020 was significantly higher than the previous peak level of 8.34 in Q2 of 2017. The Q2 of 2020 OOD rates for 18 to 39 and 40+ age groups were significantly higher from what would be expected from the trend predictions.

CONCLUSIONS: Based on these findings, Ohio has entered a COVID19 pandemic mediated fourth wave in the opioid epidemic. These findings further suggest that as efforts are made to address the worldwide COVID-19 pandemic, states need to maintain their vigilance toward combating the local opioid epidemic.

PMID:34172625 | DOI:10.1097/ADM.0000000000000874

Int J Clin Pract. 2021 Jun 25:e14575. doi: 10.1111/ijcp.14575. Online ahead of print.

ABSTRACT

Successful management of psychiatric disorders is affected by patient perspectives and several barriers, i.e., conceptual, psychological, social, or logistic reasons that can decrease patient adherence to therapy. In this perspective, pharmacists have a vital role in identifying patients in need of help and in dealing with barriers. The aim of this study was to investigate perspectives of patients diagnosed with psychiatric disorders, living in rural areas in Jerash, Jordan, regarding their awareness about their conditions, including religious and cultural factors, adherence to their treatment and related barriers, with special focus on pharmacist’s role. This cross-sectional survey study was conducted in Jordan from August to November 2019. A validated questionnaire was administered by two pharmacy students via a structured interview with patients waiting for their appointment in the psychiatric clinic. Data were analyzed using the Statistical Package for the Social Sciences. One hundred twenty patients (age 39.4±9.5, 66.7% males) completed the questionnaire. Most of them (71.0%) reported adherence to their medications, and 47.5% reported complete control of their symptoms with treatment. Most patients (59.2%) reported that they perceive their psychiatric problem in terms of religious faith as being counted for their favor in the Hereafter, and 52.5% of them always/usually looked at themselves positively and unaffected by their psychiatric problem; with both factors correlating significantly with better treatment adherence (p < 0.045 and p < 0.001; respectively). Barriers affecting adherence included mainly suffering from adverse effects (31.9%) and being unconvinced that they needed a medication (23.3%). Only 14.2% of patients reported that they refer to the pharmacist to get information about their medications. This study shows suboptimal symptom control of psychiatric patients in Jerash. Nonadherence is an issue, with barriers identified. Positive religious and self-image perspectives correlated with better adherence. Patient referral to pharmacists is minimal and needs to be optimized.

PMID:34171149 | DOI:10.1111/ijcp.14575