Tag: statistics

Anesth Pain Med (Seoul). 2021 Oct;16(4):368-376. doi: 10.17085/apm.21035. Epub 2021 Oct 14.

ABSTRACT

BACKGROUND: Epidural block placement in pediatric patients is technically challenging for anesthesiologists. The use of ultrasound (US) for the placement of an epidural catheter has shown promise. We compared landmark-guided and US-guided lumbar or lower thoracic epidural needle placement in pediatric patients.

METHODS: This prospective, randomized, comparative trial involved children aged 1-6 years who underwent abdominal and thoracic surgeries. Forty-five children were randomly divided into two groups using a computer-generated random number table, and group allocation was performed by the sealed opaque method into either landmark-guided (group LT) or real-time ultrasound-guided (group UT) epidural placement. The primary outcome was a comparison of the procedure time (excluding US probe preparation). Secondary outcomes were the number of attempts (re-insertion of the needle), bone contacts, needle redirection, skin-to-epidural distance using the US in both groups, success rate, and complications.

RESULTS: The median (interquartile range) time to reach epidural space was 105.5 (297.0) seconds in group LT and 143.0 (150) seconds in group UT (P = 0.407). While the first attempt success rate was higher in the UT group (87.0% in UT vs. 40.9% in LT; P = 0.004), the number of bone contacts, needle redirections, and procedure-related complications were significantly lower.

CONCLUSIONS: The use of US significantly reduced needle redirection, number of attempts, bone contact, and complications. There was no statistically significant difference in the time to access the epidural space between the US and landmark technique groups.

PMID:35139618 | DOI:10.17085/apm.21035

Acta Ortop Mex. 2021 Jul-Aug;35(4):311-316.

ABSTRACT

OBJECTIVE: Clinical and functional evaluation of patients with Lisfranc lesion without work or sport cause and treated in our center.

MATERIAL AND METHODS: Thirteen patients with Lisfranc lesion without occupational or sports causes were divided into two groups, high-energy and low-energy injuries. Were analyzed the return to work and sports activity prior to the injury and the use of footwear and insoles after the injury. Also were assessed AOFAS and EVA postoperative score and posterior complications after lesion recovery.

RESULTS: High-energy group included 7 patients who underwent surgery on an average of 7.3 days. Of the total of patients, 4 presented post-surgical sequelae. Of these patients, one patient was unable to return to their previous work activity and two patients were unable to practice the usual sports activity. The AOFAS was 79.4 and EVA 2.8. In the low energy group, we found six patients operated on 5.6 days on average. All of them were able to return to their previous work and sports activity. The AOFAS were 84.8 and the EVA 1.6. Statistically significant differences were not observed in any of the variables studied.

CONCLUSION: Patients with Lisfranc injury out of laboral or sports background present good clinical and functional results.

PMID:35139588

Rev Bras Ginecol Obstet. 2022 Feb 9. doi: 10.1055/s-0042-1742411. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze whether acetylsalicylic (ASA) intake modifies the mean uterine arteries pulsatility index (UtA-PI) at the 2^nd or 3^rd trimester in a cohort of pregnant women with abnormal mean UtA-PI at between 11 and 14 weeks of gestation.

METHODS: This is a retrospective cohort study. Singleton pregnancies with abnormal mean UtA-PI at between 11 and 14 weeks of gestation were studied. The participants were divided into 3 groups: 1) If the participant did not take ASA during pregnancy; 2) If the participant took ASA before 14 weeks of gestation; and 3) If the participant took ASA after 14 weeks of gestation. The mean UtA-PI was evaluated at the 2^nd and 3^rd trimesters, and it was considered to improve when it decreased below the 95^th percentile. The prevalence ratio (PR) and the number needed to treat (NNT) were calculated.

RESULTS: A total of 72 participants with a mean UtA-PI > 95^th percentile at the 1^st trimester of gestation were evaluated. Out of the 18 participants who took ASA, 8 participants started it before 14 weeks of gestation and 10 after. A total of 33.3% of these participants had improved the mean UtA-PI at the 2^nd and 3^rd trimesters of gestation, although it was not statistically significant (p = 0.154). The prevalence ratio was 0.95 (95% confidence interval [CI]: 0.31-1.89), but between the 1^st and 2^nd trimesters of gestation, the PR was 0.92 (95%CI: 0.21-0.99) and it was statistically significant.

CONCLUSION: The present work demonstrates a modification of the mean UtA-PI in participants who took ASA compared with those who did not. It is important to check if ASA can modify the normal limits of uterine arteries because this could have an impact on surveillance.

PMID:35139575 | DOI:10.1055/s-0042-1742411

Acta Ortop Mex. 2021 Jul-Aug;35(4):305-310.

ABSTRACT

INTRODUCTION: The hallux valgus is a very frequent and complex orthopedic pathology. It involves the bone and soft tissue structures of the first toe. There are multiple techniques described for the alignment of the first toe. All technics aim to restore the normal angulation of the toe while using a stable osteotomy through a painless surgical procedure. The minimal invasive techniques have been growing in acceptance since the year 2000, as a viable surgical alternative to treat this pathology.

MATERIAL AND METHODS: We included patients with a diagnostic of mild or moderate hallux valgus on whom a minimal invasive procedure was performed to correct the deformity of the first toe. We performed a distal Reverdin/Isham osteotomy on the first metatarsal and an akin osteotomy in the proximal phalanx, a lateral capsular release and a abductor tenotomy. These patients were followed for 24 months after their surgery.

RESULTS: Our patients had an adequate correction angular correction, for a distal osteotomy. They had a good pain control, with an adequate mobility in the postoperative period. The patients presented an adequate personal satisfaction, 87% of them had good results. We found an important and statistically significant improvement in the Kitaoka scale.

CONCLUSION: The minimal invasive technics for the correction of mild or moderated hallux valgus are a good alternative. Our patients are satisfied with the functional, and cosmetic results.

PMID:35139587

Rev Bras Ginecol Obstet. 2022 Feb 9. doi: 10.1055/s-0042-1742405. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to compare the frequency of the occurrence of high-risk human papillomavirus (HPV) and abnormal anal cytology in immunocompetent women with and without HPV-induced genital lesions.

METHODS: This analytical cross-sectional, observational study was conducted between July 2017 and December 2018 in a specialized outpatient clinic of a tertiary hospital in Fortaleza, CE. Fifty-seven immunocompetent women with and without genital intraepithelial lesions were assessed; they were divided into two groups: group 1 was comprised of women with HPV-associated genital lesions (n = 26), and group 2 was comprised of those without HPV-associated genital lesions (n = 31). Samples for liquid-based cytology and high-risk DNA-HPV polymerase chain reaction real-time tests were collected from the cervix and anus. All cases were evaluated using high-resolution anoscopy; biopsies were performed when required. The Fisher exact and chi-squared tests were applied for consolidated data in the contingency table, and the Student t-test and Mann-Whitney U-test for independent variables.

RESULTS: Anal high-risk HPV infections were more frequent in group 1 (odds ratio [OR], 4.95; 95% confidence interval [CI], 1.34-18.3; p = 0.012), along with concomitant high-risk HPV infections in the uterine cervix and the anus (OR 18.8; 95% CI, 2.20-160; p < 0.001). The incidence of high-risk cervical HPV infection was associated with high-risk anal HPV infection (OR, 4.95; 95% CI, 1.34-18.3; p = 0.012). There was no statistical difference concerning abnormal anal cytology or anoscopy between the groups, and no anal intraepithelial lesion was found in either group.

CONCLUSION: Immunocompetent women with HPV-associated genital lesions and high-risk cervical HPV were more likely to have high-risk anal HPV.

PMID:35139570 | DOI:10.1055/s-0042-1742405

Rev Bras Ginecol Obstet. 2022 Feb 9. doi: 10.1055/s-0042-1742404. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze the historical clinical outcomes of children with myelomeningocele (MMC) meeting the criteria for fetal surgery, but who underwent postnatal primary repair.

METHODS: Data from children undergoing postnatal MMC repair between January 1995 and January 2015 were collected from the Neurosurgery Outpatient Clinic’s medical records. Children were included if they had ≥ 1 year of postoperative follow-up and met the criteria for fetal surgery. The children’s data were then stratified according to whether they received a shunt or not. The primary outcome was mortality, and secondary outcomes were educational delays, hospitalization, recurrent urinary tract infections (UTIs), and renal failure.

RESULTS: Over the 20-year period, 231 children with MMC were followed up. Based on clinical data recorded at the time of birth, 165 (71.4%) qualify of fetal surgery. Of the 165 patients, 136 (82.4%) underwent shunt placement. The mortality rate was 5.1% in the group with shunt and 0% in the group without, relative risk (RR) 3.28 (95% confidence interval, 95% CI, 0.19-55.9). The statistically significant RRs for adverse outcomes in the shunted group were 1.86 (95% CI, 1.01-3.44) for UTI, 30 (95% CI, 1.01-537) for renal failure, and 1.77 (95% CI, 1.09-2.87) for hospitalizations.

CONCLUSION: Children with MMC qualifying for fetal surgery who underwent shunt placement were more likely to have recurrent UTIs, develop renal failure, and be hospitalized. Since approximately half of the shunt procedures could be avoided by fetal surgery, there is a clinical benefit and a possible financial benefit to the implementation of this technology in our setting.

PMID:35139573 | DOI:10.1055/s-0042-1742404

Ophthalmic Res. 2022 Feb 9. doi: 10.1159/000522219. Online ahead of print.

ABSTRACT

INTRODUCTION: Hypertension is known to impact the structure and function of the ocular vascular system and is an established risk factor for many eye diseases. This study aimed to detect the blood flow in the optic disc and macula in patients with essential hypertension and to analyze its correlation with serum cystatin C (Cys-C) levels.

METHODS: This single center, cross-sectional study included 100 patients with primary hypertension without hypertensive retinopathy, who were divided into an experimental group (50 cases, 50 eyes) with elevated serum Cys-C levels and a control group (50 cases, 50 eyes) with normal serum Cys-C . The optic disc and macular vessel density (VD) and vascular perfusion density (PD) were assessed using optical coherence tomography angiography (OCTA). Data such as the area, perimeter, and circularity of the foveal avascular zone (FAZ) were analyzed.

RESULTS: There were statistically significant between-group differences in the VD and PD of the optic disc (P<0.05). Spearman correlation analysis of related indicators revealed that serum Cys-C was positively correlated with creatinine, uric acid, and FAZ circularity (P<0.05). Furthermore, serum Cys-C was negatively correlated with optic disc VD and PD in some regions(P<0.05).

CONCLUSION: In patients with essential hypertension, serum Cys-C is negatively correlated with VD and PD in the inner layer of the optic disc (zone 10).

PMID:35139514 | DOI:10.1159/000522219

Comput Methods Programs Biomed. 2022 Jan 23;216:106650. doi: 10.1016/j.cmpb.2022.106650. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Retinal vessels provide valuable information when diagnosing or monitoring various diseases affecting the retina and disorders affecting the cardiovascular or central nervous systems. Automated retinal vessel segmentation can assist clinicians and researchers when interpreting retinal images. As there are differences in both the structure and function of retinal arteries and veins, separating these two vessel types is essential. As manual segmentation of retinal images is impractical, an accurate automated method is required.

METHODS: In this paper, we propose a convolutional neural network based on serially connected U-nets that simultaneously segment the retinal vessels and classify them as arteries or veins. Detailed ablation experiments are performed to understand how the major components contribute to the overall system’s performance. The proposed method is trained and tested on the public DRIVE and HRF datasets and a proprietary dataset.

RESULTS: The proposed convolutional neural network achieves an F₁ score of 0.829 for vessel segmentation on the DRIVE dataset and an F₁ score of 0.814 on the HRF dataset, consistent with the state-of-the-art methods on the former and outperforming the state-of-the-art on the latter. On the task of classifying the vessels into arteries and veins, the method achieves an F₁ score of 0.952 for the DRIVE dataset exceeding the state-of-the-art performance. On the HRF dataset, the method achieves an F₁ score of 0.966, which is consistent with the state-of-the-art.

CONCLUSIONS: The proposed method demonstrates competitive performance on both vessel segmentation and artery vein classification compared with state-of-the-art methods. The method outperforms human experts on the DRIVE dataset when classifying retinal images into arteries, veins, and background simultaneously. The method segments the vasculature on the proprietary dataset and classifies the retinal vessels accurately, even on challenging pathological images. The ablation experiments which utilize repeated runs for each configuration provide statistical evidence for the appropriateness of the proposed solution. Connecting several simple U-nets significantly improved artery vein classification performance. The proposed way of serially connecting base networks is not limited to the proposed base network or segmenting the retinal vessels and could be applied to other tasks.

PMID:35139461 | DOI:10.1016/j.cmpb.2022.106650

Ophthalmologica. 2022 Feb 9. doi: 10.1159/000522263. Online ahead of print.

ABSTRACT

BACKGROUND: Macular edema can be a cause of visual loss in eyes undergoing vitrectomy with epiretinal membrane(ERM) peeling.

OBJECTIVE: To evaluate the efficacy of combined vitrectomy with intravitreal corticosteroid injection for ERM.

METHODS: We conducted a systematic literature review by searching PubMed, Embase, and Medline up to December 2020 for studies that evaluated the effect of intravitreal corticosteroid injection during vitrectomy for ERM. Follow-up data on postoperative best-corrected visual acuity (BCVA) and central macular thickness (CMT) were collected and pooled using the standard mean deviation (SMD) with the corresponding 95% confidence interval (CI). Heterogeneity was statistically quantified using I2 statistics, and a meta-analysis was performed using a random-effects model.

RESULTS: Eight studies provided data on a total sample of 443 eyes. The meta-analysis revealed that concomitant intravitreal corticosteroid administration during vitrectomy contributed to a significant reduction in CMT than vitrectomy alone at 3 months after operation (pooled SMD = -0.353; 95% CI, -0.594 to -0.111; p = 0.004). However, between the two groups, no significant difference was found in CMT reduction at 1 and 6 months after operation and in postoperative BCVA improvement at 1, 3, and 6 months after operation.

CONCLUSION: Combined treatment with vitrectomy and intravitreal corticosteroid injection may accelerate CMT reduction 3 months after ERM surgery. However, it did not result in a significant change in CMT and BCVA compared with vitrectomy alone at the end of follow-up.

PMID:35139513 | DOI:10.1159/000522263

Comput Methods Programs Biomed. 2022 Feb 1;216:106677. doi: 10.1016/j.cmpb.2022.106677. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Photoplethysmography (PPG) is a device that measures the amount of light absorbed by the blood vessel, blood, and tissues, which can, in turn, translate into various measurements such as the variation in blood flow volume, heart rate variability, blood pressure, etc. Hence, PPG signals can produce a wide variety of biological information that can be useful for the detection and diagnosis of various health problems. In this review, we are interested in the possible health disorders that can be detected using PPG signals.

METHODS: We applied PRISMA guidelines to systematically search various journal databases and identified 43 PPG studies that fit the criteria of this review.

RESULTS: Twenty-five health issues were identified from these studies that were classified into six categories: cardiac, blood pressure, sleep health, mental health, diabetes, and miscellaneous. Various routes were employed in these PPG studies to perform the diagnosis: machine learning, deep learning, and statistical routes. The studies were reviewed and summarized.

CONCLUSIONS: We identified limitations such as poor standardization of sampling frequencies and lack of publicly available PPG databases. We urge that future work should consider creating more publicly available databases so that a wide spectrum of health problems can be covered. We also want to promote the use of PPG signals as a potential precision medicine tool in both ambulatory and hospital settings.

PMID:35139459 | DOI:10.1016/j.cmpb.2022.106677