Tag: statistics

Chin Med J (Engl). 2021 Oct 13. doi: 10.1097/CM9.0000000000001799. Online ahead of print.

ABSTRACT

BACKGROUND: Finding an optimal treatment strategy for adolescent idiopathic scoliosis (AIS) patients remains challenging because of its intrinsic complexity. For mild to moderate scoliosis patients with lower skeletal growth potential (Risser 3-5), most clinicians agree with observation treatment; however, the curve progression that occurs during puberty, the adolescent period, and even in adulthood, remains a challenging issue for clinicians. The aim of the study is to investigate the efficacy of Schroth exercise in AIS patients with lower skeletal growth potential (Risser 3-5) and moderate scoliosis (Cobb angle 20°-40°).

METHODS: From 2015 to 2017, data of 64 patients diagnosed with AIS in Peking University Third Hospital were reviewed. Forty-three patients underwent Schroth exercise were classified as Schroth group, and 21 patients underwent observation were classified as observation group. Outcomes were measured by health-related quality of life (HRQOL) and radiographic parameters. HRQOL was assessed using the visual analog scale (VAS) scores for back, Scoliosis Research Society-22 (SRS-22) patient questionnaire. Radiographic spinopelvic parameters were obtained from anteroposterior and lateral X-rays. The pre-treatment and post-treatment HRQOL and radiographic parameters were tested to validate Schroth exercise efficacy. The inter-rater reliability of the radiographic parameters was tested using the interclass correlation coefficient (ICC). The paired t test was used to examine HRQOL and radiographic parameters. Clinical relevance between C2-C7 sagittal vertical axis (SVA) and thoracic kyphosis was analyzed using Spearman correlation.

RESULTS: In Schroth group, VAS back score, SRS-22 pain, and SRS-22 self-image domain were significantly improved from pre-treatment 3.0 ± 0.8, 3.6 ± 0.5, and 3.5 ± 0.7 to post-treatment 1.6 ± 0.6 (t = 5.578, P = 0.013), 4.0 ± 0.3 (t = -3.918, P = 0.001), and 3.7 ± 0.4 (t = -6.468, P < 0.001), respectively. No significant improvements of SRS-22 function domain (t = -2.825, P = 0.088) and mental health domain (t = -3.174, P = 0.061) were observed. The mean Cobb angle decreased from 28.9 ± 5.5° to 26.3 ± 5.2° at the final follow-up, despite no statistical significance was observed (t = 1.853, P = 0.102). The mean C2-C7 SVA value decreased from 21.7 ± 8.4 mm to 17.0 ± 8.0 mm (t = -1.224 P = 0.049) and mean T1 tilt decreased from 4.9 ± 4.2 ° to 3.5 ± 3.1° (t = 2.913, P = 0.011). No significant improvement of radiographic parameters and HRQOL were observed in observation group.

CONCLUSIONS: For AIS patients with a Risser 3-5 and a Cobb angle 20°-40°, Schroth exercises improved HRQOL and halted curve progression during the follow-up period. Both cervical spine alignment and shoulder balance were also significantly improved after Schroth exercises. We recommend Schroth exercises for patients with AIS.

PMID:34653079 | DOI:10.1097/CM9.0000000000001799

Eur J Cancer Prev. 2021 Oct 11. doi: 10.1097/CEJ.0000000000000722. Online ahead of print.

ABSTRACT

BACKGROUND: Gastric cancer is worldwide the fourth more common cancer type by incidence, and the third by mortality. We analyzed three missense variants of TAS2R38 gene: rs713598 (A49P), rs1726866 (V262A), and rs10246939 (I296V). These variants and their combination in haplotypes (proline, alanine and valine/tasters or alanine, valine and isoleucine/nontasters) and diplotypes are responsible for individual differences in bitter perception. The single-nucleotide polymorphisms and the related phenotypes are known to be associated with susceptibility to Gram-negative bacterial infections, such as Helicobacter pylori, and with risk of various cancer types. An association between intermediate tasters (as defined by TAS2R38 diplotypes) and increased risk of gastric cancer was reported in a Korean population.

METHODS: We analyzed 2616 individuals of Latin American origin, representing the whole spectrum of lesions from gastritis to gastric cancer.

RESULTS: Comparing cancer cases vs. noncancers we observed a decrease in risk associated with heterozygous carriers of rs10246939 (P = 0.006) and rs1726866 (P = 0.003) when compared with homozygotes of the more common allele. Also, the analysis of diplotypes/phenotypes reflected the same association, with super-tasters showing a borderline increased risk of developing gastric cancer compared to medium-tasters [odds ratio (OR) = 1.63; 95% confidence interval (CI), 1.04-2.56; P = 0.033]. Also, nontasters showed an increased risk when compared to medium-tasters although not reaching statistical significance (OR = 1.58; 95% CI, 0.80-2.87; P = 0.203). We also tested the interactions between the TAS2R38 genotypes and H. pylori cagA status in a subset of samples and found no interaction.

CONCLUSION: In conclusion, our results suggest only a modest contribution of TAS2R38 gene genetic variability in gastric cancer etiology.

PMID:34653070 | DOI:10.1097/CEJ.0000000000000722

Chin Med J (Engl). 2021 Oct 13. doi: 10.1097/CM9.0000000000001787. Online ahead of print.

ABSTRACT

BACKGROUND: Ankylosing spondylitis (AS) is a common chronic progressive rheumatic disease. The aim of this study was to explore factors influencing abnormal bone mineral density (BMD) in young and middle-aged patients with AS.

METHODS: From July 2014 to August 2018, hospitalized patients with AS and health examinees in the health examination center of our clinics, ranging in age from 20 to 50 years, were monitored. The BMD of the lumbar spine and femoral neck of AS patients and those of a healthy control group were measured using dual-energy X-ray absorption. The BMDs of AS patients were compared with respect to age, course of disease, iritis, smoking habits, sex, height, weight, body mass index (BMI), medication use, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), platelet volume, platelet count, uric acid (UA), alkaline phosphatase (AKP), and calcium ion levels. Single-nucleotide polymorphisms (SNPs) related to BMD were screened using genome-wide association analysis.

RESULTS: There was no statistical difference in the proportion of abnormal bone masses between the different body parts. The BMD of all bones in AS patients was lower than that in healthy controls (P < 0.05). Additionally, BMD was correlated with serum calcium and CRP in AS patients (P < 0.05), but not with age, platelet volume, platelet count, ESR, UA, AKP, height, weight, and BMI. The incidence of abnormal bone mass in AS patients was correlated with sex (P < 0.05), but not with medication use, iritis, or smoking. BMD of the lumbar spine in AS patients did not correlate linearly with the course of the disease, but BMD of the femoral neck correlated linearly with the course of the disease (P < 0.05). BMD was correlated with multiple SNPs in patients with AS. Lumbar BMD was correlated with rs7025373 and rs7848078. Femoral head BMD was correlated with 3:102157365, 3:102157417, rs1252202, rs1681355, rs3891857, rs7842614, and rs9870734, suggesting that genetic factors play a role in BMD in patients with AS.

CONCLUSIONS: The proportion of abnormal bone mass in AS patients was higher than that in healthy individuals of the same age. The factors related to BMD in patients with AS are gender, CRP, and blood calcium. The BMD of the femoral neck of AS patients decreases with the course of the disease, but BMD of the lumbar spine is not related to the course of the disease. BMD in AS patients is associated with multiple SNPs.

PMID:34653076 | DOI:10.1097/CM9.0000000000001787

J Clin Gastroenterol. 2021 Oct 14. doi: 10.1097/MCG.0000000000001618. Online ahead of print.

ABSTRACT

GOAL: Our study aimed to explore the incidence of bleeding from ulcers due to premature band slippage and to identify possible associated factors.

BACKGROUND: Band ligation (BL) plays a vital role in treating esophageal varices; however, the procedure carries a considerable risk of band slippage, variceal site ulcer formation, and posttreatment bleeding.

MATERIALS AND METHODS: We retrospectively reviewed the records of patients with esophageal varices who underwent endoscopic hemostasis by BL at our institution between 2015 and 2020. We statistically compared the patients with post-BL ulcer bleeding and those without (controls). The outcome variable was the development of BL-induced ulcer bleeding. The patients’ demographics, clinical, and laboratory parameters, and BL procedure parameters were independent variables. Univariate followed by a multivariate logistic regression were performed to identify possible associated factors from the odds ratio (OR).

RESULTS: Of the 4579 eligible patients, 388 (8.5%) presented with post-BL ulcer bleeding. The presence of high-risk stigmata indicated a 1.271 times higher risk of bleeding [95% confidence interval (CI):1.018-1.587], and a greater number of varices was associated with an increased risk of post-BL ulcer bleeding [OR=1.184 (95% CI: 1.073-1.307)]. Conversely, the use of fewer bands per variceal site was associated with fewer bleeding incidents [OR=1.308 (95% CI: 1.090-1.569)]. Univariate analysis identified proton pump inhibitor as protective [OR=0.770 (95% CI: 0.603-0.983)]; however, the difference was not significant after multivariate analysis [OR=1.283 (95% CI: 1.003-1.640)].

CONCLUSIONS: The overall incidence of post-BL ulcer bleeding was 8.5%. The presence of high-risk stigmata, higher number of varices, and bands per variceal site were associated with an increased risk of post-BL bleeding. The effect of adjuvant proton pump inhibitors was not statistically significant.

PMID:34653067 | DOI:10.1097/MCG.0000000000001618

Int J Older People Nurs. 2021 Oct 14:e12431. doi: 10.1111/opn.12431. Online ahead of print.

ABSTRACT

PURPOSE: Fall prevention is a major health concern for the ageing population. Sarcopenia is considered a risk factor for falls. Some instruments, such as Time Up and Go (TUG), are used for screening risk. The use of sensors has also been shown to be a viable tool that can provide accurate, cost-effective, and easy to manage assessment of fall risk. One novel sensor for assessing fall risk in older people is the Fallskip device. The present study evaluates the performance of the FallSkip device against the TUG method in fall risk screening and assesses its measurement properties in sarcopenic older people.

METHODS: A cross-sectional study was made in a sample of community-dwelling sarcopenic and non-sarcopenic older people aged 70 years or over.

RESULTS: The study sample consisted of 34 older people with a mean age of 77.03 (6.58) years, of which 79.4% (n = 27) were females, and 41.2% (n = 14) were sarcopenic. The Pearson correlation coefficient between TUG time and FallSkip time was 0.70 (p < 0.001). The sarcopenic individuals took longer in performing both TUG and FallSkip. They also presented poorer reaction time, gait and sit-to-stand – though no statistically significant differences were observed. The results in terms of feasibility, acceptability, reliability and validity in sarcopenic older people with FallSkip were acceptable.

CONCLUSIONS: The FallSkip device has suitable metric properties for the assessment of fall risk in sarcopenic community-dwelling older people. FallSkip analyses more parameters than TUG in assessing fall risk and has greater discriminatory power in evaluating the risk of falls.

PMID:34652070 | DOI:10.1111/opn.12431

Eur J Phys Rehabil Med. 2021 Oct 15. doi: 10.23736/S1973-9087.21.06946-X. Online ahead of print.

ABSTRACT

BACKGROUND: Brain damage can affect several functions related to speech production leading to dysphonia and dysarthria. Most rehabilitation treatments focus on articulation training rather than on pneumophonic coordination and respiratory muscle strength. Respiratory training using an Intermitted Positive Pressure Breathing (IPPB) ventilator can be used for this last purpose; no agreement on a standard protocol has been reached to date.

AIM: To evaluate the feasibility and the effectiveness of a standardized incremental protocol of respiratory training using IPPB to treat dysphonia and dysarthria.

DESIGN: Case series study.

SETTING: Neuropsychological Rehabilitation Unit in an Italian Neurorehabilitative Division.

POPULATION: Thirty two subjects with dysphonia and dysarthria resulting from neurological lesion.

METHODS: Participants were assessed using clinical evaluation scales (GIRBAS scale of dysphonia, Robertson dysarthria profile), respiratory function test, and arterial blood gas analysis in air. The evaluations were performed at baseline and after 20 sessions of respiratory training with IPPB. The protocol provided a default increment of ventilator parameters. All subjects also underwent a standard speech and language therapy treatment. A satisfaction survey to assess acceptability and the Goal Attainment Scale were applied.

RESULTS: All participants fulfilled the protocol. No complications or discomfort were reported. Subjects’ satisfaction at survey was 97.7%. After respiratory training, all respiratory function parameters increased, but only Maximal Voluntary Ventilation (MVV), Maximum Inspiratory Pressure (MIP), and Maximum Expiratory Pressure (MEP) were statistically significant (p<0.05). Clinical evaluation scales significantly improved (p<0.05). Correlation between respiratory function parameters and clinical evaluation scales showed a moderate correlation between MVV, MEP, MIP, and Robertson dysarthria profile (p<0.01). A weak correlation was found between MIP, MVV, and GIRBAS scale (p<0.05).

CONCLUSIONS: Our protocol showed to be practical and well-tolerated. After respiratory training, MVV, MIP and MEP improved in significantly. Clinical scale scores improved in all participants.

CLINICAL REHABILITATION IMPACT: Respiratory training using IPPB ventilator can be useful in implementing speech and language treatments in subjects with dysphonia and dysarthria linked to brain injury.

PMID:34652084 | DOI:10.23736/S1973-9087.21.06946-X

J Magn Reson Imaging. 2021 Oct 15. doi: 10.1002/jmri.27939. Online ahead of print.

ABSTRACT

BACKGROUND: Magnetic resonance imaging (MRI) is increasingly being used in the diagnosis and treatment planning of uveal melanoma (UM), the most common primary intraocular tumor. Initially, 7 T MRI was primarily used, but more recently these techniques have been translated to 3 T, as it is more commonly available.

PURPOSE: Compare the diagnostic performance of 3 T and 7 T MRI of UM.

STUDY TYPE: Prospective.

POPULATION: Twenty-seven UM patients (19% female).

FIELD STRENGTH/SEQUENCE: 3 T: T1- and T2-weighted three-dimensional (3D) spin echo (SE) and multi-slice (MS) SE, 7 T: T1-weighted 3D gradient echo (GE), T2-weighted 3D SE and MS SE, 3 T and 7 T GE dynamic contrast-enhanced. T1 weighted images: acquired before and after Gadolinium (Gd) administration.

ASSESSMENT: For all sequences, scan and diagnostic quality was quantified using a 5-point Likert scale. Signal intensities on T1 and T2 relative to choroid and eye muscle respectively were assessed as well as the tumor prominence. Finally, the perfusion time-intensity curves (TICs) were classified as plateau, progressive, or wash-out.

STATISTICAL TESTS: Image quality scores were compared between both field strengths using Wilcoxon signed-rank and McNemar tests. Paired t-tests and Bland-Altman were used for comparing tumor prominences. P < 0.05 was considered statistically significant.

RESULTS: Image quality was comparable between 3 T and 7 T, for 3DT1, 3DT2, 3DT1Gd (P = 0.86; P = 0.34; P = 0.78, respectively) and measuring tumor dimensions (P = 0.40). 2DT1 and 2DT2 image quality were rated better on 3 T compared to 7 T. Most UM had the same relative signal intensities at 3 T and 7 T on T1 (17/21) and T2 (13/17), and 16/18 diagnostic TICs received the same classification. Tumor prominence measurements were similar between field strengths (95% confidence interval: -0.37 mm to 0.03 mm, P = 0.097).

DATA CONCLUSION: Diagnostic performance of the evaluated 3 T protocol proved to be as capable as 7 T, with the addition of 3 T being superior in assessing tumor growth into nearby anatomical structures compared to 7 T.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 3.

PMID:34652049 | DOI:10.1002/jmri.27939

J Magn Reson Imaging. 2021 Oct 15. doi: 10.1002/jmri.27945. Online ahead of print.

ABSTRACT

BACKGROUND: Adolescents and adults with native Ebstein’s anomaly (EA) are at the benign part of the Ebstein spectrum, having survived infancy without surgery. In this population, surgical indication and timing remain objects of controversy and depend, among other factors, on exercise capacity.

PURPOSE: To better understand the pathophysiology of exercise adaptation in native EA.

STUDY TYPE: Retrospective.

POPULATION: Ten patients with unoperated EA (age range 18-61 years) and 13 healthy subjects as controls.

FIELD STRENGTH/SEQUENCE: Balanced steady-state free precession cine and phase contrast flow sequences at 1.5 T.

ASSESSMENT: We measured volumes and flows at rest and during submaximal exercise. Hemodynamic parameters including stroke volume (SV), cardiac index (CI), ejection fraction (EF), and tricuspid regurgitation (TR) were calculated.

STATISTICAL TESTS: We used nonparametric Mann-Whitney U-test and Wilcoxon signed-rank test. A P-value of <0.05 was considered statistically significant.

RESULTS: Rest CI and SV were significantly higher in controls; rest heart rate (HR) was similar in the two groups (median 71 bpm by patients and 65 bpm by controls, P = 0.448). During exercise, CI increased significantly in both groups: from 2.40 to 3.35 L/min/m² in the patient group and from 3.60 to 4.20 L/min/m² in controls; HR increased significantly in both groups. SV increased significantly in the patient group, whereas it remained stable in controls (P = 0.5284). Patients’ median TR decreased significantly: median 42% at rest and 30% during exercise; concomitantly, left ventricular (LV) preload increased significantly (+3% indexed LV end-diastolic volume) as did LVEF (median 59% at rest vs. 65% during exercise).

DATA CONCLUSION: During submaximal exercise, patients with mild to moderate EA improved their cardiovascular system’s total efficiency by increasing CI; this was obtained by an increase in HR and by the recruitment of volume, as shown by an increased LV end-diastolic volume and SV, with simultaneous decrease in TR. This was different from healthy subjects in which CI increased only due to HR increase.

LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 3.

PMID:34652053 | DOI:10.1002/jmri.27945

Microsurgery. 2021 Oct 15. doi: 10.1002/micr.30831. Online ahead of print.

ABSTRACT

BACKGROUND: Numerous studies have compared electrical devices used for flap surgery, but the results are inconsistent. This research was performed to evaluate the efficacy of two different types of electric devices: electrocautery and ultrasonic shears.

METHODS: The PubMed, Embase, and Scopus databases were searched systematically. A total of 505 cases were included in this study, including 209 electrocautery and 296 harmonic scalpel cases. The following information was retrieved from the included studies: the first author of the article, publication year, flap type, flap harvest time, drain volume, bleeding volume and postoperative complications. Hematoma, infection, flap necrosis and wound dehiscence were considered postoperative complications. The Q statistic for heterogeneity and the I² index were calculated. If I² < 50%, we used a fixed-effects model; if I² > 50%, we employed a random-effects model in our meta-analysis.

RESULTS: A total of eight studies which met the inclusion criteria were included and reviewed systematically for a meta-analysis. The harmonic scalpel yielded a statistically significantly more favorable flap harvest time and drain volume than did electrocautery. The Harmonic scalpel led to a shorter flap harvest time by 26.29 min (95% CI = -39.38 to -13.2; p < .00001) and smaller drain volume by 58.76 ml (95% CI = -105.27 to -12.25; p = .01) on average. However, there were no significant differences in the bleeding volume or incidence rates of infection, flap necrosis and wound dehiscence.

CONCLUSION: The Harmonic scalpel method yields better outcomes in terms of the flap harvest time and drain volume than does the conventional electrocautery method. Therefore, the Harmonic scalpel is a better option for cauterization and dissection in flap surgery.

PMID:34652038 | DOI:10.1002/micr.30831

Adv Mater. 2021 Oct 13:e2105868. doi: 10.1002/adma.202105868. Online ahead of print.

ABSTRACT

Conventional optical diffusers, such as thick volume scatterers (Rayleigh scattering) or microstructured surface scatterers (geometric scattering), lack the potential for on-chip integration and are thus incompatible with next-generation photonic devices. Dielectric Huygens’ metasurfaces, on the other hand, consist of two-dimensional arrangements of resonant dielectric nanoparticles and therefore constitute a promising material platform for ultra-thin and highly efficient photonic devices. When the nanoparticles are arranged in a random but statistically specific fashion, diffusers with exceptional properties are expected to come within reach. In this contribution, we explore how dielectric Huygens’ metasurfaces can be used to implement wavelength-selective diffusers with negligible absorption losses and nearly-Lambertian scattering profiles that are largely independent of the angle and polarization of incident waves. We show that the combination of tailored positional disorder with a carefully-balanced electric and magnetic response of the nanoparticles is an integral requirement for the operation as a diffuser. We experimentally and numerically characterize the directional scattering performance of the proposed metasurfaces and highlight their usability in wavefront-shaping applications. Since our metasurfaces operate on the principles of Mie scattering and are embedded in a glassy environment, they may easily be incorporated in integrated photonic devices, fiber optics, or mechanically robust augmented reality displays. This article is protected by copyright. All rights reserved.

PMID:34652041 | DOI:10.1002/adma.202105868