Tag: statistics

Knee. 2021 Sep 6;32:183-191. doi: 10.1016/j.knee.2021.08.016. Online ahead of print.

ABSTRACT

BACKGROUND: Prosthetic joint infection (PJI) causes significant morbidity and mortality following knee replacement surgery. Identifying causative organisms and antibiotic sensitivities is critical in increasing the chance of infection eradication. This study investigated whether biopsy alone was superior to aspiration alone for serological diagnosis in PJI following knee replacement. Secondly, we investigated whether biopsy identifies the same or new/different microbiological flora as aspiration.

METHODS: Since December 2014, the Exeter Knee Reconstruction Unit (EKRU) has prospectively collated data regarding all PJIs referred from our local/regional network which have been reviewed via our Multi-Disciplinary Team (MDT). We identified and included consecutive patients from this MDT from Dec.2014-Mar.2020 and analysed their electronic records. Statistical analysis was performed using Stata.

RESULTS: 65/100 patients studied had both pre-operative aspiration and biopsy. 31/65 (48%) had positive aspiration and biopsies. No aspirate samples were positive with corresponding biopsies negative. In 19/65 (29%) of infection positive patients, biopsy identified new (7) or additional (12) organisms not identified by aspiration. Aspiration had a sensitivity of 70%, specificity of 88%, positive predictive value of 90.3% and negative predictive value of 64.7%. Biopsy had a sensitivity of 97.5%, specificity of 88%, positive predictive value of 92.9% and negative predictive value of 95.7%.

CONCLUSION: In 29% of confirmed PJI cases, arthroscopic biopsy identified either additional organisms in a polymicrobial PJI when compared to aspiration, or new positive results when aspiration alone was negative. This study demonstrates the benefits of arthroscopic biopsy for serological diagnosis in cases of knee PJI and aids treatment planning.

PMID:34500431 | DOI:10.1016/j.knee.2021.08.016

Environ Int. 2021 Sep 6;157:106853. doi: 10.1016/j.envint.2021.106853. Online ahead of print.

ABSTRACT

Developing children are particularly vulnerable to the effects of exposure to per- and polyfluoroalkyl substances (PFAS), a group of endocrine disrupting chemicals. We hypothesized that early life exposure to PFASs is associated with poor metabolic health in children. We studied the association between prenatal and postnatal PFASs mixture exposure and cardiometabolic health in children, and the role of inflammatory proteins. In 1,101 mothers-child pairs from the Human Early Life Exposome project, we measured the concentrations of PFAS in blood collected in pregnancy and at 8 years (range = 6-12 years). We applied Bayesian Kernel Machine regression (BKMR) to estimate the associations between exposure to PFAS mixture and the cardiometabolic factors as age and sex- specific z-scores of waist circumference (WC), systolic and diastolic blood pressures (BP), and concentrations of triglycerides (TG), high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) cholesterol. We measured thirty six inflammatory biomarkers in child plasma and examined the underlying role of inflammatory status for the exposure-outcome association by integrating the three panels into a network. Exposure to the PFAS mixture was positively associated with HDL-C and systolic BP, and negatively associated with WC, LDL-C and TG. When we examined the independent effects of the individual chemicals in the mixture, prenatal PFHxS was negatively associated with HDL-C and prenatal PFNA was positively associated with WC and these were opposing directions from the overall mixture. Further, the network consisted of five distinct communities connected with positive and negative correlations. The selected inflammatory biomarkers were positively, while the postnatal PFAS were negatively related with the included cardiometabolic factors, and only prenatal PFOA was positively related with the pro-inflammatory cytokine IL-1beta and WC. Our study supports that prenatal, rather than postnatal, PFAS exposure might contribute to an unfavorable lipidemic profile and adiposity in childhood.

PMID:34500361 | DOI:10.1016/j.envint.2021.106853

Environ Pollut. 2021 Sep 5;290:118122. doi: 10.1016/j.envpol.2021.118122. Online ahead of print.

ABSTRACT

Children in urban environments are exposed to potential harmful elements (PHEs) through variable exposure media. Playing activities in outdoor playgrounds have been considered of high concern due to children’s exposure to sand-bound PHEs through unintentional or intentional sand ingestion. Furthermore, the affinity of magnetic particles with dust-bound PHEs in playgrounds has been reported. In this study, playground sands (PG sands) from public playgrounds in the city of Thessaloniki, N. Greece were sampled and the levels, the contamination degree, oral bioaccessibility and exposure assessment of PHEs were evaluated. In addition, low-cost and fast magnetic measurements (i.e. mass specific magnetic susceptibility, χ_lf) were explored as potential pollution and health risk proxies. Mineralogically, siliceous PG sands dominated, while morphologically angular magnetic particles and Fe-rich “spherules” of anthropogenic origin were revealed and verified by enhanced χ_lf values. The average total elemental contents exhibited a descending order of Mn > Ba > Cr > Zn > Ni > Pb > Cu > Co > As > Sn > Bi > Cd, however only Cd, Bi, Pb, Cr, As and Zn were presented anthropogenically enhanced. Notable increase on PHEs levels and finer sand fractions were observed with continuous sand use. Anthropogenically derived elements (i.e. Cd and Pb with high I_geo values) exhibited higher bioaccessible fractions in PG sands and considered easily soluble in gastric fluids through ingestion. However, increased risks were found for specific PHEs (especially Pb) only in a worst case exposure scenario of an intentional sand ingestion (pica disorder). Statistical analysis results revealed a linkage of anthropogenic components with sand-bound magnetic particles. Moreover, the recorded high affinity of Pb contents (in an enhanced magnetized sub-set of PG sands) and bioaccessible Cd fractions with χ_lf provide a preliminary indication on the successful applicability of low-cost and fast magnetic measurements in high impacted playground environments.

PMID:34500396 | DOI:10.1016/j.envpol.2021.118122

Clin Neurol Neurosurg. 2021 Aug 28;209:106918. doi: 10.1016/j.clineuro.2021.106918. Online ahead of print.

ABSTRACT

OBJECTIVES: Vagus nerve stimulation (VNS) has been widely used as an effective treatment for patients with drug-resistant epilepsy (DRE). However, little is known about grey matter (GM) and white matter (WM) microstructure changes caused by VNS. This study aimed to detect consistent GM and WM alterations in epilepsy patients with vagus nerve stimulators.

METHODS: The diffusion tensor imaging data was acquired from 15 patients who underwent VNS implantation. The voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS) were used to detect group differences in GM and WM microstructure and explore their correlation with postoperative seizure reduction.

RESULTS: After 3 months of stimulation, GM density reduced in right cerebellum, left superior temporal gyrus, right inferior temporal gyrus and left thalamus, and increased in left cerebellum, left inferior parietal lobule, left middle occipital gyrus and left gyrus rectus. No significant volume changes had been found in 14 subcortical nuclei. The fractional anisotropy (FA) values reduced in left superior longitudinal fasciculus and left corticospinal tract, and increased in bilateral cingulum and body of corpus callosum. The mean diffusivity (MD) values reduced in right retrolenticular part of internal capsule, right posterior corona radiata and right superior longitudinal fasciculus. The seizure reduction had positive correlation trends with the volume reduction in left nucleus accumbens and right amygdala, and MD reduction in right medial lemniscus and right posterior corona radiata.

CONCLUSIONS: The results showed that VNS could cause changes of GM density, WM FA and MD values in epilepsy patients. The volume and MD reduction in some subcortical structures might participate in the seizure frequency reduction of VNS.

PMID:34500340 | DOI:10.1016/j.clineuro.2021.106918

J Psychiatr Res. 2021 Sep 3;143:163-175. doi: 10.1016/j.jpsychires.2021.09.001. Online ahead of print.

ABSTRACT

Through imaging studies, a significant increase in cerebral activity has been detected in fronto-temporal areas in patients experiencing auditory verbal hallucinations. Therefore, non-invasive neuromodulation, in particular transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), has been considered as a therapeutic intervention for medication-resistant auditory verbal hallucinations in schizophrenia. We aimed to synthesize results from randomized trials on either rTMS or tDCS versus placebo in patients with schizophrenia by including five recently published trials in the field. A systematic review and meta-analysis of relevant literature was conducted. Studies were included on the basis of pre-defined selection criteria. The quality of the studies was assessed by the Cochrane Risk of Bias Tool for Randomized Controlled Trials. RevMan 5.3 was used to conduct the statistical analysis. Including 465 and 960 patients, respectively, 12 tDCS and 27 rTMS studies were included. Regarding treatment of medication refractory auditory verbal hallucinations, no significant effect of tDCS (-0.23 [-0.49, 0.02], p = 0.08) or rTMS (-0.19 [-0.50, 0,11], p = 0.21) was found compared to sham in this meta-analysis. The current study found that it cannot be concluded that rTMS and tDCS are efficacious in treating medication-resistant auditory verbal hallucinations. Larger randomized controlled tDCS trials of a higher quality should be conducted in the future to establish substantial evidence of tDCS. The interventions appear safe and may have beneficial effects on other outcomes.

PMID:34500345 | DOI:10.1016/j.jpsychires.2021.09.001

Soc Sci Med. 2021 Aug 30;287:114357. doi: 10.1016/j.socscimed.2021.114357. Online ahead of print.

ABSTRACT

It is widely acknowledged that cancer affects not only patients but also their friends and family members who provide informal, and typically unpaid, care. Given the dual impact that cancer often has on patients and their informal caregivers (i.e., family members, partners, or friends), an expanded dyadic framework that encompasses a range of health and psychosocial outcomes and includes primary caregivers with a range of relationships to the patients is critically needed. Moreover, an emphasis on the role of social and contextual factors may help the framework resonate with a broader range of patient-caregiver relationships and allow for the development of more effective dyadic interventions. This article describes the development of the Dyadic Cancer Outcomes Framework, which was created to guide future research and intervention development. Using an iterative process, we conducted a conceptual review of currently used dyadic and/or caregiving models and frameworks and developed our own novel dyadic framework. Our novel Dyadic Cancer Outcomes Framework highlights individual- and dyad-level predictors and outcomes, as well as incorporating the disease trajectory and the social context. This framework can be used in conjunction with statistical approaches including the Actor Partner Interdependence Model to evaluate outcomes for different kinds of partner-caregiver dyads. This flexible framework can be used to guide intervention development and evaluation for cancer patients and their primary caregivers, with the ultimate goal of improving health, psychosocial, and relationship outcomes for both patients and caregivers. Future research will provide valuable information about the framework’s effectiveness for this purpose.

PMID:34500320 | DOI:10.1016/j.socscimed.2021.114357

Chemosphere. 2021 Sep 2;287(Pt 2):132132. doi: 10.1016/j.chemosphere.2021.132132. Online ahead of print.

ABSTRACT

The response surface methodology (RSM) was found useful statistical tool for understanding combined effect of filtration, backwashing time and dosage of sodium hypochlorite (NaOCl) added into backwash water as three operational parameters on transient behavior of transmembrane pressure (TMP) and organic rejection efficiency. Here, encased, hollow-fiber ultrafiltration (UF) system was developed for treating synthetic humic acid (HA) solution. To carry out RSM analysis, experimental matrix was designed by Box-Behnken model. Results showed that the NaOCl dosage for the chemical enhanced backwashing (CEB) as single parameter played most dominant role in fouling mitigation. Effect of hydraulic cleaning by applying the permeate backwashing only without performing the CEB was almost negligible to flush the fouling layer from membrane. Considering two correlated parameters, backwashing time combined with NaOCl dosage was found much more important than combination of other parameter such as filtration time to reduce fouling rate. Regardless of the operational parameters, the organic rejection efficiency was maintained 30% only. The RSM analysis also found that 40.1 min of filtration, 1.1 min of backwashing and 834 mg/L of NaOCl were optimum operating parameters to enhance both permeate recovery and fouling mitigation.

PMID:34500327 | DOI:10.1016/j.chemosphere.2021.132132

Eur J Oncol Nurs. 2021 Aug 12;54:102013. doi: 10.1016/j.ejon.2021.102013. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this retrospective study was to verify whether the revised Short Nutritional Assessment Questionnaire© (SNAQ), a simplified nutritional assessment, could be comparable with serum albumin (ALB) levels as a predictor of undernutrition in cancer patients receiving outpatient chemotherapy.

METHODS: Of 111 patients, 79 patients with baseline ALB levels ≥3.5 g/dL were included in the analysis. Patients completed the revised SNAQ, which evaluated items including appetite loss, weight loss, nutritional supplement usage, age, and body mass index, using a maximum of 12 points (a score of ≥3 was marked as severe undernutrition). ALB levels were then monitored for 1 year using patient medical records.

RESULTS: There was a significant difference in event-free survival (EFS) when the SNAQ scores were classified into two groups [i.e., scores of ≤3 (SNAQ3) or scores of ≥4 (SNAQ4)]. The 150-day EFS rate was 86.8% and 57.6% for SNAQ3 and SNAQ4, respectively (hazard ratio: 2.92; 95% confidence interval: 1.31-6.51; p = 0.009). Based on the Cox proportional-hazards analysis, a higher risk of undernutrition was associated with SNAQ4 (compared with SNAQ3), C-reactive protein levels, and serum transthyretin levels.

CONCLUSION: The revised SNAQ is a predictor of undernutrition in cancer patients receiving outpatient chemotherapy. In particular, it is important that patients with a SNAQ score of ≥4 receive dietary guidance at an early stage as they are likely to become undernourished within a year.

PMID:34500316 | DOI:10.1016/j.ejon.2021.102013

Eur J Oncol Nurs. 2021 Sep 2;54:102025. doi: 10.1016/j.ejon.2021.102025. Online ahead of print.

ABSTRACT

PURPOSE: Investigate the reported use and perceived effectiveness of self-care activities for chemotherapy-induced peripheral neuropathy (CIPN) symptoms in the feet.

METHODS: Cancer survivors with CIPN (n = 405) completed a questionnaire that assessed the use and perceived effectiveness of 25 self-care activities. Effectiveness was rated on a 0 (not at all) to 10 (completely effective) numeric rating scale. Descriptive statistics and regression analyses were conducted to identify demographic, clinical, and pain characteristics associated with the use and effectiveness of selected self-care activities.

RESULTS: The five most commonly used activities were: went for a walk (73.8%); watched television (67.8%); read a book, newspaper or magazine (64.4%); listened to radio, music (60.0%); and did exercises (jogging, swimming) (58.6%). The five most effective self-care activities were: had a trigger point injection (8.3 ( ± 1.3)); took tranquilizers (4.8 ( ± 2.6)); went for ultrasonic stimulation treatment (4.3 ( ± 3.1)); used a heating pad or hot water bottle (4.3 ( ± 2.5)); and used a transcutaneous electric nerve stimulator (4.2 ( ± 2.6)). Demographic, clinical, and pain characteristics influenced use and perceived effectiveness of selected self-care activities to varying degrees.

CONCLUSIONS: Two-thirds of the survivors used at least seven self-care activities to manage CIPN symptoms. The most commonly used activities did not receive the highest effectiveness ratings. Some activities that were rated as highly effective warrant more rigorous evaluation. Survivors can try a range of activities to decrease CIPN symptoms in the feet following discussion of their potential risks and benefits with their clinicians.

PMID:34500317 | DOI:10.1016/j.ejon.2021.102025

Oral Oncol. 2021 Sep 6;122:105503. doi: 10.1016/j.oraloncology.2021.105503. Online ahead of print.

ABSTRACT

INTRODUCTION: Patients with oropharyngeal squamous cell carcinoma (OPSCC) display a significant risk to develop a metachronous second primary neoplasia (MSPN). HPV and non-HPV-related OPSCC are 2 distinct entities with biological, clinical and prognostic differences. The aims of our study were to analyze the impact of tumor HPV status and other relevant clinical factors, such as tobacco and/or alcohol (T/A) consumption, on the risk and distribution of MSPN in OPSCC patients and to assess the impact of MSPN on patient survival.

MATERIAL AND METHODS: All OPSCC patients treated from 2009 to 2014 were included in this multicentric retrospective study. P16 immunohistochemical expression was used as a surrogate maker of tumor HPV status. The impact of tumor p16 status on the risk of MSPN was assessed in uni- and multivariate analyses. Overall survival (OS) was determined by Kaplan-Meier analysis.

RESULTS: Among the 1291 patients included in this study, 138 (10.7%) displayed a MSPN which was preferentially located in the head and neck area (H&N), lung and esophagus. Multivariate analyses showed that p16- tumor status (p = 0.003), T/A consumption (p = 0.005) and soft palate tumor site (p = 0.009) were significantly associated with a higher risk of MSPN. We found no impact of p16 tumor status on the median time between index OPSCC diagnosis and MSPN development, but a higher proportion of MSPN arising outside the H&N, lung and esophagus was found in p16 + than in p16- patients. MSPN development had an unfavorable impact (p = 0.04) on OS only in the p16 + patient group.

CONCLUSION: P16 tumor status and T/A consumption were the main predictive factors of MSPN in OPSCC patients. This study provides crucial results with a view to tailoring global management and follow-up of OPSCC patients.

PMID:34500315 | DOI:10.1016/j.oraloncology.2021.105503