Tag: statistics

Neurosurg Focus. 2021 May;50(5):E16. doi: 10.3171/2021.2.FOCUS201091.

ABSTRACT

OBJECTIVE: Oncological resection of primary spine tumors is associated with lower recurrence rates. However, even in the most experienced hands, the execution of a meticulously drafted plan sometimes fails. The objectives of this study were to determine how successful surgical teams are at achieving planned surgical margins and how successful surgeons are in intraoperatively assessing tumor margins. The secondary objective was to identify factors associated with successful execution of planned resection.

METHODS: The Primary Tumor Research and Outcomes Network (PTRON) is a multicenter international prospective registry for the management of primary tumors of the spine. Using this registry, the authors compared 1) the planned surgical margin and 2) the intraoperative assessment of the margin by the surgeon with the postoperative assessment of the margin by the pathologist. Univariate analysis was used to assess whether factors such as histology, size, location, previous radiotherapy, and revision surgery were associated with successful execution of the planned margins.

RESULTS: Three hundred patients were included. The surgical plan was successfully achieved in 224 (74.7%) patients. The surgeon correctly assessed the intraoperative margins, as reported in the final assessment by the pathologist, in 239 (79.7%) patients. On univariate analysis, no factor had a statistically significant influence on successful achievement of planned margins.

CONCLUSIONS: In high-volume cancer centers around the world, planned surgical margins can be achieved in approximately 75% of cases. The morbidity of the proposed intervention must be balanced with the expected success rate in order to optimize patient management and surgical decision-making.

PMID:33932923 | DOI:10.3171/2021.2.FOCUS201091

Neurosurg Focus. 2021 May;50(5):E9. doi: 10.3171/2021.1.FOCUS20671.

ABSTRACT

OBJECTIVE: Survival of cancer patients continues to improve with systemic treatment advancements, leading to an increase in cancer-related complications such as pathological spinal fractures. In this study, the authors aimed to evaluate the outcome of percutaneous stabilization with cement augmentation of the pedicle screws in the management of patients with metastatic cancer to the spine.

METHODS: The authors reviewed a retrospective case series of 74 patients with symptomatic pathological spine fractures treated with cement-augmented pedicle screws implanted with a percutaneous technique. The mean imaging follow-up was 11.3 months. Data on demographics, clinical outcomes, and complications were collected. Cement extravasation, spinal hardware integrity, and fusion rates were assessed on CT scans.

RESULTS: Among 50 patients with follow-up imaging, 23 patients (46%) showed facet joint fusion. The length of segmental stabilization was not a significant predictor of the occurrence of fusion. Pre- or postoperative radiation therapy, postoperative chemotherapy, and the location of spinal lesions did not have a statistically significant effect on the occurrence of fusion. Patients older than 60 years of age were more likely to have fusion across facet joints compared with younger patients. There was a significant difference in the mean visual analog scale pain score, with 6.28 preoperatively and 3.41 postoperatively, regardless of fusion status (p < 0.001). Cement extravasation was seen in 51% of the cohort, but in all instances, patients remained asymptomatic. Most importantly, the incidence of hardware failure was low (4%).

CONCLUSIONS: Percutaneous fixation with cement-augmented pedicle screws in patients with pathological spine fractures provides an improvement in mechanical back pain, with a low incidence of failure, and in some patients, spontaneous facet fusion was observed. Further research is necessary with regard to both short-term benefits and long-term outcomes.

PMID:33932939 | DOI:10.3171/2021.1.FOCUS20671

Oral Oncol. 2021 Apr 28;118:105311. doi: 10.1016/j.oraloncology.2021.105311. Online ahead of print.

ABSTRACT

BACKGROUND: The study was conducted to assess the accuracy power of Acoustic radiation force impulse imaging (ARFI) and generate a nomogram using ultrasound and ARFI to predict malignant cervical lymph nodes in head and neck squamous cell carcinoma.

MATERIAL AND METHODS: 374 cervical lymph nodes from 67 patients were evaluated. The B-mode ultrasonography and the elastography findings were compared with the final histopathological diagnosis. Radiological variables were used to construct nomogram and clinical utility of the nomogram was cross-validated.

RESULTS: In univariate analysis, status of the hilum, Long Axis Diameter, Short axis diameter, colour virtual touch imaging grade (VTI) and shear wave velocity were significant in predicting metastasis in the cervical lymph nodes. In multivariable analysis, it was found that predominance of red over yellow area on colour VTI was significantly associated with lymph node metastasis. A multiple logistic regression performed to ascertain the effects of on the likelihood that patients had lymph node metastasis on histopathology was statistically significant, χ2(10) = 44.96, p < 0.001. The model was able to correctly classify 93.28% of cases and the concordance index (c-index) was estimated to be 0.8773. A nomogram was thus established to predict metastasis in cervical lymph nodes.

CONCLUSIONS: ARFI increases the diagnostic accuracy of conventional USG in predicting metastatic lymph nodes in HNSCC. Adding the constructed nomogram to the conventional diagnostic pathway can provide an alternative option to frozen section and FNAC.

PMID:33932875 | DOI:10.1016/j.oraloncology.2021.105311

Biochem Biophys Res Commun. 2021 Apr 28;559:1-7. doi: 10.1016/j.bbrc.2021.03.125. Online ahead of print.

ABSTRACT

Various animal models of anxiety have been developed to evaluate anxiety and anxiolytic drugs. However, non-uniform measuring paradigms, variability in apparatus use and individual differences in animals confound study results. In this study, when all animals were included in the data analysis, we found no significant differences between control and stressed mice using standard behavioral paradigms for assessing anxiety (elevated plus maze and open field test). To provide a better assessment of anxiety, we therefore used a machine learning approach to analyze the behavioral patterns of each animal, and selected typical subjects in each group for use as a training set according to classical anxiety parameters. Spontaneous behaviors in these animals were captured by multi-view cameras and decomposed into sub-second modules using Behavior Atlas, and six behavioral features providing statistically significant difference between stressed and control mice were identified. Combined with low-dimensional embedding and clustering, new features were used to discriminate stressed mice from controls, in both the training set and all objects. Our results show Behavior Atlas is a powerful approach for identifying new potential biomarkers in an unbiased fashion. Our approach can complement classical measuring paradigms to objectively and comprehensively evaluate anxiety-like behaviors.

PMID:33932895 | DOI:10.1016/j.bbrc.2021.03.125

Neurosurg Focus. 2021 May;50(5):E12. doi: 10.3171/2021.2.FOCUS201121.

ABSTRACT

OBJECTIVE: Achieving rigid spinal fixation can be challenging in patients with cancer-related instability, as factors such as osteopenia, radiation, and immunosuppression adversely affect bone quality. Augmenting pedicle screws with cement is a strategy to overcome construct failure. This study aimed to assess the safety and efficacy of cement augmentation with fenestrated pedicle screws in patients undergoing posterior, open thoracolumbar surgery for spinal metastases.

METHODS: A retrospective review was performed for patients who underwent surgery for cancer-related spine instability from 2016 to 2019 at the Massachusetts General Hospital. Patient demographics, surgical details, radiographic characteristics, patterns of cement extravasation, complications, and prospectively collected Patient-Reported Outcomes Measurement Information System Pain Interference and Pain Intensity scores were analyzed using descriptive statistics. Logistic regression was performed to determine factors associated with cement extravasation.

RESULTS: Sixty-nine patients underwent open posterior surgery with a total of 502 cement-augmented screws (mean 7.8 screws per construct). The median follow-up period for those who survived past 90 days was 25.3 months (IQR 10.8-34.6 months). Thirteen patients (18.8%) either died within 90 days or were lost to follow-up. Postoperative CT was performed to assess the instrumentation and patterns of cement extravasation. There was no screw loosening, pullout, or failure. The rate of cement extravasation was 28.9% (145/502), most commonly through the segmental veins (77/145, 53.1%). Screws breaching the lateral border of the pedicle but with fenestrations within the vertebral body were associated with a higher risk of leakage through the segmental veins compared with screws without any breach (OR 8.77, 95% CI 2.84-29.79; p < 0.001). Cement extravasation did not cause symptoms except in 1 patient who developed a symptomatic thoracic radiculopathy requiring decompression. There was 1 case of asymptomatic pulmonary cement embolism. Patients experienced significant pain improvement at the 3-month follow-up, with decreases in Pain Interference (mean change 15.8, 95% CI 14.5-17.1; p < 0.001) and Pain Intensity (mean change 28.5, 95% CI 26.7-30.4; p < 0.001).

CONCLUSIONS: Cement augmentation through fenestrated pedicle screws is a safe and effective option for spine stabilization in the cancer population. The risk of clinically significant adverse events from cement extravasation is very low.

PMID:33932920 | DOI:10.3171/2021.2.FOCUS201121

Semin Arthritis Rheum. 2021 Apr 2;51(3):565-575. doi: 10.1016/j.semarthrit.2021.03.015. Online ahead of print.

ABSTRACT

OBJECTIVE: Observational studies suggest that rheumatoid arthritis (RA) may be associated with lung cancer (LC) risk, while the evidence is inconsistent. We conducted a meta-analysis and a Mendelian randomization study to investigate the association and causality between RA and the LC risk.

METHODS: We conducted a systematic search of cohort studies and performed a meta-analysis (PROSPERO ID CRD42020159082) to calculate the relative risks (RRs) and their 95% confidence intervals (95%CIs). Subgroup analyses based on sex and initiation year of follow-up were carried out. E-values of each study were calculated to evaluate if existing studies were sensitive to unmeasured confounding. Furthermore, we investigated the correlation between genetically predisposed RA and LC risk using summary statistics from the International Lung Cancer Consortium (11,348 cases and 15,861 controls) and 90 RA-related single nucleotide polymorphisms from European and East Asian descent as instrumental variables. A two-sample Mendelian randomization (MR) analysis was performed to detect the findings based on LC and histological subtypes. Sensitivity analyses were performed to test the robustness of our findings.

RESULTS: In the meta-analysis of 11 cohort studies involving 183,888 patients, an increased risk of LC was observed among RA patients (RR = 1.44, 95%CI = 1.31-1.57). Subgroup analyses suggested that male patients have a relatively higher LC risk than female patients, and an increased incidence of LC in RA patients was found from 1950 to 2010. Conversely, in the MR analysis, we found that genetically predisposed RA was associated with a decreased risk of LC overall, while neither causally associated with the risk of lung adenocarcinoma nor squamous cell lung cancer. Nevertheless, genetically predisposed RA was associated with a decreased LC risk among the East Asian population, but not in Europeans. These results were robust against extensive sensitivity analyses.

CONCLUSION: Our meta-analysis suggested that although RA was associated with a relatively higher LC risk, the causal relationship between genetically predisposed RA and LC risk was not supported by the MR study. Further studies are warranted to elucidate the possible association between RA and the risk of LC, as well as its underlying mechanisms.

PMID:33932788 | DOI:10.1016/j.semarthrit.2021.03.015

Environ Pollut. 2021 Mar 30;284:117035. doi: 10.1016/j.envpol.2021.117035. Online ahead of print.

ABSTRACT

Seabirds are widely used as indicators of marine pollution, including mercury (Hg), because they track contaminant levels across space and time. However, many seabirds are migratory, and it is difficult to understand the timing and location of their Hg accumulation. Seabirds may obtain Hg thousands of kilometers away, during their non-breeding period, and deposit that Hg into their terrestrial breeding colonies. We predicted that Hg concentration in rectrices reflects exposure during the previous breeding season, in body feathers reflects non-breeding exposure, and in blood collected during breeding reflects exposure during current breeding. To test this hypothesis, we measured total Hg concentration in these three tissues, which reflect different timepoints during the annual cycle of rhinoceros auklets (Cerorhinca monocerata) breeding on both sides of the North Pacific (Middleton Island in Alaska and Teuri Island in Hokkaido), and tracked their wintering movement patterns with biologging devices. We (i) identify the wintering patterns of both populations, (ii) examine Hg levels in different tissues representing exposure at different time periods, (iii) test how environmental Hg exposure during the non-breeding season affects bird contamination, and (iv) assess whether variation in Hg levels during the non-breeding season influences levels accumulated in terrestrial plants. Individuals from both populations followed a figure-eight looping migration pattern. We confirm the existence of a pathway from environmental Hg to plant roots via avian tissues, as Hg concentrations were higher in plants within the auklet colonies than at control sites. Hg concentrations of breast feathers were higher in Alaskan than in Japanese auklets, but Hg concentrations in rectrices and blood were similar. Moreover, we found evidence that tissues with different turnover rates could record local anthropogenic Hg emission rates of areas visited during winter. In conclusion, Hg was transported across thousands of kilometers by seabirds and transferred to local plants.

PMID:33932830 | DOI:10.1016/j.envpol.2021.117035

Mar Environ Res. 2021 Apr 26;169:105339. doi: 10.1016/j.marenvres.2021.105339. Online ahead of print.

ABSTRACT

Rhodoliths (nodular calcareous red algae) are considered one of the most important bioengineers in the Mediterranean Sea, making rhodolith beds ecologically relevant ecosystems. On the insular shelf surrounding the western Pontine Archipelago (depth from 43 to 112 m), rhodolith beds were identified through the analysis of an extensive dataset of grab samples and videos to ground-truth the backscatter acoustic facies. Six acoustic facies (low backscatter, dishomogeneous low-backscatter, dishomogeneous high-backscatter, high-backscatter, rocks and high backscatter, and rocks and medium backscatter) were recognized. We studied how rhodoliths characteristics (density, morphotype, size and structure) differently influence the backscatter signature. At the western Pontine Archipelago, rhodolith beds are mainly represented by facies dishomogeneous high backscatter, high backscatter, high backscatter with rocks, and medium backscatter with rocks. The obtained results increase both the knowledge on the heterogeneous structure of such ecologically relevant benthic habitat and highlight the use of distinctive acoustic facies for their identification. Finally, the used approach could be considered a useful method for indirect detection and mapping of rhodolith beds.

PMID:33932846 | DOI:10.1016/j.marenvres.2021.105339

J Forensic Leg Med. 2021 Apr 27;80:102174. doi: 10.1016/j.jflm.2021.102174. Online ahead of print.

ABSTRACT

SUBJECT: The objective of this study is to determine the violence experienced by women who presented to the Emergency Department (ED) due to Intimate Partner Violence (IPV) and their previous experiences of violence.

METHOD: The descriptive study was conducted with 96 women. The data was analyzed in SPSS 17.0 statistics package program.

FINDINGS: The average age of the women is X = 35.33 ± 11.72, 35.4% of them are in the 31-40 age group, 69.6% are married, 44.8% are high school graduates, 60.4% are unemployed. It was determined that women who were IPV victims were exposed to violence by being beaten (punching, kicking etc.) at the highest rate (82.3%), and nearly half of them (47.9%) were injured in the head and neck regions. The vast majority of women (86.5%) have been subjected to violence before, only %13.5 of them stated that they experienced violence for the first time. It was found that the majority of women (69.8%) continued to live with the perpetrator after violence. Only three of the women (3.4%) attempted to initiate legal action, and the majority (76.5%) did not intend to take legal action.

CONCLUSIONS: Healthcare professionals should be aware that most woman presenting to the ED with IPV has a history of violence before it, and that this will probably not be the last. Healthcare professionals should also consider the fact that the victims may be exposed to different types of violence at the same time. It is also recommended that healthcare professionals be trained on policies regarding IPV management and equipped to provide women with the right way out.

PMID:33932741 | DOI:10.1016/j.jflm.2021.102174

Cancer Treat Res Commun. 2021 Apr 18;27:100374. doi: 10.1016/j.ctarc.2021.100374. Online ahead of print.

ABSTRACT

INTRODUCTION: Renal cell carcinoma (RCC) accounts for 2-3% of all tumors being the most frequent solid lesion in the kidney.

OBJECTIVE: To determine what genetic alterations and immunohistochemical (IHC) of clear cell renal carcinoma (ccRCC) are associated with prognosis and tumor aggressiveness.

PATIENTS AND METHODS: Experimental analytical study with 57 patients who underwent radical and partial nephrectomy between 2005 and 2011, all with diagnosis of ccRCC and minimum post-operative follow-up of 36 months. The pathological study included IHC determination of biomarkers associated (CAIX, CAM 5.2, CD10, c-erbB-2, EGFR, HIF-1a, Ki67, MDM2, PAX-2 y 8, p53, survivin and VEGFR 1 and 2). Genetic analysis was carried out using multiplex ligation-dependent probe amplification (MLPA). Clinical data were collected and summarized using an access-type database, adding genetic analysis and IHC data of each patient’s tumor sample. IHC statistical analysis included Chi-square, Kruskal-Wallis and multivariate analysis. The genetic analysis was performed using multivariate logistic regression (normal/deletion-duplication). Significance level p<0.05.

RESULTS: Pathologic stage was: pT1 (61.8%), pT2 (32.7%); pT3-T4 (5.4%); 16.3% were pN+ and 19.3% M1. 23.6% recurred being predominantly to distance in 83.3%. 27.3% of patients died (73.3% ccCCR). CAIX (Carbonic anhydrase IX) and tumor size were associated with worse Fuhrman grade (p = 0.035; p = 0.001 respectively). Deletion-duplication of genes increased the likelihood: of death (APC, Bcl-2 and CDKN2A by 11, 7 and 4 respectively and SMAD4 reduced the probability by 88%); tumor recurrence (CDKN2A by fifteen fold and VHL reduced the probability by 87%); pT greater than 2 (CCND2, MDM2 and WT1 multiplied by 6, 7 and 9); risk of N+ (CDK4 and EBF1 by 13); distant metastases (BRCA2 and DLEU1 by 5); Fuhrman grade ≥3 (BRCA1, BRCA2 and p53 by 40, 75 and 34 respectively, while that FHIT reduced by 96%). Deletion-duplication of CDK4 and DCC increased survival by a factor of 13 and 16, while that DLEU1 and RUNX1 decreased survival time by 80%.

CONCLUSION: CAIX and tumor size are associated with increased aggressiveness. The mutations to level 5q, 9p, 11p, 12, 13q, 17, 18q and 21q are associated with more aggressive tumors and with worse survival rate.

PMID:33932757 | DOI:10.1016/j.ctarc.2021.100374