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Canadian Journal of Anaesthesia =... Sep 2023The P value is a widely used measure of statistical importance but has many drawbacks and limitations, one being that it does not reflect the robustness of the results...
PURPOSE
The P value is a widely used measure of statistical importance but has many drawbacks and limitations, one being that it does not reflect the robustness of the results of a clinical trial. The Fragility Index (FI) was developed as a measure of how many outcome events would need to change to nonevents to render a significant P value nonsignificant (P ≥ 0.05). The FI of trials from other medical specialties is typically < 5. We aimed to determine the FI of pediatric anesthesiology randomized controlled trials (RCT) and to test for association with various characteristics of the included trials.
METHODS
We conducted a comprehensive systematic search of high-impact anesthesia, surgical, and medical journals from the last 25 years for trials comparing an intervention between two groups with a statistically significant P value (< 0.05) for a dichotomous outcome. We also compared FI values for variables that reflect the quality and importance of a trial.
RESULTS
The median [interquartile range] FI was 3 [1-7] and correlated positively with the number of participants (r = 0.41; P < 0.001) and events (r = 0.42; P < 0.001), and negatively with the P value (r = -0.36; P < 0.001). Other measures of trial quality and impact or importance were not strongly associated with the FI.
CONCLUSIONS
The FI of published trials in pediatric anesthesiology is similarly low as in other medical specialties. Larger trials with more events and P values ≤ 0.01 were associated with a higher FI.
Topics: Humans; Child; Sample Size; Anesthesiology; Randomized Controlled Trials as Topic; Research Design
PubMed: 37286747
DOI: 10.1007/s12630-023-02513-3 -
Diagnostics (Basel, Switzerland) Oct 2023Ultrasound elastography is gaining attention for its diagnostic potential across various medical fields, and its physical properties make it valuable in modern clinical... (Review)
Review
Ultrasound elastography is gaining attention for its diagnostic potential across various medical fields, and its physical properties make it valuable in modern clinical medicine. However, its specific attributes, especially in the context of recent medical advancements, remain relatively unexplored. This study aimed to identify instrument-specific characteristics and applications of real-time ultrasound elastography, shear wave elastography, and strain elastography, particularly within gastroenterology. Following PRISMA guidelines, the study examined elastography articles on databases like PubMed, resulting in 78 included articles. Data on patient demographics, organ involvement, specificity, sensitivity, accuracy, positive predictive value, and negative predictive value were extracted. Statistical analysis involved SPSS version 21, with significance set at < 0.05. The majority of patients were male (50.50%), with a mean age of 42.73 ± 4.41 years. Shear wave elastography was the most prevalent technique (48.7%), and liver investigations were predominant in gastroenterology (34.6%). Gastrointestinal applications showed higher sensitivity, positive predictive value, and negative predictive values ( < 0.05) but lower specificity ( < 0.05). Real-time ultrasound elastography exhibited increased specificity, accuracy, and predictive values ( < 0.05). Ultrasound elastography appears more accurate and effective in gastroenterological settings. Nonetheless, its performance depends on instrument-specific and operator-dependent factors. While promising, further studies are necessary to ascertain optimal utilization in both gastrointestinal and non-gastrointestinal conditions.
PubMed: 37958199
DOI: 10.3390/diagnostics13213302 -
Beyoglu Eye Journal 2023This study aims to investigate the influence of systemic inflammation on adult patients with acquired nasolacrimal duct obstruction (ANLDO).
OBJECTIVES
This study aims to investigate the influence of systemic inflammation on adult patients with acquired nasolacrimal duct obstruction (ANLDO).
METHODS
Peripheral venous blood analysis was performed on adult patients who underwent dacryocystorhinostomy for ANLDO between June 2020 and December 2022, during their remission period just before the surgery. Platelet, Neutrophil, Lymphocyte, Monocyte, White Blood Cell (WBC) count, Platelet/Lymphocyte ratio (PLR), Neutrophil/Lymphocyte ratio (NLR), Monocyte/Lymphocyte ratio (MLR), and systemic inflammatory index (SII) (calculated as platelet × (neutrophil/lymphocyte)) were compared with a volunteer control group.
RESULTS
The study included 54 adult patients with ANLDO and 54 individuals in the control group. The mean age was 42.5±14.4 years in the ANLDO group and 37.8±12.3 years in the volunteer control group. There was no significant difference in age between the groups (p=0.064). Platelet value (295.9±70.9→254.7±43.9), PLR value (143.8±77.7→119.0±36.1), and SII value (534.7±192.0→442.6±212.2) in the ANLDO group were significantly higher compared to the Control group (p=0.000, p=0.023, p=0.020, respectively). Neutrophil, lymphocyte, monocyte, NLR, MLR, and WBC values did not exhibit significant differences between the case and control groups (p=0.299, p=0.469, p=0.125, p=0.419, p=0.143, and p=0.465, respectively).
CONCLUSION
The study revealed elevated systemic platelet counts in ANLDO patients, resulting in higher PLR and SII values. The authors suggest that a histopathological examination to assess the local impact of platelets or other inflammatory processes in nasolacrimal duct obstruction could offer valuable insights into the etiopathology of ANLDO.
PubMed: 38089075
DOI: 10.14744/bej.2023.92259 -
Otolaryngology--head and Neck Surgery :... Nov 2023To determine normative values for the Inner Effectiveness of Auditory Rehabilitation (Inner EAR) scale, a validated instrument utilized to study the impact of hearing... (Observational Study)
Observational Study
OBJECTIVE
To determine normative values for the Inner Effectiveness of Auditory Rehabilitation (Inner EAR) scale, a validated instrument utilized to study the impact of hearing loss and potential treatments.
STUDY DESIGN
Observational outcomes study.
SETTING
Academic medical center and community care sites.
METHODS
We included patients who were at least 18 years of age and completed the Inner EAR scale, pure-tone audiometry, and word recognition score assessment. Based on audiometry results, patients were categorized as having: (1) normal bilateral hearing, (2) unilateral hearing loss, and (3) bilateral hearing loss. The distributions of Inner EAR scale scores were assessed within each category. Fisher's exact test was utilized to determine whether data-driven threshold values could discriminate among the 3 clinical groups.
RESULTS
Two hundred and twenty-two consecutive patients with hearing-related complaints met inclusion criteria. Mean Inner EAR scores for patients with bilateral hearing loss (29.2, interquartile range [IQR] 10-41.5), unilateral hearing loss (38.9, IQR 23-49), and normal hearing (46.6, IQR 31-62) were significantly different (analysis of variance F < 0.0001). An Inner EAR score threshold of 50 supported the ability to statistically significantly discriminate between bilateral hearing loss and normal hearing (p = .003), as well as between unilateral hearing loss and normal hearing (p = .015).
CONCLUSION
An Inner EAR score normative threshold value of 50 provides significant discriminatory ability between normal hearing and unilateral or bilateral hearing loss on audiometry. Normative values provide useful, frequently referenced data when assessing responses to treatment. Based on these data, this threshold may help distinguish patients with and without perceived functional impact from hearing loss.
Topics: Humans; Audiometry, Pure-Tone; Auditory Threshold; Deafness; Ear, Inner; Hearing Loss; Hearing Loss, Bilateral; Hearing Loss, Unilateral; Adolescent; Adult
PubMed: 37061891
DOI: 10.1002/ohn.349 -
BMC Anesthesiology Aug 2023Sepsis and septic shock are disorders of tissue perfusion and microcirculation associated with increased mortality. The role of biomarkers such as proadrenomedullin...
INTRODUCTION
Sepsis and septic shock are disorders of tissue perfusion and microcirculation associated with increased mortality. The role of biomarkers such as proadrenomedullin (PRO-ADM), interleukin 6 (IL-6) and neutrophil CD64 (CD64) in the diagnosis and prognosis of septic shock has been studied.
METHODS
GCS, SOFA score, APACHE 2 score, lactate, CRP, procalcitonin, PRO-ADM, IL-6, CD64 level and 28-day mortality were evaluated in patients with septic shock followed-up in the intensive care unit of Marmara University Hospital between July 2021 and December 2021. The study was planned as prospective, non-drug clinical research Committee.
RESULTS
There were no statistically significant differences between patient groups in gender, BMI, and presence of comorbidities (p > 0.05). The alive patient group had significantly higher GCS values and lower SOFA, APACHE 2, lactate and CD64 values than the dead patient group (p < 0.01). The cut-off values of laboratory parameters were determined using ROC analysis to predict mortality, SOFA and CD64 had high AUC. This is also a good indicator for mortality.The multivariate logistic regression model was estimated using the backward selection method. The mortality of ICU patients was predicted by a SOFA-value ≥ 12 (OR (95%CI) = 56.13 (5.44-578.64)), CD64 value ≥ 28.54 (OR (95% CI) = 23.78 (2.61-216.85)), and ADM-value ≥ 86.79 (OR (95% CI) = 15.86 (1.02-246.49)) (p < 0.05) .
CONCLUSION
In conclusion, serum CD64 level, PRO-ADM level, and SOFA score proved to be effective parameters for predicting prognosis and mortality in septic shock. However, IL-6 proved to be a weak biomarker and failed to predict mortality. CD64, which is easier and more practical to use, can be used instead of the SOFA score.
Topics: Humans; Interleukin-6; Shock, Septic; Prospective Studies; Prognosis; Lactic Acid
PubMed: 37592204
DOI: 10.1186/s12871-023-02237-3 -
Cureus Oct 2023Introduction Rheumatoid arthritis (RA) is a chronic autoimmune condition that causes systemic inflammation and affects multiple joints. It is characterized by joint...
Introduction Rheumatoid arthritis (RA) is a chronic autoimmune condition that causes systemic inflammation and affects multiple joints. It is characterized by joint warmth, swelling, pain, and the formation of invasive synovial tissue known as pannus, which contributes to cartilage and bone degradation. Pan-immune-inflammation value (PIV), a marker derived from complete blood count parameters, has shown promise in predicting prognosis in various cancer types and pediatric conditions associated with immune abnormalities. This study aims to explore the relationship between RA, characterized by chronic inflammation and immune system involvement, and PIV, potentially shedding light on novel insights into RA's clinical implications. Methods One hundred four participants, including 64 RA patients (both newly diagnosed and established cases) and 40 healthy controls, were included in the study. Exclusion criteria for RA patients included acute infection, cancer, diabetes, or chronic illness, while control participants were excluded for inflammatory disorders, active infection, diabetes, or malignancy. We assessed disease severity using Disease Activity Score 28 (DAS 28) and obtained complete blood count values, including neutrophil, lymphocyte, platelet, monocyte, and red cell distribution width. C-reactive peptide (CRP) and erythrocyte sedimentation rate were also added. Statistical analyses included correlation assessments, t-tests, Mann-Whitney U tests, and multivariate linear regression. A multiclass receiver operating characteristic analysis determined optimal PIV cut-off values for distinguishing control, remission, and active RA groups, with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and odds ratios calculated. Results This study comprised a cohort of 104 participants, with a median age of 43.5±17.5. The Remission group was significantly younger than the Control group (p=0.006) but not compared to the Active RA group (p=0.393). CRP levels were significantly higher in the Active RA group (p<0.001). Neutrophil counts were highest in the Active RA group (p<0.001), as were monocyte counts. Lymphocyte counts were significantly lower in the Active RA group (p<0.001). There were no significant differences in sedimentation rate, hemoglobin, platelet count, and mean platelet volume. PIV was significantly elevated in the Active RA group (p<0.001) and higher in the Remission group than in the Control group (p=0.001). A PIV value of 353.48 exhibited 71.4% sensitivity, 86.2% specificity, 86.2% PPV, 71.4% NPV, and 78.13% test accuracy for distinguishing active rheumatoid arthritis (p<0.001). A PIV value exceeding 353.48 substantially increased the likelihood of a patient belonging to the active rheumatoid arthritis group, with a 14.62-fold higher probability. Furthermore, the study explored the relationship between clinical and laboratory variables and disease activity in RA patients, finding significant differences in PIV among DAS groups (p=0.025). Conclusions The PIV offers a notable advantage as its constituent parameters are routinely assessed in rheumatoid arthritis and involve cost-effective and straightforward tests. We demonstrated that PIV serves as a valuable marker for distinguishing between remission and active RA when compared to healthy individuals. Additionally, it proved to be an effective tool for assessing disease activity in patients with active rheumatoid arthritis.
PubMed: 37808603
DOI: 10.7759/cureus.46609 -
Clinical Oral Investigations Sep 2023The aim of this study was to investigate solubility, pH value, chemical structure, radiopacity, and cytotoxicity of AH Plus BC, TotalFill BC, AH Plus, and AH Plus Jet...
OBJECTIVE
The aim of this study was to investigate solubility, pH value, chemical structure, radiopacity, and cytotoxicity of AH Plus BC, TotalFill BC, AH Plus, and AH Plus Jet sealers.
MATERIALS AND METHODS
Cytotoxicity analysis with direct and extraction tests at 3 different concentrations (1:1, 1:2, 1:4 v/v%) and time (24 h, 48 h, and 72 h) on Saos-2, PdLF, and THP-1 cell lines, chemical structure with scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX) analysis, solubility, pH, and radiopacity values of AH Plus BC, TotalFill BC, AH Plus, and AH Plus Jet were evaluated. For statistical analyses of the groups, repeated measures, factorial, and one-way ANOVA tests were used. The statistical significance level was set at p < .05.
RESULTS
Resin-based sealers showed higher cytotoxicity values than the bioceramic-based sealers (p < 0.05). Time and concentrations were effective on the cell viabilities for cell lines. Higher peaks of calcium were detected bioceramic-based sealers and higher amount of zirconium was detected in AH Plus BC (p < 0.05). AH Plus BC showed similar radiopacity value with AH Plus, AH Plus Jet, whereas TotalFill BC showed the lowest radiopacity (p < 0.05). Bioceramic-based sealers had higher pH values in all experiment periods, and the difference between resin- and bioceramic-based sealer groups was significant (p < 0.05). However, the solubility values of the tested root canal sealers revealed no differences (p > 0.05).
CONCLUSIONS
The newly produced AH Plus BC Sealer showed similar properties with TotalFill BC, and their biological properties were better than AH Plus and AH Plus Jet.
CLINICAL RELEVANCE
AH Plus BC could be a possible alternative to other bioceramic- or resin-based sealers.
Topics: Root Canal Filling Materials; Epoxy Resins; Solubility; Calcium Compounds; Dental Pulp Cavity; Silicates; Materials Testing; Hydrogen-Ion Concentration
PubMed: 37486382
DOI: 10.1007/s00784-023-05160-6 -
Bioengineering (Basel, Switzerland) Dec 2023To assess the value of multimodal MRI, including amide proton transfer-weighted imaging (APT), diffusion kurtosis imaging (DKI), and T2 mapping sequences for estimating...
PURPOSE
To assess the value of multimodal MRI, including amide proton transfer-weighted imaging (APT), diffusion kurtosis imaging (DKI), and T2 mapping sequences for estimating human epidermal growth factor receptor-2 (Her-2) expression in patients with endometrial cancer (EC).
METHODS
A total of 54 patients with EC who underwent multimodal pelvic MRI followed by biopsy were retrospectively selected and divided into the Her-2 positive (n = 24) and Her-2 negative (n = 30) groups. Her-2 expression was confirmed by immunohistochemistry (IHC). Two observers measured APT, mean kurtosis (MK), mean diffusivity (MD), and T2 values for EC lesions.
RESULTS
The Her-2 (+) group showed higher APT values and lower MD and T2 values than the Her-2 (-) group (all < 0.05); there was no significant difference in MK values ( > 0.05). The area under the receiver operating characteristic curve (AUC) of APT, MD, T2, APT + T2, APT + MD, T2 + MD, and APT + MD + T2 models to identify the two groups of cases were 0.824, 0.695, 0.721, 0.824, 0.858, 0.782, and 0.860, respectively, and the diagnostic efficacy after combined APT + MD + T2 value was significantly higher than those of MD and T2 values individually ( = 0.018, 0.028); the diagnostic efficacy of the combination of APT + T2 values was significantly higher than that of T2 values separately ( = 0.028). Weak negative correlations were observed between APT and T2 values (r = -0.365, = 0.007), moderate negative correlations between APT and MD values (r = -0.560, < 0.001), and weak positive correlations between MD and T2 values (r = 0.336, = 0.013). The APT values were independent predictors for assessing Her-2 expression in EC patients.
CONCLUSION
The APT, DKI, and T2 mapping sequences can be used to preoperatively assess the Her-2 expression in EC, which can contribute to more precise treatment for clinical preoperative.
PubMed: 38135990
DOI: 10.3390/bioengineering10121399 -
Anais Brasileiros de Dermatologia 2023Previous studies have generally focused on dry eye test abnormalities and ocular involvements such as uveitis, and blepharitis in psoriasis. Psoriasis area severity...
BACKGROUND
Previous studies have generally focused on dry eye test abnormalities and ocular involvements such as uveitis, and blepharitis in psoriasis. Psoriasis area severity ındex (PASI), which is used to assess psoriasis severity, is a time-consuming and complex tool.
OBJECTIVE
To evaluate the relationship between disease severity and central corneal epithelial thickness (CCET) in psoriasis.
METHODS
175 eyes of 175 psoriasis patients and 57 eyes of 57 healthy individuals as a control group was included in this study. Psoriasis patients were divided into three subgroups according to PASI score as < 10 mild, 10‒20 moderate and > 20 severe. CCET was measured by spectral domain-optical coherence tomography (SD-OCT), and mean values were recorded. Mean CCET values were compared between the psoriasis groups and the control group. Additionally, the relationship between PASI score and CCET was examined.
RESULTS
The mean CCET value was 58.06±3.1μm in the mild group, 60.10±5.0μm in the moderate group, 65.75±6.3μm in the severe group and 56.16±3.1μm in the control group. It was determined that the mean CCET value was significantly higher in all psoriasis groups compared to the control group (p<0.001). The mean CCET value was significantly higher in the moderate psoriasis group than in the mild psoriasis group (p=0.018), and in the severe psoriasis group compared to the moderate psoriasis group (p<0.001). There was a strong positive correlation between PASI score and CCET (p<0.001, r=0.519).
STUDY LIMITATIONS
Cross-sectional design and a relatively small number of participants.
CONCLUSIONS
There is a strong positive correlation between psoriasis severity and CCET. Contactless measurement of CCET by SD-OCT can be an indicator of psoriasis severity.
Topics: Humans; Tomography, Optical Coherence; Cross-Sectional Studies; Eye; Psoriasis; Severity of Illness Index
PubMed: 37355351
DOI: 10.1016/j.abd.2022.11.006 -
Physical Review. E Sep 2023Dynamics of bidirectionally coupled swarmalators subject to attractive and repulsive couplings is analyzed. The probability of two elements in different layers being...
Dynamics of bidirectionally coupled swarmalators subject to attractive and repulsive couplings is analyzed. The probability of two elements in different layers being connected strongly depends on a defined vision range r_{c} which appears to lead both layers in different patterns while varying its values. Particularly, the interlayer static sync π has been found and its stability is proven. First-order transitions are observed when the repulsive coupling strength σ_{r} is very small for a fixed r_{c} and, moreover, in the absence of the repulsive coupling, they also appear for sufficiently large values of r_{c}. For σ_{r}=0 and for sufficiently small values of r_{c}, both layers achieve a second-order transition in a surprising two steps that are characterized by the drop of the energy of the internal phases while increasing the value of the interlayer attractive coupling σ_{a} and later a smooth jump, up to high energy value where synchronization is achieved. During these transitions, the internal phases present rotating waves with counterclockwise and later clockwise directions until synchronization, as σ_{a} increases. These results are supported by simulations and animations added as supplemental materials.
PubMed: 37849080
DOI: 10.1103/PhysRevE.108.034303