Clinician's Guide to Understanding Effect Size, Alpha Level, Power, and Sample Size

Top Ten Tips Palliative Care Clinicians Should Know About Designing a Clinical Trial in Palliative Care

The palliative care field is experiencing substantive growth in clinical trial-based research. Randomized controlled trials provide the necessary rigor and conditions for assessing a treatment's efficacy in a controlled population. It is therefore important that a trial is meticulously designed from the outset to ensure the integrity of the ultimate results. In this article, our team discusses ten tips on clinical trial design drawn from collective experiences in the field. These ten tips cover a range of topics that can prove challenging in trial design, from developing initial methodologies to planning sample size and powering the trial, as well as collaboratively navigating the ethical issues of trial initiation and implementation as a cohesive team. We aim to help new researchers design sound trials and continue to grow the evidence base for our specialty. The guidance provided here can be used independently or in addition to the ten tips provided by this team in a separate article focused on what palliative care clinicians should know about interpreting a clinical trial.

A hybrid approach for analyzing and assessing resilience engineering in healthcare

BackgroundToday, researchers try to recognize and improve the weaknesses of complex systems using resilience engineering (RE) principles.ObjectiveThis descriptive-analytical epidemiological study aims to evaluate the resilience performance of the hospital staff based on the principles of RE to enhance personnel performance.MethodA questionnaire containing 27 questions in four areas (anticipation, monitoring, response, and learning) was designed based on Hellangel's model and field surveys to collect data from nurses and managers of various wards of five hospitals. The face validity and reliability of the questionnaire were confirmed by 16 professors and some individuals from the statistical sample.A hybrid approach utilizing entropy, TOPSIS, and DEA was employed in the Excel environment to process the collected data.ResultsThe results of the entropy method indicated that the responding and monitoring indicators, with values of 0.29 and 0.23, respectively, had the greatest impact on the resilience performance of the studied units. The outcomes of TOPSIS revealed that hospital D possesses the highest level of resilience. According to the DEA method, the first, second, and fifth efficient units were associated with hospital B.ConclusionBy evaluating the cornerstone of resilience, this study's findings empower nurses and managers to mitigate the impacts of stress, emotional exhaustion, and burnout, fostering work interactions and improving their performance in the face of workplace challenges. The main limitation of the study was the spread of COVID-19, which impeded the training of personnel in the field of RE and its indicators, as well as the distribution, collection, and completion of questionnaires, along with challenging access to personnel.

Factors related to stigma among patients with cervical cancer having chemotherapy after surgery in China: A cross-sectional study

Background

Stigma is a significant issue among patients with cervical cancer undergoing postoperative chemotherapy, yet the factors contributing to stigma are not well understood. While research has explored the relationships between self-efficacy, illness perception, self-esteem, social support, and stigma, fewer studies have focused on Chinese patients, and even fewer have specifically examined stigma within this population.

Objective

This study aimed to describe stigma and assess its association with self-efficacy, self-esteem, illness perception, and social support in postoperative chemotherapy patients diagnosed with cervical cancer.

Methods

A total of 132 participants were recruited from the gynecology department of Wenzhou Medical University's First Affiliated Hospital using a random sampling technique. Data were collected between December 2023 and April 2024 using validated instruments. Descriptive statistics and Spearman's rank correlation were used for data analysis.

Results

The average stigma score was 76.3 (SD = 10.84), indicating a high level of stigma. Self-efficacy, self-esteem, illness perception, and social support were negatively correlated with stigma (r = -0.085, r = -0.158, r = -0.254, r = -0.238, all p <0.05).

Conclusion

All participants experienced significant stigma. The negative correlations found between stigma and self-efficacy, self-esteem, illness perception, and social support offer a theoretical basis for developing nursing interventions to reduce stigma in these patients.

Effectiveness of long-term cluster training and traditional resistance training in enhancing maximum strength in young adults: a systematic review and meta-analysis

Background

It is still unclear whether traditional resistance training (TRT) provides the best or optimal stimulation for increasing maximum strength compared to cluster training (CT).

Objective

This study assessed the long-term impact of cluster training on the augmentation of maximum strength in young adults through the implementation of meta-analysis and further investigation of the factors associated with training duration.

Method

Literature was searched in Web of Science, Pub Med, EBSCOhost, SPORTDiscus, and Google Scholar. After screening, 21 articles and 49 reports were included. Revman 5.4 was used for literature quality evaluation, heterogeneity testing, and data consolidation. Stata 15.1 was used for drawing forest plots, subgroup analysis, taking sensitivity analysis and meta-regression to explore the sources of heterogeneity, creating a funnel plot to evaluate publication bias, quantifying publication bias, and trimming and filling. The original protocol was prospectively registered at the PROSPERO (CRD42024547097).

Result

The random effects meta-analysis results showed significant heterogeneity (I2 = 70.7%), SMD = 0.10, 95% confidence interval (CI) [-0.14, 0.33], indicating no difference between CT and TRT in general. However, considering training duration, CT was more effective in 4-8 weeks (SMD = 0.24, 95%CI [0.06, 0.42]), while TRT was better in 9-12 weeks (SMD = -1.54, 95%CI [-3.03, -0.05]). Sub-group analysis found that CT had a better effect on people aged 23 and above (SMD = 0.38, 95% CI [0.11, 0.65]), and there was no significant difference in sex and participant type.

Conclusion

Cluster training (CT) mitigates exercise-induced fatigue more effectively than traditional resistance training (TRT) and enables more efficient maximum strength growth within the initial 8 weeks, however, the converse holds after 9 weeks. For preparation periods of 8 weeks or less, such as a microcycle or a specific stage in block periodization, trainers are advised to adopt CT for enhancing or maintaining maximum strength. This suggests that trainers, when undertaking maximum strength training, whether short-term or long-term, can not only consider CT but also precisely schedule the time-course of resistance training modalities within continuous periodization. Specifically, they can switch to TRT after 8-weeks of CT to achieve more favorable training outcomes.

Systematic Review Registration

PROSPERO.

Feasibility study of a home-based graded motor imagery intervention (GraMI protocol) for amputees with phantom limb pain

INTRODUCTION

Phantom limb pain affects 64% of amputees. Graded Motor Imagery comprises three consecutive application techniques designed to reorganize maladaptive changes that have occurred after the amputation.

OBJECTIVE

To assess the feasibility of a home-based Graded Motor Imagery intervention, the GraMI protocol, for amputee people with phantom limb pain.

METHODS

Twenty individuals over 18 years of age with upper or lower limb amputation, experiencing phantom limb pain, who were pharmacologically stable, and had been discharged from the hospital were recruited. The experimental group followed the GraMI protocol. Primary outcomes included study processes, such as recruitment time and rate, adherence, compliance, and the acceptability of digital technologies as a treatment tool. Secondary outcomes assessed the impact on phantom limb pain, quality of life, functionality, and depressive symptoms.

RESULTS

On average, seven participants were recruited monthly over a three-month period. No losses were recorded throughout the nine weeks of intervention. Treatment adherence averaged 89.32%, and all participants demonstrated familiarity with the usability of digital technologies. No significant differences were observed between groups (p = .054). However, within the experimental group, intragroup analysis revealed a significant (p = .005) and clinically relevant reduction (>2 points) with a large effect size (0.89) in phantom limb pain.

CONCLUSION

Conducting a multicenter study with a home-based intervention using the GraMI protocol is feasible. Future clinical trials are needed to verify its effectiveness in managing phantom limb pain.

Causal Inference and Annotation of Phosphoproteomics Data in Multiomics Cancer Studies

Protein phosphorylation plays a crucial role in regulating diverse biological processes. Perturbations in protein phosphorylation are closely associated with downstream pathway dysfunctions, whereas alterations in protein expression could serve as sensitive indicators of pathological status. However, there are currently few methods that can accurately identify the regulatory links between protein phosphorylation and expression, given issues like reverse causation and confounders. Here, we present Phoslink, a causal inference model to infer causal effects between protein phosphorylation and expression, integrating prior evidence and multiomics data. We demonstrated the feasibility and advantages of our method under various simulation scenarios. Phoslink exhibited more robust estimates and lower false discovery rate than commonly used Pearson and Spearman correlations, with better performance than canonical instrumental variable selection methods for Mendelian randomization. Applying this approach, we identified 345 causal links involving 109 phosphosites and 310 proteins in 79 lung adenocarcinoma (LUAD) samples. Based on these links, we constructed a causal regulatory network and identified 26 key regulatory phosphosites as regulators strongly associated with LUAD. Notably, 16 of these regulators were exclusively identified through phosphosite-protein causal regulatory relationships, highlighting the significance of causal inference. We explored potentially druggable phosphoproteins and provided critical clues for drug repurposing in LUAD. We also identified significant mediation between protein phosphorylation and LUAD through protein expression. In summary, our study introduces a new approach for causal inference in phosphoproteomics studies. Phoslink demonstrates its utility in potential drug target identification, thereby accelerating the clinical translation of cancer proteomics and phosphoproteomic data.

How Many Participants Are Needed? Strategies for Calculating Sample Size in Nutrition Research

Sample size estimation is a critical aspect of nutrition research methodology, yet it remains frequently overlooked, leading to underpowered studies and potentially inaccurate conclusions. This review addresses this gap by providing comprehensive guidance on how to calculate sample size in nutrition research. Emphasizing the importance of an a priori sample size calculation, the review outlines the key considerations, including the desired levels of significance and power, effect size estimation, and standard deviation assessment. Formulas for determining sample size for various comparisons, including two proportions, two means, three or more groups, and unevenly sized groups, are provided, along with strategies for addressing loss to follow-up. Hypothetical examples illustrate these formulas' application across different research scenarios, highlighting their practical value in ensuring study robustness. Additionally, the review discusses common pitfalls in sample size estimation, such as misjudging effect size or standard deviation, and emphasizes the need for transparent reporting of sample size calculations to enable accurate interpretation of study findings. This article is a resource for nutrition researchers, offering guidance on conducting appropriate sample size calculations to bolster methodological rigor and study reliability. By embracing the principles outlined herein, researchers can elevate the quality of nutrition research.

Unveiling causal relationships between addiction phenotypes and inflammatory cytokines: insights from bidirectional mendelian randomization and bibliometric analysis

Observational studies have suggested associations between multiple inflammatory factors and tobacco and alcohol use, but establishing causation is challenging in epidemiological investigations. We employed genetic association data about the circulating levels of 41 cytokines obtained from the genome-wide association study (GWAS), which contained 8293 Finnish participants. Genetic data on 5 substance use phenotypes were obtained from the GWAS dataset containing 1.2 million European subjects. Then, we conducted a bidirectional mendelian randomization (MR) study. The forward results indicated that smoking cessation was positively correlated with hepatocyte growth factor (HGF), interleukin-10 (IL-10), and stem cell factor (SCF); cigarettes per day was a risk factor associated with high expression in stromal cell-derived factor 1α (SDF-1 A), interferon-γ (IFN-G), IL-4, and granulocyte colony-stimulating factor (G-CSF); drinks per week and smoking initiation were risk factors respectively correlated with reduced HGF and IL-2RA levels. During inverse MR analysis, the findings revealed that both IL-16 and IL-18 increased the risk of cigarettes per day; macrophage inflammatory protein-1β (MIP-1B) and tumor necrosis factor-β (TNF-B) inhibited and promoted smoking cessation, respectively; macrophage colony-stimulating factor (M-CSF) elevated the risk of drinks per week, while interferon inducible protein 10 (IP-10) had a contrary role; IL-7 and M-CSF respectively prolonged and shortened age of initiation of regular smoking. This study provides genetic proof supporting a causal relationship between various inflammatory factors and addiction phenotypes. Further comprehensive investigations are required to uncover underlying biological mechanisms. In addition, bibliometric studies have shown that oxidative stress is one of the most important orientations in alcohol and tobacco addiction research, where an in-depth investigation of its pro-inflammatory mechanisms would facilitate the development of potential therapeutic biological targets and drugs.

Anemia during pregnancy and adverse pregnancy outcomes: a systematic review and meta-analysis of cohort studies

Objectives

Anemia in pregnancy has been a topic of interest for researchers due to its potential impact on various adverse pregnancy outcomes. This study aims to explore the relationship between anemia and adverse pregnancy outcomes such as preterm birth, low birth weight, and maternal mortality.

Methods

We conducted both a systematic review and a meta-analysis on the associations between anemia during pregnancy and adverse pregnancy outcomes. We searched Chinese databases (CNKI, Wanfang, CBM, VIP) and English ones (Cochrane Library, PubMed, Embase, Web of Science). Two researcher-authors independently assessed study quality with the Newcastle-Ottawa Scale. After extracting data, we analyzed heterogeneity and used a random-effects model for higher heterogeneity and a fixed-effects model for low heterogeneity in the meta-analysis while also systematically synthesizing and narratively describing findings in the systematic review.

Results

A total of 31 cohort studies were included. Meta-analysis showed that the risk of postpartum hemorrhage [RR [95% CI], 2.76 [1.63, 4.66]], premature rupture of membranes (PROM) [1.94 (1.26, 3.00)], preterm delivery [1.51 (1.33, 1.72)], low birth weight (LBW) [1.40 (1.19, 1.63)], cesarean section[1.33 (1.02, 1.74)], gestational hypertension[1.28 (1.14, 1.44)] and neonatal asphyxia[1.21 (1.07, 1.37)] was higher in the group of anemia in pregnancy than in the control group.

Conclusion

Maternal anemia is associated with an increased risk of seven adverse pregnancy outcomes: postpartum hemorrhage, PROM, preterm delivery, LBW, cesarean section, gestational hypertension and neonatal asphyxia. Appropriate nutritional supplementation and screening for anemia before and during pregnancy are recommended to improve maternal health and manage adverse pregnancy outcomes.

Spirituality and people with psychosis: A content analysis of influential primetime television programs

OBJECTIVE

This mixed methods study examined depictions of spirituality among people with psychosis in influential television programming. Spirituality is a central strength for many people with psychosis. Yet, despite the important role media plays in shaping perceptions, little research has examined the intersection between spirituality and psychosis in the popular media.

METHODS

To address this gap, we conducted a content analysis of the 50 most viewed primetime fictional television shows over a 10-year period as determined by the Nielsen rating organization. Characters with psychosis were identified via keyword searches of online sources (Wikis, IMDb, etc.) and subsequently independently coded by two individuals. Characters were rated on 18 items in three domains related to demographics, life status, and character framing. Inter-rater reliability ranged from good to excellent across variables.

RESULTS

Of 120 identified characters with psychosis, just 16% (n = 19) had a spiritual identity. Analysis revealed few differences between spiritual and secular characters on demographic and life status variables. Conversely, an examination of framing variables revealed spiritual characters were comparatively less attractive, exhibited a greater negative impact on society, and were more likely to be referred to pejoratively (as a psychopath) and engage in criminal activity. Trend analysis indicated portrayals of spiritual characters decreased over time.

CONCLUSIONS

The results suggest media depictions of spirituality contribute to the stigmatization of spirituality among people with psychosis, potentially preventing access to important coping resources and discouraging professional help-seeking. Primary care physicians should consider incorporating a spiritual assessment into care to determine spiritual coping assets and then support these.

Compressive Pantyhose Mitigates Muscle Fatigue in Ballet-Specific Test: A Pilot Study

Compression garments, utilized in sports and exercise for performance enhancement and recovery, lack sufficient well-controlled studies to overcome any potential placebo effect. Therefore, we tested whether wearing compressive pantyhose (CP) during the Ballet-specific aerobic fitness test (BAFT) would influence performance, recovery, physiological, and perceptual indicators. Additionally, this pilot study tested the feasibility of the research procedures and informed adjustments for the main study. Nine young classical ballerinas attended two sessions on different days: a) wearing CP (pressure of 20-30 mmHg) or b) wearing a placebo pantyhose ([PLA] no compression, containing an illusory effect) during the BAFT. We assessed heart rate (HR) and rating of perceived exertion (RPE) during the BAFT, perceived recovery (PRS), lower-limb delayed onset muscle soreness (DOMS) at Pre and 24 h Post, and standing heel-rise test performance at Pre, 30 min, and 24 h Post. No variables differed (p>0.05) between CP and PLA (e.g., HR mean over 5 BAFT phases: 178±14 bpm vs. 179±17 bpm, p=0.63; RPE 30 min post: 9.1±0.8 vs. 9.1±0.8 arbitrary units, p=0.94). However, wearing CP promoted attenuation in acute fatigue, while PLA showed a performance decrement (p<0.05) 30 min Post in the standing heel-rise test: CP 30.2±6.0 to 22.8±7.5 repetitions and PLA 36.2±11.7 to 22.9±6.3 repetitions. We conclude that CP may mitigate acute fatigue in the triceps surae muscle of amateur classical ballet dancers, making it relevant for their acute recovery, particularly in cases involving multiple daily performances. Additionally, this pilot study confirmed the feasibility of the procedures.

The association between ambient air pollution and the risk of incident nasopharyngeal carcinoma in Hangzhou, China

Ambient air pollution exposure was associated with an increased risk of incident cancer, but few previous studies have focused on the associations between ambient air pollution and nasopharyngeal carcinoma (NPC). Thus, our goal is to examine whether exposure to ambient air pollution in Hangzhou, which includes sulfur dioxide (SO2), nitrogen dioxide (NO2), and inhalable particles (PM10), will have an impact the risk of incident cancer. We collected data on daily ambient air pollution data, climate, and daily incidence of NPC in Hangzhou from Jan 1, 2013, to Dec 31, 2022. We applied a generalized additive model (GAM) based on the Poisson distribution to investigate the effect of ambient air pollution on the risk of incident NPC. The effects of ambient air pollution exposure on NPC were also discussed in subgroups by age, gender, region, and season. A total of 3121 NPC incident cases were included during the study period. We discovered that the risk of incident NPC was increased by 0.75% (95% CI: 0.01-1.58), 0.36% (95% CI: 0.03-0.69), and 0.14% (95% CI: 0.01-0.28) for every 1 μg/m3 increase in the concentration of SO2, NO2, and PM10, respectively. These pollutants continued to have a substantial impact on the risk of incident NPC even after controlling for other ambient air pollutants. A noteworthy affirmative connection was a significant positive correlation between SO2 and NPC in male, warm season, urban areas, and elderly subgroups. In contrast to SO2, there was a significant positive correlation between PM10 and NPC in female, warm season, rural areas, non-elderly, and elderly subgroups. The association between NO2 and NPC was significantly positively correlated in male, female, rural areas, and elderly subgroups. In conclusion, our study's findings demonstrated that exposure to airborne SO2, NO2, and PM10 can negatively impact the risk of incident NPC.

Cross-modal representation of chewing food in posterior parietal and visual cortex

Even though the oral cavity is not visible, food chewing can be performed without damaging the tongue, oral mucosa, or other intraoral parts, with cross-modal perception of chewing possibly critical for appropriate recognition of its performance. This study was conducted to clarify the relationship of chewing food cross-modal perception with cortex activities based on examinations of the posterior parietal cortex (PPC) and visual cortex during chewing in comparison with sham chewing without food, imaginary chewing, and rest using functional near-infrared spectroscopy. Additionally, the effects of a deafferent tongue dorsum on PPC/visual cortex activities during chewing performance were examined. The results showed that chewing food increased activity in the PPC/visual cortex as compared with imaginary chewing, sham chewing without food, and rest. Nevertheless, those activities were not significantly different during imaginary chewing or sham chewing without food as compared with rest. Moreover, subjects with a deafferent tongue dorsum showed reduced PPC/visual cortex activities during chewing food performance. These findings suggest that chewing of food involves cross-modal recognition, while an oral somatosensory deficit may modulate such cross-modal activities.

The effect of combined pudendal nerve and spermatic cord block or caudal epidural block on postoperative analgesia after posterior urethroplasty: a randomized trial

BACKGROUND

Postoperative pain management remains a significant challenge for patients undergoing posterior urethroplasty (PU). In a previous study, we proposed a novel technique of combined pudendal nerve (PN) and spermatic cord (SC) block to manage pain after PU. The present trial was conducted to test the hypothesis that this technique is effective for pain control after PU and provides longer-lasting analgesia than caudal epidural block (CB).

METHODS

Sixty patients undergoing PU were randomized into two groups: Group NB received combined PN and SC block, and Group CB received CB. General anesthesia with a laryngeal mask was performed. The primary outcome was the postoperative analgesic duration, and the secondary outcomes included the Numeric Rating Scale (NRS) scores for pain and the number of patients with different motor scores of the lower limb at 3, 6, 12, and 24 h postoperatively.

RESULTS

Two patients in Group CB were withdrawn due to block failure. The postoperative analgesic duration was statistically longer in Group NB compared with Group CB (mean difference [95% confidence interval], 115.78 min [17.80, 213.75]; P = 0.021). The NRS scores for pain at 12 and 24 h after surgery were statistically lower in Group NB compared with Group CB. Group NB had statistically more patients with motor score 0 at 3 h postoperatively than Group CB.

CONCLUSIONS

PN combined with SC block is an effective technique for postoperative analgesia in PU. This technique can achieve a longer duration of analgesia and lower pain scores, especially 12 h after surgery, than a CB.

TRIAL REGISTRATION

This study was registered in the Chinese Clinical Trial Register (registration no. ChiCTR2100042971, registration date on 2/2/2021).

Linking abnormal fat distribution with HFpEF and diastolic dysfunction: a systematic review, meta-analysis, and meta-regression of observational studies

BACKGROUND

The global prevalence of obesity has escalated into a formidable health challenge intricately linked with the risk of developing cardiac diastolic disfunction and heart failure with preserved ejection fraction (HFpEF). Abnormal fat distribution is potentially strongly associated with an increased risk of cardiac diastolic dysfunction, and we aimed to scrutinize and elucidate the correlation between them.

METHODS

Following the Cochrane Handbook and PRISMA 2020 guidelines, we systematically reviewed the literature from PubMed, Embase, and Web of Science. We focused on studies reporting the mean and standard deviation (SD) of abnormal fat in HFpEF or cardiac diastolic dysfunction patients and the Pearson/Spearman correlation coefficients for the relationship between abnormal fat distribution and the risk of developing cardiac diastolic dysfunction. Data were standardized to the standard mean difference (SMD) and Fisher's z value for meta-analysis.

RESULTS

After progressive filtering and selection, 63 studies (43,113 participants) were included in the quantitative analyses. Abnormal fat distribution was significantly greater in participants with cardiac diastolic dysfunction than in controls [SMD 0.88 (0.69, 1.08)], especially in epicardial adipose tissue [SMD 0.99 (0.73, 1.25)]. Abnormal fat distribution was significantly correlated with the risk of developing cardiac diastolic dysfunction [E/E': 0.23 (0.18, 0.27), global longitudinal strain: r=-0.11 (-0.24, 0.02)]. Meta-regression revealed sample size as a potential heterogeneous source, and subgroup analyses revealed a stronger association between abnormal fat distribution and the risk of developing cardiac diastolic dysfunction in the overweight and obese population.

CONCLUSION

Abnormal fat distribution was significantly associated with the risk of developing cardiac diastolic dysfunction.

TRIAL REGISTRATION

CRD42024543774.

Responsiveness of Patient-Reported Outcome Measures After Large Knee Articular Cartilage Transplantation: A Systematic Review and Meta-analysis

BACKGROUND

Cartilage transplantation is commonly used to treat large (>4 cm2) articular cartilage defects of the knee. The 2 most common transplants are osteochondral allograft transplantation and autologous chondrocyte implantation. Several patient-reported outcome measures (PROMs) have been used to determine the efficacy of treatment, but it is unknown which measures are the most effective.

PURPOSE

To report the multiple PROMs used after large knee articular cartilage transplantation surgery and to compare the responsiveness between them.

STUDY DESIGN

Meta-analysis; Level of evidence, 4.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search of the PubMed/MEDLINE and Web of Science databases was performed. A total of 181 articles met inclusion criteria. Patient and study characteristics were extracted, including pre- and postoperative means for PROMs. From the articles that met inclusion criteria for responsiveness analysis (2+ PROMs reported, 1-year minimum follow-up, reported pre- and postoperative means and standard deviations; n = 131), the authors compared the responsiveness between PROM instruments using effect size and relative efficiency (RE) if a PROM could be compared with another in ≥10 articles.

RESULTS

A total of 10,015 patients (10,093 knees; mean age, 34.8 years; mean body mass index, 26.1) were included in this study. The mean follow-up time was 58.3 months (range, 1.5-247.2 months), imaging findings were reported in 80 articles (44.2%), patient satisfaction was reported in 39 articles (21.5%), and range of motion was reported in 10 articles (5.5%). There were 58 unique PROM instruments identified, with the most used being the International Knee Documentation Committee (IKDC) score (n = 118; 65.2%), followed by Knee injury and Osteoarthritis Outcome Score (KOOS) Pain (n = 58; 32.0%), KOOS Sport and Recreation (n = 58; 32.0%), KOOS Quality of Life (n = 57; 31.5%), KOOS Activities of Daily Living (n = 57; 31.5%), and KOOS Symptoms (n = 57; 31.5%). Overall, IKDC was found to have the greatest effect size (1.68) and the best responsiveness of the other PROMs, which include KOOS Pain (RE, 1.38), KOOS Symptoms (RE, 3.06), KOOS Activities of Daily Living (RE, 1.65), KOOS Sport and Recreation (RE, 1.44), Lysholm (RE, 1.76), and Tegner (RE, 1.56).

CONCLUSION

The IKDC is the most responsive PROM after large knee articular cartilage transplantation surgery. The IKDC score is recommended for assessing outcomes after cartilage transplantation surgery.

Substance use disorders and disparities in hispanic and non-hispanic older adults

BACKGROUND

The global longevity revolution increased the older adult population, posing unique health and economic challenges with implications for healthcare, especially substance use disorders (SUD).

METHODS

This was a retrospective cohort study of United States older adults, Hispanic and non-Hispanic, who got at least one mental and/or behavioral disorder diagnosis between 2017 and 2021 at age 65 or older. SUD prevalence, prescription frequency changes over time, and comorbidities associated with each medication were compared.

RESULTS

Electronic health records for 356,133 older adults (110,236 Hispanics and 245,897 non-Hispanics) were analyzed. Notably, 79 % of Hispanics fell below the 100 % federal poverty level, compared to 60 % of non-Hispanics (P<.001). Non-Hispanics also had significantly more average encounters (P=.003) and diagnoses (P<.001). Regression analysis on alcohol-related disorders indicated that the odd ratios of being male (OR=2.93, P<.000), and having low income (OR=1.62, P<.000), increase the odds for this SUD, while being Hispanic and primarily speaking Spanish decreases the odds for all SUDs considered in this study.

CONCLUSIONS

This cohort study revealed significant disparities related to social determinants of health between Hispanic and non-Hispanic older adults and emphasizes the need for continuous surveillance of older adults as with SUDs. Differences in comorbidity patterns imply distinct risk factors within each population, influenced by demographic-specific elements. Recognizing these variations is essential for tailoring culturally sensitive prevention, intervention, and treatment strategies to each population's unique needs.

A Controlled Clinical Trial on the Effects of Aquatic Exercise on Cognitive Functions in Community-Dwelling Older Adults

Several therapies have been developed to reduce cognitive decline associated with aging. Aquatic exercises, which are widely used to enhance functional capacity, may play a role in stimulating cognitive functions. This study investigated the effects of a 3-month aquatic exercise program on cognitive functions in community-dwelling older adults. In this prospective, single-blinded, controlled clinical trial, 31 participants were allocated to either the experimental (aquatic exercises) or control (no-exercise) group. The intervention program consisted of exercises conducted twice a week in a 1.2 m deep indoor pool. The main outcome measures were cognitive functions, assessed using Raven's Progressive Matrices test and the Wisconsin Card Sorting Test. A repeated-measures analysis of variance was used to assess the impact of the exercise program. The effect sizes (η2p) were reported when a level of significance was achieved (p < 0.05). Compared with the control group, the participants who underwent aquatic exercises showed positive outcomes in Raven's Progressive Matrices test (p = 0.046; η2p = 0.131) and the Wisconsin Card Sorting Test (p = 0.001, η2p = 0.589). Complementary analyses of the Wisconsin Card Sorting Test indicated that the benefits of the aquatic exercise were observed in terms of the number of trials (p = 0.001, η2p = 0.478), number of errors (p = 0.001, η2p = 0.458), and number of non-perseverative errors (p = 0.001, η2p = 0.302). The results indicate that a period of three months of aquatic exercise was beneficial for stimulating specific aspects of the cognitive function of community-dwelling older individuals. Aquatic exercise should be prescribed to this population.

A pilot study of Keto Prescribed+: A healthy thinking and eating educational program for African American women

ABSTRACT

African American (AA) women have the highest prevalence of obesity in addition to health disparities in preventable diet-related diseases (i.e., diabetes, hypertension), which places them at increased risk for cardiovascular disease. The purpose of this pilot study was to assess the feasibility, acceptability, and preliminary effectiveness of the Keto Prescribed+ (KetoRx+) program on associated physical and psychosocial outcomes among this population. The KetoRx+ program is a healthy eating and thinking educational intervention. The program combined online and in-person community group sessions over 8 weeks. The Keto Prescribed+ was found to be feasible and acceptable with comments on ways to increase acceptability from participants completing program (n = 10). Physical outcomes changed showed an average decrease in weight of 10lbs (SD = 5), baseline average 226lbs. Waist-to-hip ratio and systolic blood pressure also trended down. Psychosocial outcomes showed improvement trends. The KetoRx+ program is feasible and acceptable for overweight or obese AA women. Preliminary efficacy was established for most physical and psychosocial outcomes. However, more research is needed to identify specific program components contributing to healthy lifestyle behavior change and to establish program efficacy and effectiveness. Culturally adapted community-based biopsychosocial interventions using ketogenic nutrition therapy may help improve cardiovascular health of adult AA women.

Disparities in Postmastectomy Reconstruction Use among American Indian and Alaska Native Women

BACKGROUND

American Indian/Alaska Native (AI/AN) breast cancer patients undergo postmastectomy reconstruction (PMR) infrequently relative to non-Hispanic White (NHW) patients. Factors associated with low PMR rates among AI/AN women are poorly understood. The authors sought to describe factors associated with this disparity in surgical care.

METHODS

A retrospective cohort study of the National Cancer Database (2004 to 2017) identified AI/AN and NHW women, aged 18 to 64, who underwent mastectomy for stage 0 to III breast cancer. Patient characteristics, annual PMR rates, and factors associated with PMR were described with univariable analysis, the Cochran-Armitage test, and multivariable logistical regression.

RESULTS

A total of 414,036 NHW and 1980 AI/AN women met inclusion criteria. Relative to NHW women, AI/AN women had more comorbidities (20% versus 12%; Charlson Comorbidity Index ≥ 1; P < 0.001), had nonprivate insurance (49% versus 20%; P < 0.001), and underwent unilateral mastectomy more frequently (69% versus 61%; P < 0.001). PMR rates increased over the study period, from 13% to 47% for AI/AN women and from 29% to 62% for NHW women ( P < 0.001). AI/AN race was independently associated with decreased likelihood of PMR (OR, 0.62; 95% CI, 0.56 to 0.69). Among AI/AN women, decreased likelihood of PMR was significantly associated with older age at diagnosis, more remote year of diagnosis, advanced disease (tumor size >5 cm, positive lymph nodes), unilateral mastectomy, nonprivate insurance, and lower educational attainment in patient's area of residence.

CONCLUSIONS

PMR rates among AI/AN women with stage 0 to III breast cancer have increased, yet they remain significantly lower than rates among NHW women. Further research should elicit AI/AN perspectives on PMR, and guide early breast cancer detection and treatment.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Risk, II.

Effects of Upper Limb Exercise or Training on Hand Dexterity and Function in People With Parkinson Disease: A Systematic Review and Meta-analysis

OBJECTIVE

This systematic review investigated the effects of exercise and training on hand dexterity and function outcomes in people with Parkinson disease (PD).

DATA SOURCES

We searched 5 databases (MEDLINE Ovid, CINAHL, PEDro, PubMed, Cochrane Database) from inception to October 2022.

STUDY SELECTION

Included studies were randomized controlled trials delivering upper limb exercise or training interventions to people with PD and evaluating 1 or more upper limb activity outcomes. Two independent reviewers screened 668 articles for inclusion.

DATA EXTRACTION

Two reviewers independently extracted data relating to study participants, intervention characteristics, and key outcomes. Cochrane Risk of Bias and GRADE tools assessed methodological quality of included studies, and strength of evidence for 3 outcomes: hand dexterity, self-reported hand function, and handwriting performance. Meta-analyses synthesized results for within-hand dexterity and self-reported function.

RESULTS

Eighteen randomized controlled trials (n=704) with low to unclear risk of bias were identified. Experimental interventions varied considerably in their approach and treatment dose, and 3 studies focused on training handwriting. Meta-analysis showed moderate quality evidence of a small positive effect on within-hand dexterity (SMD=0.26; 95% CI 0.07, 0.44). Very low-quality evidence pointed toward a nonsignificant effect on self-reported hand function (SMD=0.67; 95% CI -0.40, 1.75). A narrative review of handwriting interventions showed low quality evidence for improved performance after training.

CONCLUSIONS

There is moderate certainty of evidence supporting the use of exercise and training to address dexterity problems, but evidence remains unclear for self-reported hand function and handwriting. Our findings suggest that training could employ task-related approaches. Future research should interrogate aspects of clinical practice such as optimal dose and key ingredients for effective interventions.

Differential peripheral memory T cell subsets sensitively indicate the severity of nonalcoholic fatty liver disease

AIM

Differential patterns of peripheral memory T cell subsets in nonalcoholic fatty liver disease (NAFLD) were assessed using flow cytometry (FCM) to elucidate their association with NAFLD severity and provide a new noninvasive method to sensitively detect the disease severity in addition to existing biomarkers.

METHODS

We assessed the differential frequencies of peripheral memory T cell subsets in 103 patients with NAFLD according to the degree of liver fibrosis (FIB) using FCM analysis. We focused on the following populations: CCR7+ CD45RA+ naïve T, CCR7+ CD45RA- central memory T cells (TCM), CCR7- CD45RA- effector memory T, and CCR7- CD45RA+ terminally differentiated effector memory T (TEMRA) cells in CD4+ and CD8+ T, Th1, Th2, and Th17 cells, respectively. To evaluate the pathological progression of the disease, these frequencies were also examined according to the degree of the NAFLD activity score (NAS).

RESULTS

Several significant correlations were observed between laboratory parameters and peripheral memory T lymphocyte frequencies according to the degree of liver FIB and NAS in NAFLD. In univariate and multivariate analyses, the frequency of CD8+ TEMRA cells predicted severe FIB, and the predictive power was validated in an independent cohort. Furthermore, the frequencies of several memory T cell subsets sensitively indicated the pathological progression of NAFLD (Th17 TCM: steatosis, CD4+ TCM: lobular inflammation, and CD8+ TEMRA and effector memory T cells: hepatocellular ballooning).

CONCLUSIONS

Our results suggest that the analysis of peripheral memory T lymphocyte frequencies can noninvasively predict severe FIB and sensitively indicate the pathological progression of NAFLD.

Identifying subgroups of patients that may benefit from robotic arm-assisted total knee arthroplasty: Secondary analysis of data from a randomised controlled trial

BACKGROUND

The aims were to assess whether a specific subgroup(s) of patients had a clinically significant benefit in their knee specific outcome or health-related quality of life (HRQoL) when undergoing robotic total knee arthroplasty (rTKA) when compared to manually performed TKA (mTKA).

METHODS

One hundred patients were randomised to either rTKA or mTKA, 50 to each group, of which 46 and 41 were available for functional review at 6-months, respectively. Subgroup analysis was undertaken for sex, age (<67-years versus ≥ 67-years), preoperative WOMAC score (<40 versus ≥ 40) and EQ-5D utility (<0.604 versus ≥ 0.604).

RESULTS

Male patients undergoing rTKA had a clinically and statistically significant greater improvement in WOMAC pain (mean difference (MD) 16.3, p = 0.011) at 2-months, function (MD 12.6, p = 0.032) and total score (MD 12.7, p = 0.030), and OKS (MD 6.0, p = 0.030) at 6-months. Patients < 67-years old undergoing rTKA had a clinically and statistically significant greater improvement in WOMAC pain (MD 10.3, p = 0.039) at 2-months, and function (MD 12.9, p = 0.040) and total (MD 13.1, p = 0.038) scores at 6-months. Patients with a preoperative WOMAC total score of < 40 points undergoing rTKA had a clinically and statistically significant greater improvement in WOMAC pain (MD 14.6, p = 0.044) at 6-months. Patients with a preoperative EQ-5D utility of <0.604 undergoing rTKA had a clinically and statistically significant greater improvement in WOMAC pain (MD 15.5, p = 0.011) at 2-months.

CONCLUSION

Patients of male sex, younger age, worse preoperative knee specific function and HRQoL had a clinically significantly better early functional outcome with rTKA when compared to mTKA.

From big data to big insights: statistical and bioinformatic approaches for exploring the lipidome

The goal of lipidomic studies is to provide a broad characterization of cellular lipids present and changing in a sample of interest. Recent lipidomic research has significantly contributed to revealing the multifaceted roles that lipids play in fundamental cellular processes, including signaling, energy storage, and structural support. Furthermore, these findings have shed light on how lipids dynamically respond to various perturbations. Continued advancement in analytical techniques has also led to improved abilities to detect and identify novel lipid species, resulting in increasingly large datasets. Statistical analysis of these datasets can be challenging not only because of their vast size, but also because of the highly correlated data structure that exists due to many lipids belonging to the same metabolic or regulatory pathways. Interpretation of these lipidomic datasets is also hindered by a lack of current biological knowledge for the individual lipids. These limitations can therefore make lipidomic data analysis a daunting task. To address these difficulties and shed light on opportunities and also weaknesses in current tools, we have assembled this review. Here, we illustrate common statistical approaches for finding patterns in lipidomic datasets, including univariate hypothesis testing, unsupervised clustering, supervised classification modeling, and deep learning approaches. We then describe various bioinformatic tools often used to biologically contextualize results of interest. Overall, this review provides a framework for guiding lipidomic data analysis to promote a greater assessment of lipidomic results, while understanding potential advantages and weaknesses along the way.

Serum Copper/Zinc Ratio in Overweight and Obese Children: a Cross-Sectional Study

To assess the association between serum copper/zinc ratio (CZR) and overweight/obesity in children. Sociodemographic and clinical data of children aged 8-18 years old were extracted from the National Health and Nutrition Examination Survey (NHANES) database in this cross-sectional study. These associations were explored using weighted univariate and multivariate logistic regression analyses with the odds ratios (ORs) and 95% confidence intervals (CIs). High serum CZR level was related to higher odds of overweight (OR = 1.74), obesity (OR = 5.26), and central obesity (OR = 2.99). Subgroup analyses showed that high serum CZR levels were associated with high odds of overweight in children aged ≥ 12 years old (OR = 2.19) and females (OR = 2.02), while the increased odds of obesity and central obesity were found in children aged ≥ 12 years old and both male and female. Elevated serum CZR level was linked to high odds of childhood overweight, obesity, and central obesity, and this relationship was also found in children with different age and gender.

Advancing Diagnostics and Patient Care: The Role of Biomarkers in Radiology

The integration of biomarkers into medical practice has revolutionized the field of radiology, allowing for enhanced diagnostic accuracy, personalized treatment strategies, and improved patient care outcomes. This review offers radiologists a comprehensive understanding of the diverse applications of biomarkers in medicine. By elucidating the fundamental concepts, challenges, and recent advancements in biomarker utilization, it will serve as a bridge between the disciplines of radiology and epidemiology. Through an exploration of various biomarker types, such as imaging biomarkers, molecular biomarkers, and genetic markers, I outline their roles in disease detection, prognosis prediction, and therapeutic monitoring. I also discuss the significance of robust study designs, blinding, power and sample size calculations, performance metrics, and statistical methodologies in biomarker research. By fostering collaboration between radiologists, statisticians, and epidemiologists, I hope to accelerate the translation of biomarker discoveries into clinical practice, ultimately leading to improved patient care.

Chronic Mild Sleep Restriction Does Not Lead to Marked Neuronal Alterations Compared With Maintained Adequate Sleep in Adults

BACKGROUND

Sleep restriction (SR) has been shown to upregulate neuronal reward networks in response to food stimuli, but prior studies were short-term and employed severe SR paradigms.

OBJECTIVE

Our goal was to determine whether mild SR, achieved by delaying bedtimes by 1.5 h, influences neuronal networks responsive to food stimuli compared with maintained adequate sleep (AS) >7 h/night.

METHODS

A randomized controlled crossover study with 2 6-wk phases, AS (≥7 h sleep/night) and SR (-1.5 h/night relative to screening), was conducted. Adults with AS duration, measured using wrist actigraphy over a 2-wk screening period, and self-reported good sleep quality were enrolled. Resting-state and food-stimulated functional neuroimaging (fMRI) was performed at the endpoint of each phase. Resting-state fMRI data analyses included a priori region-of-interest seed-based functional connectivity, whole-brain voxel-wise analyses, and network analyses. Food task-fMRI analyses compared brain activity patterns in response to food cues between conditions. Paired-sample t tests tested differences between conditions.

RESULTS

Twenty-six participants (16 males; age 29.6 ± 5.3 y, body mass index 26.9 ± 4.0 kg/m2) contributed complete data. Total sleep time was 7 h 30 ± 28 min/night during AS compared with 6 h 12 ± 26 min/night during SR. We employed different statistical approaches to replicate prior studies in the field and to apply more robust approaches that are currently advocated in the field. Using uncorrected P value of <0.01, cluster ≥10-voxel thresholds, we replicated prior findings of increased activation in response to foods in reward networks after SR compared with AS (right insula, right inferior frontal gyrus, and right supramarginal gyrus). These findings did not survive more rigorous analytical approaches (Gaussian Random Field theory correction at 2-tailed voxel P < 0.001, cluster P < 0.05).

CONCLUSIONS

The results suggest that mild SR leads to increased reward responsivity to foods but with low confidence given the failure to meet significance from rigorous statistical analyses. Further research is necessary to inform the mechanisms underlying the role of sleep on food intake regulation. This trial was registered at clinicaltrials.gov as NCT02960776.

Parental Beliefs About the Motor Development of Dutch Infants Born Very Preterm: A Cohort Study

PURPOSE

To explore the influence of preterm birth on parental beliefs about gross motor development and parents' supportive role in infants' motor development.

METHODS

Prospective cohort study: Parents of infants born very preterm (VPT) (gestation ≤32 weeks, birth weight <1500 g, without perinatal complications) and parents of healthy infants born full-term (FT) completed the Parental Beliefs on Motor Development questionnaire.

RESULTS

Questionnaires from 37 parents of infants born VPT, aged 3.5 to 7.5 months (corrected), and 110 parents of infants born FT, aged 3.5 months, were analyzed. Parents of infants born VPT believed stimulating motor development to be more important than parents of infants born FT (F = 5.22; P = .024; ηp2 = 0.035). Most parents of infants born VPT (82.4%) and FT (85.2%) acknowledged their role in supporting motor development. More parents of infants born VPT (41.2% vs 12.0%) believed they should follow their infant's natural developmental pace.

CONCLUSION

Knowledge of parental beliefs and parents' supporting role in motor development is relevant for tailoring pediatric physiotherapists' interventions with families.

Recruiting African American Prostate Cancer Survivors for a Population-based Biobank Study

BACKGROUND

Prostate cancer affects African American men disproportionately compared with men of other racial/ethnic groups. To identify biological bases for this health disparity, we sought to create a state-wide biobank of African American prostate cancer survivors in Florida.

METHODS

African American men diagnosed with prostate cancer between 2013 and 2017 and living in Florida at diagnosis were identified through the State of Florida's cancer registry. Individuals were approached via mail and telephone, assessed for eligibility, and asked for informed consent. χ2 and t tests were conducted to identify differences between eligible and reachable individuals (i.e., had valid contact information) versus consented participants.

RESULTS

Of the 5,960 eligible and reachable individuals, 3,904 were eligible and contacted at least once, and 578 consented [overall consent rate = 10% (578/5,960); adjusted consent rate = 15% (578/3,904)]. Statistically significant (Ps < 0.05) but small differences in demographic and clinical variables were observed. Consented participants were less likely to be older than 64 (35% vs. 41%) and less likely to have received radiotherapy (36% vs. 41%) and hormone therapy (16% vs. 21%), but more likely to have regional prostate cancer (13% vs. 11%) and have undergone surgery (44% vs. 39%). Consented participants did not differ from reachable individuals on other demographic and clinical factors (Ps > 0.05).

CONCLUSIONS

Recruiting African American prostate cancer survivors to biobanking research through a cancer registry is feasible. However, the consent rate was low, and existing challenges limit consent and participation.

IMPACT

Strategies for overcoming barriers to informed consent and increasing participation in biospecimen research are needed to address cancer disparities.

Chemotherapy refusal and subsequent survival in healthy older women with high genomic risk estrogen receptor-positive breast cancer

BACKGROUND

Patients with estrogen receptor (ER)-positive, HER2-negative breast cancer (BC), and high-risk 21-gene recurrence score (RS) results benefit from chemotherapy. We evaluated chemotherapy refusal and survival in healthy older women with high-RS, ER-positive BC.

METHODS

Retrospective review of the National Cancer Database (2010-2017) identified women ≥ 65 years of age, with ER-positive, HER2-negative, high-RS (≥ 26) BC. Patients with Charlson Comorbidity Index ≥ 1, stage III/IV disease, or incomplete data were excluded. Women were compared by chemotherapy receipt or refusal using the Cochrane-Armitage test, multivariable logistical regression modeling, the Kaplan-Meier method, and Cox's proportional hazards modeling.

RESULTS

6827 women met study criteria: 5449 (80%) received chemotherapy and 1378 (20%) refused. Compared to women who received chemotherapy, women who refused were older (71 vs 69 years), were diagnosed more recently (2014-2017, 67% vs 61%), and received radiation less frequently (67% vs 71%) (p ≤ 0.05). Refusal was associated with decreased 5-year OS for women 65-74 (92% vs 95%) and 75-79 (85% vs 92%) (p ≤ 0.05), but not for women ≥ 80 years old (84% vs 91%; p = 0.07). On multivariable analysis, hazard of death increased with refusal overall (HR 1.12, 95% CI 1.04-1.2); but, when stratified by age, was not increased for women ≥ 80 years (HR 1.10, 95% CI 0.80-1.51).

CONCLUSIONS

Among healthy women with high-RS, ER-positive BC, chemotherapy refusal was associated with decreased OS for women ages 65-79, but did not impact the OS of women ≥ 80 years old. Genomic testing may have limited utility in this population, warranting prudent shared decision-making and further study.

An Overview of the Fundamentals of Data Management, Analysis, and Interpretation in Quantitative Research

OBJECTIVES

To provide an overview of three consecutive stages involved in the processing of quantitative research data (ie, data management, analysis, and interpretation) with the aid of practical examples to foster enhanced understanding.

DATA SOURCES

Published scientific articles, research textbooks, and expert advice were used.

CONCLUSION

Typically, a considerable amount of numerical research data is collected that require analysis. On entry into a data set, data must be carefully checked for errors and missing values, and then variables must be defined and coded as part of data management. Quantitative data analysis involves the use of statistics. Descriptive statistics help summarize the variables in a data set to show what is typical for a sample. Measures of central tendency (ie, mean, median, mode), measures of spread (standard deviation), and parameter estimation measures (confidence intervals) may be calculated. Inferential statistics aid in testing hypotheses about whether or not a hypothesized effect, relationship, or difference is likely true. Inferential statistical tests produce a value for probability, the P value. The P value informs about whether an effect, relationship, or difference might exist in reality. Crucially, it must be accompanied by a measure of magnitude (effect size) to help interpret how small or large this effect, relationship, or difference is. Effect sizes provide key information for clinical decision-making in health care.

IMPLICATIONS FOR NURSING PRACTICE

Developing capacity in the management, analysis, and interpretation of quantitative research data can have a multifaceted impact in enhancing nurses' confidence in understanding, evaluating, and applying quantitative evidence in cancer nursing practice.

Refraction development in anisometropic amblyopia with patching therapy

Purpose

To investigate the development of refraction in anisometropic amblyopia who had been with patching therapy.

Methods

We retrospectively reviewed 37,528 medical records of the amblyopes who had been treated with patching therapy between July 2003 and January 2020 at the School of Optometry and Ophthalmology and Eye Hospital of Wenzhou Medical University. We included unilateral anisometropic amblyopia with a follow-up length of not < 2 years. In total, 371 cases were enrolled and followed up for a mean of 4.76 ± 2.11 years. The subjects were then divided into different groups and periods according to their initial spherical equivalent (SE) refractive error and best-corrected visual acuity (BCVA) of the amblyopic eye. Linear mixed-effects models were fitted to calculate the annual change of SE.

Results

The annual changes in SE were -0.32 (-0.35 to -0.30) and -0.16 (-0.19 to -0.14) D/yr for the amblyopic eye and the fellow eye, respectively. The annual changes in SE of amblyopic eyes during the treatment period and the successfully treated period were -0.36 (-0.43 to -0.29; 95% CI) and -0.27 (-0.32 to -0.23; 95% CI) D/yr, respectively; the annual SE changes of the fellow eye during the treatment period and the successfully-treated period were -0.07 (-0.14 to -0.01; 95% CI) and -0.18 (-0.22 to -0.14; 95% CI) D/yr, respectively.

Conclusion

The amblyopic eye experienced a significantly greater degree of refractive error changes than the fellow eye and underwent a continuous refractive error reduction before and after 7 years old. After the patching therapy was terminated, emmetropization in the amblyopic eye remained synchronized, whereas the refractive error change was increased in the fellow eye.

Toll-like Receptor 2 Is Associated with the Immune Response, Apoptosis, and Angiogenesis in the Mammary Glands of Dairy Cows with Clinical Mastitis

Toll-like receptor 2 (TLR2) plays a crucial role in bacterial recognition and the host immune response during infection. However, its function and downstream biological processes (BPs) in the mammary glands (MGs) of Holstein cows with clinical mastitis (CM) are not fully understood. This study aimed to comprehensively identify the BPs and differentially expressed proteins (DEPs) associated with the bacterial response and TLR2 using data-independent acquisition (DIA) proteomic data. A possible mechanism for the action of TLR2 was proposed, and the results suggested that the expression levels of TLR2 and caspase 8 (CASP8) were positively correlated with the apoptosis of MGs. The expression patterns of TLR2 and TEK receptor tyrosine kinase 2 (Tie2) were negatively correlated with angiogenesis. These results indicated that TLR2 might promote apoptosis in mammary epithelial cells (MECs) and vascular endothelial cells (VECs) via upregulation of CASP8 expression, and inhibition of angiogenesis in VECs via downregulation of Tie2 expression in dairy cows with CM. In conclusion, TLR2 is associated with inflammation, apoptosis, and angiogenesis in the MGs of dairy cows with bacteria-induced mastitis. These results contribute to a deeper understanding of the pathogenic mechanisms and provide the knowledge needed for developing the prevention and treatment of dairy mastitis.

Assessment of three types of surgical procedures for supravalvar aortic stenosis: A systematic review and meta-analysis

Importance

The safety and efficacy of different surgical repairs of supravalvar aortic stenosis (SVAS) are inconsistent.

Objective

To compare the prognosis of single-, two- and three-patch repair for patients with SVAS.

Data sources

PubMed, EMBASE, Cochrane Library, Web of Science, and clinicaltrials.gov were searched until April 17, 2022.

Study selection

Study reported SVAS patients treated with single-, two- or three-patch repair.

Data extraction and synthesis

Two reviewers independently extracted the data of study characteristics and clinical outcomes. Multiple pairwise and frequentist network meta-analyses were conducted. And a fixed-effect model was used when no heterogeneity existed.

Main outcomes and measures

Outcomes included the rate of reintervention, aortic insufficiency, early mortality and late mortality, cardiopulmonary bypass (CPB) time, cross-clamping (CCP) time, and postoperative/ follow-up pressure gradient. Binary variables were evaluated by odds ratio (OR) and its 95% confidence interval (CI), while continuous variables were assessed by standardized mean difference (SMD) and its 95% CI.

Results

Twenty-seven retrospective cohort studies were included, comprising 1,162 patients, undergoing single-patch (46.6% of cases), two-patch (33.9%), and three-patch repair (19.4%). Two-patch method had a lower rate of reintervention compared with single-patch (OR = 0.47, 95 % CI 0.28–0.89), and three-patch (OR = 0.31, 95 % CI 0.15–0.64). This finding also applied to juvenile and non-Asian patients. Three-patch method had a lower rate of aortic insufficiency compared with single-patch (OR = 0.11, 95 % CI 0.01–0.63), and two-patch (OR = 0.11, 95 % CI 0.02–0.83). But this repair had the longest CCP time, which was significantly longer than that of single- (SMD = 0.76, 95 % CI 0.36–1.17) or two-patch repair (SMD = 0.61, 95 % CI 0.06–1.16). No significant difference was found in mortality and pressure gradient among three procedures.

Conclusion and relevance

Two-patch repair has the lowest reintervention rate and relatively reasonable operation time. Complex and severe SVAS is suggested to be treated with two-patch repair. Further prospective studies of a reasonable sample size will be required with a special focus on the use of different patch materials and surgeons' unique working experience.

Systematic review registration

http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022328146.

Effect of Kinesiology Tape on Muscle Activation of Lower Extremity and Ankle Kinesthesia in Individuals With Unilateral Chronic Ankle Instability

Background: The purpose of the study was to determine the effect of kinesiology tape (KT) on lower limb muscle activation during computerized dynamic posturography (CDP) tasks and ankle kinesthesia in individuals with chronic ankle instability (CAI). Methods: Thirty-five men with CAI participated in this study. The experimental procedure followed a repeated measures design. Muscle activation of lower extremity and ankle kinesthesia of participants were measured using four taping treatments, namely, KT, athletic tape (AT), sham tape (ST), and no tape (NT) in a randomized order. Muscle activation was assessed using surface electromyography (sEMG) synchronized with CDP tests from seven lower extremity muscles of the unstable limb. Ankle kinesthesia was measured by using a threshold to detect the passive motion direction of the unstable ankle. Parameters were analyzed by using a one-way repeated measures ANOVA and followed by pairwise comparisons with a Bonferroni correction. Results: No significant difference was observed among different taping treatments for the majority of parameters during CDP. Except for condition 4 with open eyes, sway-referenced surface, and fixed surround in the sensory organization test (SOT), gastrocnemius medialis root mean square (RMS) was 28.19% lower in AT compared with NT (p = 0.021, 95% CI = 0.002-0.039), while gastrocnemius lateralis RMS was 20.25% lower in AT compared with KT (p = 0.038, 95% CI = 0.000-0.021). In forward-small sudden translation from motor control test (MCT), for peroneal longus (PL), RMS was 24.04% lower in KT compared with ST (p = 0.036, 95% CI = 0.000-0.018). In toes-down sudden rotation from adaption test (ADT), for PL, RMS was 23.41% lower in AT compared with ST (p = 0.015, 95% CI = 0.002-0.027). In addition, no significant difference was observed for a threshold to the detection of passive motion direction among different taping treatments. Conclusion: This study indicated that KT had minimal effect on the muscle activation of the unstable lower limb during static stance, self-initiated, and externally triggered perturbation tasks from CDP and ankle kinesthesia among individuals with CAI, suggesting that the benefit of KT was too small to be clinically worthwhile during application for CAI.

FLAIR2 post-processing: improving MS lesion detection in standard MS imaging protocols

BACKGROUND

Technical improvements in magnetic resonance imaging (MRI) acquisition, such as higher field strength and optimized sequences, lead to better multiple sclerosis (MS) lesion detection and characterization. Multiplication of 3D-FLAIR with 3D-T2 sequences (FLAIR²) results in isovoxel images with increased contrast-to-noise ratio, increased white-gray-matter contrast, and improved MS lesion visualization without increasing MRI acquisition time. The current study aims to assess the potential of 3D-FLAIR² in detecting cortical/leucocortical (LC), juxtacortical (JC), and white matter (WM) lesions.

OBJECTIVE

To compare lesion detection of 3D-FLAIR² with state-of-the-art 3D-T2-FLAIR and 3D-T2-weighted images.

METHODS

We retrospectively analyzed MRI scans of thirteen MS patients, showing previously noted high cortical lesion load. Scans were acquired using a 3 T MRI scanner. WM, JC, and LC lesions were manually labeled and manually counted after randomization of 3D-T2, 3D-FLAIR, and 3D-FLAIR² scans using the ITK-SNAP tool.

RESULTS

LC lesion visibility was significantly improved by 3D-FLAIR² in comparison to 3D-FLAIR (4 vs 1; p = 0.018) and 3D-T2 (4 vs 1; p = 0.007). Comparing LC lesion detection in 3D-FLAIR² vs. 3D-FLAIR, 3D-FLAIR² detected on average 3.2 more cortical lesions (95% CI - 9.1 to 2.8). Comparing against 3D-T2, 3D-FLAIR² detected on average 3.7 more LC lesions (95% CI 3.3-10.7).

CONCLUSIONS

3D-FLAIR² is an easily applicable time-sparing MR post-processing method to improve cortical lesion detection. Larger sampled studies are warranted to validate the sensitivity and specificity of 3D-FLAIR².

Influence of metal artefact reduction tool on the detection of vertical root fractures involving teeth with intracanal materials in cone beam computed tomography images: A systematic review and meta-analysis

BACKGROUND

The effectiveness of the metal artefact reduction (MAR) tool for the detection of vertical root fracture (VRF) by cone beam computed tomography (CBCT) images is controversial.

OBJECTIVE

To evaluate the effectiveness of the MAR tool on VRF detection involving teeth with intracanal materials in CBCT images.

METHODOLOGY

In September 2019, an electronic search was performed in six databases (PubMed, Scopus, Web of Science, Cochrane, Lilacs and Embase). The electronic search was updated in May 2020 through searches in Google Scholar and references of included studies (embracing the electronic and gray literature searches). No language or year restrictions were applied. Independently, two reviewers examined titles, abstracts and full texts according to the eligibility criteria that were as follows: diagnostic studies that evaluated the effectiveness of the MAR tool on the diagnosis of VRF in human teeth (laboratory or in vivo studies) on CBCT images. The risk of bias was evaluated using the Quality Assessment Tool for Diagnostic of Accuracy Studies-2 (QUADAS-2). For conducting the meta-analysis, the values of sensitivity, specificity, diagnostic odds ratio (DOR) and area under the ROC curve (AUC) were obtained, considering the subgroups with and without MAR active. The Grading of Recommendation, Assessment, Development and Evaluation instrument was applied to assess the level of evidence across the studies using GRADEpro software.

RESULTS

A total of 8 laboratory studies were included in both systematic review and meta-analysis. The values of sensitivity, specificity, DOR and AUC to VRF diagnosis with and without MAR active were, respectively, 0.586 and 0.603; 0.699 and 0.713, 3.037 and 3.767; 0.67 and 0.71. The quality of the evidence suggested low confidence in estimating the outcomes.

DISCUSSION

The MAR tool decreased slightly the diagnostic values of VRF involving teeth with intracanal materials in laboratory studies. However, it is important to highlight that most studies had an uncertain risk of bias.

CONCLUSIONS

Although a low level of evidence and high heterogeneity were observed in the included studies, the meta-analysis revealed better diagnosis values for VRF detection when the MAR was deactivated when analysing extracted teeth in a laboratory setting.

REGISTRATION

PROSPERO-CRD42020145222.

FUNDING

This study was financed in party by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES).