PURPOSE: The mortality rate for severely injured patients with the injury severity score (ISS) ≥16 has decreased in Germany. There is robust evidence that mortality is influenced not only by the acute trauma itself but also by physical health, age and sex. The aim of this study was to identify other possible influences on the mortality of severely injured patients. METHODS: In a matched-pair analysis of data from Trauma Register DGU®, non-surviving patients from Germany between 2009 and 2014 with an ISS≥16 were compared with surviving matching partners. Matching was performed on the basis of age, sex, physical health, injury pattern, trauma mechanism, conscious state at the scene of the accident based on the Glasgow coma scale, and the presence of shock on arrival at the emergency room. RESULTS: We matched two homogeneous groups, each of which consisted of 657 patients (535 male, average age 37 years). There was no significant difference in the vital parameters at the scene of the accident, the length of the pre-hospital phase, the type of transport (ground or air), pre-hospital fluid management and amounts, ISS, initial care level, the length of the emergency room stay, the care received at night or from on-call personnel during the weekend, the use of abdominal sonographic imaging, the type of X-ray imaging used, and the percentage of patients who developed sepsis. We found a significant difference in the new injury severity score, the frequency of multi-organ failure, hemoglobine at admission, base excess and international normalized ratio in the emergency room, the type of accident (fall or road traffic accident), the pre-hospital intubation rate, reanimation, in-hospital fluid management, the frequency of transfusion, tomography (whole-body computed tomography), and the necessity of emergency intervention. CONCLUSION Previously postulated factors such as the level of care and the length of the emergency room stay did not appear to have a significant influence in this study. Further studies should be conducted to analyse the identified factors with a view to optimising the treatment of severely injured patients. Our study shows that there are significant factors that can predict or influence the mortality of severely injured patients.
Accidents ; classification ; Adult ; Age Factors ; Blood Transfusion ; Data Analysis ; Emergency Medical Services ; Female ; Fluid Therapy ; Germany ; epidemiology ; Hemoglobins ; Humans ; International Normalized Ratio ; Intubation ; statistics & numerical data ; Male ; Matched-Pair Analysis ; Multiple Organ Failure ; Registries ; Sex Factors ; Survival Rate ; Trauma Severity Indices ; Wounds and Injuries ; mortality

OBJECTIVE: We compared survival outcomes of advanced serous type epithelial ovarian cancer (EOC) patients with normal-sized ovaries and enlarged-ovarian tumors by propensity score matching analysis. METHODS: The medical records of EOC patients treated at Samsung Medical Center between 2002 and 2015 were reviewed retrospectively. We investigated EOC patients with high grade serous type histology and International Federation of Gynecology and Obstetrics (FIGO) stage IIIB, IIIC, or IV who underwent primary debulking surgery (PDS) and adjuvant chemotherapy to identify patients with normal-sized ovaries. Propensity score matching was performed to compare patients with normal-sized ovaries to patients with enlarged-ovarian tumors (ratio, 1:3) according to age, FIGO stage, initial cancer antigen (CA)-125 level, and residual disease status after PDS. RESULTS: Of the 419 EOC patients, 48 patients had normal-sized ovary. Patients with enlarged-ovarian tumor were younger (54.0±10.3 vs. 58.4±9.2 years, p=0.005) than those with normal-sized ovary, and there was a statistically significant difference in residual disease status between the 2 groups. In total cohort with a median follow-up period of 43 months (range, 3–164 months), inferior overall survival (OS) was shown in the normal-sized ovary group (median OS, 71.2 vs. 41.4 months; p=0.003). After propensity score matching, the group with normal-sized ovary showed inferior OS compared to the group with enlarged-ovarian tumor (median OS, 72.1 vs. 41.4 months; p=0.031). In multivariate analysis for OS, normal-sized ovary remained a significant factor. CONCLUSION: Normal-sized ovary was associated with poor OS compared with the common presentation of enlarged ovaries in EOC, independent of CA-125 level or residual disease.
Chemotherapy, Adjuvant ; Cohort Studies ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Matched-Pair Analysis ; Medical Records ; Multivariate Analysis ; Obstetrics ; Ovarian Neoplasms ; Ovary ; Prognosis ; Propensity Score ; Retrospective Studies

PURPOSE: Restoring the native patellar thickness after patellar resurfacing provides optimal function of the knee after arthroplasty and minimises complications related to the patellofemoral articulation. The aim of this study was to assess the usefulness of a thin patellar button (6.2 mm) in patients with a patella thickness of less than 20 mm during total knee arthroplasty. MATERIALS AND METHODS: This is a retrospective case control study. A total of 54 female patients with an intraoperative patellar thickness of < 20 mm, resurfaced with a patellar button of 6.2 mm in thickness were identified (group 1). They were matched with 54 patients with a patellar thickness of 20–23 mm, resurfaced with a patellar button of 8 mm (group 2), based on age, sex, body mass index, and deformity. A clinical and radiological evaluation was done at a minimum 2-year follow-up. RESULTS: The preoperative mean patellar thickness was 18.94±1.07 mm and was restored to 19.06±0.79 mm in group 1, as compared to 21.63±0.99 mm and 21.72±0.99 mm in group 2. The mean postoperative range of motion was 122.22°±9.25° in group 1 and 123.52°±8.72° in group 2 (p=0.13). No patellar bone or button related complications were observed in any patient in either group. CONCLUSIONS: The 6.2 mm thin patella is useful to restore the native thickness in patients with a patellar thickness of less than 20 mm without risk of button fracture, loosening or overstuffing.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Body Mass Index ; Case-Control Studies ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Knee ; Matched-Pair Analysis ; Patella ; Patellofemoral Joint ; Range of Motion, Articular ; Retrospective Studies

OBJECTIVES: This double-blind randomized placebo-controlled clinical trial evaluated the ability of a desensitizing agent and a self-etch adhesive on cervical dentin sensitivity (CDS) after periodontal surgery. MATERIALS AND METHODS: Ninety hypersensitive teeth of 13 subjects were included in the study. After periodontal surgery, the teeth of each posterior sextant treated with one of the following materials: G1: Clearfil S³ Bond (Kuraray Dental), G2: Gluma Desensitizer (Heraeus Kulzer), and G3: placebo (water). The sensitivity was assessed using evaporative stimuli before treatment (baseline, T0), 1 day after treatment (T1), after 1 week (T2), and after 1 month (T3) according to visual analog scale (VAS). RESULTS: Following the treatment, all the 3 groups showed significant reduction of CDS in T1 compared to T0. Reduction of CDS between T1 and T2 was observed only in G1 but there was no significant difference between T2 and T3 in this group. Although we observed a significant difference in T3 compared to T1 and T2 in G2 and G3, comparison of treatment groups in each assessment time showed a significant difference only in T3. According to paired comparison, this was due to the difference between G2 and G3. CONCLUSIONS: Dentin sensitivity following periodontal surgery will decrease spontaneously over time, but treating the sensitive teeth with Gluma Desensitizer and Clearfil S³ Bond can have some benefits.
Adhesives* ; Dentin Sensitivity* ; Dentin* ; Matched-Pair Analysis ; Tooth ; Visual Analog Scale

OBJECTIVES: To investigate the effect of electrical automatic massage (EAM) at bedtime on sleep quality and fatigue. METHODS: We recruited consecutively 35 adults (23 male, 48.7±8.07 y) who complained of poor sleep (Pittsburgh Sleep Quality Index≥5) and fatigue (Chalder Fatigue Scale≥4). This is a cross over study including two consecutive sleep studies with or without EAM. The EAM session includes preset ‘sleep mode’, which last 30 minutes covering whole body. Participants were seated in the commercially available massage chair (REX-L®) under the calm and dim light condition immediately before polysomnography. Participants reported perceived sleep latency, sleep duration, and fatigue using visual analogue scale following morning. RESULTS: Polysomnography parameters and subjective reports were compared between sleep with EAM and sleep without EAM. Paired comparison on average revealed sleep structure improvement N1 (13.6→10.9%) and N2 sleep (59.3→57.2%) decreased, and N3 sleep increased (3.0→6.4%), as well as sleep latency (10.3→5.6 min). Improvement in arousal index (17.1→13.0/h) and apnea-hypopnea index (9.1→7.0/h) were also seen following sleep after EAM. Sleep efficiency and total sleep time were not changed by EAM. Participants subjective reports also indicated better sleep on EAM; more lengthened sleep (306→330 minutes) and more relieved fatigue significantly after EAM. CONCLUSIONS: This study demonstrated that muscle relaxation through EAM at bedtime may improve the sleep and alleviate fatigue. It suggests that EAM may be one of alternatives to promote sleep quality. Further studies in a clinical setting are warranted to support this finding.
Adult ; Arousal ; Fatigue* ; Humans ; Male ; Massage* ; Matched-Pair Analysis ; Muscle Relaxation ; Polysomnography ; Relaxation

PURPOSE: Evaluation of alveolar bone is important in the diagnosis of dental diseases. The periodontal ligament space is difficult to clearly depict in cone-beam computed tomography images because the reconstruction filter conditions during image processing cause image blurring, resulting in decreased spatial resolution. We examined different reconstruction filters to assess their ability to improve spatial resolution and allow for a clearer visualization of the periodontal ligament space. MATERIALS AND METHODS: Cone-beam computed tomography projections of 2 skull phantoms were reconstructed using 6 reconstruction conditions and then compared using the Thurstone paired comparison method. Physical evaluations, including the modulation transfer function and the Wiener spectrum, as well as an assessment of space visibility, were undertaken using experimental phantoms. RESULTS: Image reconstruction using a modified Shepp-Logan filter resulted in better sensory, physical, and quantitative evaluations. The reconstruction conditions substantially improved the spatial resolution and visualization of the periodontal ligament space. The difference in sensitivity was obtained by altering the reconstruction filter. CONCLUSION: Modifying the characteristics of a reconstruction filter can generate significant improvement in assessments of the periodontal ligament space. A high-frequency enhancement filter improves the visualization of thin structures and will be useful when accurate assessment of the periodontal ligament space is necessary.
Cone-Beam Computed Tomography* ; Diagnosis ; Evaluation Studies as Topic ; Image Processing, Computer-Assisted ; In Vitro Techniques* ; Matched-Pair Analysis ; Methods ; Periodontal Ligament* ; Phantoms, Imaging ; Skull ; Stomatognathic Diseases

PURPOSE: Until now, there was no single standardized regional segmentation method of planar lung perfusion scan.We compared planar scan based two segmentation methods, which are frequently used in the Society of Nuclear Medicine, with reference to the lung perfusion single photon emission computed tomography (SPECT)/computed tomography (CT) derived values in lung cancer patients.METHODS: Fifty-five lung cancer patients (male:female, 37:18; age, 67.8 ± 10.7 years) were evaluated. The patients underwent planar scan and SPECT/CT after injection of technetium-99 m macroaggregated albumin (Tc-99 m-MAA). The % uptake and predicted postoperative percentage forced expiratory volume in 1 s (ppoFEV1%) derived from both posterior oblique (PO) and anterior posterior (AP) methods were compared with SPECT/CT derived parameters. Concordance analysis, paired comparison, reproducibility analysis and spearman correlation analysis were conducted.RESULTS: The % uptake derived from PO method showed higher concordance with SPECT/CT derived % uptake in every lobe compared to AP method. Both methods showed significantly different lobar distribution of%uptake compared to SPECT/CT. For the target region, ppoFEV1% measured from PO method showed higher concordance with SPECT/CT, but lower reproducibility compared to AP method. Preliminary data revealed that every method significantly correlated with actual postoperative FEV1%, with SPECT/CT showing the best correlation.CONCLUSIONS: The PO method derived values showed better concordance with SPECT/CT compared to the AP method. Both PO and AP methods showed significantly different lobar distribution compared to SPECT/CT. In clinical practice such difference according to different methods and lobes should be considered for more accurate postoperative lung function prediction.
Forced Expiratory Volume ; Humans ; Lung Neoplasms ; Lung ; Matched-Pair Analysis ; Methods ; Nuclear Medicine ; Perfusion Imaging ; Perfusion ; Tomography, Emission-Computed, Single-Photon

Disability weight for each disease plays a key role in combining years lived with disability and years of life lost in disability adjusted life year. For the Korean Burden of Disease 2012 study, we have conducted a re-estimation of disability weights for causes of disease by adapting the methodology of a recent Global Burden of Disease study. Our study was conducted through a self-administered web-based survey using a paired comparison (PC) as the main valuation method. A total of 496 physicians and medical college students who were attending in third or fourth grade of a regular course conducted the survey. We applied a probit regression on the PC data and computed the predicted probabilities of each cause of disease from the coefficient estimates of the probit regression. We used 'being dead (1)' and 'full health (0)' as anchor points to rescale the predicted probability of each cause of disease on a scale of 0 to 1. By this method, disability weights for a total of 228 causes of disease were estimated. There was a fairly high correlation between the disability weights of overlapping causes of disease from this study and a previous South Korean study despite the differences in valuation methods and time periods. In conclusion, we have shown that disability weights can be estimated based on a PC by including 'full health' and 'being dead' as anchor points without resorting to a person trade-off. Through developments in the methodology of disability weights estimation from this study, disability weights can be easily estimated and continuously revised.
Health Resorts ; Humans ; Matched-Pair Analysis ; Methods ; Quality-Adjusted Life Years ; Republic of Korea ; Weights and Measures*

In statistic tests, the probability distribution of the statistics is important. When samples are drawn from population N (micro, sigma2) with a sample size of n, the distribution of the sample mean X should be a normal distribution N (micro, sigma2/n). Under the null hypothesis micro = micro0, the distribution of statistics z=X-micro0/sigma/radical(n) should be standardized as a normal distribution. When the variance of the population is not known, replacement with the sample variance s2 is possible. In this case, the statistics X-micro0/s/radical(n) follows a t distribution (n-1 degrees of freedom). An independent-group t test can be carried out for a comparison of means between two independent groups, with a paired t test for paired data. As the t test is a parametric test, samples should meet certain preconditions, such as normality, equal variances and independence.
Biostatistics ; Matched-Pair Analysis ; Normal Distribution ; Sample Size

BACKGROUND/AIMS: Prothrombin induced by vitamin K deficiency or antagonist II (PIVKA-II) is a widely used diagnostic marker for hepatocellular carcinoma (HCC). We evaluated the correlation between alcoholic liver disease (ALD) and serum PIVKA-II levels in chronic liver disease (CLD) patients. METHODS: We retrospectively reviewed the medical records of 2,528 CLD patients without HCC. Among these patients, 76 exhibited serum high PIVKA-II levels of >125 mAU/mL (group 1). We categorized 76 control patients matched by age, sex, and the presence of liver cirrhosis from the remaining patients who were negative for serum PIVKA-II (group 2). RESULTS: Group 1 revealed increased antibiotic usage (23.7% vs 2.6%, p<0.001) and incidence of ALD (60.5% vs 14.5%, p<0.001) as well as elevated aspartate aminotransferase (52.5 IU/L vs 30.5 IU/L, p=0.025) and gamma glutamyl transpeptidase (67.5 IU/L vs 36.5 IU/L, p=0.005) levels compared with group 2. Further, group 1 was significantly associated with a worse Child-Pugh class than group 2. In the multivariate analysis, ALD (odds ratio [OR], 7.151; p<0.001) and antibiotic usage (OR, 5.846; p<0.001) were significantly associated with positive PIVKA-II levels. CONCLUSIONS: Our study suggests that ALD and antibiotics usage may be confounding factors when interpreting high serum PIVKA-II levels in patients without HCC. Therefore, serum PIVKA-II levels in patients with ALD or in patients administered antibiotics should be interpreted with caution.
Adult ; Age Distribution ; Aged ; Anti-Bacterial Agents/therapeutic use ; Aspartate Aminotransferases/blood ; Biomarkers/*blood ; Carcinoma, Hepatocellular/blood ; Diagnosis, Differential ; Female ; Humans ; Liver Cirrhosis/blood ; Liver Diseases, Alcoholic/*blood ; Liver Neoplasms/blood ; Male ; Matched-Pair Analysis ; Middle Aged ; Multivariate Analysis ; Protein Precursors/*blood ; Prothrombin/analysis ; Retrospective Studies ; Sex Distribution ; gamma-Glutamyltransferase/blood