Analysis Of Treatment Effects Research Articles

On the Use of Micro-Computed Tomography for Pre-Clinical Testing of Cardiovascular Devices that Treat Intravascular Calcium

Micro-computed tomography (µCT) is a powerful, non-destructive tool that generates three-dimensional images of objects using penetrative X-rays. µCT is useful when imaging hardened, biological tissues and is particularly useful when studying the efficacy of cardiovascular devices for the treatment of intravascular calcium (IVC). IVC is an advanced state of atherosclerosis that commonly afflicts the elderly and is associated with vessel hardening (i.e., calcification) and narrowing. If left untreated, adverse events due to IVC include myocardial infarction, stroke, and amputation. However, because of its high strength and the fragility of the surrounding artery, IVC is difficult to treat. Further, device innovations are stymied because of the lack of readily available, pre-clinical models. Currently, the best model of IVC is diseased cadaveric and endarterectomy tissue, but the morphological inconsistencies of these tissues require a standardized approach when used for evaluating IVC treatments. We report a generalized approach that employs µCT to enable qualitative and quantitative analyses of the treatment effect of new devices on IVC tissue. This approach consists of 1) specimen screening, storage, and preparation, 2) pre-, peri-, and post-treatment µCT imaging, and 3) image analysis of IVC morphology and treatment effect. Various examples are provided to guide future bioengineering and medical device testing applications in this space.

Information theoretic approach to high‐dimensional multiplicative models: Stochastic discount factor and treatment effect

This paper is concerned with estimation of functionals of a latent weight function that satisfies possibly high‐dimensional multiplicative moment conditions. Main examples are functionals of stochastic discount factors in asset pricing, missing data problems, and treatment effects. We propose to estimate the latent weight function by an information theoretic approach combined with the ℓ 1‐penalization technique to deal with high‐dimensional moment conditions under sparsity. We study asymptotic properties of the proposed method and illustrate it by a theoretical example on treatment effect analysis and empirical example on estimation of stochastic discount factors.

Long-term fertility experiments for irrigated rice in the West African Sahel: Effect on macro- and micronutrient concentrations in plant and soil

Little is known about the impact of long-term intensive irrigated rice cropping on secondary macro and micronutrients in soils and crops. Therefore, the present study analysed the effect of intensive irrigated rice cropping on nutrient concentrations in soils and rice (grain and straw at harvest) in two long-term experiments that were established in 1991 for intensive rice-based irrigated systems in the Senegal River valley at Ndiaye and Fanaye, Senegal. The experiments included six different fertilizer treatments and rice was grown for two seasons per year. The samples were collected in the 2016/17 dry season (26 years or 52nd continuous rice cropping season after the establishment). Average grain yields from 1991 to 2016/17 for the different fertilizer treatments indicate that yield was limited by N and P at both sites. At Ndiaye, 120 kg N ha −1 seemed sufficient to reach highest achievable yields, whereas 180 kg N ha −1 was necessary at Fanaye. Soil organic carbon and total soil N did increase considerably over the full length of the experiment at both sites and in all treatments even though all crop residues were removed every season. The estimated increase in total topsoil N (across all fertilizer treatments) per season was 10.8 and 11.4 kg N ha −1 at Ndiaye and Fanaye, respectively. Fertilizer treatments differed in their N, P and K rate but significant effects on total soil concentrations were only detected for P. Using the Mehlich3 soil test, we analysed treatment effects on available P, K, Ca, Mg, S, Mn, Zn and Fe. Critical Mehlich3 values from the literature indicated likely P limitation at both sites and in all but one treatment (high PK treatment), a starting but minor K limitation at Fanaye, a strong S limitation at Fanaye, and a minor Zn limitation at Fanaye and Ndiaye. These indications were mostly confirmed by the grain and straw analysis but with the exception of the P limitation, the actual effect of these possible nutrient limitations on production would need to be tested with targeted field experiments. We conclude that continuous rice cultivation in the Sahel for 26 years can be sustained and even increases soil organic carbon and total soil nitrogen. However, in addition to the common N and P deficiencies, likely deficiencies of K, S and Zn are appearing and may begin to limit rice yields in intensive systems in Africa. The Mehlich3 test seems an efficient tool to identify such deficiencies in irrigated rice soils. • 26 years of continuous rice cultivation increased SOC and total soil N significantly • System N losses are therefore over-estimated when based on crop uptake only • Fertilizer application effects on total soil concentrations were only detected for P • The Mehlich3 method indicated possible upcoming limitations from K, S and Zn

Long-term Oncological Outcomes after Resection and Thermal Ablation of Colorectal Liver Metastases: A Propensity Score Matched Analysis

Introduction: Thermal ablation of colorectal liver metastases is mostly used where resection is not possible, but has recently emerged as a parenchyma-sparing alternative to resection. High-quality data comparing oncological outcomes after resection and ablation of colorectal liver metastases are wanting. Method: Data for patient with colorectal liver metastases treated with laparoscopic resection at Oslo University Hospital between 2007 and 2020 was extracted from a prospectively maintained database and compared to patients undergoing ablation (radiofrequency or microwave). The primary endpoint was overall survival (OS). An average treatment effect (ATE) and potential-outcome means analysis using inverse-probability assignment and censoring using prognostic variables (CEA, largest tumor size, synchronous disease, primary tumor nodal status and sidedness, chemotherapy, previous liver surgery and others). Results: We identified 223 ablation sessions and 765 resection sessions available for comparison. The 5-year OS was 53% in the ablation group and 51% in the resection group. Median OS was 62,4 months (ablation) and 61,6 months (resection). The ATE for ablation versus resection was estimated to be 0,47 months (95% CI -8,1 to 9,9; P=0,92), meaning if every patient was treated with ablation, the average time to death would be 0,47 months longer than if every patient was treated with resection. A complete dataset including local recurrence will be presented at the meeting. Conclusion: Thermal ablation in patients with colorectal liver metastases was associated with rates of OS similar to surgical resection. Our results indicate adequate equipoise for a randomized trial to overcome selection bias.

Impact of Inspiratory Muscle Training on Weaning Parameters in Prolonged Ventilator-Dependent Patients: A Preliminary Study.

IntroductionPatients require prolonged mechanical ventilation to overcome respiratory failure in the chronic respiratory care ward; however, how to facilitate ventilator weaning using a nurse-led strategy is limited.ObjectivesThis study aimed to examine the impact of adjusting ventilator trigger sensitivity as inspiratory muscle training on weaning parameters in patients with prolonged ventilator dependence.MethodsMultiple pre-test–post-test with a non-equivalent control group design was conducted at a chronic respiratory care ward in southern Taiwan. A convenience sampling method was used to recruit patients who received prolonged mechanical ventilation for more than 21 days into control (n = 20) and intervention groups (n = 22). Adjustment of ventilator trigger sensitivity started from 10% of the initial maximum inspiratory pressure and increased to 40% after a training period of six weeks. The weaning parameters were collected for pre-test and multiple post-tests, and statistical analysis of treatment effects was performed using the generalized estimating equation.ResultsMagnitude of weaning parameters was significantly higher in the intervention group after the six-week training, including maximum inspiratory pressure, rapid shallow breathing index, tidal volume, and ratio of arterial-to-inspired oxygen.ConclusionAdjustment of ventilator trigger sensitivity as inspiratory muscle training can help prolonged ventilator-dependent patients improve their respiratory muscle strength, breathing patterns, and oxygenation.

Effect or Treatment Heterogeneity? Policy Evaluation with Aggregated and Disaggregated Treatments

Binary treatments in empirical practice are often (i) ex-post aggregates of multiple treatments or (ii) can be disaggregated into multiple treatment versions after assignment. In such cases it is unclear whether estimated heterogeneous effects are driven by effect heterogeneity or by treatment heterogeneity. This paper provides estimands to decompose canonical effect heterogeneity into the effect heterogeneity driven by different responses to underlying multiple treatments and potentially different compositions of these underlying effective treatments. This allows to avoid spurious discovery of heterogeneous effects, to detect potentially masked heterogeneity, and to evaluate the underlying assignment mechanism of treatment versions. A nonparametric method for estimation and statistical inference of the decomposition parameters is proposed. The framework allows for the use of machine learning techniques to adjust for high-dimensional confounding of the effective treatments. It can be used to conduct simple joint hypothesis tests for effect heterogeneity that consider all effective treatments simultaneously and circumvent multiple testing procedures. It requires weaker overlap assumptions compared to conventional multi-valued treatment effect analysis. The method is applied to a reevaluation of heterogeneous effects of smoking on birth weight. We find that parts of the differences between ethnic and age groups can be explained by different smoking intensities. We further reassess the gender gap in the effectiveness of the Job Corps training program and find that it is largely explained by gender differences in the type of vocational training received.

RNA sequencing of glioblastoma tissue slice cultures reveals the effects of treatment at the transcriptional level.

One of the major challenges in cancer research is finding models that closely resemble tumors within patients. Human tissue slice cultures are a promising approach to provide a model of the patient's tumor biology ex vivo. Recently, it was shown that these slices can be successfully analyzed by whole transcriptome sequencing as well as automated histochemistry, increasing their usability as preclinical model. Glioblastoma multiforme (GBM) is a highly malignant brain tumor with poor prognosis and little is known about its genetic background and heterogeneity regarding therapy success. In this study, tissue from the tumors of 25 patients with primary GBM was processed into slice cultures and treated with standard therapy (irradiation and temozolomide). Total RNA sequencing and automated histochemistry were performed to enable analysis of treatment effects at a transcriptional and histological level. Slice cultures from long‐term survivors (overall survival [OS] > 24 months) exhibited more apoptosis than cultures from patients with shorter OS. Proliferation within these slices was slightly increased in contrast to other groups, but not significantly. Among all samples, 58 protein‐coding genes were upregulated and 32 downregulated in treated vs. untreated slice cultures. In general, an upregulation of DNA damage‐related and cell cycle checkpoint genes as well as enrichment of genotoxicity pathways and p53‐dependent signaling was found after treatment. Overall, the current study reproduces knowledge from former studies regarding the feasibility of transcriptomic analyses and automated histology in tissue slice cultures. We further demonstrate that the experimental data merge with the clinical follow‐up of the patients, which improves the applicability of our model system.

Effect of Spontaneous and Water-Based Passivation on Components and Parameters of Ti6Al4V (ELI Grade) Surface Tension and Its Wettability by an Aqueous Solution of Sucrose Ester Surfactants

Solid wettability is especially important for biomaterials and implants in the context of microbial adhesion to their surfaces. This adhesion can be inhibited by changes in biomaterial surface roughness and/or its hydrophilic–hydrophobic balance. The surface hydrophilic–hydrophobic balance can be changed by the specifics of the surface treatment (proper conditions of surface preparation) or adsorption of different substances. From the practical point of view, in systems that include biomaterials and implants, the adsorption of compounds characterized by bacteriostatic or bactericidal properties is especially desirable. Substances that are able to change the surface properties of a given solid as a result of their adsorption and possess at least bacteriostatic properties include sucrose ester surfactants. Thus, in our studies the analysis of a specific surface treatment effect (proper passivation conditions) on a biomaterial alloy’s (Ti6Al4V ELI, Grade 23) properties was performed based on measurements of the contact angles of water, formamide and diiodomethane. In addition, the changes in the studied solid surface’s properties resulting from the sucrose monodecanoate (SMD) and sucrose monolaurate (SML) molecules’ adsorption at the solid–water interface were also analyzed. For the analysis, the values of the contact angles of aqueous solutions of SMD and SML were measured at 293 K, and the surface tensions of the aqueous solutions of studied surfactants measured earlier were tested. From the above-mentioned tests, it was found that water environment significantly influences the components and parameters of Ti6Al4V ELI’s surface tension. It also occurred that the addition of both SMD and SML to water (separately) caused a drop in the water contact angle on Ti6Al4V ELI’s surface. However, the sucrose monolaurate surfactant is characterized by a slightly better tendency towards adsorption at the solid–water interface in the studied system compared to sucrose monodecanoate. Additionally, based on the components and parameters of Ti6Al4V ELI’s surface tension calculated from the proper values of components and parameters of model liquids, it was possible to predict the wettability of Ti6Al4V ELI using the aqueous solutions of SMD and SML at various concentrations in the solution.

Efficacy and Safety of Tacrolimus-Based Maintenance Regimens in De Novo Kidney Transplant Recipients: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

BackgroundTacrolimus is an established component of immunosuppressive regimens for kidney transplant recipients (KTRs); however, data comparing long-term outcomes between formulations are lacking. We conducted a systematic literature review and network meta-analysis assessing tacrolimus (primarily Advagraf [once-daily] and Prograf [twice-daily])-based maintenance regimens.Material/MethodsEmbase, MEDLINE, and Cochrane databases and congress proceedings were searched to identify studies of adult de novo KTRs who received tacrolimus-based therapy in phase II/III randomized controlled trials. Outcomes were acute rejection, graft/patient survival, and incidence of new-onset diabetes mellitus after transplantation (NODAT) and cytomegalovirus (CMV) infection. Bayesian network meta-analysis was used to analyze treatment effects on graft/patient survival.ResultsSixty-eight publications (61 primary) were included. Of 21 publications reporting graft rejection following Advagraf or Prograf treatment in ≥1 study arm, 12-month biopsy-proven acute rejection (BPAR) ranged from 3.3% with Prograf to 55.0% with mycophenolic acid (MPA)+corticosteroids (CS); >24 month BPAR ranged from 0% to 58.7% (the latter with bleselumab-based therapy). Fourteen publications reported graft loss following Advagraf (0–9.6%) or Prograf (0–7.5%). Patient mortality ≤24 months after transplantation (14 publications) ranged from 0% to 8.1% with Advagraf or Prograf. Advagraf+MPA+CS and reference treatment, Prograf+MPA+CS, were associated with a similar risk of graft loss (odds ratio 1.19; 95% credible-interval 0.51, 3.06) and mortality (odds ratio 1.21; 95% credible-interval 0.1557, 9.03). Incidence of NODAT and CMV varied by treatment arm.ConclusionsGraft loss and patient mortality rates were generally comparable between Advagraf- and Prograf-based regimens. Further prospective studies are needed to evaluate longer-term outcomes.

Pre- and in-hospital anticoagulation therapy in coronavirus disease 2019 patients: a propensity-matched analysis of in-hospital outcomes.

To estimate if chronic anticoagulant (CAC) treatment is associated with morbidity and mortality outcomes of patients hospitalized for SARS-CoV-2 infection. In this European multicentric cohort study, we included 1186 patients of whom 144 were on CAC (12.1%) with positive coronavirus disease 2019 testing between 1 February and 30 July 2020. The average treatment effect (ATE) analysis with a propensity score-matching (PSM) algorithm was used to estimate the impact of CAC on the primary outcomes defined as in-hospital death, major and minor bleeding events, cardiovascular complications (CCI), and acute kidney injury (AKI). We also investigated if different dosages of in-hospital heparin were associated with in-hospital survival. In unadjusted populations, primary outcomes were significantly higher among CAC patients compared with non-CAC patients: all-cause death (35% vs. 18% P < 0.001), major and minor bleeding (14% vs. 8% P = 0.026; 25% vs. 17% P = 0.014), CCI (27% vs. 14% P < 0.001), and AKI (42% vs. 19% P < 0.001). In ATE analysis with PSM, there was no significant association between CAC and primary outcomes except for an increased incidence of AKI (ATE +10.2%, 95% confidence interval 0.3-20.1%, P = 0.044). Conversely, in-hospital heparin, regardless of dose, was associated with a significantly higher survival compared with no anticoagulation. The use of CAC was not associated with the primary outcomes except for the increase in AKI. However, in the adjusted survival analysis, any dose of in-hospital anticoagulation was associated with significantly higher survival compared with no anticoagulation.

Exploring differential response to an emergency department-based care transition intervention.

To identify multivariable subgroups of patients with differential responses to a nurse-delivered care transition intervention after an emergency department (ED) visit in a randomized controlled trial (RCT) using an emerging data-driven method. Secondary analysis of RCT. 512 individuals enrolled in an RCT of a nurse-delivered care transition intervention after an ED visit. All 512 participants were included in a pre-specified subgroup analysis, and 451 of these had sufficient complete case data to be included in a model-based recursive (MoB) partitioning analysis. The primary outcome was having at least one ED visit in 30 days after the index ED visit. Two analytical methods explored heterogeneity of treatment effects: data driven model-based recursive partitioning (MoB) using 37 candidate baseline variables, and a contextual point of comparison with prespecified subgroups defined by ED super-user status (≥ 3 ED visits in previous 6 months or not), sex (male/female), and age, individually examined via treatment arm by subgroup interaction terms in logistic regression models. Internal validation of the MoB analysis via bootstrap resampling with an optimism corrected c-statistic was conducted to provide a bias-corrected estimate. MoB detected treatment effect heterogeneity in a single subgroup, marital status. Unmarried patients randomized to the intervention had a repeat ED use rate of 22% compared to 34% in the usual care group; married patients randomized to the intervention had a 27% ED return rate compared to 12% in the usual care group. Internal validation demonstrated an optimism corrected c-statistic of 0.54. No treatment-by-covariate subgroup interactions were identified among the 3 prespecified subgroups. Although exploratory, the results of the MoB analysis suggest that patient factors related to social relationships such as marital status may be important contributors to differential response to a care transition intervention after an ED visit. These were characteristics that the investigators had not anticipated or planned to examine in the individual prespecified subgroup analysis. Data-driven methods can yield unexpected findings and contribute to a more complete understanding of differential treatment effects in subgroup analysis, which can inform further work on development of effective care transition interventions in the ED setting.

Estimating heterogeneous treatment effects in road safety analysis using generalized random forests

Numerous evaluation studies have been conducted on a variety of road safety measures. However, the issue of treatment heterogeneity, defined as the variation in treatment effects, has rarely been investigated before. This paper contributes to the literature by introducing generalized random forests (GRF) for estimation of heterogeneous treatment effects (HTEs) in road safety analysis. GRF has high functional flexibility and is able to search for complex treatment heterogeneity. We first perform a series of simulation experiments to compare GRF with three causal methods that have been used in road safety studies, i.e., outcome regression method, propensity score method, and doubly robust estimation method. The simulation results suggest that GRF is superior to these three methods in terms of model specification, especially with the existence of nonlinearity and nonadditivity. On the other hand, a large dataset is required for accurate GRF estimation. Then we conduct a case study on the UK’s speed camera program. Our results indicate significant reductions in the number of road accidents at speed camera sites. And the heterogeneity in treatment effects is found to be statistically significant. We further consider the associations between the baseline accident records, traffic volume, local socio-economic characteristics, and the safety effects of speed cameras. In general, the effect of speed cameras is larger at the sites with more baseline accident records, higher traffic volume, and in more densely-populated and deprived areas. Several policy suggestions are provided based on these findings. The evaluation of HTEs likely offers more comprehensive information to local authorities and policy makers, and improves the performance of speed camera programs. Moreover, GRF can be a promising approach for revealing treatment effect heterogeneity in road safety analysis.

Analysis of Hemodialysis Treatment and Clinical Effectiveness of Severe Acute Renal Failure

Analysis of Hemodialysis Treatment and Clinical Effectiveness of Severe Acute Renal Failure

Political orientations, economic policies, and environmental quality: Multi-valued treatment effects analysis with spatial spillovers in country districts of Poland

Many studies have found a positive association between liberal political views and support for environmental protection activities even though they require greater involvement of the state in market economies. However, such a conclusion is contradicted by empirical studies on pro-environmental activities with regard to the theory of planned behavior. On the one hand, subjective norms (including the expectations of public authorities) are usually found to be insignificant or very weak drivers of ecological behavior. On the other hand, self-efficacy (individual attitudes and beliefs in one’s capabilities) is perceived as a leading factor. This inspired us to explore the long-term effects of localism on environmental quality in Poland. Because liberalism and conservatism exist in their ‘pure’ forms, Poland is very well suited to such a study. The aim of the article is to assess the long-term impact of local and liberal orientations (with conservatism as the reference), as reflected by electoral decisions on the quality of the environment. First, the current state of the environment is measured over four dimensions (air, water, soil, and biodiversity), and the effects of environmental policies (including spatial dependence) are estimated. Subsequently, the treatment effects on the environment when a particular political orientation is adopted are estimated using multi-valued treatment effect analyses. The study confirms that local orientation is conducive to long-term environmental care. Moreover, greater coordination of environmental policies at different levels is recommended, focusing on the negative spatial dependence of local environmental expenditure.

Heterogeneous treatment effect analysis based on machine-learning methodology.

Heterogeneous treatment effect (HTE) analysis focuses on examining varying treatment effects for individuals or subgroups in a population. For example, an HTE‐informed understanding can critically guide physicians to individualize the medical treatment for a certain disease. However, HTE analysis has not been widely recognized and used, even given the explosive increase of data availability attributed to the arrival of the Big Data era. Part of the reason behind its underuse is that data are often of high dimension and high complexity, which pose significant challenges for applying conventional HTE analysis methods. To meet these challenges, a newly developed causal forest HTE method has been derived from the random forest machine‐learning algorithm. We conducted a systematic performance evaluation for the causal forest method against the conventional two‐step method by simulating scenarios with different levels of complexity for the analysis. Our results show that causal forest outperforms the conventional HTE method in assessing treatment effect, especially when data are complex (e.g., nonlinear) and high dimensional, suggesting that causal forest is a promising tool for real‐world applications of HTE analysis.

Lower versus higher oxygenation targets in critically ill patients with severe hypoxaemia: secondary Bayesian analysis to explore heterogeneous treatment effects in the Handling Oxygenation Targets in the Intensive Care Unit (HOT-ICU) trial

BackgroundIn the Handling Oxygenation Targets in the Intensive Care Unit (HOT-ICU) trial, a lower (8 kPa) vs a higher (12 kPa) PaO2 target did not affect mortality amongst critically ill adult patients. We used Bayesian statistics to evaluate any heterogeneity in the effect of oxygenation targets on mortality between different patient groups within the HOT-ICU trial. MethodsWe analysed 90-day all-cause mortality using adjusted Bayesian logistic regression models, and assessed heterogeneous treatment effects according to four selected baseline variables using both hierarchical models of subgroups and models with interactions on the continuous scales. Results are presented as mortality probability (%) and relative risk (RR) with 95% credibility intervals (CrI). ResultsAll 2888 patients in the intention-to-treat cohort of the HOT-ICU trial were included. The adjusted 90-day mortality rates were 43.0% (CrI: 38.3–47.8%) and 42.3% (CrI: 37.7–47.1%) in the lower and higher oxygenation groups, respectively (RR 1.02 [CrI: 0.93–1.11]), with 36.5% probability of an RR <1.00. Analyses of heterogeneous treatment effects suggested a dose–response relationship between baseline norepinephrine dose and increased mortality with the lower oxygenation target, with 95% probability of increased mortality associated with the lower oxygenation target as norepinephrine doses increased. ConclusionsA lower oxygenation target was unlikely to affect overall mortality amongst critically ill adult patients with acute hypoxaemic respiratory failure. However, our results suggest an increasing mortality risk for patients with a lower oxygen target as the baseline norepinephrine dose increases. These findings warrant additional investigation. Clinical trial registrationNCT03174002.

OAB-052: Impact of chromosome 1 abnormalities on newly diagnosed multiple myeloma treated with proteasome inhibitor, immunomodulatory drug, and dexamethasone: analysis from the ENDURANCE ECOG-ACRIN E1A11 trial

<h3>Background</h3> Chromosome 1 abnormalities (C1A) are frequently identified in multiple myeloma (MM). We assessed impact of C1A in a post hoc analysis of E1A11 trial. <h3>Methods</h3> E1A11 randomized newly diagnosed (ND) MM patients (pts) with traditional ‘standard risk' features or t(4;14), not intended for upfront transplant, to bortezomib (V) or carfilzomib (K), in combination with lenalidomide (R) and dexamethasone (d), followed by indefinite or 2-year (y) R maintenance. Impact of C1A and ultra-high risk (UHR) MM [≥2 of the following: +1q [gain1q (3 copies) or amplification (amp)1q21 (≥4 copies)], deletion (del)1p and t(4;14)], was assessed. <h3>Results</h3> Of 1087 pts, 912 were evaluated for + 1q (gain1q or amp1q) and 774 for del1p. Gain1q, amp1q and del1p were noted in 23%, 7.5% and 9% pts, respectively. Best responses to VRd or KRd within each response category were similar, irrespective of +1q/del1p status. Within each arm, progression-free survival (PFS) was inferior for pts with +1q versus (v) pts without +1q; median 29 v 42 months (m) for both arms [VRd, HR 1.51 p 0.011; KRd, HR 1.63, p 0.002]. Corresponding 3y overall survival (OS) rates on VRd were 74 v 86% (HR 1.47, p 0.069) and 82 v 88% (HR 1.34, p 0.185) on KRd. Regarding copy number, pts with gain1q v those without +1q had inferior PFS with both VRd (median 29m, HR 1.59, p 0.012) and KRd (median 33m, HR 1.41, p 0.051). OS rates with gain1q were inferior within VRd arm only (3y 71%, HR 1.78, p 0.014; KRd 3y OS 89%, HR 1.02, p 0.93). By contrast, pts with amp1q, v pts without +1q, had inferior outcomes with KRd (median PFS 24m, HR 2.37, p<0.001; 3y OS 62%, HR 2.43, p 0.008) but not with VRd: median PFS 32m, HR 1.43; p 0.186; 3y OS 75%, HR 1.29; p 0.48). Pts with del1p, v those without del1p, had inferior PFS (median 29 v 39m; HR1.49, p=0.042) and OS rates (3y 74 v 85%, HR 2.03; p 0.003) in the entire cohort. Within KRd arm, the respective OS rates were comparable (3y, 87 v 86%, HR 1.10, p 0.818). By contrast, pts with del1p on VRd had inferior OS (3y 60 v 84%, HR 3.30, p<0.001). UHR MM pts had worst outcomes (median PFS, 20 v 38m, HR 2.01, p<0.001; 3y OS, 68 v 85%, HR 1.99, p 0.004). However, OS for UHR MM pts on KRd was similar to that of pts without UHR MM (3-yr, 87 v 86%, HR 0.95, p 0.902; VRd 3-yr, 45 v 84%, HR 4.15, p<0.001). Analyses of treatment effect within subgroups showed superiority of KRd over VRd for OS among pts with gain1q [HR 0.50 (0.28-0.90)], del1p [HR 0.34 (0.13-0.89)] and UHR MM [HR 0.18 (0.07-0.51)], but not amp1q [HR 1.56 (0.64-3.78)]. <h3>Conclusion</h3> Gain1q or amp1q portends poor outcome among NDMM pts treated with either VRd or KRd. Specifically, pts with amp1q as a sole high-risk abnormality have distinctly poor outcomes with KRd. By contrast, KRd, but not VRd, appears to abrogate the adverse impact of del1p. Given the limitations of the trial design and post hoc subset analyses, longer follow up and confirmatory studies are warranted for definitive conclusions.

Analysis of treatment effect of acupuncture on cervical spondylosis and neck pain with the data mining technology under deep learning

Analysis of treatment effect of acupuncture on cervical spondylosis and neck pain with the data mining technology under deep learning

Cloud Computing into Respiratory Rehabilitation Training-Assisted Treatment of Patients with Pneumonia.

In order to study the therapeutic effect of respiratory rehabilitation training on patients with pneumonia, this paper proposes an integrated adjuvant therapy program based on the cloud computing model. A total of 60 pneumonia patients admitted to Zhujiang Hospital of Southern Medical University from January to July 2020 were selected as the research objects and Southern Medical University pneumonia patients as the research object, to be evenly divided into two groups, each group of 30 people. The control group was treated with conventional anti-infection treatment, and the observation group was treated with supplementary respiratory rehabilitation training on the basis of conventional treatment. The therapeutic effects of the two groups were compared. The results showed that the absorption time of lung lesions was (9.17 ± 3.46) days in the observation group and (13.97 ± 3.07) days in the control group, and the difference between the two groups was statistically significant (t = 5.683, P < 0.001). Respiratory therapy based on the cloud computing model has the characteristics of integration and extensibility, which can be effectively applied to the treatment effect analysis of patients with pneumonia and is of great significance for the effective analysis of patients' blood gas indexes and lung function indexes.

Medical and social aspects of women with menstrual dysfunction in puberty

The reproductive system is exposed to various adverse factors and harmful effects at all stages of the functioning of the body. Against the background of a decrease in the level of reproductive female health in recent years, there is a clear tendency towards an increase in the number of patients with pathology of the puberty period. The low level of somatic and reproductive health before pregnancy causes a high frequency of complicated births, which leads to a deterioration in the development of subsequent generations. The objective. Based on clinical and anamnestic data, laboratory and instrumental methods of research, analysis of risk factors, clinical presentation, treatment effectiveness and clinical observation, to give a clinical description of women who had menstrual dysfunction in the pubertal period. Materials and methods. According to the nature of the violations, the main group of women (n=210) who had a pathology of menstrual function in the puberty period was divided into 3 subgroups (n=70): the first – women with primary oligomenorrhea and timely average population menarche, the second – with a late age menarche, the third – with puberty bleeding. The control group included women (n=70) with the correct rhythm of menstruation in puberty. Results. During a clinical prospective study, the social status of women with impaired reproductive function in the puberty was analyzed, the frequency and structure of existing concomitant somatic diseases, the duration of the menstrual cycle, the nature of diseases of the female genital organs; an assessment of the complex treatment of the revealed violations was made, which allowed to obtain a favorable reproductive prognosis. Most of the women examined (53.3%) planned a pregnancy, which occurred in 75.9% of those planning. Conclusion. A study of the clinical and anamnestic analysis of the reproductive function of women with menstrual irregularities in the puberty period will increase the effectiveness of the treatment of identified disorders and develop algorithms for the management of such women during planning and during pregnancy.