Spearman's Bivariate Correlation Research Articles

Evaluating functional outcomes and quality of life in musculoskeletal tumor patients with distal femoral megaprostheses: a case-control study

BackgroundEndoprosthetic knee replacement using megaprostheses has become a common strategy for preserving joint function in patients with distal femur tumors. While existing literature has primarily focused on surgical techniques, complications, and implants, recent improvements in patient survival rates have sparked increased interest in the long-term functional outcomes associated with this treatment.MethodsThis case-control study evaluated functional outcomes—Timed Up and Go (TUG), 6-Minute Walk Test (6MWT), knee flexor and extensor muscle strength, and sagittal knee range of motion—and health-related quality of life (SF-36) between patients with distal femoral megaprostheses (n = 31) and healthy controls (n = 48). Participants performed the TUG and 6MWT equipped with an inertial measurement unit. Additionally, bivariate Spearman correlations were calculated within the patient group to assess relationships between Musculoskeletal Tumour Society (MSTS) scores and functional outcomes.ResultsPatients performed significantly worse than controls in the TUG test, with longer completion times (Mean Difference: -3.3 s; 95% CI: -5.7 to -0.9; p = 0.008), reduced rotational speed during the middle turn (Mean Difference: 16°/s; 95% CI: 7 to 25; p < 0.001) and final turn (Mean Difference: 22°/s; 95% CI: 9 to 34; p < 0.001), and lower vertical acceleration during the Sit-to-Stand phase (Mean Difference: 1.3 m/s²; 95% CI: 0.1 to 2.5; p = 0.032). In the 6MWT, patients walked 86 m less on average than controls (95% CI: 35 to 136; p = 0.002). Knee range of motion was significantly reduced, with median flexion of 90.2° (range: 5–125) in patients versus 136.4° (range: 115–150) in controls (p < 0.001, Z = -7.268). Muscle strength was also markedly lower in patients (p < 0.001). The SF-36 revealed significant differences in the Physical Component Summary (Mean Difference 95% CI: 15.5 [10.0 to 20.9]; p < 0.001), while no significant differences were found in the Mental Component Summary (p > 0.05). In patient group, bivariate Spearman correlations indicated a very strong positive association between MSTS scores and knee extension strength (ρ = 0.710; p < 0.001), and strong positive correlations with sagittal knee range of motion (ρ = 0.472; p = 0.015), total walking distance in 6MWT (ρ = 0.474; p = 0.019), and final turn rotational speed in TUG (ρ = 0.439; p = 0.032).ConclusionOur findings demonstrate a strong association between knee extensor strength and range of motion with overall functional performance, as reflected in MSTS scores. While nearly 75% of patients achieved scores classified as “good” to “excellent,” objective measures from the TUG and 6MWT revealed significant performance deficits compared to healthy controls, likely due to limitations in knee extensor strength and range of motion. These results highlight the need for targeted rehabilitation strategies focused on enhancing muscle strength and range of motion to optimize long-term functional recovery in these patients.

Insights into the baseline blood pH homeostasis at admission and the risk of in-hospital mortality in COVID-19 patients.

Aim: A laboratory finding in critically ill COVID-19 patients is blood academia (pH <7.35). We investigated its cause in connection with the admission baseline blood pH homeostasis.Patients & methods: We retrospectively monitored the baseline blood pH homeostasis of 1215 COVID-19 patients who were admitted with pneumonia using data-driven knowledge. Two categories of patients were identified: non-survivors (107) and survivors (1108).Results: Non-survivors showed greater levels of lactate and lower blood pH, saturation, and partial pressure of oxygen than survivors. A bivariate Spearman's correlation matrix showed that the [HCO3-]/pCO2 and pCO2 of non-survivors exhibited an unmatched connection, but not in the survivor group. When comparing non-survivors to survivors, the dendrograms derived from the bivariate comparison matrix showed differences in gasometry parameters like blood pH, [HCO3-]/pCO2 ratio, anion gap and pO2.Conclusion: The little variations in the gasometry readings between survivors and non-survivors upon admission suggested abnormal changes in the complementary renal and respiratory systems that bring blood pH back to normal. In advanced COVID-19, modest blood acid-base imbalances could become blood acidemia if these compensatory strategies were overused. Data-driven monitoring of acid-base parameters may help predict abnormal blood pH and the advancement of metabolic acidemia before it is too late.

Using heart rate variability to evaluate the association between the autonomic nervous system and coagulation function in patients with endometrial cancer.

The incidence of endometrial cancer (EC) is increasing worldwide, but the specific mechanism of coagulation dysfunction in EC is not fully understood. The objective of the present study was to explore the relationship between autonomic nervous system function and coagulation function in patients with EC using heart rate variability (HRV) analysis. The study included 100 patients with EC who were treated at the Department of Gynecological Oncology of The First Affiliated Hospital of Bengbu Medical University (Bengbu, China) from December 2021 to March 2023. A 5-min resting electrocardiogram was collected from each patient to analyze HRV parameters, including the time domain parameters standard deviation of the normal-normal intervals (SDNN) and root mean square of successive interval differences (RMSSD), and the frequency domain parameters low-frequency power and high-frequency power (HF). Blood samples were submitted to biochemistry tests to measure coagulation markers, namely prothrombin time (PT), international normalized ratio of PT (PT-INR), prothrombin activity (PTA), activated partial thromboplastin time (APTT) and fibrinogen. Bivariate Spearman correlation analyses revealed that PT, PT-INR and APTT were significantly positively correlated with SDNN, RMSSD and HF, while PTA was significantly negatively correlated with RMSSD. Following adjustments for confounding factors, namely age, body mass index, menopause, ligation of the fallopian tubes, diabetes, hypertension, adjuvant chemotherapy and mean heart rate, linear regression analysis demonstrated that SDNN, RMSSD and HF were independent factors influencing PT and PT-INR in patients with EC. The findings of the present study indicate that certain HRV parameters correlate with coagulation markers in EC and provide new insight into the occurrence of cancer-associated coagulation dysfunction.

Neutrophils-derived Parameters as Cost-effective Inflammatory, Disease Activity Marker in Systemic Lupus Erythematosus (SLE) and Role in Prediction of Lupus Nephritis

Introduction: Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with various clinical manifestations and approximately 50% of the SLE patients develop lupus nephritis (LN), which increases the risk of renal failure, cardiovascular diseases and overall survival. Objectives: Evaluation of neutrophil-derived parameters (Neut-X, Neut-Y and Neut-Z) as an inflammatory, disease activity marker and as a predictor of nephritis in SLE patients. Material and Methods: In this cross-sectional study, 3 ml K3EDTA blood was taken from 110 SLE patients presented in Department of Clinical Immunology to evaluate neutrophil-derived parameters in Sysmex XT2000i haematology analyser and their correlation with other inflammatory biomarkers like, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as well as SLE disease activity index-2000 (SLEDAI-2K). 24-hours urine protein levels were also estimated as a marker of renal involvement. Records of renal biopsy were available in 73 SLE patients, who belonged to different morphologic classification of LN. Results: After performing bivariate Spearman correlation analysis (SPSS software, version 26.0), Neut-X (measures cytoplasmic granularity by side scattering) and Neut-Z (vector sum of Neut-X and Neut-Y) showed a significant positive correlation ( r &gt; 0.200, P &lt; .05) with ESR, CRP and SLEDAI-2K while Neut-Y (measures nucleic acid content by sideward fluorescence) showed a significant negative correlation ( r &gt; 0.200, P &lt; .05) with ESR and CRP. Receiver-operating characteristic curve analysis was used to evaluate diagnostic value of 24-hour urine protein and predictive values of neutrophil-derived parameters for renal involvement in SLE patients. Among neutrophil-derived parameters, Neut-X was found to be the best predictor of renal dysfunction with highest AUC of 0.710 (95% CI: 0.604-0.816; cut-off: 1344.50; sensitivity: 84.7%; specificity: 50%) followed by Neut-Z with AUC of 0.707 (95% CI: 0.600-0.813; cut-off: 1403.67; sensitivity: 87.5%; specificity: 50%). Conclusion: Our study shows that neutrophil-derived parameters may be used as novel cost-effective, non-invasive biomarker of disease activity as well as for predicting renal involvement in SLE patients.

Social context and hardiness in selected national athletes of weightlifting

The objective of this research is to identify relationships between social context dimensions and hardiness in elite weightlifting athletes. Methods: The design: non-experimental, cross-sectional and correlational, the participants were 20 athletes who belong to the elite as the national team of Mexico, they are between 19 and 28 years of age, M = 22.05 SD = 2.91, 8 men (40%) and 12 women (60%). 2 instruments were used, the first is the Perception of Factors Related to Excellence in Sport (PFED), (Simón, 2009) consisting of 54 items 6 variables, coach, environment and resources, athlete, family, nature of training and characteristics of the training and the second the questionnaire of hardiness in Central American and Caribbean Athletes (PRDCC) (Ponce, 2017; Ponce-Carbajal et al. 2015) of 18 items and three variables, commitment control and challenge. In the procedure, a file was created in google forms and coaches who are in charge of athletes from the Mexican national weightlifting team were contacted. The statistical analyzes used were frequencies, descriptive, reliability, and Spearman's bivariate correlations. Results: Adequate internal consistency in almost all the variables, between .40 and .92 in the 2 questionnaires. In the correlations between variables of the social context and those of the hardiness, relationships were evidenced between the total resistant personality and the nature of the training with an r = .767** and the challenge variable correlated with two, the first is the nature of the training r =.834** and with the characteristics of training r =.671**. Conclusion, the relationships between the variables of the social context and the resistant personality are confirmed.

Violence against Deaf Women from an Intersectional Framework in Mexico

This research aimed to analyse the association between violence with linguistic knowledge in Mexican Sign Language (LSM) and sociodemographic data of Mexican Deaf women. To collect data from an intersectional framework, this study applied an opportunistic and chain sampling of 46 Deaf women from different areas of Mexico. Methods included in-person and remote interviews. Forty-one per cent of women indicated that they had been victims of abuse by their partner. In comparison, 73.9% of women had suffered some abuse in schools, and 39% of women had been victims of sexual abuse. The analyses with Spearman bivariate correlation showed that as the LSM learning age of the Deaf women increased, the levels of labour abuse (rs = .50, p &lt; .0001), violence in a bank (rs = . 51, p &lt; .0001), violence in school (rs = .56, p &lt; .0001), and violence by an interpreter (rs = .45, p &lt; .01) increased too. Results also revealed that a more excellent LSM family knowledge of LSM is moderately related to less labour abuse (rs = -.53, p &lt; .0001), violence in a bank (rs = -.45, p &lt; .01), violence in school (rs = -.43, p &lt; .01), violence by an interpreter (rs = -.39, p &lt; .01), and with lower magnitude to institutional violence (rs = -.37, p &lt; .05).

Socioeconomic and Inflammatory Correlates of Plasma Cortisol Among Individuals with Sickle Cell Disease

Introduction: Cortisol plays a critical role in the biological link between stress and health outcomes. It is frequently investigated in the association between socioeconomic stress and morbidity, and the hypothesized biological mechanism by which socioeconomic stress and cortisol impact health is through chronically elevated systemic inflammation. This research is relevant to individuals with sickle cell disease (SCD) for several reasons. First, up to 40% of children and adolescents with SCD are impacted by neighborhood poverty. Furthermore, individuals with SCD are faced with significant disease-related morbidities, such as chronic and acute pain, renal injury, and cerebrovascular disease that are further complicated by elevated inflammatory markers. Finally, cortisol is heavily understudied in this population, with no research investigating socioeconomic or inflammatory correlates. The purpose of this study was to investigate plasma cortisol and its association with neighborhood-level socioeconomic factors (income and poverty) and immunomodulatory cytokines (IL-6, IL-10), among individuals with SCD. Method: Plasma from individuals with SCD within Children's Hospital of Philadelphia (CHOP) and University of Pennsylvania School of Medicine (Penn Medicine) BioBanks were identified. A cortisol radioimmunoassay was used to determine plasma cortisol levels. The Olink immune response panel was used to measure plasma levels of 92 proteins involved in inflammatory pathways. Home address collected from electronic health records was used to determine neighborhood census tract geoid, which was then used to collect data on median neighborhood income and percentage of families living in poverty from the 2020 American Census Survey. Bivariate and multivariate analyses were conducted across 4 subgroups in the total sample: pediatric patients, adult patients, SCA (HbSS/HbSß 0), and other SCD genotypes (HbSC/HbSß +). Control samples (healthy and sickle cell trait; n = 22) without neighborhood information were also available for comparison. Results: Fifty-four independent outpatient samples were identified after excluding duplicates and siblings. Twenty-seven samples were from children and adolescents receiving pediatric care at CHOP (Range age = .8 to 21; Mage= 13.6, SD = 5.3; 51.9% female, 74.1% SCA) and 27 samples were from adults receiving care at Penn Medicine (Range age = 19 to 56; Mage= 35.8, SD = 10.1; 51.9% female, 51.9% SCA). There were no significant differences in cortisol levels across each subgroup ( Mpeds= 16.6, SDpeds = 6.2; Madult= 13.4, SDadult = 6.9; MSCA= 15.1, SDSCA = 7.1; MSCD= 14.9, SDSCD = 6.3). Neighborhood income and poverty did not differ across pediatric and adult patients, and income did not differ across SCD types. However, neighborhood poverty was lower among patients with SCA ( M = 13.9; SD = 11.9) relative to other SCD genotypes ( M = 21.7; SD = 13.5; p = .041). Bivariate Spearman analyses found that neighborhood variables were not correlated with cortisol or cytokines in the total sample or subgroups. Yet, multivariate analyses controlling for sex and time of blood draw showed a positive main effect for patient age ( p = .019) and a significant age by poverty interaction ( p = .041) predicting cortisol among pediatric patients. Cortisol levels were higher with age, yet the association among poverty and cortisol was strongest in younger patients. Analyses also showed a sex*poverty interaction among pediatric patients that approached significance ( p = .081), such that poverty only predicted cortisol in male patients. There were no significant differences for immunomodulatory cytokines across each SCD subgroups; however, IL-6 and IL-10 were elevated in patients with SCA relative to healthy controls ( p IL6 = .021; p IL10 = .003). Bivariate Spearman correlations showed that cortisol was positively related to IL-6 (rho [ρ]= .38, p = .027) and IL-10 (ρ= .34, p = .048) among patients with SCA. There were no additional significant bivariate or multivariate effects. Conclusion: Neighborhood factors likely have downstream effects on the biological stress response and inflammation in SCD. Further research must be conducted to elucidate concurrent and prospective associations among neighborhood socioeconomic factors, stress-related cortisol response, and inflammatory outcomes when extending this work to investigate the impact of stress on SCD morbidity and mortality.

Difference in perception-reaction time of plain and plateau drivers at expressway exit ramps

The low-pressure (and low-oxygen) environment in plateau regions significantly impacts the driver’s perception-reaction time (PRT) and, in turn, road safety. However, drivers faced increased workloads at interchange exit areas while the Tibet region experienced a significant improvement in high-grade highway construction. Therefore, this study aimed to quantitatively analyze the influence of the plateau environment on PRT. Using a UC/win-road simulator, 6 scenarios of expressway exit ramps were constructed. Then, a total of 50 participants (35 males, 15 females) in Nanjing (altitude of 50 m) and 50 participants (36 males, 14 females) in Lhasa (altitude of 3650 m) were recruited for the simulation experiments. The driver’s PRT was measured according to the visual fixation characteristics (using an eye-tracking device) and vehicle running data. The no-difference in PRT for various scenarios was validated using the one-way-ANOVA test. Then, the Spearman bivariate correlation and generalized linear regression model were used to analyze the influence of driver’s age, driving experience, gender, and acclimation period on PRT. In addition, the difference in PRT of different groups of plain and plateau drivers was further analyzed using the Mann-Whiteney U and Kruskal-Wallis tests. Although driving experience and gender affected the PRT of the plain and plateau drivers, the effect was greater in the plain areas. The low-pressure environment at high altitude had a more significant impact on young novice male drivers. These findings serve as valuable references for refining the design of expressway exit ramps and improving road safety in the plateau areas.

Free-Living Peak Cadence in Multiple Sclerosis: A New Measure of Real-World Walking?

Background Physical function and walking performance have become important outcomes in clinical trials and rehabilitation involving persons with multiple sclerosis (MS). However, assessments conducted in controlled settings may not reflect real-world capacity and movement in a natural environment. Peak cadence via accelerometry might represent a novel measure of walking intensity and prolonged natural effort under free-living conditions. Objective We compared peak 30-minute cadence, peak 1-minute cadence, and time spent in incremental cadence bands between persons with MS and healthy controls, and examined the associations between peak cadence and laboratory-assessed physical function and walking performance. Methods Participants (147 MS and 54 healthy controls) completed questionnaires on disability status and self-reported physical activity, underwent the Short Physical Performance Battery, Timed 25-Foot Walk, Timed Up and Go, and 6-Minute Walk, and wore an accelerometer for 7 days. We performed independent samples t-tests and Spearman bivariate and partial correlations adjusting for daily steps. Results The MS sample demonstrated lower physical function and walking performance scores, daily steps, and peak cadence (P < .001), and spent less time in purposeful steps and slow-to-brisk walking (40-119 steps/minutes), but accumulated more incidental movement (1-19 steps/minutes) than healthy controls. The associations between peak cadence and performance outcomes were strong in MS (|rs| = 0.59-0.68) and remained significant after controlling for daily steps (|prs| = 0.22-0.44), P-values < .01. Peak cadence was inversely correlated with age and disability, regardless of daily steps (P < .01). Conclusions Our findings provide preliminary evidence for the potential use of peak cadence with step-based metrics for comprehensively evaluating free-living walking performance in MS.

Mild cognitive impairment in type 2 diabetes is associated with fibrinogen-to-albumin ratios.

Cognitive impairment is the main manifestation of diabetes central neuropathy. Currently, there is no effective dementia treatment; early diagnosis and treatment are particularly crucial. Inflammation index fibrinogen-to-albumin ratio (FAR) has been shown to predict complications of type 2 diabetes (diabetic kidney disease and diabetes-related arteriosclerosis), but its relationship with mild cognitive impairment (MCI) in type 2 diabetes (T2D) is undetermined. In this study, we examined the association between the FAR and mild cognitive impairment in type 2 diabetes. This is a retrospective and cross-sectional study. From January 2022 to December 2022, we have retrieved 328 inpatient medical records for T2D patients hospitalized at the First Hospital of Harbin Medical University from the hospital's electronic system. Subjects' cognitive function was assessed and grouped by the MoCA scales. Subjects' demographic and various laboratory indicators were collected. Using Spearman's bivariate correlation analysis, the FAR and other clinical variables were analyzed for association strength. A multiple linear regression analysis was conducted to determine the independent relationship between FAR and MoCA scores. Multivariate logistic regression was used to analyze the independent relationship between FAR and MCI. The capacity of the FAR to detect MCI was carried using receiver operating characteristic (ROC) analysis. The included participants' (n = 328; 61.9% male) mean age was 52.62 ± 10.92 years. MoCA scores and MCI prevalence significantly differed (p < 0.05) between the four subgroups of FAR quartiles. The FAR and the MoCA score were significantly negatively correlated in the entire population (p < 0.05). Based on the multiple linear regression analysis, lnFAR and lnMoCA are significantly correlated (β = -0.449, t = -8.21, p < 0.05, R2 = 0.469). In multivariate logistic regression analysis, FAR and MCI were independently correlated after adjusting for covariates (OR 95% CI 34.70 [13.90-86.66]). Finally, the analysis of receptor working characteristics shows that the optimal FAR cut-off value was 0.08 (sensitivity: 95.81%, specificity: 84.47%) for detecting MCI in type 2 diabetes. In type 2 diabetes, the FAR was positive associations with MCI and negative associations with MoCA score. The high FAR was associated with an increased risk of MCI. FAR maybe a appropriate indicator of MCI risk for type 2 diabetes.

A Mexican Spanish Adaptation of the Dutch Eating Behavior Questionnaire: Psychometric Properties and Influence of Sociodemographic Variables in Pregnant Women.

Eating behaviors are complex phenomena, entangling physiological signals of hunger and satiety, food choices, emotional states, and social factors and expectations, as well as food availability and sensory appearance. Evaluating eating behaviors is challenging and must cover different motives. One instrument for such evaluation is the Dutch Eating Behavior Questionnaire (DEBQ), composed of three subscales for exploring emotional eating, external eating, and restrained eating. In this article, we aimed to (1) evaluate the psychometric properties of a Mexican Spanish adaptation of the DEBQ; and (2) explore the associations between the three adapted DEBQ scales and the influence of sociodemographic factors on each of the three eating behaviors in Mexican pregnant women. A sample of 514 pregnant women responded to our adapted version of the DEBQ and a questionnaire about sociodemographic information. We performed an exploratory factor analysis using a principal component analysis with varimax rotation; based on this analysis, we removed items that loaded on two factors and then performed a confirmatory factor analysis. The final version of the adapted DEBQ has 26 items, clearly divided into a three-factor structure and satisfactorily reliable (Cronbach's ⍺ = 0.903). We then performed Spearman bivariate correlations and multivariate linear regression with backward variable selection to test the associations and influence of sociodemographic factors on each of the three eating behaviors evaluated with the DEBQ. In pregnant women, emotional eating (EmoE) had a medium-high correlation with external eating (ExtE) and a low correlation with restrained eating (RestE), while ExtE and RestE showed no association. The three eating behaviors are associated with maternal sociodemographic and reproductive variables, which partly explain their variation, most notably maternal schooling. Our adapted version of the DEBQ is suitable for use with Mexican Spanish-speaking pregnant women. Maternal sociodemographic and reproductive factors have an influence on the variance of eating behaviors during pregnancy.

Epigenetic age acceleration mediates the relationship between neighborhood deprivation and pain severity in adults with or at risk for knee osteoarthritis pain

An estimated 250 million people worldwide suffer from knee osteoarthritis (KOA), with older adults having greater risk. Like other age-related diseases, residents of high-deprivation neighborhoods experience worse KOA pain outcomes compared to their more affluent neighbors. The purpose of this study was to examine the relationship between neighborhood deprivation and pain severity in KOA and the influence of epigenetic age acceleration (EpAA) on that relationship. The sample of 128 participants was mostly female (60.9%), approximately half non-Hispanic Black (49.2%), and had a mean age of 58 years. Spearman bivariate correlations revealed that pain severity positively correlated with EpAA (ρ = 0.47, p ≤ 0.001) and neighborhood deprivation (ρ = 0.25, p = 0.004). We found a positive significant relationship between neighborhood deprivation and EpAA (ρ = 0.47, p ≤ 0.001). Results indicate a mediating relationship between neighborhood deprivation (predictor), EpAA (mediator), and pain severity (outcome variable). There was a significant indirect effect of neighborhood deprivation on pain severity through EpAA, as the mediator accounted for a moderate portion of the total effect, PM = 0.44. Epigenetic age acceleration may act as a mechanism through which neighborhood deprivation leads to worse KOA pain outcomes and may play a role in the well-documented relationship between the neighborhood of residence and age-related diseases.

Retrospective clinical and X-ray-based outcome analysis of a short-stem hip arthroplasty taking into account the operative learning curve over 7 years in the 3-year control course

IntroductionSelf-monitoring is crucial to work progressively with a high-quality standard. A retrospective analysis is a valuable tool for studying the postoperative outcome of a prosthesis and for evaluating the learning process for the surgeon.Materials and methodsThe learning process of one surgeon was analysed in 133 cases of hip arthroplasty. These were divided into seven groups representing the surgical years 2008–2014. Over the course of 3 postoperative years, a total of 655 radiographs were analysed at regarding three radiological quality parameters (centrum-collum-diaphyseal angle (CCD angle), intramedullary fit&fill ratio (FFR), and migration) and ancillary outcome parameters (Harris Hip Score (HHS), blood loss, operating time, and complications). This period was divided into five times: 1st-day post-op, 6 M, 12 M, 24 M, and 36 M. Bivariate Spearman's correlation analysis and pairwise comparisons were performed.ResultsThe total collective achieved a proximal FFR of over 0.8. The distal prosthesis tip migrated and was located on the lateral cortex within the first months. The CCD angle initially showed a variation with a subsequent constant course. The HHS showed a significant increase (p < 0.001) to over 90 points postoperatively. Over time, the operating time and blood loss decreased. Intraoperative complications existed only at the beginning of the learning phase. A learning curve effect can be determined for almost all parameters by comparing the subject groups.ConclusionsOperative expertise was shown to gain through a learning curve, whereby postoperative results corresponded to the system philosophy of the short hip stem prosthesis. The distal FFR and the distal lateral distance could represent the principle of the prosthesis, which overall could be an interesting approach for verification of a new parameter.

Stressful life events and passive behavioral patterns in women with major depressive disorder: a mixed method analysis nested in a clinical trial

BackgroundWomen are more vulnerable to presenting with major depressive disorder (MDD) as they seem more sensitive to stressful life events (SLE). Few studies describe the effect of SLE on the development of avoidant/passive behavioral patterns (PBP) of MDD. Understanding the relationship between SLE and PBP is essential for the clinical management of MDD. Here, we aim (1) to describe and categorize the perceptions about SLE, emotional experience, and PBP in women with MDD and (2) to discuss the PBP according to evolutionary and behavioral processes. This mixed-method study, including qualitative and quantitative analyses, was nested in a clinical trial with 76 patients. We selected a sample of 18 female patients, randomized to behavioral activation therapy (BAT). In the first sessions, we interviewed the patients about SLE, emotional experience, and PBP perceived during their current depressive episode. The reports were submitted to content analysis and categorized under similar themes. We performed bivariate Spearman correlations to test the strenghts of associations between depressive symptoms (HAM-D), anxiety symptoms (BAI), disability (SDS), and cognitive distortions (CD-Quest).ResultsIn our sample, the most frequent SLE were romantic relationship problems and family problems. The patients most reported emotional experiences were sadness, discouragement, and anxiety. The most common PBP categories were getting isolated, stopping doing activities, and ruminating.ConclusionsWomen frequently perceive interpersonal, family, and affective problems as triggers of depressive episodes. The most common passive patterns include isolation, stopping doing activities, and ruminations. The evolutionary functions of PBP are to keep the organism passive, avoiding energy expenditure, and risk exposure in the face of a chronically stressful environment with few opportunities for reward.

Diagnostic performance of texture analysis in the differential diagnosis of perianal fistulising Crohn’s disease and glandular anal fistula

Perianal fistulising Crohn's disease (PFCD) and glandular anal fistula have many similarities on conventional magnetic resonance imaging. However, many patients with PFCD show concomitant active proctitis, but only few patients with glandular anal fistula have active proctitis.To explore the value of differential diagnosis of PFCD and glandular anal fistula by comparing the textural feature parameters of the rectum and anal canal in fat suppression T2-weighted imaging (FS-T2WI).Patients with rectal water sac implantation were screened from the first part of this study (48 patients with PFCD and 22 patients with glandular anal fistula). Open-source software ITK-SNAP (Version 3.6.0, http://www.itksnap.org/) was used to delineate the region of interest (ROI) of the entire rectum and anal canal wall on every axial section, and then the ROIs were input in the Analysis Kit software (version V3.0.0.R, GE Healthcare) to calculate the textural feature parameters. Textural feature parameter differences of the rectum and anal canal wall between the PFCD group vs the glandular anal fistula group were analyzed using Mann-Whitney U test. The redundant textural parameters were screened by bivariate Spearman correlation analysis, and binary logistic regression analysis was used to establish the model of textural feature parameters. Finally, diagnostic accuracy was assessed by receiver operating characteristic-area under the curve (AUC) analysis.In all, 385 textural parameters were obtained, including 37 parameters with statistically significant differences between the PFCD and glandular anal fistula groups. Then, 16 texture feature parameters remained after bivariate Spearman correlation analysis, including one histogram parameter (Histogram energy); four grey level co-occurrence matrix (GLCM) parameters (GLCM energy_all direction_offset1_SD, GLCM entropy_all direction_ offset4_SD, GLCM entropy_all direction_offset7_SD, and Haralick correlation_all direction_ offset7_SD); four texture parameters (Correlation_all direction_offset1_SD, cluster prominence _angle 90_offset4, Inertia_all direction_offset7_SD, and cluster shade_angle 45_offset7); five grey level run-length matrix parameters (grey level nonuniformity_angle 90_offset1, grey level nonuniformity_all direction_offset4_SD, long run high grey level emphasis_all direction_offset1_SD, long run emphasis_all direction_ offset4_ SD, and long run high grey level emphasis_all direction_offset4_SD); and two form factor parameters (surface area and maximum 3D diameter). The AUC, sensitivity, and specificity of the model of textural feature parameters were 0.917, 85.42%, and 86.36%, respectively.The model of textural feature parameters showed good diagnostic performance for PFCD. The texture feature parameters of the rectum and anal canal in FS-T2WI are helpful to distinguish PFCD from glandular anal fistula.

Association of Plasma Biomarkers with Sleep Outcomes and Treatment Response After Mild Traumatic Brain Injury.

Sleep disturbances occur in up to 70% of patients with mild traumatic brain injury (mTBI). Modern mTBI management recommends targeted treatment for the patient's unique clinical manifestations (i.e., obstructive sleep apnea, insomnia). The purpose of this study was to evaluate the association of plasma biomarkers with symptom reports, overnight sleep evaluations, and response to treatment for sleep disturbances secondary to mTBI. This study is a secondary analysis of a prospective multiple interventional trial of patients with chronic issues related to mTBI. Pre- and post-intervention assessments were conducted, including overnight sleep apnea evaluation, the Pittsburgh Sleep Quality Index (PSQI), and blinded analysis of blood biomarkers. Bivariate Spearman correlations were conducted for pre-intervention plasma biomarker concentrations and 1) PSQI change scores and 2) pre-intervention sleep apnea outcomes (i.e., oxygen saturation measures). A backward logistic regression model was built to evaluate the association of pre-intervention plasma biomarkers with improvement in PSQI over the treatment period (p < 0.05). Participants were 36.3 ± 8.6 years old and 6.1 ± 3.8 years from their index mTBI. Participants reported subjective improvements (PSQI = -3.7 ± 3.8), whereas 39.3% (n = 11) had improved PSQI scores beyond the minimum clinically important difference (MCID). PSQI change scores correlated with von Willebrand factor (vWF; ρ = -0.50; p = 0.02) and tau (ρ = -0.53; p = 0.01). Hyperphosphorylated tau correlated with average saturation (ρ = -0.29; p = 0.03), lowest desaturation (ρ = -0.27; p = 0.048), and baseline saturation (ρ = -0.31; p = 0.02). The multi-variate model (R 2 = 0.33; p = 0.001) retained only pre-intervention vWF as a predictor (odds ratio = 3.41; 95% confidence interval, 1.44-8.08; p = 0.005) of improving PSQI scores beyond the MCID. vWF had good discrimination (area under the curve = 0.83; p = 0.01), with an overall accuracy of 77%, sensitivity of 46.2%, and specificity of 90.0%. Validation of vWF as a potential predictive biomarker of sleep improvement post-mTBI could optimize personalized management and healthcare utilization.

Development and validation of a novel non-invasive test for diagnosing nonalcoholic fatty liver disease in Chinese children.

With the exploding prevalence of obesity, many children are at risk of developing nonalcoholic fatty liver disease. Using anthropometric and laboratory parameters, our study aimed to develop a model to quantitatively evaluate liver fat content (LFC) in children with obesity. A well-characterized cohort of 181 children between 5 and 16years of age were recruited to the study in the Endocrinology Department as the derivation cohort. The external validation cohort comprised 77 children. The assessment of liver fat content was performed using proton magnetic resonance spectroscopy. Anthropometry and laboratory metrics were measured in all subjects. B-ultrasound examination was carried out in the external validation cohort. The Kruskal-Wallis test, Spearman bivariate correlation analyses, univariable linear regressions and multivariable linear regression were used to build the optimal predictive model. The model was based on indicators including alanine aminotransferase, homeostasis model assessment of insulin resistance, triglycerides, waist circumference and Tanner stage. The adjusted R2 of the model was 0.589, which presented high sensitivity and specificity both in internal [sensitivity of 0.824, specificity of 0.900, area under curve (AUC) of 0.900 with a 95% confidence interval: 0.783-1.000] and external validation (sensitivity of 0.918 and specificity of 0.821, AUC of 0.901 with a 95% confidence interval: 0.818-0.984). Our model based on five clinical indicators was simple, non-invasive, and inexpensive; it had high sensitivity and specificity in predicting LFC in children. Thus, it may be useful for identifying children with obesity who are at risk for developing nonalcoholic fatty liver disease.

Dietary Choline Intake Is Directly Associated with Bone Mineral Density in the Hordaland Health Study

BackgroundCholine is an important nutrient either obtained from a variety of foods or synthesized endogenously, and it is the precursor of betaine. We previously reported positive associations between plasma free choline and bone mineral density (BMD). Animal studies suggest an impact of dietary choline on bone metabolism, but the role of dietary intake of choline and betaine for human bone health is unknown. ObjectiveThe main aims were to examine the associations of dietary choline, choline species, and betaine with BMD and to study the relations between dietary and plasma free choline and betaine. MethodsStudy subjects were participants in the Hordaland Health Study, including 2649 women and 1983 men (aged 46–49 or 71–74 y). BMD was measured by dual-energy X-ray absorptiometry, and dietary intake was obtained by using a validated 169-item food-frequency questionnaire. Risk associations were assessed by logistic regression and correlations by ρ (Spearman's bivariate rank order correlation). ResultsSubjects in the lowest compared with the highest tertile of dietary total choline, free choline, glycerophosphocholine, phosphocholine, phosphatidylcholine, and sphingomyelin had a higher risk of low–femoral neck BMD, defined as the lowest BMD quintile. Particularly strong associations were found among middle-aged men for intake of free choline (OR: 1.83; 95% CI: 1.24, 2.69; P = 0.002) and glycerophosphocholine (OR: 2.13; 95% CI: 1.43, 3.16; P < 0.001) and among elderly women for total choline (OR: 1.96; 95% CI: 1.33, 2.88; P = 0.001) and phosphatidylcholine (OR: 1.94; 95% CI: 1.33, 2.84: P = 0.001) intake. No significant associations were observed between dietary betaine and BMD. Dietary total choline, free choline, glycerophosphocholine, phosphatidylcholine, and sphingomyelin correlated weakly with plasma free choline (ρ: 0.07, 0.05, 0.07, 0.07, and 0.05, respectively; P < 0.01). Dietary betaine correlated with plasma betaine (ρ: 0.23; P < 0.001). ConclusionsDietary choline was positively associated with BMD in middle-aged and elderly participants.

Development and Predictive Validation of the Brazilian Adductor Performance Test for Estimating the Chance of Hip Adductor Injuries in Elite Soccer Athletes.

To develop and validate the Brazilian Adductor Performance Test (BAPT) for predicting hip adductor muscle injuries in elite soccer athletes. A total of 108 soccer athletes were assessed, followed up for 3months, and evaluated for a history of adductor injury 6months before BAPT evaluation. The Shapiro-Wilk test was used as the normality test. The Mann-Whitney U test was used to compare BAPT scores between injured and uninjured athletes. Binary logistic regression was performed to identify the athletes' chances of injury based on their BAPT scores. A receiver operating characteristic curve was used to determine the cutoff point for the number of repetitions in the BAPT and Spearman bivariate correlation and identify factors potentially related to the test score. Furthermore, the intraclass correlation coefficient was used to determine interexaminer agreement. The level of significance was set at 95%. The BAPT scores for hip adductor injury history did not differ significantly (P = .08). A significant deficit was identified in the BAPT scores of the injured athletes at the 3-month follow-up (P = .001). The cutoff point identified was 33 repetitions. Low BAPT scores increased the chance of injury by 20% (odds ratio, 1.20%; P = .001). The interexaminer agreement was .96 (P = .001). BAPT can be used to identify athletes most likely to sustain hip adductor muscle injuries, indirectly reducing the rate of this injury in soccer clubs.

Autophagy biomarkers in patients with acute myocardial infarction

Abstract Introduction Acute myocardial infarction (AMI) is still one of leading cause for mortality and disability in cardiovascular disease [1]. Autophagy is an intracellular mechanism involved in the elimination and the recycling of proteins and organelles by lysosomes [2]. Autophagy has an important role of critical cellular process for the self-protective degradation mechanism and recycling of cellular components in ischemic events such as AMI and left ventricular remodeling [3]. However, very few studies are evaluated the activity of autophagy and the relationship between autophagy activity and prognosis in patients with AMI. Purpose We aimed to evaluate the activity of autophagy in patients with AMI. Moreover, our study evaluated the associations of autophagy biomarkers with traditional cardiac biomarkers such as CK-MB, Troponin T and NT-proBNP, and echocardiographic left ventricular ejection fraction (LVEF). Methods We prospectively enrolled AMI patients with urgent coronary revascularization and controls who underwent coronary angiography without significant coronary artery stenosis. We obtained the serum of patients from peripheral artery and coronary artery before coronary revascularization. Levels of LC3-II, ATG5, Beclin 1 and M30 were quantified by ELISA in the serum from 22 AMI patients and 19 controls. Associations between autophagy biomarkers and traditional cardiac biomarkers were analyzed by Spearman bivariate correlation analysis. Results There were no significant differences in age, gender, systolic blood pressure, diastolic blood pressure, heart rate and medical history including hypertension, diabetes, dyslipidemia and atrial fibrillation between two groups. AMI patients had significant higher concentrations of autophagy biomarkers such as LC3-II (218.2±47.1 vs. 117.2±28.0 ng/ml; 238.4±60.5 vs. 118.5±27.7 ng/ml; p&amp;lt;0.001), ATG5 (205.6±57.8 vs. 62.9±40.0 ng/ml; 199.5±56.3 vs. 68.4±54.7 ng/ml; p&amp;lt;0.001), and Beclin 1 (225.6±55.1 vs. 123.8±16.6 ng/ml; 222.1±51.4 vs. 115.4±21.4 ng/ml; p&amp;lt;0.001) in peripheral artery and coronary artery, both (Figure 1). M30 of apoptosis level was also significantly higher in AMI patients than in controls (262.0±78.6 vs. 148.4±57.7 ng/ml; 290.4±128.5 vs. 144.5±50.1 ng/ml; p&amp;lt;0.001). Especially, LC3-II and Beclin 1 in coronary artery had strong positive correlations with Troponin T (rho=0.630, p&amp;lt;0.001; rho=0.624, p&amp;lt;0.001, respectively). Conclusions Autophagy biomarkers such as LC3-II, ATG5 and Beclin 1 were significantly higher in AMI patients than in controls. Autophagy biomarkers had significant positive correlations with Troponin T and NT-proBNP as the traditional cardiac biomarkers and negative correlations with LVEF. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT)