Comparison Of Groups Research Articles

Palliative Care Outcomes for Critically ill Children After Rapid Whole Genome Sequencing.

Clinical utility of rapid whole genome sequencing (rWGS) has been reported in 30-70% of pediatric ICU patients who receive a molecular diagnosis. Rapid molecular diagnostic techniques have been increasingly integrated into critical care, yet the influence of genetic test results on palliative care related decision making is largely unknown. This study evaluates palliative care related outcomes after rWGS. Retrospective chart review. Tertiary children's hospital. Acutely ill children 18 years of age who received rWGS due to suspected genetic disease between July 2016 and November 2019. rWGS with associated precision medicine. 536 patients underwent rWGS, of whom 152 (28.4%) received a molecular diagnosis. Diagnostic rWGS was associated with more code status modifications, an increase in palliative care inpatient consultations, and greater enrollment in home-based palliative services. A comparison of diagnostic and nondiagnostic rWGS groups where palliative decisions were made prior to reporting of genomic testing results did not identify differences between the groups. In the subset of patients who had palliative care interventions (n = 57, 53% with diagnostic rWGS), time to palliative care consultation and time to compassionate extubation were shorter for patients with rWGS-based diagnoses (Kaplan-Meier method, P = .008; P = .015). Significantly more patients in this subgroup with diagnostic rWGS received home-based palliative care (Chi-squared, P = .025, 95% CI [-0.47, -0.05]). Univariate Poisson regression indicated that diagnostic rWGS is associated with significantly fewer emergency visits, PICU admissions, and unplanned intubations. Diagnostic rWGS correlates with more rapid engagement of pediatric palliative care services, higher enrollment rates in home-based palliative care, and shorter time to compassionate extubation. Further studies are needed with larger cohort sizes and validated pediatric palliative care outcome measurement tools to accurately determine if this change in care is driven by the underlying condition or knowledge of a molecular diagnosis.

Validity and Reliability of Wind Speed Calculated by Notio in Comparison with a Hot-Wire Anemometer

Optimizing aerodynamic efficiency is crucial in competitive cycling, where aerodynamic resistance significantly limits performance. Devices like Notio have emerged to calculate the coefficient of drag area (CDA) considering dynamic pressure data calculated by an integrated Pitot-static tube. This study aimed to evaluate the validity and reliability of Pitot-static tube calculations through wind speed (WS) data against a hot-wire anemometer (HWA). Sixty recordings were made, lasting 30 s each, in a closed-circuit wind tunnel at four different WS (≈30 to ≈60 km/h), and at five different yaw angles (0° to 20°). Initially, Notio showed WS 6.44% higher than HWA. The calibration process recommended by the Notio manufacturer reduced the differences to a non-significant 0.76%. Comparison of the WS of Notio calibrated and HWA only showed significant differences in the WS group of ≈60 km/h. There were no significant differences in the comparison of yaw angles groups. The reliability of Notio was worse than that of the HWA. In conclusion, Notio calibrated at a speed close to its use allows for reliable and accurate calculation of WS over a wide range of yaw angles under controlled wind tunnel conditions without the presence of a cyclist and bicycle. However, due to the influence of WS on aerodynamic drag, small errors in WS could translate into considerable values of CDA for cycling performance.

Gastrointestinal cancer surgery in the elderly: The effects of preoperative oral nutritional supplements - A retrospective study.

The current study aimed to explore the effect of nutritional prehabilitation on the clinical prognosis of elderly patients undergoing abdominal cancer surgery. A retrospective study was conducted, where participants were divided into two groups based on whether they received oral nutritional supplementation at the first outpatient visit. The nutritional prehabilitation group (n=41) adopted a nutritional prehabilitation mode (a standard energy intake of 25-30 kcal/kg· d was recommended). While the control group (n=55) received routine care. All patients underwent laparoscopic surgery according to the National Comprehensive Cancer Network (NCCN) guidelines. Changes in nutritional status, complications, psychological status, symptoms, hospitalization days, and expenditures were compared between the two groups. Both groups of patients experienced weight loss. However, the decline in body weight in the prehabilitation group was less than that in the control group (-1.88 vs. -2.56 kg, p < 0.001). In the comparison of nutritional prehabilitation group and control group, significant improvements were observed in the Hospital Anxiety Scale scores (5 vs. 5, p = 0.01) and MD Anderson Symptom Inventory scores (3 vs. 0, p < 0.001) respectively. The infection rate in the nutritional prehabilitation group was lower than that in the control group (17.1% vs. 36.4%, p = 0.04). Additionally, patients in the nutritional prehabilitation group had significantly fewer hospitalization days at discharge (14.3 vs. 17.1 days, p = 0.03). In elderly patients undergoing abdominal cancer surgery, a nutritional prehabilitation model may help maintain better physical and mental status, reduce infection rates, and shorten hospitalization days.

Kids save lives: Who should train schoolchildren in resuscitation? A systematic review

AimCPR training for schoolchildren to increase bystander CPR-rates is widely applied. HCPs are regarded as the instructor gold standard, but using non-HCP instructors (e.g., peer-tutors, schoolteachers, medical students) challenges that. This systematic review assesses whether cardiopulmonary resuscitation (CPR) training for children led by peer-tutors, schoolteachers, or medical students results in different learning outcomes to training by health-care professionals (HCPs). MethodsWe searched studies that compared CPR training for schoolchildren (population) delivered by peer-tutors, schoolteachers, or medical students (intervention), with training led by HCPs (comparison), assessing student knowledge, skills, willingness and/or confidence to perform CPR (outcome). We included randomized and non-randomized controlled trials (study design). Medline, Embase, Psychinfo, Cinahl, Cochrane, Scopus, Web of Science, and Eric were searched from inception until December 23rd, 2023 (timeframe). Two independent reviewers performed title, abstract, full text screening, bias assessment, and grading of certainty of evidence. We followed the Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA) guidelines, and registered the review with PROSPERO. ResultsOf 9′092 studies identified, 14 were included. Comparison of intervention groups to HCP-led training showed similar overall results (knowledge, skills, self-confidence). Superior results for HCP training were only reported for ‘ventilation volume’, while schoolteachers and medical students achieved superior knowledge transfer. A meta-analysis was possible for ‘compression depth’ between peer-tutors and HCPs showing no significant differences. Certainty of evidence was ‘low’ to ‘very low’. ConclusionThis systematic review of CPR training for school children revealed that peer-tutors, schoolteachers and medical students achieve similar educational outcomes compared to those of HCPs. Non-HCPs training schoolchildren is an appropriate cost-efficient alternative and easy to implement in school curricula.

Psychosocial and psychopathological dimensions of patients with Takotsubo Syndrome.

Takotsubo syndrome (TTS) is an acute reversible heart dysfunction affecting mostly post-menopausal women, frequently precipitated by a significant stressful event, presenting as an acute coronary syndrome (ACS) in the absence of obstructive coronary artery disease. The pathogenesis is not fully understood, but a close relationship between individual's mind, brain, neuroendocrine system and the heart may be involved in a mind-heart axis. The purpose of this study was to compare the prevalence of psychopathological findings in TTS patients as compared to healthy subjects, patients affected by psychiatric diseases and patients affected by ACS. This observational study enrolled 40 female subjects divided into 4 subgroups: TTS patients, healthy subjects, psychiatric patients and ACS patients, matched for age. Psychosocial factors and psychopathological dimensions have been evaluated. Patients who signed informed consent were interviewed by the administration of a complex psychometric battery, including Mini International Neuropsychiatric Interview, Hamilton Rating Scale for Depression, State Trait Anxiety Inventory, Form Y. Comparing the groups, the TTS group showed a statistically significant difference vs. ACS group concerning psychological violence subscale (P=0.049) of the Childhood Trauma Questionnaire, while significant statistical difference emerged in TTS group vs. healthy subjects control group, regarding cyclothymia subscale (P=0.008). Statistically significant differences were documented in TTS group vs. psychiatric cohort in cyclothymia subscale (P=0.012). Moreover, comparison between TTS and ACS group, revealed a statistically significant difference in the sub-scale of self-confidence and management of negative emotions (P=0.0028). One of the most significant features was the evidence of statistically significant differences in TTS vs. ACS group, concerning total and average value of anxiety (P=0.014 and P=0.031 respectively) and in the comparison of TTS group vs healthy subjects (P=0.005 for the total anxiety value and P=0.021 for the average value). Finally, both depression and mania were statistically significant raised in the TTS group compared to the healthy subjects' group (P=0.00 and P=0.013, respectively). Psychosocial and psychopathological dimensions of TTS patients have been explored and analyzed in a cohort of TTS patients vs. ACS, healthy subjects and psychiatric patients, showing statistically significant differences among the various groups. Psychopathological symptoms were more frequent in TTS patients, suggesting an evident involvement of mind-heart axis in this disease. Future studies are needed to investigate the cause-effect relationship between psychopathological features and the occurrence of TTS.

Effect of blood pressure variability on the outcomes of acute ischemic stroke patients undergoing intravenous thrombolysis

BackgroundThere is limited research on the relationship between blood pressure variability (BPV) and outcomes among patients receiving intravenous thrombolysis (IVT) for acute ischemic stroke (AIS). This study aimed to investigate the effect of 24-h BPV on the outcome of patients with AIS treated with IVT. MethodsA retrospective analysis was conducted on clinical data of patients with AIS who had undergone IVT treatment. During the initial 24 h after IVT, various BPV parameters for systolic and diastolic blood pressure were calculated, including the maximum BP, minimum BP, mean BP, standard deviation, coefficient of variation, and average real variability (ARV). Follow-up was conducted at 90 days post-onset, with outcomes classified as “good” or “poor” based on a modified Rankin Scale score of ≤2 or >2, respectively. ResultsA total of 216 patients were included in the study and divided into two groups based on their outcomes: a good-outcome group (n = 151, 69.9 %) and a poor-outcome group (n = 65, 30.1 %). A comparison of the poor-outcome group with the other group revealed significant differences in age, baseline National Institutes of Health Stroke Scale, Trial of Org 10172 in Acute Stroke Treatment classification, diabetes mellitus, and atrial fibrillation (P < 0.05). The maximum systolic blood pressure (163.58 ± 19.76 vs. 173.91 ± 18.51 mmHg) and average rate of ventricular response (10.35 vs. 12.09) in the good-outcome group were lower than those in the poor-outcome group (all P < 0.05). After adjusting for confounding factors in the binary logistic regression analysis, the maximum systolic blood pressure (odds ratio = 1.023, 95 % confidence interval = 1.004–1.043, P = 0.019] and ARV (odds ratio = 1.103, 95 % confidence interval = 1.007–1.208, P = 0.035) were significantly associated with adverse outcomes. ConclusionThe maximum systolic blood pressure and mean true variation rate were negatively correlated with outcomes.

Comparison of Resin Infiltrant and Sealants on Pre-Cavitated Lesions in Primary Teeth: A Quantitative Analysis Using Atomic Absorption Spectrophotometry

ABSTRACT Aim: This study was conducted to analyze the effects of sealants and resin infiltrant on pre-cavitated lesions in primary teeth (AAS) using an atomic absorption spectrophotometer. Material and Method: Forty freshly extracted intact human primary molars were used for the study. All the specimens were then divided into four groups of ten specimens. These groups are treated differently. The specimens were stored in artificial saliva throughout the study. The AAS was then used to assess the calcium dissolution of artificial saliva. Result: A comparison of Group III and Group IV established a statistically significant difference found in the amount of calcium dissolution in artificial saliva. Group III showed lesser calcium dissolution from enamel compared to Group IV in artificial saliva. Conclusion: Resin infiltration showed more resistance to the release of calcium from enamel as compared to Clinpro Sealant in artificial saliva.

Changes in fatty acids, vitamins, cholesterol and amino acid profiles of ram semen by freeze-thawing process

The objective of this study was to examine the impact of freeze-thawing on the levels of oxidative stress, fatty acids, vitamins A, D, E, and K, cholesterol, and amino acids, as well as on spermatological parameters, in ram semen. Semen was collected and pooled from each of the seven rams twice a week for three weeks. The mixed semen was diluted with tris + egg yolk diluent at 38 °C (Group 38 °C) and the temperature was reduced to 5 °C (Group 5 °C). Following the glycerolization-equilibration process (Group G-E), the samples were automatically frozen in liquid nitrogen vapor at −140 °C. The semen samples were thawed 24 h after freezing (Group Frozen-Thawed, F-T). A comparison of Group 38 °C with Group F-T revealed significant differences in several parameters. Motility rates, kinematic values, percentage of membrane integrity (HOS), some PUFA levels, ∑SFA and amino acid levels were significantly lower in Group F-T. Conversely, the ratio of dead and static spermatozoa, lipid peroxidation level, some PUFA levels, ∑MUFA, vitamins A, E and cholesterol levels were significantly higher in Group F-T. The majority of these alterations were also evident in semen samples subjected to G-E treatment. In conclusion, exposure of ram semen to G-E and F-T treatments results in modifications to semen, fatty acid, vitamin, and amino acid profiles, accompanied by elevated levels of lipid peroxidation. Moreover, this study demonstrated, for the first time, that oxidative stress was induced, some amino acid levels were altered, vitamin A and E levels were increased, vitamin D and K levels were not affected, and β-sitosterol levels were decreased after freeze-thawing in ram semen.

Natural Chiral Ligand Strategy: Metal-Catalyzed Reactions with Ligands Prepared from Amino Acids and Peptides

Amino acids and peptides are readily available biomolecules and can function as chiral ligands for transition metal catalysis. An example is the copper complex catalyzed 1,4-addition of dialkylzinc to acyclic enones, which employs peptide ligands. This review provides a dataset of amino acids and peptides reported in the literature proving to be effective ligands for metal-centered catalysts. Several parameters were highlighted, including amino acid combination, metal atoms, carboxyl and amino protecting groups, modification of natural amino acids, and the mechanism of catalysis. Along with analyzing physical-chemical properties, the SMILES representation for each amino acid and/or peptide was generated and made available online, providing an easy-to-use means of training machine learning models. This review offers an opportunity for the development of more efficient peptide ligands for enantioselective metal-centered catalysts. The available online dataset is a reliable manually curated table, it enables the benchmark for comparison of new terminal functional groups. Moreover, the review provides insight into the structures of the more successful peptide ligands and can be used as the foundation for the development of the next generation of peptide-based chiral ligands.

The effect of methylphenidate on the reproductive function of female rats.

Research on the effects of methylphenidate on female fertility is limited. This study evaluated the effects of methylphenidate on reproductive function, oxidants, antioxidants, proinflammatory cytokines, prolactin, and cortisol in female rats. Forty-eight albino Wistar female rats were divided into four groups consisting of 12 rats, which were given pure water orally once daily for 7 days (HG-1), 10 mg/kg methylphenidate orally once daily for 7 days (MP-1), pure water orally once daily for 30 days (HG-2), and 10 mg/kg methylphenidate orally once daily for 30 days (MP-2). At the end of the treatment periods, tail vein blood was collected from six rats per group for prolactin and cortisol determination. Subsequently, euthanasia was performed and the ovaries were removed. Ovaries were analyzed for malondialdehyde (MDA), total glutathione (tGSH), superoxide dismutase (SOD), catalase (CAT), interleukin-1 beta (IL-1β), and tumor necrosis factor-alpha (TNF-α), and immunohistochemically. For breeding, the remaining six rats were mated with male rats for 1 month. Rats that failed to give birth were classed as infertile. A comparison of MP-1 and MP-2 groups to healthy controls revealed an elevation in MDA and corticosterone levels, and a decline in tGSH, SOD, and CAT levels (p < 0.001). Methylphenidate did not affect prolactin, IL-1β, and TNF-α levels (p > 0.05). MP-1 and MP-2 exhibited immunopositivity for 8-hydroxy-2'-deoxyguanosine (8-OHDG). MP-2 rats developed 66.7% infertility while MP-1, HG-1, and HG-2 rats did not. In ovaries, methylphenidate caused oxidative stress, but did not induce inflammation. Long-term use of methylphenidate caused increased cortisol levels and infertility.

Comparison of group versus individual patient education for promoting safety skills of patients with autoimmune rheumatic diseases treated with biologics: a multicentre randomised controlled trial.

To evaluate the effectiveness of a nurse-led intervention combining face-to-face and group education sessions for the acquisition of safety skills by patients with autoimmune rheumatic diseases treated with biologics. This multicentre randomised controlled trial compared two individual patient education sessions against a combination of an individual session at baseline and a group session 3months later. The primary outcome was a validated questionnaire (BioSecure) scored at 6 and 12 months that assessed competencies and problem-solving abilities to deal with fever, infection, vaccination, and daily situations. Secondary outcomes were fear of disease, anxiety, depression, and arthritis helplessness. A total of 120 patients with rheumatoid arthritis and spondyloarthritis were included (60 in each arm) from 7 French rheumatology departments; 99 patients completed the study at 6months and 83 at 12months. The BioSecure score improved at 6months in both arms (delta from baseline 14.9 ± 16.3 in face-to-face education and 16.0 ± 17.9 in combined education) and was maintained for 12months but no significant difference was found between arms at 6 and 12months (p = 0.35 and p = 0.13, respectively). Fear of disease, arthritis helplessness, and anxiety were improved at 6 and 12months with no difference between arms. Educating patients using individual nurse-led sessions or a combination of individual and group sessions increased their safety skills on biologics, with no superiority shown for the combined format. Given the time and resources required to educate patients, these results could lead to potential cost savings. Clinical Trials: NCT03838939. Key Points • Face-to-face patient education has been shown effective in promoting safety skills of patients treated with biologics compared to information provided by the rheumatologist in usual care. • This randomised controlled trial showed that a patient education format combining one individual and one group session was not superior to two individual sessions regarding safety skills assessed at 6 and 12months • Safety skills, fear of disease, arthritis helplessness, and anxiety were improved in both arms. • As the most common barriers to the implementation of patient education are constraints in time and resources, these results could lead to potential cost savings.

Effects of SI-PASS on a high-risk course – A randomized controlled trial

BackgroundSI-PASS is a structured academic support program employing successful later-year students to facilitate peer-learning sessions attached to high-risk courses, specifically here statistics for psychology at ULiège. The research translates as: How much does this method improve academic performance and impact socio-affective perceptions in first-year students? AimsThis study compares academic performance and socio-affective variables of first-year students in the experimental condition and the control condition. SampleParticipants were 245 freshmen for the experimental trial, and 985 for the quasi-experimental trial. MethodsParticipants were assigned to either participate to the SI-PASS scheme or not during the first semester following a randomized controlled trial with stratified random assignment method. Then, the whole cohort enlisted for the course was analyzed to validate supplementary hypotheses. ResultsThe first step of the study reveals no difference between both groups on academic performance, unless the level of attendance is considered; nor does it identify any significant impact on socio-affective variables. The second step consisted in the comparison of the experimental group and the group of students who chose not to volunteer for SI-PASS and resulted in significant improvement in academic performance in favor of SI-PASS. ConclusionsThis delivered significant results in favor of the program but only when attendance is considered, thus offering empirical evidence that a genuine experimental design is likely to mitigate the effects found in a tradition of quasi-experimental designs. These results are valuable for the SI-PASS community, where randomized trials are still scarce, and for higher education institutions seeking evidence-based assistance.

Identification of the Biomarkers for Chronic Gastritis with TCM Damp Phlegm Pattern by Using Tongue Coating Metabolomics.

This study aimed to establish a model for identifying chronic gastritis with the traditional Chinese medicine damp phlegm pattern by examining metabolite changes in the tongue coating of patients. It also explored the role of metabolic pathways in the pathogenesis of this condition. This cross-sectional study involved 300 patients diagnosed with chronic gastritis. Of these, 200 patients exhibited the damp phlegm pattern, while 100 did not. Metabolomic methods employing GC-TOF-MS and UHPLC-QE-MS were utilized to identify various metabolites in the tongue coating of patients. An identification model for chronic gastritis with the damp phlegm pattern was created based on ROC curves derived from differential biomarkers. Additionally, 50 samples not included in model construction were collected for external validation. Comparison of the damp phlegm pattern group with the non-damp phlegm pattern group revealed a total of 116 differential metabolites. Among these, lipids and lipid-like compounds were most abundant, comprising 27 types, which included four lipid metabolites related to sphingomyelin metabolism. The ROC model, which included phenol, 2.6-diaminoheptanedioic acid, and N-hexadecanoyl pyrrolidine, demonstrated the highest accuracy, with accuracy, sensitivity, and specificity metrics of 94.0%, 91.0%, and 87.0%, respectively. Furthermore, external validation using tongue coating metabolites from 50 patients revealed accuracy, sensitivity, and specificity in the validation set of 93.9%, 90.6%, and 83.3%, respectively. Differential metabolites between patients with the damp phlegm pattern and those without are primarily lipids and lipid-like compounds. N-hexadecanoyl pyrrolidine, phenol, and 2.6-diaminoheptanedioic acid may serve as potential biomarkers for chronic gastritis characterized by the damp phlegm pattern.

Оцінка інформативності клініко-інструментальних та лабораторних показників у виявленні активності патогенетичних факторів, асоційованих зі змінами перебігу інфаркту міокарда в період воєнного стану

The aim – to establish markers of clinical and functional state development in patients with acute myocardial infarction inherent in wartime.Materials and methods. A cohort of 133 STEMI patients was examined (77.4 % men, 61.7±0.9 years). Part of the patients (group 1) was hospitalized from February to May 2019 (n=87), while the other part of them (group 2) was hospitalized in the period from February 24, 2022 to May 2023 (n=46) within the first 24 hours from the development of symptoms (average time of admission 5.2±0.4 hours). In order to eliminate discrepancies in indicators, which with a low probability are related to the action of wartime factors, comparable samples were made from groups 1 and 2 (52 patients and 17 patients, respectively). Comparison of groups was carried out based on clinical and anamnestic and laboratory parameters of the first day.Results and discussion. At the admission to the hospital, markers of a specific clinical and functional state in patients with STEMI due to the influence of wartime factors are: level of leukocytes &gt; 13.0 · 109/L, monocytes &gt; 0.5 · 109/L, lymphocytes &gt; 1.2 . 109/L, triglycerides &gt; 1.63 mmol/L, heart rate &gt; 76 beats/min, as well as criteria made up of these indicators (in particular, products of the level of monocytes or lymphocytes, the level of triglycerides and heart rate, as well as the 7-component scale, which takes into account heart rate, ESR, glucose and triglyceride levels, as well as the number of monocytes, lymphocytes and platelets). Moreover, the increase in the number of monocytes is not associated with hospital complications in these patients. Instead, the level of triglycerides, the number of lymphocytes and platelets are directly related both to the influence of wartime factors and to the complicated hospital course of STEMI.Conclusions. The influence of wartime factors in patients with STEMI is combined with the response to myocardial damage. It leads to an increase in the risk of a complicated course of the hospital stage, as well as to specific clinical and laboratory changes. These changes make it possible to recognize the impact of wartime factors and patients at high risk of hospital course of myocardial infarction.

Evaluation of Eating Behavior in Children with Psoriasis: Retrospective Cross Sectional Study

Background. Patients with psoriasis have increased thickness of visceral fat, including epicardial adipose tissue (EAT) that has wide spectrum of biological effects. Its thickness can be affected by the presence of obesity and eating behavior (EB) changes. Studying the associations between EB and markers of adipose tissue functional activity in children with psoriasis may help to better understand this variables correlations in the scope of comorbidities. Objective. Aim of the study is to analyze the relationship between Psoriasis Area and Severity Index (PASI), Children’s Dermatology Life Quality Index (CDLQI), EAT thickness, and leptin levels in pediatric patients with psoriasis and EB disorders. Methods. Retrospective cross sectional single-center study was conducted. 72 medical records of children with psoriasis (with varying body mass index level) who were examined and treated in dermatology department in the period from December 2021 to January 2024. All included patients have underwent dietician consultation and survey with DEBQ and CEBQ questionnaires, as a result predominant EB type was determined. EAT thickness (via two-dimensional echocardiography) and leptin levels were also measured. Psoriasis severity was evaluated via PASI and CDLQI indices. Patients were divided into three groups: with external, emotiogenic, and restrictive EB. The medians of the obtained values were calculated with determination of the confidence interval, all results were compared with each other via Kruskall-Wallis test. Results. Group of patients with external EB has shown following results: median EAT thickness was 2.5 mm (Q1–Q3: 2.1–2.8), median leptin level — 17.3 ng/ml (Q1–Q3: 14.4–26.4), median of PASI — 17 points (Q1–Q3: 12.5–20.5), median of CDLQI — 7 points (Q1–Q3: 4–13.5). Group of patients with emotionogenic EB has median EAT thickness of 2.2 mm (Q1–Q3: 1.85–2.55), median leptin level — 20.1 ng/ml (Q1–Q3: 14.5–23.95), median of PASI — 14 points (Q1–Q3: 12–16.5), median of CDLQI — 6 points (Q1–Q3: 3–12). Group of patients with restrictive EB has median EAT thickness of 3.4 mm (Q1–Q3: 3.1–3.9), median leptin level — 28.2 ng/ml (Q1–Q3: 26.1–33.5), median of PASI — 24 points (Q1–Q3: 21–27), median of CDLQI — 13 points (Q1–Q3: 9–21). Statistically significant (p = 0.0014) increase in PASI and CDLQI points was observed at comparison of different groups via Kruskall-Wallis test. Patients from restrictive EB group have shown higher values of EAT thickness, leptin levels, PASI, and CDLQI scores compared to patients with emotionogenic and external EB. No statistically significant differences were observed when comparing leptin levels and EAT thickness in the remaining groups. Conclusion. Patients with restrictive EB had higher PASI and CDLQI scores compared to patients with emotionogenic and external EB. No statistically significant differences were observed when comparing EAT thickness and leptin levels. Small study sample was the only research limitation.

On the application of Gaussian graphical models to paired data problems

Gaussian graphical models are nowadays commonly applied to the comparison of groups sharing the same variables, by jointly learning their independence structures. We consider the case where there are exactly two dependent groups and the association structure is represented by a family of coloured Gaussian graphical models suited to deal with paired data problems. To learn the two dependent graphs, together with their across-graph association structure, we implement a fused graphical lasso penalty. We carry out a comprehensive analysis of this approach, with special attention to the role played by some relevant submodel classes. In this way, we provide a broad set of tools for the application of Gaussian graphical models to paired data problems. These include results useful for the specification of penalty values in order to obtain a path of lasso solutions and an ADMM algorithm that solves the fused graphical lasso optimization problem. Finally, we carry out a simulation study to compare our method with the traditional graphical lasso, and present an application of our method to cancer genomics where it is of interest to compare cancer cells with a control sample from histologically normal tissues adjacent to the tumor. All the methods described in this article are implemented in the R package pdglasso available at https://github.com/savranciati/pdglasso.

Cardiac Myosin-binding Protein-C as a Biomarker in the Early Diagnosis of Acute Coronary Syndrome and Differentiation of Its Types

Abstract Background: Coronary heart disease (CHD) is primarily caused by atherosclerotic lesions within the intima of coronary arteries and acute coronary syndrome (ACS) is the main acute clinical manifestation of CHD. The ACS is manifested in one of three subtypes and it is the leading cause of mortality worldwide. The three subtypes of ACS include: acute myocardial infarction (MI) with the electrocardiogram (ECG) presenting ST-segment elevation (STEMI), MI with no ST-segment elevation on ECG (NSTEMI), and the third subtype is unstable angina (UA). The early diagnosis of is important in decreasing morbidity and mortality in ACS patients. Objective: To investigate the role of serum level of cardiac myosin-binding protein-C (cMyC), compared with high-sensitivity cardiac troponin-I (hsCTn-I) in the early diagnosis of ACS and differentiation of its subtypes. Materials and Methods: One hundred and twenty patients (72 males and 48 females), aged ≥30 years selected from those who were admitted to emergency department (ED) of Al-Yarmouk teaching hospital and diagnosed with ACS by cardiologists. The duration between the onset of chest pain and admission to ED should not exceed 3 h in any cohort. Apparenty healthy subjects as controls group for the study were recruited from those who had no current illness, particularly CHD, no other systemic disease and each had a normal ECG. For each study subject, cMybp-C and hsCT-I serum levels on admission were measured using the enzyme-linked immunosorbent assay kits. For each ACS patient, serum level of hsCTn-I level was measured 3 h after admission. Results: The comparison of cMybp-C levels among study groups revealed an overall significant difference and on paired comparison of study groups, the cMybp-C mean level was significantly higher in each ACS subgroup than in controls group (P &lt; 0.001), except in UA subgroup versus controls group. The cMybp-C levels showed a significant positive correlation with hsCT-I levels on admission in STEMI and NSTEMI subgroups but not in UA subgroup. The cMybp-C levels also showed a significant positive correlation with hscT-I levels 3 h after admission in STEMI and NSTEMI subgroups but not in UA subgroup. On receiver operating characteristic curve analysis, the cMybp-C level had a better diagnostic accuracy than hscTn-I on admission in differentiation of patients with “STEMI or NSTEMI” from those with UA or from controls. Conclusion: Serum cMybp-C mean level is significantly higher in ACS patients with STEMI and NSTEMI than in controls and the increase was more significant than hsCTn-I mean level on admission, so it could help the early diagnosis of ACS patients. The serum levels of cMybp-C also had a better diagnostic accuracy than hsCTn-I on admission in differentiation of ACS patients with STEMI or NSTEMI from those with UA or from controls.

Effect of disabling biventricular pacing in patients with left ventricular assist device and cardiac resynchronization therapy

Abstract Introduction Taking into account the mechanism of the left ventricular assist device (LVAD) function, the cardiac resynchronization therapy (CRT) seems to be unnecessary and, according to the current reports, the left ventricular lead (LVL) should be disabled. However, observation of the patients suggests that deactivation of the left ventricle (LV) pacing leads to deterioration of the patients condition and progression of the heart failure (HF) symptoms. Purpose The study aimed to determine differences in survival of the patients with LVAD and maintained or disabled CRT, including patients subjected to heart transplantation, as well differences in left and right ventricle function, kidneys and liver condition, NTproBNP value, subjective exercise tolerance and frequency of HF exacerbation before and after CRT deactivation. Methods The study group involved 55 patients with LVAD and CRT devices, including 11 patients with disabled LV pacing. The statistical analysis concerned the comparison of groups with and without biventricular stimulation as well results within the group with disabled LVL before and after its deactivation. Analyzed data included laboratory results, echocardiographic parameters, number of HF exacerbation episodes and exercise tolerance by NYHA classification. Results Total CRT period did not differ in group with maintained and disabled CRT [24 (12-36)months vs. 30 IQR(12-48)months respectively; p=0,74]. The median period of CRT deactivation was 30 IQR(12-48) months after LVAD implantation. Time from LVAD implantation to heart transplantation differed significantly between patients with and without CRT [20 IQR(9-32)months vs. 49,5 IQR(46,5-62)months respectively; p=0,003]. LV disabling was connected with a significant increase of NTproBNP [3072 IQR(2287-6636) pg/ml vs. 2133 IQR(1618-3437) pg/ml before LVL deactivation; p=0,009), without an aggravation of the exercise intolerance by NYHA classification (p=0,11) or total number of HF exacerbation episodes (p=0,72). Lack of LV pacing was not related to change of concentration of creatinine (p=0,13), AST (p=0,89, ALT (p=0,5), bilirubin (p=0,06) and albumin (p=0,69) before and after LV deactivation. Comparison of echocardiographic parameters with and without CRT did not demonstrate significant differences in LV ejection fraction (p=0,37), LV end-diastolic diameter (p=0,33), TAPSE (p=0,72) and tricuspid regurgitation degree (p=0,39). Death-free survival from LVAD implantation has not differed in patients with and without CRT(p=0,08), similarly like death-free survival from heart transplantation (p=0,56), however with tendency to better outcome of patients with CRT till 12 months after the heart transplant. Conclusion CRT does not improve general health condition as well death-free survival in LVAD recipients, including patients subjected to heart transplantation, however with tendency to better outcome of patients with CRT till 12 months after the heart transplant.Death-free surival after LVADDeath-free survival after transplant

The 14-bp insertion/deletion as a promising gene polymorphism to understand cancer risk: Evidence from a systematic review and comprehensive meta-analysis

BackgroundHLA-G is associated with cancer cell escape. The 3′UTR polymorphism is involved in the regulation of membrane-bound HLA-G and soluble HLA-G proteins. The aim of our study was to assess the association of the HLA-G 14-bp insertion (I)/deletion (D) polymorphism with cancer susceptibility and its interaction with clinicopathological features and environmental factors. MethodsA meta-analysis was performed to investigate the association between the HLA-G 14-bp I/D polymorphism and different types of cancers according to the Prisma guidelines. ResultsThirty-nine publications that studied the 14-bp I/D polymorphism in cancers met our inclusion criteria. The findings of the meta-analysis showed a significant association between the 14-bp I/D polymorphism and cancer risk under the allelic contrast model D vs. I (OR = 1,112, 95 % CI = 1,009–1,227; P = 0,033) suggesting that the D allele was a risk factor for cancer susceptibility. Stratification by cancer type demonstrated a significant association of the 14-bp I/D polymorphism with breast cancer under the D vs. I contrast allele model (OR = 1,267, 95 % CI = 1,028–1,563; P = 0,027). No significant association was found for digestive, cervical, haematological and thyroid cancers. A comparison of groups stratified by ethnicity showed a significant association for Caucasians under the D vs. I model (OR = 1,147, 95 % CI = 1,002–1,313; P = 0,047); and for mixed ethnicities under the DD + DI vs. II (OR = 1,388, 95 % CI = 1,083–1,780; P = 0,010) and DI vs. II (OR = 1,402, 95 % CI = 1,077–1,824; P = 0,012) models. A comparison of cancer risks associated with the 14-bp I/D polymorphism according to geographic location revealed significant risks for the D allele and DD genotype in North Africa, the Middle East and South America. However, no significant susceptibility to cancer associated with the 14-bp I/D polymorphism was shown for Europe and North Asia. The findings of a meta-analysis of subgroups by disease stage showed a significant association in both early and advanced stages, with the 14-bp deletion variant being a risk factor. Similarly, a significant cancer risk was shown for the 14-bp deletion variant in both low- and high-grade cancers. Finally, the risk associated with the 14-bp I/D polymorphism was higher in cancers with concomitant viral infection with human papillomavirus (HPV), hepatitis B virus (HBV) or hepatitis C virus (HCV). ConclusionThe findings of the overall meta-analysis showed a significant association between the HLA-G 14-bp I/D polymorphism and cancer susceptibility. The findings stratified analysis and subgroup comparisons showed that the 14-bp I/D deletion variant was associated with an increased risk of breast cancer. The HLA-G 14-bp I/D polymorphism may interact with individual and clinicopathological factors to alter cancer risk. These promising findings for cancer risk provide the basis for further studies that explore 14bp I/D polymorphism in cancer screening and immunotherapeutic approach.

Heatmap analysis for artificial intelligence explainability in diabetic retinopathy detection: illuminating the rationale of deep learning decisions.

The opaqueness of artificial intelligence (AI) algorithms decision processes limit their application in healthcare. Our objective was to explore discrepancies in heatmaps originated from slightly different retinal images from the same eyes of individuals with diabetes, to gain insights into the deep learning (DL) decision process. Pairs of retinal images from the same eyes of individuals with diabetes, composed of images obtained before and after pupil dilation, underwent automatic analysis by a convolutional neural network for the presence of diabetic retinopathy (DR), output being a score ranging from 0 to 1. Gradient-based Class Activation Maps (GradCam) allowed visualization of activated areas. Pairs of images with discordant DL scores or outputs within the pair were objectively compared to the concordant pairs, regarding the sum of activations of Class Activation Mapping (CAM), the number of activated areas, and DL score differences. Heatmaps of discordant pairs were also qualitatively assessed. Algorithmic performance for the detection of DR attained 89.8% sensitivity, 96.3% specificity and area under the receiver operating characteristic (ROC) curve of 0.95. Out of 210 comparable pairs of images, 20 eyes and 10 eyes were considered discordant according to DL score difference and regarding DL output, respectively. Comparison of concordant versus discordant groups showed statistically significant differences for all objective variables. Qualitative analysis pointed to subtle differences in image quality within discordant pairs. The successfully established relationship among objective parameters extracted from heatmaps and DL output discrepancies reinforces the role of heatmaps for DL explainability, fostering acceptance of DL systems for clinical use.