Significant Statistical Difference Research Articles

The liver fibrosis-8 index is a predictor for all-cause mortality in cardiovascular disease patients: A cohort study.

Participants with cardiovascular diseases (CVD) often exhibit liver function abnormalities, hepatic fibrosis and cirrhosis. The extent of liver fibrosis is closely related to the prognosis of CVD. However, the association between the liver fibrosis-8 (FIB-8) index, a marker of liver fibrosis, and all-cause mortality in CVD participants remains unclear. This study aims to investigate the relationship between the FIB-8 index and all-cause mortality among individuals with CVD. A total of 1727 CVD American participants were enrolled from the National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2018. Initially, we constructed weighted COX regression models and performed sensitivity analyses to examine the correlation between the FIB-8 index and all-cause mortality in CVD participants. Subsequently, we employed restricted cubic spline (RCS) to visualize their linear relationship. Finally, the stratified analyses and interaction tests of covariates were performed and presented in the forest plot. A total of 1727 participants were included in our study, with a mean age of 61.68 ± 0.47 years, with men accounting for 59.19%. After adjustment for relevant covariables, weighted COX regression models indicated that the hazard ratio (HR) and 95% confidence interval (95% CI) for the association between the FIB-8 index and all-cause mortality in CVD participants was 1.21 (1.12, 1.30). Sensitivity analysis was then conducted, revealing that the results remained stable. In fully adjusted model, individuals in quartiles 3 and 4 demonstrated significant statistical differences compared to the lowest FIB-8 index quartile, with HR (95% CI) values of 1.88 (1.23, 2.87) and 2.17 (1.33, 3.53), respectively. Subsequently, RCS showed a linear relationship between the FIB-8 index and all-cause mortality among CVD participants. Finally, the interaction test revealed that no other covariables had significant interactions with the FIB-8 index in this study. A positive and linear correlation was observed between the FIB-8 index and all-cause mortality among CVD adult participants in NHANES from 1999 to 2018. Our findings indicated that the FIB-8 index could serve as an excellent indicator for assessing all-cause mortality within the CVD population. The lower the FIB-8 index, the lower the all-cause mortality among CVD participants.

Macrodebitage Writ Small? Studying Stoneknapping with Experimental Archaeology, Dynamic Image Analysis, and Statistics

ABSTRACT Microscopic artifacts help archaeologists study ancient societies and site formation processes. They have struggled to analyze them objectively, though. The traditional microscope-based approach has limited the number of samples and increased intra- and inter-observer errors. Here, we present an alternative based on experimental archaeology, Dynamic Image Analysis (DIA), and statistics. We ask whether microdebitage – the almost invisible debris from stone-knapping – has the same shape as macrodebitage or lithic artifacts wider than 4 mm. We collaborated with four modern stone-knappers to gather lithic debris. A new type of particle analyzer allowed us to measure five relevant variables for 23,694 knapping debris items. We use DIA to count, describe, and size-grade the debitage. We then analyze the resulting spreadsheet statistically. The results indicate highly significant statistical differences between microdebitage and macrodebitage as well as among microdebitage size classes. Combining experimental archaeology, DIA, and statistics enables the quantitative study of microdebitage.

Radiative energy budgets of migrational microphytobenthic biofilms

Epipelic, biofilm-forming diatoms are key drivers of the primary production of mudflats. Such primary production is strongly affected by the vertical migration of diatoms, which is modulated by diurnal photoperiods, tidal cycles, and photoprotection mechanisms. However, the role of vertical migration in the radiative energy budget (REB) of microphytobenthic biofilms remains largely unknown. Here we used microsensor measurements of temperature and O2 in combination with reflectance spectroscopy and variable chlorophyll fluorimetry to construct the REB of intertidal, epipelic diatom-dominated biofilms for different emersion times (1, 3 and 5 h after the beginning of the in-situ emersion) and photon irradiance regimes, i.e., 400 and 800 µmol photon m−2 s−1. The effect of migration on REBs was studied by inhibiting diatom motility with Latrunculin A (Lat-A). Photosynthetic activity and light utilization efficiency decreased slightly, after adding Lat-A, while the amount of reflected light energy remained constant at ~ 23% of the incident irradiance and the majority (76–78%) of the incident light energy was dissipated as heat. Of the energy dissipated as heat, < 24% was dissipated upward in Lat-A treated samples, while an increasing downward heat dissipation was observed in Lat-A treated samples, as compared to control samples under an irradiance of 800 µmol photon m−2 s−1. However, we found no statistical significant differences in the REB and physiological parameters in the different treatments. Thus, we did not find any evidence that vertical migration of diatoms affected photosynthesis and light efficiency in the microphytobenthic biofilm over an emersion cycle, and a clear effect of non-photochemical quenching in REB and heat dissipation fluxes was not observed.

Associations between type of bariatric surgery and obstructive sleep apnoea, employment outcomes, and body image satisfaction: A systematic review and meta-analysis.

Bariatric surgery has been shown to provide significant patient benefits in terms of weight loss and mitigation of obesity linked co-morbidities, as well as providing improvements in occupational productivity and patient quality of life. However, the choice of which bariatric surgery procedure provides the most patient benefit in each of these cases is still in question. In this study we provide a systematic review, with the objective of evaluating associations between different bariatric surgery procedures and mitigation of obesity linked co-morbidities, improvement in occupational productivity, and patient quality of life, concentrating on three areas: obstructive sleep apnoea (OSA), employment prospects and body image. The CINAHL, PubMed, Web of Science, and CENTRAL databases were searched for eligible studies. Summary risk ratio (RR) and 95% confidence intervals were estimated using random-effects models. Thirty-three studies were included in this review, including 29 cohort studies and 4 randomised clinical trials (RCTs). Pooled analysis of the observational studies showed significantly lower OSA remission in sleeve gastrectomy (SG) compared to Roux-en-Y gastric bypass (RYGB) across both short-term (1-2 years) and longer-term (3+ years) follow-up periods, (RR=0.91, 95% CI = 0.84-0.99, p=0.02 and RR=0.88, 95% CI = 0.65-0.99, p=0.03 respectively). In contrast, a metanalysis of the RCT studies found no difference in OSA remission between SG and RYGB (RR=1.01, 95% CI = 0.81-1.25, p=0.93). An analysis of four studies showed significantly higher OSA remission for SG versus Adjustable Gastric Band (RR=1.83, 95% CI = 1.57-2.14, p&lt;0.001). No significant difference was observed regarding improvement in employment status between SG and RYGB (RR=0.77, 95% CI = 0.32-1.87, p = 0.57). A narrative synthesis of studies on body image reported no significant differences between body image scores and surgery types. This review found significantly lower OSA remission in SG as compared to RYGB across different follow up periods, while no significant statistical difference was observed in RCTs studies. Further studies are recommended to assess the effectiveness of the various bariatric surgeries in relation to improving employment status and body image, where primary studies are lacking.

Association of Sleep Duration and BMI with Periodontitis in Nurses Working in Day and Night Shifts and Its Impact on Co-morbidities

Background: Gender imbalances persist in high-ranking leadership roles, particularly in Aim: To evaluate the association between duration of Sleep and Body-Mass Index (BMI) as potential risk factors with Periodontitis and other co morbidities in duty nurses. Methodology: An observational study was carried out on 42 duty nurses working in hospital. Two Questionnaires (PSQI) Pittsburgh Sleep Quality Index and (ESS) Epworth-Sleepiness Scale were subjectively filled. Study was conducted in 2 phases in the same duty nurses. Phase 1 Duty nurses in morning shift underwent evaluation for periodontal health, BMI and Waist -Hip ratio was recorded. Blood Samples were drawn for analysis of C-Reactive protein, lipid profile and Fasting Blood Sugar. Participants were asked to maintain sleep diary for 6 months. Phase 2: Same Duty Nurses working in Night Shift after 6 months of sleep diary maintenance underwent evaluation of same parameters as phase 1. All-the data were tabulated and sent for statistical-analysis. Results: The result showed that, the association of duration of sleep to Periodontitis was statistically significant in the morning-shift and night-shift (p=0.001), although association of Body Mass Index to periodontitis was statistically significant in the night shift with p value=0.001 than in the morning-shift. The association of Plaque Index and Gingival-Index with duration of sleep and BMI was statistically significant. The parameters taken to study the co-morbidities showed statistical significant difference between the two shifts except WHR ratio, LDL, HDL, Triglyceride, Plaque index. Conclusion: There is an association of Duration of Sleep and Body Mass Index as a potential risk factor for periodontitis and other co-morbidities (Cardiovascular disease and Diabetes) in duty nurses, however the association is much stronger in duty nurses working in night shift than morning shift.

Prospective Observational Study Of Surgical Site Infections In Obstetrics And Gynaecological Operations In Teaching Hospital

Background: Surgical site infections (SSI) are defined as infections occurring upto 30 days after surgery or (upto one year in patients receiving implants) and affecting either the incision or deep tissue at the operative site. SSIs are potential complications associated with any type of surgical procedure. Even though SSIs are among the most preventable hospital acquired infections, they still symbolize a significant burden in terms of patient’s morbidity and mortality leading to prolonged hospital stay and increase the patient susceptibility to other nosocomial infections affecting the financial condition of patients. Risk factors for SSIs are grouped as patient related, preoperative or pre pregnancy, intraoperative or intrapartum, and postoperative. SSI causes a substantial risk to patients and financial loses for health system because the multi-factorial causes achieving a measurable and sustained reduction in SSIs. In this context it becomes important to determine the prevalence of SSI, assess the magnitude of problem and provide a rationale to set priorities in infection control in the hospitals. Materials and Methods: The present prospective observational study was conducted on 200 patients in the Department of Obstetrics and gynaecology, at Dr B R Ambedkar Medical College and Hospital for a period of 12 months. Prior to the initiation of the study, Ethical and Research Committee clearance was obtained from Institutional Ethical Committee. Results: There was a significant statistical difference in the incidence of SSIs basing on the body mass index of subjects (pvalue:&lt;0.001). SSI incidence was high in morbidly obese subjects. There was a highly significant statistical difference in the incidence of SSIs basing on the history of previous surgeries of subjects (p-value: &lt;0.0001). SSI incidence was low in subjects with no history of previous surgeries. There was a highly significant statistical difference in the incidence of SSIs basing on the type of surgery (p-value: 0.48). SSI incidence was high in caesarean and low in tubectomy surgeries. There was a significant no statistical difference in the incidence of SSIs basing on the type of incision (p-value: 0.70). There was a highly significant statistical difference in the incidence of SSIs basing on the methods of skin closure (p-value: 0.002). SSI incidence was high in mattress method of skin closure and low in subcuticular method of skin closure. There was a highly significant statistical difference in the incidence of SSIs basing on the class of wound (p-value: 0.00001). SSI incidence was high in dirty wounds and low in clean wounds of skin closure. Conclusion: Although several preoperative risk factors (e.g., age, morbid obesity, ability to pursue a minimally invasive approach, type of gynaecologic surgery, type of incision, methods of skin closure, class of wound) may not be within the surgeon’s control, several evidence based interventions can limit the incidence of SSIs.

Investigating the complications of frequent pregnancy loss in patients referred to obstetrics and gynecology clinics at King Khalid University Hospital

ABSTRACT Background: Recurrent pregnancy loss (RPL) is a common problem affecting many women. This study aimed to investigate the baseline characteristics of 400 women with RPL and to examine any differences in baseline characteristics of the recruited women with RPL throughout the years. Methods: This study used retrospective data, which included the records of patients with RPL who visited King Khalid University Hospital’s obstetric clinic between 2019 and 2022. The records of 400 patients who met the inclusion criteria were reviewed and analyzed. Results: The mean age of enrolled women was 36.5 ± 5.4 years, and the mean RPL was 3.8 ± 2.5. The study also revealed that there were significant statistical differences in obesity and vitamin D deficiency among women with RPL based on year (P = 0.013 and P = 0.036, respectively), whereas no significant statistical differences were found between women with RPL in terms of age, parity, diabetes, hypothyroidism, hyperprolactinemia, antiphospholipid antibodies (APLs), uterine malformation, or consanguinity. Conclusion: Advanced maternal age, number of previous miscarriages, parity, diabetes, hypothyroidism, APLs, uterine malformations, first-degree consanguinity, and vitamin D deficiency were found to be significant risk factors associated with RPL among women in Saudi Arabia.

Comparison of the effects of nursing and peer education on quality of life and resilience in patients with multiple sclerosis: A randomized clinical trial

BackgroundMultiple sclerosis (MS) is a prevalent disease of the central nervous system that often leads to diminished resilience and quality of life in affected individuals. This study aims to compare the effects of nursing and peer education on improving the quality of life and resilience in patients with multiple sclerosis. Materials and methodsThis three-group clinical trial study was conducted before and after interventions at the MS Society in Hamedan, Iran. In this study, 120 patients with MS were randomly selected and assigned to three groups: nurse education, peer education, and control. Quality of life and resilience questionnaires were self-reported before and two months after the completion of the intervention. The educational sessions were conducted over five meetings, each lasting between 45 and 60 min, held every two days. Group one received education led by nurses, while group two participated in peer-led education sessions. ResultsThe results indicated that before the intervention, there were no significant statistical differences in demographic variables, resilience, and quality of life among the three groups (p > 0.05). However, after the intervention, both the peer and nurse groups showed a significant increase in quality of life and resilience compared to the control group (p < 0.05). Nevertheless, no differences were observed between the nurse and peer groups regarding these variables (p > 0.05). ConclusionsBoth nursing and peer education methods had an equal impact on enhancing the resilience and quality of life of patients with MS. It is recommended that peer support be utilized to empower MS patients, especially in contexts where there is a shortage of nurses.

Long-Term Clinical Outcomes After Cerebral Revascularization in Moyamoya Disease With Extracranial Internal Carotid Artery Occlusion

ObjectiveThe aim of this study is to evaluate the efficacy of cerebral revascularization for Moyamoya disease (MMD) with extra-cranial internal carotid artery occlusion (ICAO). MethodsThis study retrospectively analyzed 37 patients diagnosed with MMD with extra-cranial ICAO who underwent cerebral revascularization surgery. We conducted propensity score matching for MMD patients without extra-cranial ICAO from database of 932 MMD patients. Outcome data, recurrent strokes and modified Rankin Scale (mRS) were collected during follow-up. ResultsA total of 37 MMD patients with extra-cranial ICAO were included in the study. The average follow-up time of MMD patients with extra-cranial ICAO included in the study was 74 months. During the follow-up period, there were 15 hemispheres recurred stroke events. All hemispheres underwent surgery, and the follow-up mRS score was significantly reduced (P <0.001). Kaplan-Meier analysis showed no significant statistical difference in stroke events between the indirect bypass (IB), direct bypass (DB), and combined bypass (CB) groups (P = 0.131). After propensity matching, 48 hemispheres of MMD patients without extra-cranial ICAO were identified from a review of 932 MMD patients. There was no significant statistical difference in stroke events between the MMD patients with extra-cranial ICAO group and the MMD group (P = 0.271). ConclusionsCerebral revascularization can prevent recurrent ischemic and hemorrhagic stroke events for MMD patients with extra-cranial ICAO. There was no difference on long-term clinical outcomes after CB, DB, and IB surgery. The cerebral revascularization has similar effect on the MMD patients with extra-cranial ICAO and MMD patients without.

Large sensory analysis of vegetables from conventional, organic and no-till practices

There is a growing interest in agriculture to address soil deterioration issues and achieve a sus-tainable agrosystem. Many producers introduce no-till techniques and show significant yields with better ecosystem functioning, as well as improved carbon and water cycles. However, sensory analysis to compare vegetables from these practices are scarce. In this paper, we conduct triangle and hedonic tests over 15 panels of consumers for a total of 915 consumers. Based on statistical hypothesis testing and maximum likelihood estimation, significant statistical differences (p < 0.05 and less) are produced for both triangle tests and hedonic ranking in some specific cases. These results show a trend for sensory preferences of no-till practices.

Changes in the Centers of Rotation in Different Prosthetic Segments Following Continuous Two-Level Cervical Disc Replacement: A Retrospective Study

To observe the short-term to medium-term therapeutic effects and radiological outcomes of adjacent 2-level cervical spondylosis treated with artificial cervical disc replacement (ACDR) using Mobi-C and Bryan discs. To observe changes and discrepancies in the flexion-extension centers of rotation (FE-COR) of different ACDR segments. Twenty-four patients undergoing 2-level (C4/5 and C5/6) ACDR were analyzed retrospectively (11 patients in the Mobi-C group and 13 patients in the Bryan group). Clinical outcomes were assessed using modified Japanese Orthopedic Association score, Neck Disability Index, and visual analog scale. Preoperative and 2years' follow-up radiographs were collected to compare total cervical spine curvature (C2-C7) range of motion (ROM), upper and lower ACDR segmental ROM, and the operated adjacent segmental ROM. The FE-COR of the ACDR segment was measured using the mid-plumb line method. The degree of disc degeneration in the adjacent segment was observed. At the 2years' follow-up, in both group, the modified Japanese Orthopedic Association score increased significantly, and the Neck Disability Index and neck and upper extremity visual analog scale scores decreased significantly compared with preoperative (P<0.05). There were no significant statistical differences in postoperative scores between the 2 groups (P > 0.05). The overall cervical ROM, the upper and lower segmental ROM at the 2years' follow-up showed no significant statistical differences compared with the preoperative period (P > 0.05). There was no statistically significant difference in the adjacent segmental ROMs compared with the preoperative period (P > 0.05). Furthermore, the statistical analysis revealed no significant differences in the measurements of the ROM at each time points between the Mobi-C Group and the Bryan Group (P > 0.05). There was no significant difference in the preoperative FE-COR-X (indicating the horizontal position of the point in the coordinate system) and FE-COR-Y (indicating the vertical position of the point in the coordinate system) of upper or lower ACDR segments between the 2 groups (P > 0.05). At the 2years' follow-up, there were significant differences both in FE-COR-X and FE-COR-Y between the 2 groups (P < 0.05). For the Mobi-C group, in both the upper and lower segment, the FE-COR-X significantly increased compared with preoperative (P < 0.05), while the FE-COR-Y decreased compared with preoperative (P < 0.05). For the Bryan group, no significant changes were observed in the upper or lower segment in both FE-COR-X and FE-COR-Y compared with preoperative (P > 0.05). Fourty-eight adjacent segments (24 superior and 24 inferior segments) were included in the studies of adjacent segment disease. Four segments showed imaging adjacent segment disease (4/48, 8.33%) in 4 patients, of which 2 were mild and 2 were moderate according to the grading criteria. Among them, 2 were from the Mobi-C group and 2 were from the Bryan group. No severe imaging degeneration was observed. In continuous 2-level cervical ACDR surgery, both Mobi-C and Bryan artificial cervical discs achieved satisfactory clinical outcomes in the short to medium term postoperatively. The FE-COR exhibited different trends of change. In the Mobi-C group, the FE-COR for both upper and lower segments shifted anteriorly and inferiorly, whereas in the Bryan group, whether upper or lower, the FE-COR remained closer to the preoperative state. The changes in FE-COR did not significantly affect the short-term to medium-term clinical outcomes postoperatively.

The impact of perception bias for cardiovascular disease risk on physical activity and dietary habits

ObjectiveCardiovascular disease (CVD) remains a significant public health challenge in China. Accurate perception of individual CVD risk is crucial for timely intervention and preventive strategies. This study aims to determine the alignment between CVD risk perception levels and objectively calculated CVD risk levels, then investigate the disparity in physical activity and healthy diet habits among distinct CVD risk perception categories. MethodsFrom March to August 2022, a cross-sectional survey was conducted in Zhejiang Province using convenience sampling. Participants aged between 20 and 80 years, without prior diagnosis of CVD were included. CVD risk perception was evaluated with the Chinese version of the Attitude and Beliefs about Cardiovascular Disease Risk Questionnaire (ABCD-C), while objective CVD risk was assessed through the Prediction for Atherosclerotic Cardiovascular Disease Risk (China-PAR) model. Participants’ demographic information, self-reported physical activity, and healthy diet score were also collected. ResultsA total of 739 participants were included in the final analysis. Less than a third of participants (29.3%) accurately perceived their CVD risk, while 64.5% over-perceived it and 6.2% under-perceived it. Notably, half of the individuals (50.0%) with high CVD risk under-perceived their actual risk. Compared to the accurate perception group, individuals aged 60-80 years old (OR = 6.569), currently drinking (OR = 3.059), and with hypertension (OR = 2.352) were more likely to under-perceive their CVD risk. Meanwhile, participants aged 40-<60 years old (OR = 2.462) and employed (OR = 2.352) were more likely to over-perceive their risk. The proportion of individuals engaging in physical activity was lowest in the under-perception group, although the difference among the three groups was not statistically significant (χ2=2.556, P=0.278). In addition, the proportion of individuals practicing healthy diet habits was also lowest in the under-perception group, and a significant statistical difference was observed among the three groups (χ2=10.310, P=0.006). ConclusionOnly a small proportion of participants accurately perceived their CVD risk, especially among those with high actual CVD risk. Individuals in the under-perceived CVD risk group exhibited the lowest rates of physical activity engagement and healthy diet adherence. Healthcare professionals should prioritize implementing personalized CVD risk communication strategies tailored to specific subgroups to enhance the accuracy of risk perception.

The role of pulmonary rehabilitation in improving lung functions in patients with ankylosing spondylitis

Background Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by axial and peripheral entheseal inflammation and new bone production(1). The development of syndesmophytes, enthesophytes, and spinal fusion along the course of the disease is linked to chronic pain, functional impairment, and disability(2). Fibrosis of the upper lobes of the lungs (interstitial lung disease) and chest wall abnormalities are two of the emerging forms of pulmonary involvement in AS. (3). Pulmonary rehabilitation is a multifaceted program of education, counselling, breathing exercises, and other modalities that can increase the patient’s independence and ease of functioning(4). Aim To estimate the role of pulmonary rehabilitation in enhancing lung function in AS individuals in relation to disease activity, clinical, and functional parameters. Patients and methods This study was an interventional study: single-arm group (prospective randomized clinical study). Thirty people (30) participated in that study from those presented to Physical Medicine, Rheumatology and Rehabilitation inpatient and outpatient clinic at Ain Shams University hospitals, diagnosed as radiographic axial spondyloarthropathy (SPA) from 02/2022 to 12/2022. All patients underwent pulmonary rehabilitation program and were exposed to a detailed history, clinical, and pulmonary function testing. Disease activity was evaluated by Ankylosing Spondylitis Disease Activity Score C-reactive protein (ASDAS-CRP), Valuation of function by using Bath Ankylosing Spondylitis Functional index (BASFI), 6-Minute walk test (6MWT), the Modified Borg Dyspnoea Scale (MBS), and Timed Up and Go (TUG) test. All function and clinical scores were done at baseline and repeated after completing pulmonary rehabilitation program. Result The mean age of patients was 36.57 ± 7.83 years (23–45 years), with a median disease duration of (5 (3–9) years). In total, there were 19 out of the studied patients with restrictive pattern. With comparison between pre- and postintervention of pulmonary rehabilitation, there was a significant statistical difference in all, disease activity (ASDAS and BASFI) and functional (MBS, TUG, and 6MWT) parameters (P &lt;0.001), except for occiput to the wall. Regarding pulmonary function tests, including forced vital capacity (FVC), expiratory volume in one second (FEV1), and peaked expiratory flow (PEF), there was a statistically significant change at baseline and at the end of exercise (P &lt;0.001). Conclusion Improved respiratory function and disease activity and overall functional activity are possible outcomes of pulmonary rehabilitation programs in combination with other rehabilitation interventions.

A comprehensive study on the digestion, absorption, and metabolization of tropane alkaloids in human cell models

Tropane alkaloids (TAs) are toxic compounds with potent anticholinergic effects. Herbal infusions are among the most contaminated food commodities; however, the fate of TAs after ingestion remains poorly understood. This study presents a comprehensive investigation into the absorption, and metabolism of five TAs (atropine, scopolamine, tropine, homatropine, and apoatropine) following the digestion of contaminated tea.In vitro human cell models were employed, including gastric (NCI-N87), intestinal (Caco-2:HT29-MTX), and hepatic (HEP-G2) cells. TAs were found to be highly absorbed in the intestinal epithelium, while gastric cells exhibited poor absorption. Metabolism was studied using a custom-made database, revealing that it occurs predominantly in intestinal cells, involving hydroxylation and methylation reactions.Cell metabolomics was conducted using annotation, fragment simulation, and statistical software platforms. Significant statistical differences were observed for 40 tentatively identified compounds. MetaboAnalyst 5.0 was employed to discern the most disturbed metabolic pathways, with amoniacids biosynthesis pathways and TCA cycles being the most affected. These pathways are involved in responses to cellular metabolic stress, neurotransmitter production, cellular energy generation, and the regulation of oxidative stress response. The findings of this study enhance our understanding of the fate of TAs after ingestion, their metabolization and their effects at the cellular level.

Thyroid Uncomplicated Surgery with Lack Placement of Drains. A Retrospective Analysis.

Thyroid drains after thyroid surgery are often used despite evidence. The aim of this retrospective study was to determine the post-operative complication rates following thyroid uncomplicate surgery without drain. The medical records of two hundred and thirty-nine patients who undergone thyroid surgery without and with drain were reviewed. The rate of post-operative either complications and pain were evaluated. The distribution of the operations performed were similar in two groups, in no-drain group (group A) there were total thyroidectomy 68.7% and lobectomy 31.3% while in drain group (group B) the total thyroidectomy were 70.8% and the lobectomy were 29.2%, this without statistical significant difference. Postoperative complications that occurred included seromas, hematoma and wound infections were without significantly differences. Postoperative pain was significantly lower in group A than in group B at two timepoint. The mean hospital stay was significantly shorter in the non-drained group. The no-drain uncomplicated thyroid surgery was safe and didn't increase a rates of post-operative complications. In addition, we achieved significant reduction of postoperative pain, hospital stay and overall costs.

Well calculated is better than quickly calculated: Comparison of Pencil beam and Monte Carlo algorithms according to the number of lesions and fractionation in radiosurgery of multiple brain metastases

PurposeIn this work we compared pencil beam (PB) and Monte Carlo (MC) algorithms in single isocenter plans of multiple brain metastases radiosurgery (SIMM-SRS) plans using the quality indices reported for SRS. MethodThe plans were evaluated concerning the prescribed dose, fractions and the number of metastases. The quality indices studied were mean dose (Dmean), D95, Paddick conformity index (PCI), Radiation Therapy Oncology Group (RTOG) homogeneity (HIRTOG) and quality of coverage indices (QRTOG), gradient index (GI), efficiency index for targets (Gη12Gy) and organs at risk (OARη12Gy) and V12-V18 for brain. ResultsThe D95 for plans calculated with PB algorithm increased and differences were statistically significant (p < 0.001). For Dmean no differences were observed (p > 0.194). The PCI for the single-fraction cases showed statistical significant differences (p < 0.039). The PCI for the three-fraction cases did not show statistical significant difference (p < 0.569). However, the mean value of the index for all cases did not differ significantly between PB (0.84) and MC (0.81). The GI showed statistically significant differences, only for the plans with more than 10 metastases for a single-fraction (p = 0.0001). The Gη12Gy values reported are within the interval of 0.26–0.80, and for all cases, there were no statistically significant differences. ConclusionConsidering that MC is more accurate for small volumes and heterogeneities, and computational time is reasonable for clinical use, it should be selected in all cases for SIMM-SRS plans. We introduced the potential of novel indices as Gη12Gy, and OARη12Gy for clinical evaluation that potentially serve as optimization factor.

Efficacy of extended infusion of β-lactam antibiotics for the treatment of febrile neutropenia in haematologic patients (BEATLE): a randomised, multicentre, open-label, superiority clinical trial

ObjectivesThe efficacy of extended infusions (EI) of β-lactam antibiotics for optimising outcomes in febrile neutropenia is unclear. We assessed whether the administration of β-lactams was more effective in EI than in intermittent infusion (II) for the treatment of febrile neutropenia. MethodsWe performed a randomised, open-label, superiority clinical trial of patients with febrile neutropenia at four Spanish university hospitals. Patients undergoing haematopoietic stem cell transplantation or with acute leukaemia receiving chemotherapy who required empirical antibiotic treatment for febrile neutropenia were randomly assigned (1:1) to receive EI of β-lactam or II after a first dose in bolus. The choice of antipseudomonal β-lactam was left to the discretion of the attending physician. The primary endpoint was treatment success at day 5, defined as defervescence without modifying the antibiotic treatment. Secondary endpoints included adverse events, attainment of the pharmacokinetic/pharmacodynamic target of 50, 75 and 100%ƒuT>MIC, and 30-day mortality. ResultsBetween November 19, 2019 and June 22, 2022, 295 patients we screened for eligibility, of whom 150 were randomly assigned to receive EI (n=77) or II (n=73) of the antipseudomonal β-lactam of choice. In the intention-to-treat analysis, treatment success at day 5 was achieved in 39/77 patients (50.6%) receiving EI versus 46/73 patients (63.0%) receiving II (risk difference -12.4%; 95% confidence interval, -29.4 to 4.7, p=0.17). The pharmacokinetic/pharmacodynamic targets of 75 and 100% ƒuT>MIC for empirical treatment were achieved more frequently in the EI group. No statistically-significant differences were found between groups in terms of adverse events or 30-day mortality. ConclusionsOur findings do not support the routine use of empirical EI of β-lactams in febrile neutropenia. Further studies should consider the clinical heterogeneity of febrile neutropenia and focus on patients with sepsis/septic shock and microbiologically documented infections, particularly those with infections caused by microorganisms less susceptible to β-lactams.

Assessing the real-world effectiveness of 8 major metastatic breast cancer drugs using target trial emulation

BackgroundDemonstration of trial emulation ability to benchmark randomised controlled trials (RCTs) from real-world data (RWD) is required to increase confidence in the use of routinely collected data for decision making in oncology. MethodsTo assess the frequency with which emulation findings align with RCTs regarding effect size on overall survival (OS) in metastatic breast cancer (MBC), 8 of 13 pre-selected pivotal RCTs in MBC were emulated using data from 32,598 patients enrolled in the French ESME-MBC cohort between January 1, 2008 and December 31, 2021. Adjustment methods and confounders were selected a priori for each emulation; stabilized weight was the reference method to mitigate confounding. Concordance in OS hazard ratios with associated 95% confidence intervals between RCTs and emulations were assessed used predefined metrics based on statistical significance, estimates, and standardized differences. ResultsThe effect sizes were consistent with RCT results in 7 out of the 8 emulations; 4 emulations achieved full statistical significance agreement; 5 emulations had a point estimate included in the RCT CI (estimate agreement); 6 emulations reported no significant differences between RCT and emulation (standardized difference agreement). Discrepancies related to residual confounders and significant shifts in prescription practices post-drug approval may arise in some cases. ConclusionTarget trial emulation from RWD combined with appropriate adjustment can provide conclusions similar to RCTs in MBC. In oncology, this methodology offers opportunities for confirming the impact on long-term survival, for expanding indications in patients excluded from RCTs and for comparative effectiveness in single-arm trials using external control arms.

Comparison Between Monofocal and Aspheric Monofocal Intraocular Lens With Higher Order Aspheric Optic in Pediatric Patients: Early Outcomes.

To retrospectively compare the visual acuity outcomes for far, intermediate, and near vision of an aspheric monofocal intraocular lens (IOL) with higher order aspheric optic with a monofocal IOL in pediatric patients. Thirty-eight eyes of 38 patients (mean age: 9.0 ± 2.3 years) affected by monolateral infantile cataract were evaluated 6 months after surgery performed with simultaneous IOL implantation. The Tecnis Eyhance ICB00 aspheric monofocal IOL (Johnson & Johnson Vision) was implanted in 17 eyes (Tecnis Eyhance group, mean age: 8.9 ± 2.5 years) and the Tecnis PCB00 monofocal IOL (Johnson & Johnson Vision) was implanted in 21 eyes (control group, mean age: 9.1 ± 2.2 years). Corrected visual acuity expressed in logarithm of the minimum angle of resolution (logMAR) was assessed for distance (CDVA) and, expressed in Jaeger standard, for intermediate (DCIVA) and near vision (CNVA). DCIVA was measured with distance correction and without addition. The Mann-Whitney test for two independent samples was performed, and a P value less than .05 was considered statistically significant. Six months postoperatively, mean CDVA was 0.20 ± 0.2 logMAR and mean DCIVA and CNVA were 5 ± 1 and 2 ± 1 Jaeger, respectively, in the Tecnis Eyhance group. In the control group, mean CDVA was 0.21 ± 0.2 logMAR and mean DCIVA and CNVA were 8 ± 1 and 3 ± 1 Jaeger, respectively. Only DCIVA showed a significant statistical difference between groups (P < .0001). In pediatric patients, the aspheric monofocal IOL with higher order aspheric optic seems to provide better intermediate distance visual acuity than a monofocal one, whereas no significant difference was observed for CDVA and CNVA. [J Refract Surg. 2024;40(10):e724-e727.].

Assessing the impact of telephone call intervention on medication adherence in individuals with mental health disorders: A longitudinal study in a tertiary facility in Volta Region

Medication adherence strategies that are successful, suitable and economical are vital to the treatment outcome of persons living with mental illness. Mobile-phone-based intervention is one such strategy and is particularly critical to reducing medication non-adherence, especially in mental health disorders. This study aimed to assess the impact of telephone adherence counselling on medication adherence in persons with mental health disorders. A longitudinal study was conducted on study participants who were randomly assigned to control and intervention groups over three months. Both groups received standard medication adherence counselling for the first month and then baseline adherence levels were determined using the medication adherence rating scale (MARS). The control group received standard medication adherence counselling at the psychiatric clinic whilst the intervention group received additional telephone calls made to each member of the intervention group once a week for a total of 8 times over 2 months. Of the patients who were screened for potential participation, 149 participants passed and 87 participants participated making a response rate of 58.40 %. The t-test conducted on the participants after the first (Month 2) and second (Month 3) on those with Telephone Call Intervention inferred significant statistical differences (p < 0.001). MARS Scores appreciated in the intervention group compared to the control group in Month 2 (1.64) and Month 3 (1.79). A positive impact of Telephone Call Interventions on medication adherence was achieved. This intervention can be a medication adherence strategy to supplement the standard medication adherence counselling which could improve treatment outcomes.