Fisher Exact Probability Research Articles

Health status and living conditions of fathers of multiple babies: Analysis of the Comprehensive Survey of Living Conditions

Objective This study explored the physical and mental health status and living conditions of fathers raising 0-year-old multiples in Japan compared with those raising singletons to gain insight into fathers' health issues and the need for support.Methods Household and health data from the Comprehensive Survey of Living Conditions (2016, 2019, and 2022) were used. Because of the small number of fathers with multiples in each dataset, three datasets were combined. The t-test and Fisher's exact probability test were used to compare fathers with multiples and singletons for various factors.Results Fathers with multiples were significantly more likely to sleep for < 5 h than those of singletons. There was no significant difference between both groups in the percentage of fathers with a K6 score of ≥ 10. However, the percentage of fathers with multiples exceeded the target set by the government. There were no differences in the counseling status regarding worries and stress. The proportion of consultations with public institutions was extremely low in both groups.Conclusion The analysis of representative data from Japan highlights health issues and the need for support for fathers with multiples. Fathers with multiples showed a high percentage of short sleep durations, worries, and stress related to childcare. The need for mental health support, accumulation of knowledge and experience on support for fathers with multiples, and development of support systems were suggested.

Characteristics of ResectionParameters in Robot-Assisted Total Knee Arthroplasty With the Ligament Balancing Workflow.

Robotic-assisted total knee arthroplasty (TKA) is a novel orthopedic technique. The workflow of robotic-assisted TKA is quite different from that of traditional manual TKA and may result incompletely different resection parameters. Understanding these parameters may help surgeons better perform robotic-assisted TKA. This study aims to analyze the specific resection parameters of robotic-assisted TKA. We retrospectively reviewed 85 MAKO-assisted TKA surgeries performed by three surgeons at our institution between May 2021 and November 2023. All patients had unilateral primary knee arthritis, and a Triathlon PS (Stryker) knee prosthesis was used. Intraoperative resection plan, radiological outcomes, and clinical outcomes were collected among them. The angle between the transepicondylar axis (TEA) and the femoral prosthesis axis was defined as rTEA, the angle between the posterior condylar axis (PCA) and the femoral prosthesis axis was defined as rPCA. The t-test and the Chi-square test (or Fisher's exact probability test) were used to determine differences in categorical variables. rTEA averaged 2.7° (range, 0°-6.7°), and rPCA averaged 4.9° (range, 0.2°-9.6°). The mean resection of the medial distal femur was 7.7 mm (range, 3.0-12.5), that of the lateral tibial plateau was 6.4 mm (range, 1.5-13.0), and that of the medial posterior condyle of the femur was 10.6 mm (range, 6.5-17.5), whereas that of the lateral posterior condyle of the femur was 6.7 mm (range, 2.0-13.0). Robotic-assisted TKA using the ligament balancing workflow generally resulted in greater external rotation than reported reference values for conventional manual TKA within the existing literature, with reference to both the TEA and PCA. In addition, tibial resection was generally less, and the joint line was generally shifted upwards.

Fracture resistance and behavior of endodontically treated maxillary premolars with varying ferrule heights and post numbers: A laboratory study.

To investigate how varying ferrule heights and the number of glass fiber posts affect fracture resistance and behavior of endodontically treated maxillary first premolars with substantial loss of tooth structure. Twenty-four extracted endodontically treated human maxillary first premolars were divided into three groups (n=8) based on ferrule height and post number. The groups were as follows: premolars of 2mm ferrule height that were restored with single posts (control group), premolars of 0.5mm ferrule height that were restored with single posts in palatal canals (single-post group), and premolars of 0.5mm ferrule height that were restored with double posts in palatal and buccal canals (double-post group). All groups were then restored with composite core and metal-ceramic crowns cemented with zinc phosphate cement. All specimens were subjected to 10,000 thermal cycles at temperatures of 5°C and 55°C, as well as 1.2 million cyclic loadings of 49N load at 1.2Hz using a chewing simulator. The specimens were loaded to fracture in a universal testing machine and fracture behavior was examined under stereomicroscope and divided into restorable and unrestorable fracture modes. Fracture loads and modes were analyzed by one-way ANOVA, Tukey's post hoc test, and Fisher's exact probability test (p≤0.05). The control group showed the highest mean fracture load (1127±172) of all groups (p<0.001). The specimens in the single-post group showed numerically higher mean fracture load (522±171) but with no significant difference compared to the ones in the double-post group (518±157; p>0.967). In the control group, 75% of specimens showed unrestorable fractures compared to 50% and 12.5% in single-post and double-post groups. The specimens in the control group had similar unrestorable fractures, starting from the coronal part and extending obliquely to the cervical third of the root below resin level. Two specimens in the control group showed unrestorable fractures in the middle third of the root. No middle-third root fractures were observed in single-post and double-post groups, and unrestorable fractures in both groups were similar to those of the control group. The single-post group had two specimens with core-post crown complex restorable fractures, while the control and double-post groups had one specimen each. The remaining specimens showed cervical-third root restorable fractures above resin level. The ferrule height significantly influences the fracture resistance of endodontically treated premolars compared to the number of placed posts. Nonetheless, more restorable fractures are seen in endodontically treated premolars restored with double posts than single posts regardless of ferrule height.

Clinical characteristics and risk factors for adverse outcomes in omphalocele

Objective: To investigate the clinical characteristics of omphalocele, and to assess the risk factors associated with adverse outcomes. Methods: A retrospective cohort study was conducted. Clinical data of 224 patients diagnosed with omphalocele, who were hospitalized at Children's Hospital, Zhejiang University School of Medicine from January 2013 to December 2022, were collected. Based on their discharge outcomes, the patients were classified into 2 groups: favorable outcomes and unfavorable outcomes. Chi-square test or continuity correction χ2 test or Fisher exact probability method, and Mann-Whitney U test were used for intergroup comparisons. Logistic regression analysis was performed to identify risk factors associated with adverse outcomes in omphalocele. Results: Among the 224 patients with omphalocele, 126 were male. A total of 208 patients (92.9%) had favorable outcomes, while 16 patients (7.1%) had unfavorable outcomes. In the unfavorable outcomes group, 14 patients had giant omphaloceles, while 100 patients had giant omphaloceles in the favorable outcomes group. The rates of herniation of more than two intra-abdominal organs in the hernial sac, congenital heart defects, patent ductus arteriosus, pulmonary hypertension, sepsis and infection of the hernial sac, were all higher in the unfavorable outcomes group compared to the favorable outcomes group (all P<0.05). Patients with unfavorable outcomes had longer mechanical ventilation time, duration of oxygen use, duration of parenteral nutrition, hospital stays, and higher rates of parenteral nutrition-associated cholestasis compared to those with favorable outcomes (all P<0.01). Multivariate Logistic regression analysis indicated that pulmonary hypertension (OR=9.39, 95%CI 1.20-73.32), sepsis (OR=8.59, 95%CI 1.32-55.86), and congenital heart defects (OR=6.55, 95%CI 1.11-38.73) were all independent risk factors for adverse outcomes in omphalocele (all P<0.05). Conclusions: Infants with omphalocele are prone to complications such as cardiovascular malformations, infections, and pulmonary hypertension. Adverse outcomes in omphalocele are associated with pulmonary hypertension, sepsis, and congenital heart defects.

Current situation and demand for specialized development of allergy nursing in eighty-eight hospitals in Guangdong Province

To investigate the current situation and demand for specialized development of allergy nursing in 88 hospitals in Guangdong Province, as well as to provide evidence for the management of allergy nursing. From August to December 2023, a cross-sectional study was conducted to analyze the core managers of allergy nursing-related work in eighty-eight hospitals in Guangdong Province supported by the Allergy Nursing Branch of the Guangdong Nurses Association and the Nursing Group of the Allergy Branch of the Guangdong Medical Association. An online survey was conducted using the Delphi method to compile a questionnaire on the current status and demand for specialized development of allergy nursing in Guangdong Province. Chi-square tests and Fisher's exact probability method were used to analyze the differences in the current status of specialty technology applications and the development and demand of specialized nursing between hospitals with or without allergy specialty departments. The results showed that among the eighty-eight hospitals in the nineteen prefecture-level cities surveyed in Guangdong Province, 17 hospitals (19%) had established allergy specialty departments, all of which were top-tier tertiary hospitals. The establishment duration [M (Q1, Q3)] was 3 (1, 10) years. The implementation rates of skin prick test (94%, 16/17), in-vitro examination (82%, 14/17), nasal endoscopy (82%, 14/17), subcutaneous specific immunotherapy (82%, 14/17), multidisciplinary consultation (65%, 11/17), fractional exhaled nitric oxide detection (47%, 8/17), skin patch test (41%, 7/17), and autologous serum skin test (35%, 6/17) in hospitals with allergy department were higher than those in hospitals without allergy department [59%, 42/71 (χ2=7.462, P=0.006)], [54%, 38/71 (χ2=4.717, P=0.030)], [51%, 36/71 (χ2=5.599, P=0.018)], [34%, 24/71 (χ2=13.177, P<0.001)], [24%, 17/71 (χ2=10.505, P=0.001)], [24%, 17/71 (χ2=5.540, P=0.019)], [11%, 8/71 (Fisher's exact test, P=0.008)], [11%, 8/71 (Fisher's exact test, P=0.025)]. In the development plan of allergy nursing in the next two years, hospitals that had set up allergy departments had a higher proportion in adding nurses (82%, 14/17, χ2=13.177, P<0.001), formulating specialized nurse training plans (71%, 12/17, χ2=3.980, P=0.046), formulating group standards or clinical guidelines (41%, 7/17, Fisher's exact test, P=0.046), and formulating assessment standards (53%, 9/17, Fisher's exact test, P=0.002). The demand for all aspects of allergy specialty nursing knowledge and skills accounted for more than 50%, and it was not related to whether the hospital set up an allergy department. In conclusion, the specialized development of allergy nursing in Guangdong province is still in its early stages, and there is a great demand for improving knowledge and skills in allergy. Further standardization of specialty construction is needed, along with the training of allergic nurses, to promote the comprehensive development of allergic reaction nursing specialties from point to area.

Exploratory assessment of the parent attitudes about childhood vaccines survey tool to assess vaccine hesitancy and pet vaccination status among pet owners.

To assess the applicability of the parent attitudes about childhood vaccines (PACV) survey to pet owners and its association with vaccine hesitancy. A national survey including an adapted version of the PACV was administered to 2,853 dog and 1,977 cat owners. Respondents were queried about the vaccination status of their pets. Exploratory factor analysis, Mokken scale analysis, Cronbach α, McDonald ω, and bivariate analyses were used to assess the validity and reliability of the PACV and shortened versions. The Fisher exact test and linear probability models were used to assess the association between the PACV and other factors and vaccination status. The PACVs for pet owners were valid and reliable with high internal consistency and served as correlates for vaccination status. In multivariate analyses, long-term relationships with veterinarians were also associated with vaccination. Individual survey items indicated substantial concerns about vaccine safety, side effects, and efficacy. Most respondents indicated trust and good relationships with their veterinarian, had not avoided or delayed vaccinations, understood the severity of pet diseases, supported the recommended vaccine schedule, and did not self-identify as vaccine hesitant (VH). The PACV identified 21.7% of dogs and 25.9% of cat owners as VH. The full and the reduced versions of the PACV are valid and reliable tools to assess VH status in dog and cat owners. The PACV could serve as an important tool for veterinary researchers to identify factors associated with vaccine hesitancy and develop effective interventions.

Magnetic resonance imaging (MRI) and clinical features of different parts of the pancreas involved in acute pancreatitis: a cross-sectional study.

Patients with acute pancreatitis (AP) have different sites of pancreatic involvement. The aim of this study was to investigate the differences in magnetic resonance imaging (MRI) findings and clinical features of different sites of involvement (subtypes) in AP, with a view to complement and complete the classification of AP based on anatomical imaging features. We consecutively collected data from inpatients with AP from January 2018 to October 2022 at a tertiary care hospital. The patients with AP were classified into three subtypes by MRI: type I mainly involved the head of the pancreas; type II mainly involved the body and tail of the pancreas; and type III involved the entire pancreas (head, body, and tail simultaneously). We examined the MRI findings and clinical features of the three subtypes, including their prevalence, gender, etiology, age, assessment of severity, prevalence of hypertension, diabetes mellitus, coronary artery disease, laboratory markers, prognosis, necrosis, and the incidence of complications. The three subgroups were analyzed using one-way analysis of variance (ANOVA), Kruskal-Wallis H-test, Chi-squared test or Fisher's exact probability method depending on the data distribution, and logistic regression and linear regression were used to determine the risk factors for poor short-term prognosis of AP and the number of days in hospital. Results were considered statistically significant at P<0.05. Among the 240 patients recruited, the mean age was 51±15 years (range, 12-89 years); 146 (60.83%) were male and 94 (39.17%) were female. Biliary pancreatitis accounted for 45.00% (108/240), hyperlipidemic pancreatitis for 33.75% (81/240), alcoholic pancreatitis for 8.75% (21/240), and unknown etiology for 12.5% (30/240). Some 81.25% (195/240) of the cases were edematous pancreatitis, whereas 18.75% (45/240) were necrotizing pancreatitis. Overall, 75 patients (31.25%) had type I AP, 108 patients (45.00%) had type II AP, and 57 patients (23.75%) had type III AP. These three subtypes were significantly different in terms of etiology, incidence of diabetes, C-reactive protein (CRP), severity, incidence of necrosis, local complications, clinical and imaging severity scores, and prognosis (P<0.05). Total pancreatic involvement (Type III) was the most severe subtype, with hyperlipidemia as the main cause. Regression analysis revealed that subtype classification is an important risk factor for prognosis. We classified AP into three subtypes based on different sites of involvement and revealed the MRI features and clinical characteristics of each subtype of AP. The subtype classification helps to characterize AP from the imaging dimension and predict the prognosis. The results of this study could be a target for future studies to adopt new classification methods.

A Retrospective Analysis of the Long-Term Safety and Efficacy of A1-UV Intraocular Lens Combined with Capsular Tension Ring in the Treatment of Patients with Cataract and Suspensory Ligament Abnormalities

Objective: To evaluate the long-term safety and efficacy of the combination therapy of A1-UV Intraocular Lens (IOL) and Capsular Tension Ring (CTR) for cataract patients with abnormal suspensory ligaments. Method: Retrospective data analysis. Extract all patient information related to A1-UV IOL and 920H IOL from the existing Clinical Trial Database of CTR to form a new dataset. The new dataset focuses on IOL and the clinical safety and efficacy of A1-UV IOL and 920H IOL combined with CTR was compared and analyzed based on it. The follow-up time points include 1-2 days, 1 week, 1 month, 3 months, 6 months and 1 year. Evaluation indicators include Best-Corrected Distance Visual Acuity (BCDVA), Uncorrected Distance Visual Acuity (UCDVA), spherical power, cylindrical power, Equivalent Spherical power (SE), Intraocular Pressure (IOP), corneal endothelial cell density, inflammatory response, Adverse Events (AE) and Serious Adverse Events (SAE). Statistical analysis was conducted using SPSS 22.0 software. All statistical tests are conducted using a two-sided test, and a P-value less than 0.05 is considered statistically significant for the difference being tested. Compare the quantitative data using t-test or Wilcoxon rank-sum test. Compare count data using chi-square test or Fisher's exact probability. Results: The number of cases in the A1-UV group and 920H group were both 27 (monocular), with an average age of 68.46 ± 6.93 years old and 70.27 ± 10.95 years old, respectively. The sample sizes at 6 months and 1 year after surgery were 26 cases (96.30%) and 21 cases (77.77%) in the A1-UV group, respectively, while the 920H group consisted of 26 cases (96.30%) and 22 cases (81.48%), respectively. The use of two types of IOLs combined with CTRs can significantly improve BCDVA and UCDVA (both P&lt;0.05). The differences between the groups during each follow-up period were not statistically significant (all P&gt;0.05). The average residual spherical power, residual cylindrical power, and residual SE of both groups of patients after surgery were close to emmetropic eye. There was no statistically significant difference (P&gt;0.05) in the comparison of other refraction indicators between the groups during each follow-up period, except for the cylindrical power at 3 months and 1 year after surgery. In the A1-UV group, a total of 2 patients experienced 3 episodes of mild IOP elevation, which was judged by the investigator to be unrelated to IOL, and no drug treatment was used, and it recovered spontaneously. 3 patients in the 920H group experienced three episodes of high IOP, including two mild cases (one possibly related to the IOL) and one moderate case (possibly related to the IOL), all of which were controlled by medication and recovered. In addition, the IOP of the remaining patients during each follow-up period after surgery was within the normal range. There was no AE or SAE related to implanted products in the A1-UV group. Conclusion: The combination of A1-UV IOL and CTR has long-term good safety and efficacy in the treatment of complex cataract patients with suspensory ligament abnormalities.

Analysis of the clinical characteristics of HBeAg-negative chronic HBV infection in indeterminate phase with a low viral load

Objective: To analyze the clinical characteristics of HBeAg-negative chronic hepatitis B virus (HBV) infection in indeterminate phase with a low viral load. Methods: One hundred and thirty-nine cases with persistent normal alanine aminotransferase (ALT) and HBeAg-negative chronic HBV infection with low viral load who visited the Department of Infectious Diseases of the Affiliated Hospital of Yan'an University from September 2013 to July 2021 were retrospectively collected. Patients were divided into low hepatitis B surface antigen (HBsAg) group (n=59) and high HBsAg group (n=80) according to the baseline hepatitis B surface antigen (HBsAg) level. The changes of various indicators at baseline and follow-up endpoints were analyzed between the two groups. The rate of HBsAg decrease ≥0.5 log10IU/ml, HBV DNA negative conversion rate, ALT persistently normal rate, and liver stiffness measurement (LSM) persistently normal rate at the end of the follow-up were compared. The t-test, or non-parametric Mann-Whitney U test, and Wilcoxon signed rank test were used for comparison of continuous data between the two groups. The χ2 test, or Fisher's exact probability method, was used for comparing count data between the two groups. Results: There were statistically significant differences in age, gender, and HBsAg at baseline, but there was no statistically significant difference in terms of family history of hepatitis B, follow-up time, anti-HBe, anti-HBc, HBV DNA, ALT, aspartate aminotransferase (AST), albumin (Alb), and LSM between the two groups. There were statistically significant differences in HBsAg, anti-HBc, and ALT levels before and after follow-up in the low HBsAg group, but no statistically significant differences in anti-HBe, HBV DNA, AST, Alb, and LSM levels. There were statistically significant differences in HBsAg and anti-HBc before and after follow-up in the high HBsAg group, but no statistically significant differences in anti-HBe, HBV DNA, ALT, AST, Alb, and LSM. A liver biopsy was performed in 66 patients during follow-up, and 27.27% of the patients had moderate liver damage. In the low HBsAg group, 45.76% of patients had a HBsAg decrease rate of ≥0.5 log10IU/ml, 10.17% of patients had HBV DNA negative conversion, 88.14% of patients had a persistently normal ALT, and 96.61% of patients had a persistently normal LSM at the end of follow-up. In the high HBsAg group, 3.75% of patients had a HBsAg decrease of ≥0.5 log10IU/ml, no patient had a HBV DNA negative conversion, 90% of patients had a persistently normal ALT, and 98.75% of patients had a persistently normal LSM. There were statistically significant differences in the HBsAg decrease rate (45.76% vs. 3.75%, χ2=32.975, P＜0.001) and HBV DNA negative conversion rate (10.17% vs. 0, χ2=6.219, P=0.013) between the two groups at the end of follow-up, but there were no statistically significant differences in the persistently normal ALT and LSM rates. Conclusion: The vast majority of patients with HBeAg-negative chronic HBV infection in the indeterminate phase with low viral load had persistent hypoviremia over the long term. Some patients have liver tissue damage and may progress to cirrhosis and liver cancer as a result of HBV DNA positivity, so antiviral treatment should be initiated in all.

Hepatobiliary phase image manifestation classification and pathological features of nodules in nodules accompanied by hepatocellular carcinoma

Objective: To analyze the hepatobiliary phase (HBP) image manifestation classification and pathological features of nodules in nodules accompanied by hepatocellular carcinoma (NIN-HCC). Methods: Twenty-five cases cases (27 lesions) with cirrhosis who were confirmed as NIN-HCC by surgical pathology and underwent gadoxetate disodium-enhanced MRI examination before surgery at Nantong Third Hospital affiliated with Nantong University from July 2015 to November 2022 were retrospectively enrolled. The size, signal intensity, enhancement pattern, and pathological features of internal and external nodules were analyzed in NIN-HCC. The lesions score were recorded according to the 2018 version of the Liver Imaging Reporting and Data Systems (LI-RADS) classification criteria. NIN-HCCs were grouped and typed according to the different HBP signal intensities of the inner and outer nodules. The independent-samples t-test, Mann-Whitney U test or Fisher's exact probability method were used to compare the differences in imaging features and LI-RADS scores between the groups. The Spearman correlation coefficient was used to evaluate the correlation between the pathological differentiation degree of internal and external nodules and the HBP signal intensity. The Kaplan-Meier curve was used to analyze recurrence-free survival (RFS) following NIN-HCC surgery. Results: The internal nodules of the 27 NIN-HCCs showed altered hypervascularity with a maximum diameter of (13.2±5.5) mm during the arterial phase. 51.9% (14/27) and 48.1% (13/27) showed "fast in and fast out" and fast in and slow out"enhancement patterns. The external nodules showed altered hypovascularity with a maximum diameter of (25.7±7.3) mm, and 13 (48.1%) of them were accompanied to manifest during the arterial phase. NIN-HCC was divided into two groups according to the signal intensity of HBP of the outer nodules with the background liver parenchyma signal intensity as a reference: the hyposignal group (n=17, 63.0%) and the isosignal group (n=10, 37.0%). The hyposignal group and the isosignal group were divided into A~C type and D~F type, a total of six types, according to the hypo, iso, and hyper signals of the inner nodules and the signal intensity of the outer nodules as a reference. Within the hyposignal group, 7.4% (2/27) of the inner nodules showed hyposignal (type A), 37.0% (10/27) showed isosignal (type B), and 18.5% (5/27) showed hypersignal (type C). Within the isosignal group, 29.6% (8/27) of the inner nodules showed hyposignal (type D), 7.4% (2/27) showed isosignal (type E), and there was no hypersignal (type F). 40.7% (11/27) of the lesions were LR-4 in LI-RADS score, and 59.3% (16/27) were LR-5. There was no statistically significant difference (P>0.05) in the maximum diameter, enhancement pattern, and LI-RADS score of internal and external nodules between the hypo and iso signal group. Histologically, NIN-HCC showed fine trabecular/pseudoglandular duct type without microvascular invasion, among which the inner nodules were mainly moderately differentiated HCC, and the outer nodules were mainly well-differentiated HCC. The degree of differentiation between the inner and outer nodules and the HBP signal intensity had no statistically significant difference (r=0.290, P=0.143; r=0.079, P=0.697). The median RFS follow-up time after NIN-HCC radical resection was 31.7 months, and the cumulative RFS rates at 1, 3, and 5 years were 96.0%, 76.0%, and 64.0%, respectively. Conclusions: NIN-HCC can serve as a morphological marker for early-stage diagnosis of multi-step cancer evolution in HCC, with certain imaging and pathological features. HBP imaging classification is helpful to enhance the diagnostic recognition of this disease.

Relationship between severe radiodermatitis and skin barrier functions in patients with head and neck cancer: A prospective observational study

ObjectiveSevere radiodermatitis with erosion is a painful condition that affects quality of life; therefore, developing methods for its prevention is an urgent issue. Therefore, this study aimed to determine the morphological characteristics of the development and healing processes of severe radiodermatitis in patients with head and neck cancer and to explore the association between skin barrier function and development of severe radiodermatitis. MethodsIn this prospective observational study, the cervical regions of patients with head and neck cancer who underwent radiotherapy at a university hospital from October 2022 to March 2023 were photographed, and morphological characteristics of the development and healing process of severe radiodermatitis were extracted using the qualitative sketch method. Skin barrier function, including skin microbiota and dermal echogenicity, was investigated before initiating radiotherapy, and its relationship with radiodermatitis was examined using the Mann–Whitney U test or Fisher's exact probability test. ResultsNine patients were followed for a median of 61 (range 55–87) days with a total of 88 observations. The morphological characteristics of severe radiodermatitis were “localized erosion–epithelialization” and “widespread erosion–crusting,” and compared to non-severe radiodermatitis, with low levels of Staphylococcus aureus (P ​= ​0.024), Staphylococcus hominis (P ​= ​0.024), and reduced dermal echogenicity (P ​= ​0.036). Furthermore, the “widespread erosion–crusting” was associated with a subepidermal low echogenic band. ConclusionsTo prevent severe radiodermatitis, in addition to moisturizing the irradiated area and protecting it from mechanical irritation, improving skin barrier function before radiotherapy initiation may be effective.

Clinical characteristics and associated factors of pediatric acute necrotizing encephalopathy: a retrospective study.

In the clinic, pediatric acute necrotizing encephalopathy (ANE) primarily affects children under five years of age and is characterized by severe brain damage and high mortality. However, some challenges remain regarding the diagnosis and treatment of ANE. In the present study, we analyzed the clinical characteristics and related factors of ANE with the aim of providing improved diagnostic and treatment strategies. Thirty-four pediatric ANE patients admitted to Zhejiang University School of Medicine Hospital between February 2019 and December 2023 were included in this study. To identify the factors associated with mortality, clinical, laboratory and imaging data were analyzed with independent-sample t tests, Mann‒Whitney U tests, Fisher's exact probability tests and receiver operating characteristic (ROC) curve analyses. In this cohort of 34 patients, the most common symptoms were fever, seizures, altered consciousness, vomiting, diarrhea and shock. The mortality rate was 55.9%. Laboratory tests revealed that patients who died had higher creatinine, lactate, activated partial thromboplastin time (APTT), thrombin time (TT), interleukin-6 (IL-6), interleukin-10 (IL-10), creatine kinase (CK), and D-dimer than survivors. Imaging examinations predominantly revealed symmetrical lesions in the thalamus. The fatal group displayed lower Glasgow Coma Scale (GCS) scores and severe complications. Other factors related to mortality included the arterial pH, GCS score and hospitalization duration. The most common symptoms of ANE are fever, seizures, altered consciousness, vomiting, diarrhea and shock, and ANE has a high mortality rate. The GCS score and arterial pH are critical biomarkers for assessing the severity of ANE.

Therapeutic effect of proprioceptive neuromuscular facilitation combined with muscle energy technique on post-stroke dysphagia.

According to the Global Burden of Disease Study the prevalence of stroke worldwide has significantly increased from 1990 to 2019, making it the second leading cause of death worldwide. Approximately 70%-80% of stroke patients are unable to live independently due to disability. To explore the therapeutic effect of proprioceptive neuromuscular facilitation (PNF) combined with muscle energy technique (MET) on post-stroke dysphagia. A total of 122 stroke patients with dysphagia admitted to our hospital from January 2017 to December 2020 were divided into the control group (n= 61) and the study group (n= 61). Patients in the control group received conventional rehabilitation plans, while those in the study group were given a combined therapy of MET and PNF. Standard Swallowing Function Assessment Scale (SSA), Videofluoroscopic Swallow Study (VFSS), Swallowing Quality of Life (SWAL-QOL) scores, Water Swallow Test (WST) grading, and efficacy indicators were compared between two group with t-tests, Wilcoxon signed-rank test, χ2 test or Fisher's exact probability test. After treatment, the study group showed lower SSA score (P= 0.036), and VFSS, P= 0.013 than the control group. The changes in SSA score (P= 0.013) and VFSS score (P< 0.001) in the study group were greater than the control group. Furthermore, after treatment, both the study group and the control group showed a decrease in WST grading (P< 0.001); and the degree of post-treatment WST grading decline in the study group was higher (P= 0.009). Besides, after treatment, the SWAL-QOL score of the study group was higher than the control group (P< 0.001); and the effective rate of patients in the study group was higher than that in the control group (P= 0.021). Compared with traditional rehabilitative training strategies, PNF combined with MET can effectively improve swallowing function, and enhance the quality of life in patients with post-stroke dysphagia.

Tumor Heterogeneity of STEAP4 in Malignant Progression of Oral Squamous Cell Carcinoma.

Background: Recent research suggests that STEAP4, a metalloreductase in vivo, plays a crucial role in various types of tumorigeneses, especially in gastrointestinal cancers. However, few oncogenes have been reported in oral squamous cell carcinoma (OSCC). Therefore, this study aimed to explore the potential role of STEAP4 in OSCC. Methods: The expression level of STEAP4 in OSCC tissues and adjacent normal tissues, was detected using immunohistochemistry. Publicly available online tools were utilized to analyze the expression, prognostic significance, and related enriched pathways of STEAP4 in head and neck squamous cell carcinoma (HNSCC) and OSCC. The relationship between STEAP4 expression and clinicopathological parameters in OSCC patients was validated using the χ2 test and Fisher's exact probability test. Results: STEAP4 exhibited low expression in both HNSCC and OSCC. Whereas the prognosis for HNSCC patients was favorable, OSCC patients had poor outcomes. Genetic variability analysis revealed no alterations in STEAP4 in OSCC, whereas gene amplification was observed in HNSCC, suggesting tumor heterogeneity in STEAP4 among these cancer types. Conclusion: STEAP4, as a risk factor associated with poor patient prognosis, shows tumor heterogeneity in OSCC patients, that is potentially related to genetic mutations or differences in histological distribution of oral mucosa. These findings indicate that STEAP4 could serve as an independent predictor for assessing the prognosis of OSCC patients.

Public school teachers' perceptions of internet gaming problems among students: current status and challenges

Objectives This study aimed to identify and understand the challenges faced by public school teachers regarding issues related to Internet gaming.Methods An electronic questionnaire was administered to 400 public school teachers in the Saitama Prefecture from September to November 2021. A total of 352 valid responses were obtained. The survey content included teachers' knowledge of gaming disorders, whether their students experienced gaming-related problems, difficulties perceived by teachers, how they discovered the problems, how they dealt with them, the challenges they faced in dealing with the problems, and desired support. Data were analyzed based on the teachers' roles, responsibilities, type of school, and knowledge of gaming difficulties. Fisher's exact probability tests were used to determine significance, and adjusted standardized residuals were used to assess the differences between groups.Results Nearly 63.1% of the teachers already had knowledge of gaming disorders, and 49.4% acknowledged the existence of students with gaming problems. The most common reasons for discovering problems were disrupted daily rhythm (51.7%) and increased tardiness and early dismissal (34.7%). The main actions taken to address gaming problems were "consultation and information sharing with families" (48.6%) and "individual guidance by teachers" (34.1%). Approximately half of the teachers indicated that they regularly experienced difficulties in activities related to prevention, early detection, student support, and interaction with parents. Specific challenges included limited guidance and involvement with families (61.4%) and the inability to intervene and provide effective support (62.5%). Teachers' support included programs for addiction recovery (56.8%), awareness programs for parents (56.0%), and staff training to increase the understanding of gaming disorders (50.5%). The responses varied according to teacher role and school type, indicating that implementation rates and difficulties were higher in middle schools.Conclusion We found that teachers tended to view internet gaming problems as family problems and provide complementary support for home education. Teachers also found it difficult to deal with students with gaming problems. Depending on the teacher's role in the school and the type of school, requests for support varied. Elementary and special-needs schools needed teaching materials that could be used for classroom and school-wide instruction and guidance for concerned students and their parents; junior high schools needed a consultation system with school counselors and other professionals and cooperation with healthcare; and high schools needed measures and support, including social support.

Study of related factors to vascular complications after pediatric liver transplantation

Objective: To explore the related factors of vascular complications after liver transplantation in children. Methods: This is a retrospective case series research. The clinical data of 89 pediatric liver transplant patients admitted to the Organ Transplantation Center, the Affiliated Hospital of Qingdao University from January 2016 to March 2024 were collected retrospectively. This study included 44 males and 45 females,aged from 4 months to 17 years. The ratio of graft to recipient weight was 0.6% to 7.7%. The primary diseases included 48 cases of biliary atresia and 41 cases of non-biliary atresia. The Wilcoxon rank sum test, χ2 test, and Fisher's exact probability method were used for data analysis. Multivariate Logistic regression was used to analyze the related factors of vascular complications. Results: All 89 children with liver transplantation completed surgery successfully. There were 8 cases of arterial complications after surgery, including 6 cases of hepatic artery thrombosis and 2 cases of hepatic artery stenosis. There were 16 cases of portal vein complications after surgery, including 9 cases of portal vein stenosis and 7 cases of portal vein thrombosis. The results of univariate analysis showed that the age of the recipient ≤1 year was the relevant factor for hepatic arterial complications(χ2=4.772,P=0.029). The age of the recipient ≤1 year, the age of the donor, the hepatic phase, and the time of cold ischemia were the relevant factors for the occurrence of portal vein complications(χ2=7.270,Z=388.500,Z=838.000, Z=894.500;all P<0.05). The results of multivariate analysis showed that age(≤1 year vs. >1 year) and duration of cold ischemia(every additional 1 hour) were independent related factors for portal vein complications after liver transplantation in children(both P<0.05). Conclusion: Children aged ≤1 year and with prolonged cold ischemia are more likely to develop portal vein complications after liver transplantation.

Evaluation of the Safety and Efficacy of Foldable One-Piece Intraocular Lens A1-UV for the Treatment of Cataracts: Summary of Two Clinical Trials

Objective: Through the combined analysis of data from two clinical trials, the clinical safety and efficacy of aspheric intraocular lens A1-UV implantation in cataract patients was evaluated at 1 year after surgery. Methods: A total of 239 subjects (239 eyes) were enrolled, including 117 subjects in the A1-UV group (study group), 61 subjects in the SN60WF group (control group 1) and AQBHL group (control group 2), respectively. Follow-up time points included: preoperative, intraoperative and postoperative 1~2days, 1 week, 1 month, 3 months, 6 months and 1 year. The evaluation indexes included: visual acuity, refraction, contrast sensitivity, intraocular pressure and complications. Statistical methods mainly include Wilcoxon rank-sum test, independent samples t-test, chi-square test or Fisher exact probability test. Results: The uncorrected distance visual acuity of the A1-UV group increased from logMAR 0.77±0.33 preoperatively to 0.15±0.22 at 1 year after surgery, from 0.74±0.33 in the SN60WF group to 0.18±0.23 at 1 year after surgery, and from 0.78±0.34 in the AQBHL group to 0.21±0.24 at 1 year after surgery. For best-corrected distance visual acuity, the A1-UV group increased from logMAR 0.60±0.36 preoperatively to 0.05±0.10 at 1 year after surgery, the SN60WF group increased from 0.59±0.36 preoperatively to 0.07±0.15 at 1 year after surgery, and the AQBHL group increased from 0.59±0.35 preoperatively to 0.08±0.11 at 1 year after operation. There was no significant difference between the A1-UV group and the other two groups (all P&gt;0.05). At different follow-up times after surgery, the residual diopters was significantly lower than that before operation (all P&lt;0.05), and the refractive error before operation was effectively corrected. The contrast sensitivity was high, and the visual function was better. The mean intraocular pressure of the subjects implanted with A1-UV was within the normal range during each follow-up period after surgery. None of the patients had serious adverse events related to intraocular lens. Conclusion: The efficacy and safety of A1-UV foldable one-piece intraocular lens in cataract treatment are good

Evaluating the impact of loperamide on irinotecan-induced adverse events: a disproportionality analysis of data from the World Health Organization pharmacovigilance database (VigiBase).

SN-38, the active metabolite of irinotecan, may cause adverse events necessitating treatment discontinuation and management. Diarrhea, which is treated with loperamide, is one such event. However, loperamide may delay SN-38 elimination, causing more adverse events. Therefore, understanding the adverse events caused by symptomatic drugs is crucial for safe drug therapy. This study aimed to assess the association between loperamide and irinotecan-induced adverse events. We analyzed data up to December 2022 from VigiBase, the World Health Organization's adverse event database. The study used reporting odds ratios (RORs) to evaluate the associations between concomitant medications and irinotecan-induced adverse events. Fisher's exact probability test was used to analyze the adverse events. Logistic regression analysis was performed to identify associated adverse event signals. Of the 32,520,983 cases analyzed, 57,454 involved the use of irinotecan. Among these, 1589 (2.8%) patients were co-treated with loperamide. Signals for neutropenia (ROR 1.37, 95% confidence interval (CI) 1.20-1.57, p < 0.001), anemia (ROR 1.81, 95% CI 1.43-2.30, p < 0.001), and alopecia (ROR 1.89, 95% CI 1.30-2.74, p < 0.01) were detected with concomitant loperamide. Multivariate logistic regression analysis confirmed that concomitant loperamide use was associated with signals for neutropenia, anemia, and alopecia. Our results suggest that loperamide increases the risk of irinotecan-induced adverse events and enhances irinotecan toxicity. The study methodology may be useful for predicting adverse event risk when choosing symptomatic therapy drugs during irinotecan use.

Analysis of the changes of bacterial spectrum and drug resistance in sputum culture of ICU children in a hospital of pediatric in Jiangsu Province from 2017 to 2022

Objective: To investigate the changes of the distribution and drug resistance profile of bacteria from ICU children with lower respiratory tract infection (LRTI) in Suzhou City, Jiangsu Province from 2017 to 2022. Methods: From January 2017 to December 2022, a cross-sectional observational study on the bacterial spectrum analysis among intensive care unit (ICU) children with LRTI was conducted in Children's Hospital of Soochow University. The bacteria was cultivated by culture methods from sputum samples, and identified by MALDI-TOF mass spectrometry. Drug sensitivity tests were performed by the VITEK2 Compact fully automated analysis system and the paper slide method. The χ2 test or Fisher's exact probability was used to analyze the changes of the distribution of sputum culture-positive bacteria and drug resistance in ICU children. Results: The overall detection rate of sputum culture was 42.06% (1 182/2 810). Staphylococcus aureus (25.63%,303/1 182), Acinetobacter baumannii (13.62%,161/1 182) and Haemaphilus influenzae (13.28%,157/1 182) were the top three. Proportions of Acinetobacter baumannii (17.90% vs. 11.02%,χ²=11.17, P=0.001), especially carbapenem-resistant Acinetobacter baumannii (43.70% vs. 23.50%, χ²=15.21, P<0.001) increased significantly from 2020 to 2022. However, the proportions of Haemophilus influenzae (8.50% vs. 16.19%, χ²=14.27, P<0.001), Streptococcus pneumoniae (8.50% vs. 15.92%, χ²=13.42, P<0.001) and extended-spectrum-lactamase producing Escherichia coli (8.89% vs. 18.00%, χ²=5.45, P=0.025) decreased. Drug resistant results showed that Acinetobacter baumannii was obviously more resistant to imipenem (χ²=4.43, P=0.035) and levofloxacin (χ²=12.53, P<0.001), while more sensitive to minocycline (χ²=8.34, P=0.004). Escherichia coli showed a significant increase in resistance to piperacillin tazobactam (χ²=8.29, P=0.008) and cefoperazone sulbactam (χ²=5.07, P=0.024) from 2020 to 2022; Klebsiella pneumoniae consistently maintained a resistance rate of more than 60% to first and second-generation cephalosporins, and remain susceptible to quinolones and carbapenems. Staphylococcus aureus remained highly susceptible to levofloxacin (drug resistance rate: 2.31%,7/303) and sulfamethoxazole/trimethoprim (drug resistance rate: 4.95%,15/303) from 2020 to 2022. Conclusion: Higher detection and resistance rates of Acinetobacter baumannii from sputum culture in ICU children from 2020 to 2022 were explored. Resistance of Escherichia coli to β-lactamase inhibitor combinations was more serious. Regular monitoring the changes of the etiology of respiratory tract infections in ICU Children is particularly important for the prevention and treatment of multidrug-resistant bacterial infections.

8192 A Two-Cycle Clinical Audit Testing Inpatient Management Of Hypophosphatemia In A UK District Hospital

Abstract Disclosure: J. Porto: None. E. Ssemmondo: None. N. Obike: None. A. Abobaker: None. R. March: None. N. Tun: None. T. Pawlak: None. Objective: A clinical audit was conducted to assess if there was any improvement in management of hypophosphatemia among patients admitted to the medical wards using the local Trust protocol, following structured edcational sessions to the junior doctors covering medical wards. Design and methodology: The 2 cycles of the audit were conducted between March 2020 and September 2021 in Scarborough district Hospital. The clinical notes of 52 patients (20 in the first cycle and 32 in the re-audit) with hypophosphatemia were reviewed. These were identified using the electronic laboratory results of patients within the study period. The aspects of the trust protocol for management of hypophosphatemia that were audited; documentation of symptoms associated with low phosphate levels, cardiac monitoring in severe hypophosphatemia, identification of the likely cause of hypophosphatemia, the presence or absence of associated acute kidney injury (AKI) and initiation of phosphate replacement. The results of the first audit were presented at the local hospital clinical governance meeting (August 2020). Following this, 2 teaching sessions and 2-case based discussion on hypophosphatemia were organised for all the doctors in the department of medicine. The re-audit was subsequently conducted after the fourth teaching session. The proportions of each audited item were compared between the first audit and the re-audit using Fisher exact probability test. Results:25% of patients in the first audit had severe hypophosphatemia compared to 28% in the re-audit. In patients with severe hypophosphataemia, only 33.3% had cardiac monitoring during the re-audit cycle compared to 60% in the first cycle, and the difference was not statistically significant (p=0.58). There was significant improvement in the documentation of symptoms of hypophosphataemia amongst inpatients during the re-audit cycle compared with the initial cycle; 62.5% vs only 10% (P 0.002). Most patients had an underlying cause of the hypophosphatemia identified (80% and 62.5%-first and second cycle respectively). AKI was associated with hypophosphataemia in 15% &amp; 34.4% (P 0.2) in the first and second cycles respectively. Despite low phosphate levels, 25% and 28.1% at the initial audit and the second cycle respectively did not receive any form of phosphate replacement. Conclusion: The two-cycle clinical audit showed that the teaching sessions on management of hypophosphatemia increased the awareness of the importance to document whether the patients were symptomatic or asymptomatic following the drop in their phosphate levels, which can help to identify patients at risk of developing complications, such as cardiac arrythmias. However, these sessions were not sufficient to improve overall management of patients with low phosphate levels. Presentation: 6/1/2024