Independent Samples Mann-Whitney U-test Research Articles

The power of social media: broader Twitter outreach and higher Altmetric scores significantly amplify neurosurgical citation reach.

The authors sought to quantify the role of social media-related academic activity through use of the Altmetric score (a composite score based on social media attention from a variety of sources) and investigate its potential impact on the number of citations received at 3 years postpublication (articles published between January 2019 and December 2019). Articles published in the top 12 neurosurgical journals according to Google Scholar (based on 5-year Web of Science impact factors, 2017-2021) were identified. Data collected included days since publication, Altmetric scores, and total number of tweets (posts), and 3-year citations were obtained from Google Scholar. A multiple linear regression model was created that featured a blocking method to stratify confounding variables from most to least contributing. Furthermore, the data were dichotomized by publications with ≥ 10 citations (top 25th percentile) and those with < 10 to analyze the impact of the score on total number of citations received at 3 years, using an independent-samples Mann-Whitney U-test. Among 6721 included articles, the mean Altmetric score was 3.76 ± 15.69 and the mean number of citations received was 9.61 ± 22.16. When accounting for relevant control variables, the Altmetric score was a significant predictor of the total number of citations accumulated at 3 years (variability of 10.17%). On statistical testing, the Altmetric score was significantly higher in publications with ≥ 10 citations (p < 0.001). The authors report a strong, statistically significant correlation between the Altmetric score and the number of citations received. To their knowledge, this is the first study to demonstrate the impact of social media academic activity on neurosurgery article citation dissemination, potentially influencing resident medical education.

Perspectives of medical undergraduate students toward self-directed learning

Objectives: Self-directed learning (SDL) is a process in which individuals take the initiative with or without the help of others in diagnosing their learning needs, formulating goals, identifying human as well as material resources for learning, implementing appropriate strategies and evaluating learning outcomes. In SDL, the onus of learning is on the learner and learning control is slowly transferred from facilitator to learner. Hence, this study helped to understand the SDL readiness in undergraduate medical students and figure out whether it differed between students of 2nd and 3rd professional years. Materials and Methods: The study was conducted on undergraduate medical students of 2nd and 3rd professional year of tertiary care medical college hospital in south India after receiving permission from the Institutional Ethics Committee. A total of 285 students were considered in this study from both years after informed consent. A pre-validated questionnaire of the self-rating scale for SDL (SRSSDL) tool was included, and it comprised five components, namely, awareness, learning strategy, learning activity, evaluation and interpersonal skills, with 12 questions in individual sections. Demographic data were expressed in percentages while the Chi-square test and independent sample Mann–Whitney U-test were applied to understand the differences between 2 professional years. Results: Out of 285 students, 56.8% had a moderate level of readiness, followed by a high level of readiness (42.9%). The majority of the students from both academic years had a moderate level of readiness toward SDL. Learning strategy had the highest mean response score of 3.7 ± 0.52, followed by awareness with 3.69 ± 0.49. This mean score reflects that the majority of participants’ responses recorded were either ‘sometimes’ or ‘often’ for various components of the SRSSDL tool. The distribution of awareness, learning strategy, learning activities, evaluation and interpersonal skills did not show any significant association across academic years and gender. Conclusion: The moderate level of readiness shows that areas of improvement must be identified and evaluated with teacher guidance when necessary. The SRSSDL tool can be used as a measure of evaluation, as it helps to classify student readiness toward SDL.

Nursing students' attitudes regarding euthanasia due to unbearable mental suffering: Cross-sectional study using the adapted and validated Euthanasia Attitude Scale.

To explore final year nursing students' attitudes towards euthanasia due to unbearable mental suffering by using the adapted and validated Euthanasia Attitude Scale. Cross-sectional survey. Explorative, descriptive cross-sectional study conducted using an e-mail survey between October 2020 and March 2021 by a sample of final-year baccalaureate nursing students (n=273) from eight of the eleven Flemish university colleges. The actual questionnaire contains 21 questions and was developed based on a consensus reached following independent translations. The psychometric properties of the Euthanasia Attitude Scale were assessed, including reliability and validity. Independent-sample Mann-Whitney U-test was used to investigate relation between demographic and education-related data, and domain and total score of the UMS-EAS-NL. This study received ethical approval from the Ethical Committee of the University Hospital Brussels, Belgium. McDonald's omega was 0.838 for the total Euthanasia Attitude Scale scores, supporting the validity of the questionnaire. A statistically significant difference in 'Naturalistic beliefs' score was found relating to the year of birth. There are clinically important results between those students who have been involved in euthanasia and those who have not. Most of the final-year nursing students supported the probability of patients' access to euthanasia due to unbearable mental suffering. To monitor adequate care, it is necessary to prepare nursing students adequately for this complex matter. To date, no large-scale study has examined nursing students' attitudes towards euthanasia because of unbearable mental suffering. It is expected that nursing students may be confronted with such a euthanasia request during an internship, or later in their professional career, in countries where euthanasia is legal. Students showed a high acceptability towards UMS-euthanasia. Clinically significant differences were found for students who had ever been involved in euthanasia.

The Addition of a Krackow Rip Stop Suture Augment After Achilles Tendon Debridement for Insertional Achilles Tendinopathy: A Biomechanical Study.

In the operative treatment of insertional Achilles tendinopathy, the Achilles tendon is often released from its insertion to allow for adequate debridement of pathologic tissue. The use of a double row suture anchor construct has become increasingly favorable among surgeons after Achilles tendon debridement. This study hypothesized that the addition of a Krackow rip stop suture augment to the double row suture anchor construct would increase the repair's maximum load to failure. A biomechanically stronger repair would potentially decrease the risk of catastrophic failure with early weight-bearing or accidental forced dorsiflexion after operative management for insertional Achilles tendinopathy. Fourteen cadaveric specimens were used to compare the 2 repair techniques. Achilles tendons were debrided and repaired using either a double row suture anchor with and without the additional Krackow rip stop suture augment. The 2 repair techniques were compared using an axial-torsion testing system to measure average load to failure. The average load to failure for the double row suture anchor repair alone was 152.00 N. The average load to failure for the tendons with the double row suture anchor with the Krackow rip stop augment was 383.08 N. An independent-samples Mann-Whitney U-test was conducted and the suture anchor plus Krackow augment group had a significantly higher load to failure (P = .011, Mann-Whitney U = 5.00, n1 = n2 = 7, P < .05, 2-tailed). This study confirmed that the addition of a Krakow rip stop augment to the double row suture anchor is able to increase the maximum load to failure when compared to the double row suture anchor alone. These results suggest the potential of this added technique to decrease the risk of catastrophic failure.

Rectal Volume and Quality of Life in Prostate Cancer Patients Receiving Pediococcus-Based Probiotics and Radiation Therapy: A Prospective Randomized Trial

Previous research identified Lactobacillus-based probiotic administration significantly reduced median and percent rectal volumes in prostate cancer (PC) patients undergoing daily radiation therapy (RT). However, Lactobacillus is sensitive to the acidic environment in the stomach. Pediococcus-based probiotics are resistant to pH as low as 1.5. We designed a prospective randomized trial to determine if administration of a Pediococcus-based probiotic therapy is feasible in patients undergoing prostate RT. An exploratory aim was to determine if probiotic therapy decreased rectal volumes throughout RT for PC compared to placebo.This was a single-institution prospective randomized study for men with PC undergoing prostate-only RT. Patients were randomized 1:1 to probiotic (2 gelatin capsules containing 4 × 109 colony-forming units of Pediococcus-based probiotics) or placebo. Administration of study agent was initiated 10 days prior to the start of daily RT. Quality of life (QOL) EPIC - Bowel Domain only surveys were completed at baseline, midway during RT, end of RT, and 1-month follow-up. Toxicities were recorded in accordance with CTCAE v5. Rectal volumes were contoured per the Radiation Therapy Oncology Group guidelines on the initial CT simulation, week 2, and week 6 using quality assurance CTs or cone-beam CTs, and compared using an independent samples Mann-Whitney U-test.Thirty patients were enrolled to the study. Two patients withdrew prior to initiating treatment, leaving 28 patients with evaluable data. Seven patients withdrew from the study for a completion rate of 75%. Of the patients that withdrew, 6 of 7 were on the placebo arm. In the placebo arm, one withdrew before starting the pills and five cited inconvenience as the reason for discontinuation. In the probiotic arm, one participant reported "increased blood pressure" which did not resolve with cessation; this was the only protocol-related toxicity. There were no differences in QOL in bowel function or bother scores between the two groups relative to each patient's baseline. The relative rectal volumes at week 2 (RV2) and 6 (RV6) were not significantly different between probiotic and control arms. RV2 averaged across all patients in each of the two trial arms was 9.9% larger in the probiotic arm compared with controls, RV2p/RV2c = 1.099 with 95% significance limits 0.82 and 1.47, P = 0.51. At 6 weeks, RV6p/RV6c = 0.868, 95% CI 0.654 to 1.152, P = 0.31.While feasible and with rare protocol-related toxicity, compliance with daily capsule administration during conventionally fractionated prostate RT proved difficult, with 25% of patients withdrawing before study completion. Within the limitations of this pilot study, Pediococcus-based probiotic administration did not significantly alter QOL metrics or rectal volumes.

Foot posture assessment in people with primary medial compartment knee osteoarthritis: An observational study

BACKGROUND: Foot postures are integral to the biomechanical alignment and the dynamic function of the lower extremity. This study compared foot postures in people with primary medial compartment osteoarthritis (OA) and age-, gender-, and body mass index (BMI)-matched controls using various foot measures. Grade-wise variations were also assessed. AIM: The aim of the study was to assess the foot postures in people with primary medial compartment knee OA. METHODS: This was an observational, analytical study and the subjects were recruited by convenient sampling from tertiary hospitals in Pune. The target population were primary knee OA who were clinically and radiologically diagnosed for their severity based on the Kellgren–Lawrence grading, a severity classification based on radiographic evidence. The Centre of Rheumatic Diseases version of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Foot Function Index (FFI) which are both self-report questionnaires were duly filled by the knee OA subjects for the pain and dysfunction of the knee and foot, respectively. The control group consisted of age-, gender-, and BMI-matched asymptomatic healthy subjects. Foot postures of all subjects namely, the OA (n=48) and controls (n = 33) were assessed using the foot posture index (FPI), arch index, and navicular drop test. The FPI as well as the navicular drop test categorized the subjects into 3 groups: pronated, neutral, and supinated. The arch index was calculated from the inked imprint of the foot of the affected limb where higher values indicated dropped arch. STATISTICAL ANALYSIS AND RESULTS: Independent samples Mann–Whitney U-test and unpaired t-test were used to investigate the differences between the two groups in the foot characteristics. The Spearman's rho was used to analyze the correlation of FPI with the grades of OA and of WOMAC with the FFI within the OA group. The study included 48 medial knee OA subjects (48 knees and the corresponding foot) and 33 age-, gender-, and BMI-matched healthy controls. The percentages of foot postures (neutral, pronated and highly pronated) of both groups were 71%, 25% and 4% respectively in the OA group and 92%, 2% and 6% respectively in the control group. Comparative study of foot postures between the two groups showed more pronated feet in the OA group (P CONCLUSION: The foot postures were altered in the knee OA group as compared to healthy controls, with the OA group showing more pronated foot type.

Clinical-laboratory characteristic and arterial blood pressure in children of under school and early school age with obesity

For the last 20 years obesity and overweight in childhood have become one of the most important healthcare problems for the vast majority of countries, including Russia. There is a data that obesity in early age correlates with the risk factors of chronic diseases in adultness, including diabetes, cardio-vascular diseases, arterial hypertension and many others. That is why the main goal of our survey was to compare clinical-laboratory parameters and lab based indicators and to explore the details of arterial blood pressure indicators of pre-school and younger school children with and without obesity in one region of Russia (Lipetsk Region). We have analyzed those parameters in 2 groups of children: first group consisted of 50 children with obesity, and second 50 children with normal body mass. For checking the differences between two groups we have used Students t-test or its counterpart for independent samples MannWhitney U-test in cases when the variances of the values were high. The results of survey have shown the high index of hereditary burden among children with obesity, more birth weight of those ones, higher levels of glucose, cholesterol, and low density triglicerids andindex atherogenicity. The measurements of arterial blood pressure (systolic and diastolic) three times per day every day during a week showed significant increasing from mornings to evenings and from the beginning to the end of the week. The highest number of significant coefficients of correlation has been revealed between body mass of the children with obesity and arterial blood pressure (systolic and diastolic) during the day.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P40. 18F-Fluoride PET/CT as an early predictor of bony fusion after posterior lumbar interbody fusion

BACKGROUND CONTEXT The clinical success of posterior lumbar interbody fusion (PLIF) may be limited by pseudarthrosis (PA), defined as the absence of solid fusion 1 year after surgery. At present, no noninvasive technique is available to reliably assess bone graft incorporation in the early phase after PLIF. Positron emission tomography (PET) is a nuclear imaging modality that is able to identify changes at the cellular and molecular level in an early stage, well before manifestation of anatomical changes. PET/CT with the bone seeking tracer 18F-fluoride allows localization and quantification of bone metabolism. PURPOSE This study investigates whether an 18F-fluoride PET/CT scan early after PLIF is able to predict the fusion status on CT at 1 year postoperative. METHODS Twenty patients were enrolled after PLIF and gave written informed consent. At 6 weeks and at 1 year after PLIF, intravenous injection of 18F-fluoride was followed by a static scan at 60 minutes (Philips, Gemini TF PET/CT). Processing of images resulted in a bone metabolism parameter that is standardized uptake value (SUV). This parameter was determined for 3 regions of interest (ROIs): the intervertebral disc space (IDS) and the upper and the lower endplate (UE and LE, respectively) of the operated segment.Interbody fusion was scored on a diagnostic CT scan made 1 year postoperative and was defined as the amount of complete bony bridges between vertebrae i.e 0, 1 or 2. Based on these scores, patients were divided in either the PA group (score 0) or the fusion group (scores 1 and 2). Differences between groups were analyzed using the independent samples Mann-Whitney U-test. RESULTS Ten patients were classified as PA (0 bridges: n=10) and 10 patients as fused (1 bridge: n=5, 2 bridges: n=5).Patients in the PA group showed significantly lower bone metabolism values in the IDS on the 6 weeks PET/CT scan compared to patients in the fusion group (SUVIDS=13.3±5.62 for PA and SUVIDS=22.6±6.42 for the fusion group, p=.003), whereas values at the endplates were similar (SUVUE=20.3±5.85 for PA and SUVUE=21.6±4.24 for the fusion group, p=.282). Furthermore, only in the PA group, bone metabolism in the IDS was significantly lower than at the endplates (p=.006). In the fusion group, bone metabolism in the IDS and at the endplates was similar (p=.470).The PET/CT scan at 1 year postoperative showed that in the PA group, bone metabolism of the IDS remained lower compared to the endplates (SUVIDS=13.2±4.37, SUVUE=16.4±5.33, p=.004), while in the fusion group, IDS and endplate bone metabolism was similar (SUVIDS=13.6±2.91, SUVUE=14.4±3.14, p=.397). CONCLUSIONS This study shows that lower bone metabolism values in the intervertebral disc space of the operated segment as seen on 18F-fluoride PET/CT 6 weeks after PLIF, is related to development of PA 1 year postoperatively. These results suggest that 18F-fluoride PET/CT might be an early diagnostic tool to identify patients prone to develop PA after PLIF.

Renal Pelvic Pressure in Percutaneous Nephrolithotomy: The Effect of Multiple Tracts.

During percutaneous nephrolithotomy (PCNL), elevated renal pelvic pressures (RPPs) may spread infection through pyelovenous backflow whereas decreased pressures can hinder observation and increase bleeding. The purpose of this study was to evaluate the effects of multiple access tracts and different sized endoscopic equipment on RPP in a porcine model. RPP was measured in one- vs two-tract access, rigid vs flexible nephroscopy, and suction vs no suction. Twenty trials were performed for each condition. An independent samples Mann-Whitney U-test was used to compare parameters, with p < 0.05 considered significant. With one tract, rigid nephroscopy resulted in higher mean pressures (31.35 mm Hg) than flexible nephroscopy (11.1 mm Hg; p < 0.001). The RPP was higher with rigid nephroscopy in one tract (31.35 mm Hg) than when two tracts were present (9.35 mm Hg; p < 0.001). In contrast, there was no difference in pressure during the use of a flexible nephroscope in one (11.1 mm Hg) vs two tracts (10.7 mm Hg; p = 0.63). Use of suction with the rigid nephroscope resulted in significantly lower pressures with one (-1.3 mm Hg) than with two tracts (1.8 mm Hg; p = 0.004). In PCNL, RPP is significantly affected by an additional tract during rigid nephroscopy and suctioning but not when using a flexible nephroscope. Understanding the effects of multiple tracts and equipment type on RPP may improve the safety of PCNL.

Monopolar versus bipolar transurethral resection of prostate for benign prostatic hyperplasia: Operative outcomes and surgeon preferences, a real-world scenario.

Context:Monopolar transurethral resection of prostate (M-TURP) is considered the gold standard for the management of bladder outlet obstruction due to benign prostatic hyperplasia. Its newly introduced modification, bipolar TURP (B-TURP), promises to overcome its most prominent shortcomings, namely bleeding and dilutional hyponatremia. Literature is conflicting regarding merits of B-TURP over M-TURP.Aims:To find a difference, if any, in perioperative outcomes between M-TURP and B-TURP in a real-wold setting.Settings and Design:Prospective nonrandomized study.Subjects and Methods:Operative outcomes of patients undergoing M-TURP and B-TURP from February 2014 to October 2015 were compared.Statistical Analysis Used:Categorical data were compared by Fischer exact test and numerical data were compared by independent samples Mann–Whitney U-test. P <0.05 was considered statistically significant.Results:The mean size of prostate operated by bipolar technology was significantly greater than those operated by monopolar technology (38.12 ± 9.59 cc vs. 66.49 ± 22.95 cc; P < 0.001). The mean fall in postoperative serum sodium concentration was 0.99 ± 0.76 mEq/L for the B-TURP group as compared to 3.60 ± 2.89 mEq/L for the M-TURP group (P < 0.001). The mean drop in postoperative hemoglobin concentration (P = 0.28) was statistically insignificant, even though larger glands were operated by B-TURP. There were three instances of the transurethral resection (TUR) syndrome in the M-TURP group whereas no TUR syndrome occurred in the B-TURP group.Conclusions:In spite of various contrary viewpoints in literature, surgeons prefer to operate on larger prostates using bipolar technology. B-TURP definitely reduces the incidence of bleeding and dilutional hyponatremia, making it a contender to replace M-TURP as the new gold standard.

Diagnostic whole body scan (pre-therapy scan) in differentiated thyroid cancer: A single center community hospital experience.

Diagnostic whole body scan (pre-therapy scan) with either I-123 or I-131 (radioactive isotopes of iodine) is performed to assess the extent of thyroid cancer especially distant metastasis prior to administering the therapeutic dose of I-131. Our aim of the following study was to determine the utility of the diagnostic pre-therapy scan in the management of differentiated thyroid cancer. It was a case-control study carried out by retrospective chart review, of a randomly selected 100 patients with differentiated thyroid cancer who had followed in our community hospital over the course of 1 year. We collected data on multiple variables in the subjects - including age, gender, pre-operative size of the nodules, diagnosis, stage of the malignancy, size of the tumor, multifocality, lymphovascular invasion, dose of radioiodine used for remnant ablation, recurrence rates and persistence rates. Continuous variables were compared using the independent sample Mann-Whitney U-test whereas the Chi-square test was used for nominal variables. The mean dose of radioactive iodine administered was 97.56 (±27.98) in the pre-therapy scan group and it was 97.23 (±32.40) in the control group. There was no difference between the two groups (P - 0.45). There was also no difference in the recurrence rates between the groups (P = 1.0). There was a trend toward a higher degree of persistent cancer in the group that had the pre-therapy scans (P - 0.086). Pre-therapy scan may not affect the dose of radio-iodine I-131 used for remnant ablation of differentiated thyroid cancer and does not influence the recurrence rates. This was especially true with respect to I-131 remnant ablation for low risk tumors.

Lower Continuous Infusion, Higher Bolus Dose Patient-Controlled Analgesia Results in Shorter Hospitalization in Children with Sickle Cell Vaso-Occlusive Pain Crisis

▪Background:Children with sickle cell disease (SCD) and vaso-occlusive pain crisis (VOC) require opioid analgesia, but there is little evidence to determine the most effective strategy for opioid dosing via patient-controlled analgesia (PCA) for this patient population. In January 2013, the opioid PCA dosing strategy for VOC at St. Louis Children's Hospital was changed from high continuous infusion/low demand dose (regimen A, Table) to lower continuous infusion/higher demand dose (regimen B, Table). In this retrospective cohort study, we tested the hypothesis that hospital length of stay (LOS), intravenous opioid utilization, and opioid side effects would be reduced in regimen B compared with regimen A.Methods:All hospitalizations for VOC management during January 1-July 31, 2012, and January 1-July 31, 2013, were identified from pharmacy records and patients' electronic medical records. Opioid doses, ibuprofen, and supportive care were part of standardized VOC order sets for both time periods. In both regimens, PCA opioid was weaned by 20-25% daily after achieving pain control, until equivalent to home opioid dose. Inclusion criteria were diagnosis of any SCD phenotype; admission for VOC; and treatment with morphine or hydromorphone PCA. Subjects were excluded for age 18 years or older; opioid continuous infusion ordered without patient-controlled demand dose; intensive care unit admission; opioid PCA ordered > 24 hours after hospital admission; post-operative PCA; participation in a clinical trial; or discharge diagnosis other than VOC. Data were abstracted from subjects' medical records into a REDCap database. Opioid administration was recorded as morphine equivalents (1 mg hydromorphone = 6.667 mg morphine). Data were analyzed in SPSS version 21 (IBM, Armonk, NY). Continuous variables were compared with the independent-samples Mann-Whitney U-test, and categorical variables with Fisher's exact test. The level of significance was specified as p<0.05.Results:Of 303 hospitalizations identified during the study period, 101 met all criteria for analysis: 45 in 2012 (all regimen A) and 56 in 2013 (2 regimen A, 54 regimen B). The median number of hospitalizations per subject was 2 (range 1-8). Age, sex, SCD type, acute chest syndrome diagnosis, and hydroxyurea use were not significantly different between regimens.The median LOS was significantly shorter for regimen B hospitalizations at 5 days [interquartile range (IQR) 4, 6.25] versus 6 days (IQR 4, 9) for regimen A hospitalizations (p=0.004). The median total morphine equivalents administered per admission was significantly less in regimen B (150 mg, IQR 74.8-349) than in regimen A (246 mg, IQR 129-601; p=0.03). This was due to fewer morphine equivalents given by continuous infusion in regimen B hospitalizations (median 90.3 mg, IQR 52-158) than in regimen A (median 191 mg, IQR 102-361; p<0.001). Total morphine equivalents delivered by demand dose were not significantly different between groups (p=0.077), but a greater fraction of opioid was delivered by demand dose in regimen B (median 0.38, IQR 0.21, 0.48) compared to regimen A (median 0.09, IQR 0.021, 0.22) (p<0.001). Ondansetron was prescribed for nausea in 33.3% of regimen B versus 55.3% of regimen A admissions [odds ratio 0.65 for regimen B (95% confidence interval 0.43, 0.97, p=0.029)].Conclusion:In this cohort of children with SCD treated for VOC with two different opioid PCA regimens, lower continuous infusion/higher demand dose opioid resulted in significantly shorter LOS, less opioid exposure, and less use of antiemetics. Pain control may be improved when patients control a greater fraction of the opioid they receive. These results should guide future prospective studies of VOC management.TableRegimen ARegimen BMorphineContinuous infusion (CI)0.05-0.1 mg/kg/hour0.03 mg/kg/hourDemand dose0.0085-0.017 mg/kg (17% of CI)0.03 mg/kg(100% of CI)Demand dose lockout20 minutes20 minutesHydromorphoneContinuous infusion0.015 mg/kg/hour0.003 mg/kg/hourDemand dose0.0025 mg/kg(17% of CI)0.003 mg/kg (100% of CI)Demand dose lockout30 minutes20 minutes DisclosuresNo relevant conflicts of interest to declare.

Up-regulation of Bcl-2 expression in cultured human lymphocytes after exposure to low doses of gamma radiation.

Lymphocytes have demonstrated complex molecular responses to induced stress by ionizing radiation. Many of these reactions are mediated through modifications in gene expressions, including the genes involved in apoptosis. The primary aim of this study was to assess the effects of low doses of ionizing radiation on the apoptotic genes, expression levels. The secondary goal was to estimate the time-effect on the modified gene expression caused by low doses of ionizing radiation. Mononuclear cells in culture were exposed to various dose values ranged from 20 to 100 mGy by gamma rays from a Cobalt-60 source. Samples were taken for gene expression analysis at hours 4, 24, 48, 72, and 168 following to exposure. Expression level of two apoptotic genes; BAX (pro-apoptotic) and Bcl-2 (anti-apoptotic) were examined by relative quantitative real-time polymerase chain reaction (PCR), at different time intervals. Radio-sensitivity of peripheral blood mononucleated cells (PBMCs) was measured by the Bcl-2/BAX ratio (as a predictive marker for radio-sensitivity). The non-parametric two independent samples Mann–Whitney U-test were performed to compare means of gene expression. The results of this study revealed that low doses of gamma radiation can induce early down-regulation of the BAX gene of freshly isolated human PBMCs; however, these changes were restored to near normal levels after 168 hours. In most cases, expression of the Bcl-2 anti-apoptotic gene was up-regulated. Four hours following to exposure to low doses of gamma radiation, apoptotic gene expression is modified, this is manifested as adaptive response. Modification of these gene expressions seems to be a principle pathway in the early radioresistance response. In our study, we found that these changes were temporary and faded completely within a week.

Association between pseudoexfoliation syndrome and sensorineural hearing loss

PurposeThe aim of this study was to investigate the sensorineural hearing loss (SNHL) in patients with pseudoexfoliation (PXF) syndrome and its correlation with clinical ophthalmological findings.MethodsA total of 25 patients with PXF and 15 age-matched and sex-matched normal controls were subjected to complete ophthalmological and audiological evaluation. The degree of hearing loss was compared between the two groups and correlated with the clinical findings including glaucoma, cataract, and laterality of PXS. The independent-sample Mann-Whitney U-test, the Kruskal-Wallis one-way analysis of variance, the related-sample McNemar test and Pearson's correlation were used for statistical analysis.ResultsA total of 22 patients had bilateral symmetrical SNHL. Overall, three ears (6%) had normal hearing sensitivity, 29 ears (58%) had mild SNHL, 15 ears (30%) had moderate SNHL, and three ears (6%) had moderately severe SNHL. On an average, patients had mild degree of SNHL in the frequencies 250-2000 Hz, moderate degree of SNHL in the frequency 4000 Hz, and moderately severe SNHL in the frequency 8000 Hz. SNHL was not affected by the association of cataract or glaucoma. A total of 28 ears of the controls had mild degree of hearing loss and two ears had normal hearing sensitivity.ConclusionThe prevalence and severity of SNHL increases in cases of PXF compared with age-matched controls. This is not affected by the laterality of ocular involvement, or the presence or absence of cataract or glaucoma. This confirms the systemic nature of the disease and may add to difficulties during ophthalmic surgery when performed under local anesthesia due to difficulty in communication.

Serum clusterin as a tumor marker and prognostic factor for patients with esophageal cancer.

Background. Recent studies have revealed that clusterin is implicated in many physiological and pathological processes, including tumorigenesis. However, the relationship between serum clusterin expression and esophageal squamous cell carcinoma (ESCC) is unclear. Methods. The serum clusterin concentrations of 87 ESCC patients and 136 healthy individuals were examined. An independent-samples Mann-Whitney U test was used to compare serum clusterin concentrations of ESCC patients to those of healthy controls. Univariate analysis was conducted using the log-rank test and multivariate analyses were performed using the Cox proportional hazards model. Results. In healthy controls, the mean clusterin concentration was 288.8 ± 75.1 μg/mL, while in the ESCC patients, the mean clusterin concentration was higher at 412.3 ± 159.4 μg/mL (P < 0.0001). The 1-, 2-, and 4-year survival rates for the 87 ESCC patients were 89.70%, 80.00%, and 54.50%. Serum clusterin had an optimal diagnostic cut-off point (serum clusterin concentration = 335.5 μg/mL) for esophageal squamous cell carcinoma with sensitivity of 71.26% and specificity of 77.94%. And higher serum clusterin concentration (>500 μg/mL) indicated better prognosis (P = 0.030). Conclusions. Clusterin may play a key role during tumorigenesis and tumor progression of ESCC and it could be applied in clinical work as a tumor marker and prognostic factor.

Comparative evaluation of intragastric bile acids and hepatobiliary scintigraphy in the diagnosis of duodenogastric reflux

To assess the diagnostic value of a combination of intragastric bile acids and hepatobiliary scintigraphy in the detection of duodenogastric reflux (DGR). The study contained 99 patients with DGR and 70 healthy volunteers who made up the control group. The diagnosis was based on the combination of several objective arguments: a long history of gastric symptoms (i.e., nausea, epigastric pain, and/or bilious vomiting) poorly responsive to medical treatment, gastroesophageal reflux symptoms unresponsive to proton-pump inhibitors, gastritis on upper gastrointestinal (GI) endoscopy and/or at histology, presence of a bilious gastric lake at > 1 upper GI endoscopy, pathologic 24-h intragastric bile monitoring with the Bilitec device. Gastric juice was aspirated in the GI endoscopy and total bile acid (TBA), total bilirubin (TBIL) and direct bilirubin (DBIL) were tested in the clinical laboratory. Continuous data of gastric juice were compared between each group using the independent-samples Mann-Whitney U-test and their relationship was analysed by Spearman's rank correlation test and Fisher's linear discriminant analysis. Histopathology of DGR patients and 23 patients with chronic atrophic gastritis was compared by clinical pathologists. Using the Independent-samples Mann-Whitney U-test, DGR index (DGRi) was calculated in 28 patients of DGR group and 19 persons of control group who were subjected to hepatobiliary scintigraphy. Receiver operating characteristic curve was made to determine the sensitivity and specificity of these two methods in the diagnosis of DGR. The group of patients with DGR showed a statistically higher prevalence of epigastric pain in comparison with control group. There was no significant difference between the histology of gastric mucosa with atrophic gastritis and duodenogastric reflux. The bile acid levels of DGR patients were significantly higher than the control values (Z: TBA: -8.916, DBIL: -3.914, TBIL: -6.197, all P < 0.001). Two of three in the DGR group have a significantly associated with each other (r: TBA/DBIL: 0.362, TBA/TBIL: 0.470, DBIL/TBIL: 0.737, all P < 0.001). The Fisher's discriminant function is followed: Con: Y = 0.002TBA + 0.048DBIL + 0.032TBIL - 0.986; Reflux: Y = 0.012TBA + 0.076DBIL + 0.089TBIL - 2.614. Eighty-four point zero five percent of original grouped cases were correctly classified by this method. With respect to the DGR group, DGRi were higher than those in the control group with statistically significant differences (Z = -5.224, P < 0.001). Twenty eight patients (59.6%) were deemed to be duodenogastric reflux positive by endoscopy, as compared to 37 patients (78.7%) by hepatobiliary scintigraphy. The integrated use of intragastric bile acid examination and scintigraphy can greatly improve the sensitivity and specificity of the diagnosis of DGR.