Multivariate Tests Research Articles

Role of tumor-specific and whole-body imaging biomarkers for prediction of recurrence in patients with stage III colorectal cancer.

Imaging biomarkers are emerging as non-invasive predictors of cancer prognosis and clinical outcome. We assessed tumor-specific ("radiomics") and body composition imaging features ("morphomics") extracted from baseline pre-treatment CT for prediction of recurrence in patients with stage III colorectal cancer (CRC). Patients with newly diagnosed stage III CRC were enrolled in this prospective observational study. Patients with available preoperative scans were included (N = 101). The tumor, if visible, was manually segmented and first-order radiomics features were extracted with a commercially available software. The morphomics features (reflecting muscle, fat, and bone characteristics) were extracted in a standardized fashion using a proprietary software and the values were adjusted and normalized based on a reference standard. Time to recurrence was the final outcome. Correlation between demographics, clinical features, radiomics, and morphomics features and outcome were assessed using univariate and multivariate tests as well as Kaplan-Meier and log-rank tests. Morphomic analysis was performed in all 101 patients. 60 patients had discrete tumors suitable for radiomics analysis. These patients had lower ECOG score (p < 0.05), more muscle mass (p > 0.05), and lower fat density (p > 0.05) compared to the patients in whom radiomics analysis could not be performed. Pathological stage (HR: 2.69; p = 0.03), CEA level after surgery (HR: 1.11 for 1ng/mL; p < 0.005), bone mineral density (HR: 1.01 for 1 Hounsfield Unit; p < 0.01), and tumor skewness (HR: 0.33 for 1 unit; p < 0.05) had association with recurrence based on both univariate and multivariate analyses. A model using Cox's regression analyses was able to divide the patients into low-, medium-, and high-risk for recurrence. Both radiomics and morphomics features were independently associated with the risk of CRC recurrence and, when combined, each contributed valuable information to explain risk of recurrence. Clinical trial.gov NCT02842203. Patient recruitment occurred between 22/07/2016 and 18/03/2020.

THE EFFECTS OF 12 WEEKS BASIC GYMNASTICS EXERCISES ON BODY COMPOSITION AND LIPID PROFILES IN OBESE CHILDREN

Obesity is a major health concern in the world because it is associated with many diseases. It has been shown that basic gymnastics exercises effectively prevent and treat this problem. Therefore, the present study investigated the effect of 12 weeks of basic gymnastics exercises on body composition and lipid profile in obese girls. In this quasi-experimental study, with a design pre-test-post-test and a control group, 30 obese girls with Body Mass Index (BMI) at or above the 95th percentile and the average age of 9.4 years, were selected purposefully and were divided into 2 groups (Basic gymnastics training, and control) randomly. The training protocol was implemented for 12 weeks, three times a week, and 45 minutes for each session incrementally. Body composition and lipid profile indices were measured in two stages: pre-test and post-test. In order to analyze the data, multivariate covariance tests were used. The results of the study showed that the exercise intervention significantly reduced the fat percentage and BMI index in obese children (p≤0.001). In addition, a significant decrease in total cholesterol, triglyceride, and Low Density Lipoprotein Cholesterol (LDL-C) and a significant increase in High Density Lipoprotein Cholesterol (HDL-C) were observed (p≤0.002). These findings indicate the beneficial effects of basic gymnastics training on body composition and lipid profile in obese children. Therefore, the use of basic gymnastics training is recommended to improve these factors.

Does foliar fertilization with zinc enhance physiological pro-cesses and biofortify grains in bean cultivars?

Beans are one of the staple grains of the Brazilian diet and are strategic in combating malnutrition, since their grains are rich in iron. However, zinc (Zn) is another relevant micronutrient in issues related to malnutrition, but little is known about it in bean grains. Thus, the objective of this study was to evaluate the effects of foliar fertilization with Zn on physiological and productive processes and grain biofortification in bean cultivars. The experiment was conducted in randomized blocks, in a 10x2 factorial scheme, with 10 bean cultivars (BRS FP403; BRS Campeiro; BRS Esplendor; BRS Esteio; BRS FC310; BRS FC402; BRS FC415; BRS FC409; BRS Estilo and BRS Pérola) fertilized via foliar or not with Zn, with four replicates. The yield components of beans, chlorophyll fluorescence, chlorophylls a, b and total, carotenoids and pigments in leaves and Zn content in leaves and grains were evaluated. The evaluated characteristics showed significant differences by the multivariate tests of Wilks' Lambda, Pillai's Trait, Hotelling-Lawley's Trait and Roy's Maximum Root. Foliar fertilization with zinc enhanced physiological processes and biofortified grains in bean cultivars, especially in the materials BRS FC409, BRS FC310, BRS FC402 and BRS Pérola.

Effects of a multidisciplinary program with physical exercise in pediatric obesity

Abstract Background Childhood obesity is a growing public health concern worldwide, with prevalence rates increasing in recent decades. This epidemic not only predisposes children to immediate health risks such as cardiovascular disease and musculoskeletal problems but also significantly increases their risk of obesity-related comorbidities in adulthood. Recognizing the multifactorial nature of pediatric obesity, interventions targeting lifestyle modifications are crucial to its control. Among these interventions, physical exercise emerges as a cornerstone in combating pediatric obesity. Purpose Our study examines the effectiveness of a twelve-week online physical exercise program on body composition and functional capacity in children and adolescents with obesity. Methods The sample consists of 30 participants (9 girls and 21 boys, aged 11-17 y) from the Pediatrics Department of Senhora da Oliveira Hospital in Guimarães (HSOG). Using standardized protocols, anthropometric measures (body weight and waist circumference) were measured. Functional capacity was assessed through squats, push-ups, and elbow plank tests (maximum repetitions in 60 seconds). All analyses were done using SPSS software, and the alpha level was 5%. Results Significant impacts of the exercise program were observed in body weight and waist circumference variables. Multivariate tests indicated a statistically significant interaction between the Moment*Groups factors (weight p = 0.040; waist circumference p = 0.007). Moreover, functional capacity was also influenced by the exercise program (squat p = 0.034; push-ups p = 0.013; and elbow plank p = 0.025). Conclusions Our results underscore the significant public health impact of integrating physical exercise into a multidisciplinary program for pediatric obesity. Innovative use of online interventions facilitated broader reach and accessibility, resulting in measurable improvements in body weight, waist circumference, and functional capacity among participants. Key messages • Integrating exercise into multidisciplinary programs improves pediatric obesity outcomes. • Online interventions broaden accessibility and effectiveness in preventing childhood obesity.

Identifying missing tools in aortic systolic upstroke parameter for valvular aortic stenosis diagnosis

Abstract Background Echocardiography is a widely accepted method for diagnosing severe aortic stenosis (AS), but it has certain limitations. Alternative methods, such as the direct catheter-based crossing of the valves, carry a risk of stroke. Delayed aortic upstroke parameters might predict the severity of aortic stenosis. Objective This study aimed to investigate the diagnostic utility of measuring catheter-based aortic acceleration time with ejection (AT/ET) for the diagnosis of severe aortic stenosis, including low-gradient (LG) AS. Methods We included 139 patients who underwent cardiac catheterization at our hospital, including patients with varying degrees of AS. Patients with LGAS were classified byan algorithm according to ESC guideline. All patients received echocardiographicassessments and direct hemodynamic measurements of AT/ET. The association between AT/ET and AS severity and other conventional utilities was analyzed using logistic regression and ROC analysis. Results Among the 139 patients, 73 had severe AS (52.5%), and 20 also had low gradient (27.3%). The mean AT/ET was 0.33 in the severe AS group and 0.28, 0.24 in moderate, and mild-no AS patients, respectively. AT/ET was significantly correlated with conventional echocardiographic and hemodynamic parameters. Furthermore, AT/ET is the strongest predictor of severe aortic stenosis using the multivariable test with relevant variables (OR; 2.01, 95% CI 1.17-3.45). Using a cut-off value of 0.30, catheter-based AT/ET had a sensitivity of 80% and specificity of 92% for diagnosing severe AS (AUC 0.94, 95% CI 0.90-0.97), withconsistent results from subgroup LGAS (AUC 0.94, 95% CI 0.93-0.99). Conclusion This study supports the use of catheter-based AT/ET of greater than 0.30 as a complementary diagnostic tool for severe aortic stenosis across the spectrum of low-gradient AS. Further studies are needed to validate these findings in larger, multicenter studies with more diverse patient populations.

Assessment of body composition in young adulthood and its associations to early changes in cardiovascular phenotypes: a cross-sectional study

Abstract Introduction Obesity in young adulthood is associated with various cardiovascular structural and functional changes, commonly used as markers of early subclinical cardiovascular disease. Whether these changes occur predominantly in relation to increased fat mass (FM) or are instead more closely related to simultaneous increases in underlying fat-free mass (FFM) that are known to occur in obesity, is incompletely understood. Purpose To investigate associations between both FM and FFM and a wide range of cardiac (left ventricular mass, LVM; end-diastolic volume, EDV; cardiac output, CO; stroke volume, SV), vascular (systolic blood pressure, SBP; diastolic blood pressure, DBP; mean arterial pressure, MAP; systemic vascular resistance, SVR) and autonomic (heart rate variability triangular index, HRVTI; baroreceptor reflex sensitivity, BRS) phenotypes commonly used to monitor the early evolution of subclinical CVD. Methods The study used data from extensive adipose and cardiovascular phenotyping of 408 healthy young adults (mean age 21 years) participating in a sub-study of the long-running ALSPAC birth cohort. We performed cross-sectional analysis using multiple imputation, multivariable linear regression and interaction testing to assess the association between both FM and FFM and cardiovascular phenotypes. Results Our study revealed that FFM resulted in a much greater increase in CO (difference in outcome per 1-SD difference in exposure β=0.58L/min, p&amp;lt;0.01, 95% CI=0.38, 0.77) than FM (β=0.20L/min, p=0.01, 95% CI=0.05, 0.36), following adjustment for both tissue types. FFM was also associated with an increase in LVM (β=19.1g, p&amp;lt;0.01, 95% CI=16.61, 21.58), EDV (β=22ml, p&amp;lt;0.01, 95% CI=18.18, 25.13) and SV (β=13ml, p&amp;lt;0.01, 95% CI=10.96, 15.75). FFM was also associated with improved autonomic and peripheral vascular function, including lower HR (β=-4bpm, p&amp;lt;0.01, 95% CI=-6.12, -1.95), higher HRVTI (β=2.1, p&amp;lt;0.01, 95% CI=0.72, 3.48) and lower SVR (β=-1.1, p&amp;lt;0.01, 95% CI=-2.12, -1.07), resulting in unchanged MAP despite elevations in CO. On the contrary, FM was not associated with LVM (β=-0.91g, p=0.35, 95% CI=-2.85, 1.02), and was associated with lower EDV (β=-4.62ml, p&amp;lt;0.01, 95% CI=-7.34, -1.88) and reduced autonomic function, as seen with HRVTI (β=-1.83, p&amp;lt;0.01, 95% CI=-3.02, -0.64) and BRS (β=-2.47, p=0.01, 95% CI=-4.27, -0.67). FM was also associated with increased HR (β=3.26bpm, p&amp;lt;0.01, 95% CI=1.57, 4.94) and increased SBP (β=2.14mmHg, p&amp;lt;0.01, 95% CI=1.01, 3.27) DBP (β=2.68mmHg, p&amp;lt;0.01, 95% CI=1.60, 3.77), and MAP (β=2.34mmHg, p&amp;lt;0.01, 95% CI=1.34, 3.34). Conclusion In young adults, changes in surrogate clinical markers of cardiac, vascular, and autonomic function commonly attributed solely to increases in fat mass should be interpreted with caution as they may be associated with underlying changes in FFM. Future work should focus on longitudinal studies of this cohort to confirm remodelling patterns based on these clinical markers.

Exploring the Impacts of Artificial Intelligence Interventions on Provider Practice practice

Abstract Background Despite the growing prevalence of AI in healthcare, there has been a lack of recent studies exploring its impact on providers’ practices and patient outcomes. This study investigates healthcare providers’ perceptions of AI interventions’ influence on their practice efficiency and patient outcomes, as well as the correlation between providers’ perceptions of AI and its effects on patient outcomes. Methods A self-administered questionnaire was mailed to 38 healthcare providers at a rural medical center in north Texas, with a 70% percent response rate (n = 27). In addition to descriptive statistics, multivariable logistic regression test was conducted to discern the relationship between their perceptions of AI and its impact on patient outcomes. Results The findings revealed that a majority of providers perceived AI to still be in its early stages, posing challenges for practice and having a limited impact on patient outcomes. Additionally, various factors such as age, gender, a user-centered design approach, AI experience, along with perceptions of workplace support and stress, significantly shape providers’ attitudes toward AI and ultimately affecting patient outcomes. Conclusions Before AI technology can fulfill its promise of transforming healthcare through integration with other technologies, the healthcare sector must address numerous hurdles. It is crucial to approach the development and testing of intricate systems like AI-integrated electronic health record (EHR) systems with caution to ensure their reliability and dependability in clinical decision-making. Additionally, navigating medico-legal responsibilities and pursuing fair distribution of benefits are equally crucial. Key messages • This study offers insights into the extent of AI interventions’ impact on healthcare. • This study specifically focuses on enhancing patient care, reducing costs, and improving the efficiency of the healthcare system.

Efficiency of multivariate tests in trials in progressive supranuclear palsy

Measuring disease progression in clinical trials for testing novel treatments for multifaceted diseases as progressive supranuclear palsy (PSP), remains challenging. In this study we assess a range of statistical approaches to compare outcomes as measured by the items of the progressive supranuclear palsy rating scale (PSPRS). We consider several statistical approaches, including sum scores, a modified PSPRS rating scale that had been recommended by FDA in a pre-IND meeting, multivariate tests, and analysis approaches based on multiple comparisons of the individual items. In addition, we propose two novel approaches which measure disease status based on Item Response Theory models. We assess the performance of these tests under various scenarios in an extensive simulation study and illustrate their use with a re-analysis of the ABBV-8E12 clinical trial. Furthermore, we discuss the impact of the FDA-recommended scoring of item scores on the power of the statistical tests. We find that classical approaches as the PSPRS sum score demonstrate moderate to high power when treatment effects are consistent across the individual items. The tests based on Item Response Theory (IRT) models yield the highest power when the simulated data are generated from an IRT model. The multiple testing based approaches have a higher power in settings where the treatment effect is limited to certain domains or items. The study demonstrates that there is no one-size-fits-all testing procedure for evaluating treatment effects using PSPRS items; the optimal method varies based on the specific effect size patterns. The efficiency of the PSPRS sum score, while generally robust and straightforward to apply, varies depending on the specific patterns of effect sizes encountered and more powerful alternatives are available in specific settings. These findings can have important implications for the design of future clinical trials in PSP and similar multifaceted diseases.

Association of time to start of enteral nutrition and outcome in cats with hepatic lipidosis.

Enteral nutrition (EN) is essential for management of hepatic lipidosis (HL) in cats. To determine if time to start of EN and other clinicopathologic variables are associated with outcome in cats with HL. Forty-eight cats with HL. Retrospective study. Information retrieved from medical records and client communications included clinicopathologic findings, time to start of EN, initial % of resting energy requirements provided, type of feeding tube, duration of hospitalization, and 3-month survival. Variables were compared between surviving and nonsurviving cats and between cats fed ≤12 hours and >12 hours after hospital admission. Multivariable statistical testing was performed to further investigate variables of interest. Seventeen of 25 (68%) cats fed ≤12 hours and 13 of 23 (57%) of cats fed >12 hours after hospital admission survived (P = .55). Only increasing age (odds ratio [OR], 1.313; 95% confidence interval [CI], 1.032-1.671; P = .03) and the presence of ascites (OR, 6.415; 95% CI, 1.354-30.395; P = .02) were associated with death in multivariable analysis. Hospitalization duration (median, interquartile range [IQR]) was shorter in cats fed >12 hours (2.8 days; IQR, 2.1-3.8 days) as compared with cats fed ≤12 hours (4.8 days; IQR, 3.6-6.2 days) after hospital admission (P < .001). An initial stabilization period before EN introduction does not decrease survival or increase duration of hospitalization in cats with HL.

Naturalization of the Ornamental Plant Crocus tommasinianus Herb. (Iridaceae) in Forest Ecosystems: A Case Study from Poland

Highlights: Though not highly invasive, bulb and corm ornamental plants can escape cultivation and naturalize in new areas. Studying their naturalization is key to understanding their ecological impact and managing biodiversity. Objectives: This study aimed to document the first naturalization case of Crocus tommasinianus Herb. in Poland and assess the morphological variability of the naturalized population under different environmental conditions. Another objective was to identify diagnostic features in seed testa ornamentation to distinguish C. tommasinianus from related species (C. vernus (L.) Hill. and C. scepusiensis (Rehmann et Wol.) Borbás ex Kulcz.). Methods: The morphometric studies were performed within four subpopulations of C. tommasinianus differing in environmental conditions, determined with Ellenberg indices. Multivariate tests, ANOVA, and post-hoc tests were used to determine the morphometric diversity of specimens and to relate them to environmental factors. Seed micro-ornamentation was examined using a scanning electron microscope. Results: Light and temperature were negatively correlated, while moisture, soil pH, and nitrogen were positively correlated with many morphological traits. Plants spreading into forest ecosystems exhibited better-developed features (larger leaves and flowers) than those in former cultivation sites, indicating higher survival potential. The seed coat is papillate, with distinct differences in the shape, size, and secondary sculpture of the papillae compared to C. vernus and C. scepusiensis. Given that floristic studies often occur during the fruiting period of crocuses, testa ornamentation is crucial for identifying the studied species. Conclusions: The observed naturalization of C. tommasinianus demonstrates the high morphological plasticity of plants, which makes them capable of colonizing new areas, including forest habitats.

Latent factors affecting safer injection practices that can reduce infections and how education can improve them.

The incidence of healthcare-associated infections, particularly injection-related infections, can increase patient comorbidities even in countries with adequate medical resources. Although there are clear guidelines for injection practices to prevent infections, their application in clinical settings is insufficient. Therefore, the objective of this study was to identify factors affecting injection practices associated with reduced infections by conducting surveys targeting practicing healthcare providers involved in administering injections at each healthcare organization and performing data analysis. We administered a survey to healthcare providers responsible for injection practices at each healthcare organization that included items related to infection-safe injection practice guidelines. All survey questions were reviewed by an expert panel of infectious disease and infection control nurses. Survey contents were subjected to exploratory factor analysis (EFA), confirmatory factor analysis, and multivariable robust regression tests to determine the impact of each factor and their correlations. A total of 842 questionnaires were analyzed. Each questionnaire was classified into four factors: reuse and contamination, compliance with aseptic technique, exchange of infusion set, and use of multidose vials. Nurses with higher careers showed more compliance. Education within one year and awareness of each item of the questionnaire had positive associations with proper injection practice. Education is thought to be the most important factor in good injection practices that could reduce infections. Relevant knowledge through timely training is expected to have a positive impact on performance and compliance related to safe injections.

Clinical and Functional Outcomes Associated with Quality of Life in Patients with Lymphangioleiomyomatosis: A Cross-Sectional Study.

Lymphangioleiomyomatosis (LAM) is a rare (twenty-one per million female inhabitants) neoplastic cystic lung disease that impairs health-related quality of life (HRQoL). However, the factors associated with impaired quality of life in patients with LAM are poorly understood. To assess the clinical, psychosocial, and functional characteristics associated with impaired quality of life in patients with LAM. This was a cross-sectional study performed on two nonconsecutive days. HRQoL (SF-36 and CRQ), lung function tests, anxiety and depression symptoms (HADS), maximal (CPET and ISWT), and submaximal exercise capacity (6MWT) were assessed. Linear associations among outcomes were assessed using Pearson's correlation and multivariate tests. Forty-five women with LAM (46 ± 10.years; FEV1,74%pred) were evaluated. The lowest SF-36 scores were observed for general health and vitality and the highest for the physical and social domains. The lowest CRQ scores were observed for dyspnea and fatigue, and the highest were for the emotional function and self-control domains. Sixteen (35%) women had anxiety, and 8 (17%) had depression symptoms. Most of the SF-36 and CRQ domains were associated with anxiety and depression symptoms (from r = 0.4 to r = 0.7; p < 0.05) and exercise capacity (from r = 0.3 to r = 0.5; p < 0.05). Lung function parameters were weakly or not associated with quality of life domains. After multiple linear regression, HRQoL was independently associated with depression symptoms and physical capacity but not with lung function. Our results show that aerobic capacity and depression symptoms are the main factors, rather than lung function, related to quality of life in patients with LAM.

Exploring Connections Between Living Situations and Antipsychotic Prescribing Practices for People With Intellectual Disabilities

ObjectiveAntipsychotic prescribing practices in people with intellectual disabilities (ID) have sparked growing concerns about appropriateness and potential risks. The connection between living situations and antipsychotic prescribing practices in this population is a crucial but underexplored area. This study aims to investigate the association between living situation and antipsychotic prescriptions among people with ID.MethodsThis retrospective chart review included 112 adults with ID who received care from 2019 to 2021. The investigation examined participants' living situations and assessed antipsychotic prescription rates, antipsychotic class, the presence of a corresponding mental health diagnoses, and polypharmacy. Statistical analyses included univariate and multivariate tests to assess the relationship between living situations and antipsychotic prescriptions, controlling for relevant covariates.ResultsUnivariate analysis revealed a significant association between living situation and antipsychotic prescriptions (p &lt; 0.05), with patients in non‐familial support homes and group homes more likely to receive antipsychotics. However, multivariate analysis did not confirm this association after adjusting for other variables. Male gender (OR = 4.207, 95% confidence interval (CI) 1.721–10.286) and total medication count (OR = 1.101, 95% CI 1.038–1.169) emerged as significant predictors of antipsychotic prescriptions.ConclusionsThese findings highlight the complexity of antipsychotic prescribing practices among people with ID. While living situation initially appeared to influence prescription patterns, multivariate analysis suggests the importance of considering other factors. Gender and medication count emerge as significant predictors, underscoring the need for tailored interventions and closer monitoring in this population.

Analysis of Demographics Characteristics on Depression in Perimenopausal Staff at a Central General Hospital in Medan, Indonesia

Introduction/Objective Perimenopause is a period where the ovary gradually starts to produce less estrogen. One of the impacts that could happen during perimenopause is the onset of depression arising from hormonal and metabolic disorders due to the significant decrease of ovarium function and secretion of endogenous estrogen. This study was conducted to assess the factors related to depression in perimenopausal women. Methods A multivariate linear regression analysis with a cross-sectional design was conducted at a Central General Hospital in Medan, Indonesia, from October 2023 to January 2024. Subjects were perimenopausal female staff at the hospital who met the inclusion and exclusion criteria. Symptoms of depression were assessed using the Beck Depression Inventory-II (BDI-II) score. Data analysis was conducted using bivariate and multivariate tests with linear regression. Results A total of 111 subjects were included in this study. The median age was 48 years, and the median Body Mass Index (BMI) was 25. The mean depression score based on BDI-II was 12.96±7.084. Bivariate analysis showed significance on age, years of education, total monthly income, BMI, and number of pregnancies. Multivariate analysis showed that total monthly income had the highest correlation amongst other variables, followed by age, while the number of pregnancies had the lowest correlation. Conclusion In conclusion, there was a significance between depression and age, income, and number of pregnancies in perimenopausal staff. On the other hand, there was no significance between depression and years of education, BMI, marital status, and chronic disease.

Exclusive Breastfeeding Among Adolescent Mothers in Indonesia: Does Maternal Education Level Matter?

Exclusive breastfeeding (EBF) is a vital element in the early stages of life. Feeding newborns solely breast milk from birth until they are six months old is sufficient. However, EBF by adolescent mothers is still not optimal. The study analyzed the effect of maternal education on EBF among babies with adolescent mothers in Indonesia. The cross-sectional study examined 560 babies (a–5 months). We analyzed EBF practice as a dependent variable. We included six mothers' characteristics (education, residence, age, marital, employment, and wealth) and two baby characteristics (sex and early breastfeeding initiation) as independent variables. In this study, the initial stage was a bivariate analysis using chi-square. Then, a multicollinearity test was conducted to ensure no strong relationship between the independent variables. Finally, a multivariate test was conducted to determine the factors of EBF in babies with adolescent mothers. The results showed that adolescent mothers with primary education were 2.920 times more likely than those without education to perform EBF (AOR = 2.920, 95% CI [2.521–3.382]). Moreover, adolescent mothers with secondary education were 2.325 times more likely to achieve EBF than those without (AOR = 2.325, 95% CI [2.001–2.701]). The study concluded that all education levels were likelier to perform EBF than those without formal education. Further research is needed to understand the breastfeeding experience of adolescent mothers. Exceptional support and attention regarding EBF should be directed to adolescent mothers who are without formal education.

Risk factors for relapse of immune-related pneumonitis after 6-week oral prednisolone therapy: a follow-up analysis of a phase II study.

Immune-related pneumonitis (irP) is one of the most important immune-related adverse events caused by immune checkpoint inhibitors (ICIs). After corticosteroid therapy irP frequently relapses, which can interfere with cancer therapy. However, risk factors for irP relapse are unknown. This study was a follow-up analysis of a phase II study that evaluated 56 patients with grade ≥ 2 irP treated with oral prednisolone, 1mg/kg/day, tapered over 6 weeks. Clinical factors including patient characteristics, blood test findings, and response to prednisolone therapy were assessed to identify risk factors for irP relapse using the Fine-Gray test. Among 56 patients with irP, 22 (39.3%) experienced irP relapse after 6 weeks of prednisolone therapy during the follow-up observation period. Radiographic organising pneumonia (OP) pattern and duration to irP onset ≥ 100 days from ICI initiation were determined to be significant risk factors for irP relapse in a multivariate Fine-Gray test (hazard ratio [HR] = 3.17, 95% CI 1.37-7.32, p = 0.007, and HR = 2.61, 95% CI 1.01-6.74, p = 0.048, respectively). Other patient characteristics, blood test findings, irP severity, and response to prednisolone therapy were not associated with irP relapse. In irP patients treated with 6-week prednisolone tapering therapy, OP pattern and duration to irP onset ≥ 100 days were associated with relapse risk. Assessment of the risk factors for irP relapse will be helpful for irP management.

Energy and exergy analysis and performance optimization of buildings integrated with transpired solar collectors and phase change materials

Transpired solar collectors (TSCs) are one of the cost-effective air heating technologies that can be easily installed on building facades to provide heated fresh air to condition indoor space. The economics of TSCs can be further enhanced by integrating with phase change materials (PCMs). This study presents the performance investigation and optimization of a building-integrated TSC and PCM system (TSC-PCM). The interactions between PCM thermal properties, their locations in the building envelope, and TSC design parameters were investigated. Based on the modeling of the TSC-PCM by using energy balance and enhanced enthalpy method, a series of orthogonal tests, which varied PCM type, thickness, and location within building envelopes, and TSC suction flow rate were conducted. Multivariate testing, through the Taguchi method, was then applied to identify the optimal design combination. The results showed that the suction flow rate of the TSC-PCM on the external wall showed the highest influence on enhancing indoor thermal performance (up to 77.6%), followed by PCM location on the external wall (up to 9.2%). The optimized TSC-PCM system improved the thermal comfort increase index (TCI) to 3.7 and achieved a maximum thermal efficiency of 401.8%, with an exergy improvement of 26.9% in comparison with the use of the TSC-only. The optimized TSC-PCM system increased the average indoor room temperature to 18.8 oC, which was 6.8% and 18.2% higher than the use of the TSC-only and a baseline without using PCM and TSC, respectively.

The Association between the Duration of Anterior Cruciate Ligament Rupture-reconstruction with Meniscal Lesions and Knee Functional Outcomes

Background: Given the controversial correlation between the duration of anterior cruciate ligament (ACL) rupture-reconstruction and knee functional outcomes reported in previous studies, this study aimed to investigate the correlation between the duration of ACL rupture-reconstruction with knee meniscal lesions and functional outcomes. Patients and Methods: This retrospective cohort study was conducted on 221 patients with ACL rupture who underwent ACL reconstruction at a referral hospital in Tehran, Iran, from April 2021 to May 2023. Demographic characteristics and data about the duration of ACL rupture reconstruction were collected using the patients’ clinical documents. The status of knee meniscal lesions had been evaluated using magnetic resonance imaging report or operation note. After that, knee functional outcomes had been assed using Osteoarthritis Outcome Score scale. The correlation between the duration of ACL rupture-reconstruction with knee meniscal lesions and functional outcomes was evaluated using the multivariate regression test. Results: Most patients were male, with a mean age of 28.38 ± 7.33 years. The correlation between the duration of ACL rupture-reconstruction and knee meniscal lesions was statistically significant (P = 0.026); however, the correlation between the duration of ACL rupture-reconstruction with the KOOS questionnaire scale score and all its dimensions as a scale for assessing knee outcomes was not significant (P &gt; 0.05). Conclusion: Although early ACL reconstruction is accompanied by reduced knee meniscal lesions, this cannot improve knee functional outcomes.

Significance-Based Decision Tree for Interpretable Categorical Data Clustering

Numerous clustering algorithms prioritize accuracy, but in high-risk domains, the interpretability of clustering methods is crucial as well. The inherent heterogeneity of categorical data makes it particularly challenging for users to comprehend clustering outcomes. Currently, the majority of interpretable clustering methods are tailored for numerical data and utilize decision tree models, leaving interpretable clustering for categorical data as a less explored domain. Additionally, existing interpretable clustering algorithms often depend on external, potentially non-interpretable algorithms and lack transparency in the decision-making process during tree construction. In this paper, we tackle the problem of interpretable categorical data clustering by growing a decision tree in a statistically meaningful manner. We formulate the evaluation of candidate splits as a multivariate two-sample testing problem, where a single p-value is derived by combining significance evidence from all individual categories. This approach provides a reliable and controllable method for selecting the optimal split while determining its statistical significance. Extensive experimental results on real-world data sets demonstrate that our algorithm achieves comparable performance in terms of cluster quality, running efficiency, and explainability relative to its counterparts.

Relation Between Multiplication of Venous Carbon Dioxide Partial Pressure (PvCO2) and the Ratio of Gas Flow to Pump Flow (Ve/Q) with Hyperlactatemia During Cardiopulmonary Bypass.

The incidence of hyperlactatemia due to hypoperfusion during cardiopulmonary bypass (CPB) increases morbidity. Carbon dioxide production during CPB is one of the lactate production markers, in addition to other markers such as delivery oxygen (DO2), oxygen consumption (VO2), mixed vein oxygen saturation (SvO2), and oxygen extraction ratio (O2ER). This observational analytic study was conducted on 40 adult cardiac surgery patients using a CPB machine. Initial lactate is taken when entering CPB and final lactate is examined 15 min after coming off bypass. The values of DO2, VO2, SvO2, VCO2, respiratory quotient (RQ), DO2/VCO2, PvCO2 × Ve/Q were calculated from the results of blood and venous gas analysis 1 h after entering CPB in the nadir of core temperature and lowest pump flow. The multivariate test showed that the value of PvCO2 × Ve/Q was more effective than other oxygenation and carbon dioxide parameters in predicting an increase in the percentage of lactate. Each increase of 1 mmHg PvCO2 ×× Ve/Q can predict a final lactate increase of 29% from the initial lactate. The high PvCO2 × Ve/Q value is also the strongest correlation factor for the incidence of hyperlactatemia after CPB (final lactate >3 mmol/L). The cutoff value of this marker is >19.3 mmHg, which has a sensitivity of 100% and a specificity of 55.6% with a strong correlation value. The PvCO2 × Ve/Q value proved to be one of the significant markers in predicting hyperlactatemia during cardiac surgery using CPB.