Non-parametric Wilcoxon Test Research Articles

ALTERATIONS IN KNOWLEDGE, ATTITUDE, AND BEHAVIOURAL PATTERNS OF DENTISTS IN CIMAHI, INDONESIA REGARDING DENTAL MEDICAL WASTE MANAGEMENT POST COVID-19 PANDEMIC

Management of dental medical waste is essential in preventing the spread of diseases, especially during the COVID-19 pandemic. The COVID-19 pandemic has increased the amount of medical waste in healthcare facilities, including dental practices. This study aims to determine the changes in dentists' knowledge, attitudes, and behaviours regarding the management of dental and medical waste after the COVID-19 pandemic. The research used a survey with an observational analytical approach, quantitative methods, and a cross-sectional research design. The research sample or respondents were 50 dentists practising independently in Cimahi. Data collection used questionnaire about dentists' knowledge, attitudes, and behaviours regarding managing dental and medical waste before and after the COVID-19 pandemic. The results of the Wilcoxon non-parametric test showed that the knowledge and attitudes of dentists regarding the management of dental medical waste after the COVID-19 pandemic experienced significant changes statistically (p < 0.05). However, dentists' behaviour in managing dental and medical waste did not show substantial statistical changes (p > 0.05). The study results concluded that the COVID-19 pandemic has positively impacted increasing dentists' awareness of the importance of managing medical waste. However, reinforcement is needed to maintain the good behaviour of dentists in managing dental medical waste.

Service-Learning in Biochemstry Course: A Model to Improve the Problem-Solving Skills of Biology Education Students

Collaboration, communication, and problem-solving skills are becoming increasingly important in the modern workplace. Integration of learning activities, research, and community service was discovered to be an effective way to develop these abilities in students. The present study employed a mixed-methods sequential explanatory design to examine the effect of the service-learning model on seventeen college students. Observation, interview, and a problem-solving test were used to collect the data. The data were analyzed qualitatively and quantitatively. The quantitative data analysis was performed using the parametric pretest and post-test design. The results showed that participants’ problem-solving skills improved after being exposed to the service-learning model, indicated by the significance value of more than 0.05 in the non-parametric Wilcoxon test. Likewise, the qualitative analysis indicated that 95% of the participants considered the SL model effective in improving their problem-solving skills, especially the abilities to explore content, identify problems, solve the problems, and communicate scientific concepts.

EDUPERES and GAMERES: A smart interactive education platform and digital gamification for basic circuit analysis

AbstractThis paper introduces Education Platform for Equivalent Resistance (EDUPERES) and Gamification of Equivalent Resistance (GAMERES), two different parts of a new computer aided education platform with interactive and imaginative design and game elements, which have been created during 4 years. In Vocational School of Transportation of Eskişehir Technical University, electrical circuit analysis is a compact course which exhaustively yet quickly covers all the DC and AC circuit concepts. During the course, it is observed that some students have difficulties in some basic capabilities such as calculation of equivalent resistance of either a standard or a compact circuit, dividing currents, and so on. More sadly, this inability spreads to the rest of the semester. This study aims to overcome this issue through a smart interactive education platform and gamification. The first part, that is, EDUPERES visualizes and animates the solutions of electrical circuits. To make the students exercise circuit questions, it provides an interface which simulates the comfort of using paper and pencil. This platform is powered by a smart algorithm to watch almost all of the actions of the students and to give prompt warnings. It allows students to transform the shapes of compact circuits during circuit reduction. The second part, that is, GAMERES imaginatively converts the circuit questions into action, competition, shooter, puzzle, and maze games. Via box plots and Mann–Whitney–Wilcoxon nonparametric tests, it is shown that EDUPERES and GAMERES can significantly increase students' learning. The success of EDUPERES and GAMERES is discussed with regard to previous studies and gamers' motivations.

PSII-11 Achieving heavier piglet weights at weaning with live yeast (Saccharomyces cerevisiae) supplementation under field conditions

Abstract The benefits of live yeast supplementation during both gestation and lactation on piglet performance, nutrient digestibility and immune status have been well reported. However, the application of live yeast to gestation diets in some commercial practices may not be warranted. Therefore, the objective of this study was to evaluate the effect of feeding live yeast to lactating sows on piglet performance at weaning under field conditions. Before start of the study, a total of 268 Camborough L42 gestating sows were fed a restricted, commercial diet. From ≈112 d of gestation until weaning, sows were fed a commercial lactation mash diet with or without inclusion of live yeast (Vistacell, AB Vista, UK) at 1 kg/t. Piglets were cross-fostered within treatment to standardize piglet numbers on sows, and weaned at approximately 24 d. Body weights of piglets at weaning were collected from around 40% of sows. Data were statistically analyzed by Mixed Model using JMP Pro v.16.2 software (SAS Institute Inc, Cary, NC), with significance being accepted at P < 0.05. Treatment was included as a fixed factor in all models, with sow ID and piglet ID nested within treatment included as random variables for sow and piglet performance, respectively. The interaction between treatment and parity was also included in the model for sow performance. Sow parities of 4 and above were combined into one group. Proportional piglet body weights were assessed by non-parametric Wilcoxon Test. An interaction between treatment and parity was shown for average daily feed intake (ADFI), whereby parity-1 sows fed the control diet and parities-3 and -4 sows fed live yeast had greater feed intakes than parity-2 sows fed live yeast. Sow body weights and body condition scores at weaning were unaffected by treatment. Piglet body weights at processing, the number of piglets weaned and weaning ages were also unaffected by treatment. However, piglets from sows fed live yeast were significantly heavier (7.12 kg vs. 6.85 kg) at weaning than piglets from sows fed control diets (P < 0.01). In addition, the proportion of piglets at weaning with body weights of less than 7 kg tended to be fewer (45% vs. 55%), with a greater percentage of heavier (>7 kg) piglets, from sows supplemented with live yeast (P = 0.08). In conclusion, these findings indicate that supplementing live yeast solely to the lactating sow can promote growth of nursing piglets leading to improved piglet performance at weaning.

A multi-stage integrated model based on deep neural network for credit risk assessment with unbalanced data

PurposeWith the rapid growth of the domestic lending industry, assessing whether the borrower of each loan is at risk of default is a pressing issue for financial institutions. Although there are some models that can handle such problems well, there are still some shortcomings in some aspects. The purpose of this paper is to improve the accuracy of credit assessment models.Design/methodology/approachIn this paper, three different stages are used to improve the classification performance of LSTM, so that financial institutions can more accurately identify borrowers at risk of default. The first approach is to use the K-Means-SMOTE algorithm to eliminate the imbalance within the class. In the second step, ResNet is used for feature extraction, and then two-layer LSTM is used for learning to strengthen the ability of neural networks to mine and utilize deep information. Finally, the model performance is improved by using the IDWPSO algorithm for optimization when debugging the neural network.FindingsOn two unbalanced datasets (category ratios of 700:1 and 3:1 respectively), the multi-stage improved model was compared with ten other models using accuracy, precision, specificity, recall, G-measure, F-measure and the nonparametric Wilcoxon test. It was demonstrated that the multi-stage improved model showed a more significant advantage in evaluating the imbalanced credit dataset.Originality/valueIn this paper, the parameters of the ResNet-LSTM hybrid neural network, which can fully mine and utilize the deep information, are tuned by an innovative intelligent optimization algorithm to strengthen the classification performance of the model.

The Effectiveness of Case-Based STEM Integrated with Mobile Simulation to Foster Students’ Creative Thinking Skills

This study aims to determine the effect of case-based science, technology, engineering, and mathematics (STEM) integrated with mobile simulation on fostering students’ creative thinking skills. This study utilized an experimental design, specifically a pretest-posttest control group design. The research subjects were 40 students from a university in Surabaya City. The research instrument used was a test measuring creative thinking ability. The data was analyzed using the Wilcoxon non-parametric test because it was not normally distributed. The results showed that: (1) there is a statistically significant difference between the initial test and the final test; (2) there is a significant increase in the creative thinking ability of students who participate in oscillation-based STEM Embedded learning with mobile simulation; (3) there is a positive relationship between the use of mobile simulation and students’ STEM Embedded creative thinking ability. The conclusion of this study is that case-based STEM embedded oscillation with mobile simulation is effective in improving students’ creative thinking skills.

Análisis de microorganismos funcionales y su relación con parámetros fisicoquímicos del suelo en un bosque reservado

Este estudio aborda la necesidad de entender la presencia microorganismos funcionales en suelos tropicales, proporcionando información valiosa para la conservación y manejo sostenible. Tiene como principal objetivo analizar la variabilidad de microorganismos funcionales en diferentes profundidades del suelo y las correlaciones con los parámetros fisicoquímicos. Para ello se recolectaron muestras de suelo de 15 puntos aleatorios en un bosque reservado y se analizaron propiedades fisicoquímicas y microbiológicas a dos profundidades (10 y 20 cm). Se cuantificaron los siguientes microorganismos funcionales: aerobios viables, lactobacilos, actinomicetos, hongos y bacterias fijadoras de nitrógeno utilizando protocolos específicos. Se empleó la prueba no paramétrica de Wilcoxon para determinar diferencias entre profundidades y el coeficiente de correlación de Pearson (|ρ| ≥ 0,8) para analizar correlaciones entre parámetros fisicoquímicos y microorganismos. Los resultados sugieren que la abundancia de microorganismos aerobios viables, Lactobacillus, Actinomicetos y Fungi disminuye con la profundidad del suelo, mientras que las bacterias fijadoras de nitrógeno no muestran diferencias significativas. La disminución de la abundancia se relaciona con factores como la disponibilidad de nutrientes y oxígeno y las condiciones microambientales. Existe una correlación positiva fuerte entre la cantidad de microorganismos aerobios viables y Lactobacillus con el contenido de fósforo, y una correlación negativa entre Actinomicetos y el contenido de Arcilla. Los Actinomicetos prefieren suelos arenosos, mientras que los Fungi prosperan en suelos ricos en materia orgánica. La correlación negativa entre Fungi y Actinomicetos sugiere competencia por recursos limitados y posibles interacciones químicas, como la producción de compuestos antibióticos por parte de los Actinomicetos. Este estudio demuestra que la comprensión detallada de la microbiota del suelo puede ofrecer nuevas oportunidades para mejorar las prácticas agrícolas, especialmente en términos de gestión de la fertilidad del suelo y sostenibilidad ambiental.

The Influence of Assistance and the Success of Early Breastfeeding Initiation on Maternity Mothers

Colostrum, which is yellowish breast milk, is considered vital because it is the first immunization for newborns and plays a significant role in the newborn's immune defence system. This research aimed to determine the effect of assistance in early breastfeeding initiation and the success of early breastfeeding initiation among mothers giving birth at the Independent Midwife Practice in Pematangsiantar City. The method used in this research was a quasi-experiment with a two-group design pretest-posttest with the control group, which was carried out on 67 mothers divided into two groups, using consecutive sampling (n=34 and unaccompanied mothers n=33). Assistance in the form of providing information on Early Breastfeeding Initiation (EBI) using materials, leaflets, and AVA/videos. The Early Breastfeeding Initiation Satisfaction Questionnaire was adopted from the Maternal Breastfeeding Evaluation Scale. The non-parametric Wilcoxon test was used for testing. Testing used the SPSS.The results of this study showed a significant relationship between mothers' knowledge and satisfaction with success before and after being given the intervention with (p=0.001) and (p=0.025). Assistance for mothers giving birth will increase the success of women in labour to breastfeed their babies as early as possible.

Rachel score: a nomogram model for predicting the prognosis of lung neuroendocrine tumors.

Lung NET, classified in typical carcinoids (TC) and atypical carcinoids (AC), are highly heterogeneous in their biology and prognosis. The histological subtype and TNM stage are well-established prognostic factors for lung NET. In a previous work by our group, we demonstrated a significant impact of laterality on lung NET survival outcomes. We developed a nomogram that integrates relevant prognostic factors to predict lung NET outcomes. By adding the scores for each of the variables included in the model, it was possible to obtain a prognostic score (Rachel score). Wilcoxon non-parametric statistical test was applied among parameters and Harrell's concordance index was used to measure the models' predictive power. To test the discriminatory power and the predictive accuracy of the model, we calculated Gonen and Heller concordance index. Time-dependent ROC curves and their area under the curve (AUC) were used to evaluate the models' predictive performance. By applying Rachel score, we were able to identify three prognostic groups (specifically, high, medium and low risk). These three groups were associate to well-defined ranges of points according to the obtained nomogram (I: 0-90, II: 91-130; III: > 130 points), providing a useful tool for prognostic stratification. The overall survival (OS) and progression free survival (PFS) Kaplan-Meier curves confirmed significant differences (p < 0.0001) among the three groups identified by Rachel score. A prognostic nomogram was developed, incorporating variables with significant impact on lung NET survival. The nomogram showed a satisfactory and stable ability to predict OS and PFS in this population, confirming the heterogeneity beyond the histopathological diagnosis of TC vs AC.

Effects of the prone position on gas exchange and ventilatory mechanics and their correlations with mechanical power in burn patients with ARDS

Background Prone position has many documented benefits on severe ARDS patients especially on mortality. The benefits in ARDS secondary to severe burns have not been fully documented. Aim To quantify the effects of prone positioning on gas exchange, ventilatory mechanics and their correlations with mechanical power in burn subjects with ARDS. Methods Cross-sectional observational analytical study that took place between January 2023 and October 2023 in Burns ICU in Brazil on subjects with moderate to severe ARDS ventilated with the volume controlled mode. Data were collected in the first prone positioning lasting 24 hours in the first 30 minutes after changing position and 30 minutes before returning to the supine position. The parameters of the components of mechanical ventilation and mechanical power calculated by the Gatinoni’s formula (respiratory rate, tidal volume, driving pressure, PEEP, peak and plateau pressures) were collected to evaluate ventilatory mechanics, and the values of the FiO2, PaO2, PaO2/FiO2 ratio, SpO2, EtCO2, PaCO2, PaCO2 - EtCO2 gradient to assess gas exchange. Mean, minimum and maximum values, 1st and 3rd quartiles, median and standard deviation are calculated. To compare the results obtained at the two evaluation moments, the student’s t-test for dependent samples and non-parametric Wilcoxon tests were considered. To evaluate the association between the variation between the two moments of each variable, and the variation in mechanical power, the Pearson correlation coefficient was calculated. The normality of the variables was assessed using the Jarque-Béra test. P values &lt;0.05 indicated statistical significance. Results Except for EtCO2 (P 0.939) and PaCO2 (P 0.391) all other variables presented statistical significance in relation to their variations with reduction in FiO2 (P &lt;0.001), reduction in PaCO2 - EtCO2 gradient (P 0.011), and increases in PaO2 (P 0.008), PaO2/FiO2 (P &lt;0.001), SpO2 (P 0.004). In the analysis of variables, reduction in respiratory rate (P 0.142), VT (P 0.385), peak pressure (P 0.085), plateau pressure (P 0.009), PEEP (P 0.032), driving pressure (P 0.083), elastance (P 0.180), mechanical power (P &lt; 0.001) with increase static compliance (P 0.414) and resistance pressure (P 0.443). Among the ventilatory mechanics variables, only the reductions in plateau pressure, PEEP, and mechanical power showed statistical significance. Conclusion The prone position in burns induced ARDS improved oxygenation and reduced arterial partial pressure to end tidal CO2 gradient, furthermore, reducing plateau pressures and PEEP, which in turn reduced mechanical power. Keywords: mechanical power, burns, ARDS, prone position

Cardiodynamic adjustments in skilled civil aircraft pilots while unexpected emergency conditions appeared during a simulated flight within a homemade Airbus A300 cockpit

To highlight which cardiodynamic adjustments take place in civil aircraft pilots when unexpected mechanical accidents occur while they are in flight, in 8 skilled pilots we detected the mean blood arterial pressure (MAP) and heart rate (HR) while a unexpected failing of one engine occurred when they were engaged in a simulated flight with a homemade Airbus A300 cockpit. Comparing these two cardiovascular variables in a simulated flight test, just as when the accident happened, together with the values assessed in a simulated control flight without accidents, by the non-parametric Wilcoxon test for paired data it has been found a significant increase of MAP’s median (+ 20.3%, P = 0.008) without significant increase in HR one. However, in several tested pilots this sudden MAP increase tended to progressively recover baseline values while simulating the flight despite the event triggering this functional response was still present.We concluded that the cardiovascular apparatus of skilled aircraft civil pilots adapts in such a way of sudden respond to unexpected emergency conditions by adjusting mean arterial blood pressure for adequate blood flow to limb muscles, and this happens without a concomitant tachycardia response in order to maintain an optimal mechanical/metabolic efficiency of the heart.

Impact of COVID-19 pandemic on pediatric dental procedures in primary healthcare settings in Piracicaba, Brazil: an ecological study

BackgroundThe COVID-19 pandemic brought significant changes to dental care, which may have affected pediatric dental care offered in primary healthcare settings. Therefore, the aim of this study was to analyze the quantity of dental procedures performed in primary healthcare for children aged 6 to 12 years, before and during the COVID-19 pandemic.MethodsThis is an ecological study using data from the health information system of Piracicaba, São Paulo, Brazil. The variables considered were: coverage of first programmed dental consultation, restoration of permanent and deciduous teeth, topical fluoride application (individual per session), emergency care, and deciduous tooth extraction. Two periods were considered: period I (March 1, 2019 to February 29, 2020) and period II (April 1, 2020 to March 31, 2021), before and during the pandemic, respectively. Comparisons between periods were made using the paired nonparametric Wilcoxon test with a significance level of 5%.ResultsThere was an increase in emergency care from 15.4 to 32.4% (p = 0.0095) and a decrease in the number of restorations of deciduous teeth from 32.8 to 20.2% (p = 0.0217). The first programmed consultation showed a decrease of 9.60% (p = 0.0930) in period II.ConclusionsThe COVID-19 pandemic has hindered access to primary dental care for children, impacting the quantity of emergency care, reducing restorations of deciduous teeth, and first programmed dental consultations. These findings highlight the need for strategies to ensure that pediatric dental care is not neglected during pandemics.

Biomechanical comparison of two surgical methods for Hallux Valgus deformity: Exploring the use of artificial neural networks as a decision-making tool for orthopedists.

Hallux Valgus foot deformity affects gait performance. Common treatment options include distal oblique metatarsal osteotomy and chevron osteotomy. Nonetheless, the current process of selecting the appropriate osteotomy method poses potential biases and risks, due to its reliance on subjective human judgment and interpretation. The inherent variability among clinicians, the potential influence of individual clinical experiences, or inherent measurement limitations may contribute to inconsistent evaluations. To address this, incorporating objective tools like neural networks, renowned for effective classification and decision-making support, holds promise in identifying optimal surgical approaches. The objective of this cross-sectional study was twofold. Firstly, it aimed to investigate the feasibility of classifying patients based on the type of surgery. Secondly, it sought to explore the development of a decision-making tool to assist orthopedists in selecting the optimal surgical approach. To achieve this, gait parameters of twenty-three women with moderate to severe Hallux Valgus were analyzed. These patients underwent either distal oblique metatarsal osteotomy or chevron osteotomy. The parameters exhibiting differences in preoperative and postoperative values were identified through various statistical tests such as normalization, Shapiro-Wilk, non-parametric Wilcoxon, Student t, and paired difference tests. Two artificial neural networks were constructed for patient classification based on the type of surgery and to simulate an optimal surgery type considering postoperative walking speed. The results of the analysis demonstrated a strong correlation between surgery type and postoperative gait parameters, with the first neural network achieving a remarkable 100% accuracy in classification. Additionally, cases were identified where there was a mismatch with the surgeon's decision. Our findings highlight the potential of artificial neural networks as a complementary tool for surgeons in making informed decisions. Addressing the study's limitations, future research may investigate a wider range of orthopedic procedures, examine additional gait parameters and use more diverse and extensive datasets to enhance statistical robustness.

The Effect of Traditional Games Congklak Lidi and Sumbar Suru on the Concentration Level of Grade 3 SD Student

Technological sophistication attracts students’ attention to gadgets, thereby impacting student learning achievement. Several factors cause decreased student achievement, one of which is low student concentration. The purpose of this study was to test the effect of the traditional congklak lidi and sumbar suru game treatment on the concentration of 3rd grade elementary school students. This research is a type of quasi-experimental research with a research design between subject design and non-randomized pretest-posttest control group design. The sample technique used is purposive sampling with the required subject characteristics in the study, namely elementary school students aged 8–9 years, no physical disabilities or mental disorders, female and male, and a low pretest scores. Researchers took 9 subjects at each school to be given congklak lidi and sumbar suru treatment. The data collection method used was the Wilcoxon non-parametric analysis test and Mann–Whitney analysis to see the difference in pretest and posttest scores. Based on the results of data analysis, it can be concluded that the traditional games of congklak lidi and sumbar suru are able increase student concentration.&#x0D; Keywords: concentration, congklak lidi, sumbar suru

Sagittal Profi le of the Spine in Patients after Lumbar Stabilisation Surgeries

Spine stabilization surgery is nowadays one of the most common spinal surgical procedures. Spinopelvic alignment is considered to be an important factor impacting the patients' preoperative diffi culties as well as the outcome of surgery. In our study, the outcomes of stabilization surgeries in patients with lumbar spine disorders were evaluated - especially in those with stenosis and spondylolisthesis, in whom the importance of sagittal parameters were assessed with respect to the patients' clinical outcomes and diffi culties. The study included 50 patients with lumbar spine disorders who had undergone a spine stabilization surgery for a degenerative disease - lumbar spinal stenosis, spondylolisthesis between 2015 and 2017. Spino-pelvic radiological parameters and clinical parameters were evaluated using the nonparametric Kruskal-Wallis, Mann-Whitney, and Wilcoxon tests. In 38 of 50 patients, who at the end of the follow-up period did not have the PI-LL (pelvic incidence-lumbar lordosis) mismatch, i.e. PI-LL was ≤10°, a statistically signifi cant difference in pelvic tilt (p=0.049) and sagittal vertical axis (p<0.001) was reported, which was not the case in the remaining patients of the study population. Claudication and OSWESTRY (ODI) showed no statistically signifi cant difference. We have also compared the differences in the number of fused vertebrae and type of stabilization. A signifi cant change was seen in the claudication parameter at 12 and 24 months after surgery (p=0.007, p=0.005), with better outcomes achieved by 360° lumbar fusion compared to posterior lumbar fusion. The improvement of VAS and ODI scores in both the groups over time (from 6.1 to 3.6 or from 6.3 to 3.5 in VAS and from 62 to 32, or from 62 to 30 in ODI) was also statistically signifi cant (p<0.001 in both groups), while when comparing the groups against each other it was statistically insignifi cant. The authors confi rmed signifi cant improvement in the studied clinical parameters in all groups of patients (VAS, ODI, claudication), which is consistent with the results of recently published papers. The authors also established the correlation between different radiological parameters in the studied groups. The results do not confi rm the importance of the length or type of instrumentation for the clinical outcomes. This is consistent with the fi ndings of other published manuscripts. The authors failed to confi rm a signifi cant change in clinical parameters in dependence on the matching relationship between the pelvic incidence and lumbar lordosis. Proper spinopelvic balance in patients after spinal surgery is a very important indicator of postoperative development and condition, but our cohort showed no statistically signifi cant difference in the clinical outcomes of patients whose postoperative sagittal parameters were unsatisfactory. sagittal profi le, spine stabilization, pelvic tilt, pelvic incidence, sagittal vertical axis, SVA.

Pengaruh Terapi Bermain Media Playdough Terhadap Kemampuan Kognitif Anak Retardasi Mental Ringan

Background of Study: Mental retardation is a condition of imperfection development of mental abilities. The problem of children with mental retardation exists in the state of development of the restrained or incomplete mind, for example cognitive abilities. Various methods are used for cognitive development. This research provides playdough playing media therapy to improve cognitive abilities of children with mental retardation. Playdough is a dough of flour, water, salt, oil, and food coloring. Playdough has not been applied in this SDLB. This study aimed to determine the effect of playdough playing media therapy toward cognitive abilities of children with mental retardation. Methods: This research included pre-experimental design with one group pretest and post test design. On the first day, pretest activity toward children with mild mental retardation was done, intervention of playdough playing media therapy about numbers and letters was done on days 2-6, the researcher did post test on day 7. The collected data were statistically analyzed by using the Wilcoxon Nonparametric test because the data were not normally distributed. Results: Mean score of cognitive abilities pretest is about 11.0 and mean score of cognitive abilities post test is about 13.6. The difference between mean score of cognitive abilities pretest and cognitive abilities post test is 2.6. with value of p = 0.017 (p &lt;0.05). Conclusion: There is effect of playdough playing media therapy toward cognitive abilities of children with mild mental retardation and be reference for nurse related about learning media while playing wich can be used for children with mental retardation who stayed in the hospital. Keywords: Playdough, Cognitive Ability, Mental Retardation Children

Reversibility of the Enlargement of the Pulmonary Artery in COVID-19 Pneumonia as a Marker of Remission of the Disease.

Coronavirus disease 2019 (COVID-19) pneumonia is associated with extensive pulmonary microangiopathy and the enlargement of the pulmonary artery (PA), while its progression after the remission of the disease has not been investigated yet. The aim was to assess the diametral increase in the PA in COVID-19 pneumonia, as revealed on chest computed tomography (CT), and further investigate its progression. This was a retrospective cohort study of patients with COVID-19 pneumonia, without prior history of pulmonary hypertension, who underwent CT pulmonary angiography before, during, and after the infection. Pulmonary embolism was excluded in all cases. The main PA diameter (MPAD) was assessed in consecutive chest imaging. Statistical analysis was performed with the non-parametric Wilcoxon and Kruskal-Wallis tests, while correlations were performed with the non-parametric Spearman test. A mean ± SD MPAD of 3.1 ± 0.3 cm in COVID-19 pneumonia was significantly decreased to 2.8 ± 0.3 cm in the post-infectious state after 2-18 months in 31 patients (p-value: <0.0001). In a subgroup of six patients with more than one post-COVID-19 CT, a significant further decline in the diameter was observed (p-value: 0.0313). On the other hand, in accordance with the literature, a significant increase in the MPAD during COVID-19 pneumonia was noted in a group of 10 patients with a pre-COVID-19 CT (p-value: 0.0371). The enlargement of the PA is a common finding in COVID-19 pneumonia that regresses after the remission of the disease, indicating that this reversible cardiovascular event is a potential marker of disease activity, while its course in long COVID is yet to be determined.

MRI Assessment of Myocardial Deformation for Risk Stratification of Major Arrhythmic Events in Patients With Non-Ischemic Cardiomyopathy Eligible for Primary Prevention Implantable Cardioverter Defibrillators.

Implantable cardioverter-defibrillator (ICD) intervention is an established prophylactic measure. Identifying high-benefit patients poses challenges. To assess the prognostic value of cardiac magnetic resonance imaging (MRI) parameters including myocardial deformation for risk stratification of ICD intervention in non-ischemic cardiomyopathy (NICM) while accounting for competing mortality risk. Retrospective and prospective. One hundred and fifty-nine NICM patients eligible for primary ICD (117 male, 54 ± 13 years) and 49 control subjects (38 male, 53 ± 5 years). Balanced steady state free precession (bSSFP) and three-dimensional phase-sensitive inversion-recovery late gadolinium enhancement (LGE) sequences at 1.5 T or 3 T. Patients underwent MRI before ICD implantation and were followed up. Functional parameters, left ventricular global radial, circumferential and longitudinal strain, right ventricular free wall longitudinal strain (RV FWLS) and left atrial strain were measured (Circle, cvi42). LGE presence was assessed visually. The primary endpoint was appropriate ICD intervention. Models were developed to determine outcome, with and without accounting for competing risk (non-sudden cardiac death), and compared to a baseline model including LGE and clinical features. Wilcoxon non-parametric test, Cox's proportional hazards regression, Fine-Gray competing risk model, and cumulative incidence functions. Harrell's c statistic was used for model selection. A P value <0.05 was considered statistically significant. Follow-up duration was 1176 ± 960 days (median: 896). Twenty-six patients (16%) met the primary endpoint. RV FWLS demonstrated a significant difference between patients with and without events (-12.5% ± 5 vs. -16.4% ± 5.5). Univariable analyses showed LGE and RV FWLS were significantly associated with outcome (LGE: hazard ratio [HR] = 3.69, 95% CI = 1.28-10.62; RV FWLS: HR = 2.04, 95% CI = 1.30-3.22). RV FWLS significantly improved the prognostic value of baseline model and remained significant in multivariable analysis, accounting for competing risk (HR = 1.73, 95% CI = 1.12-2.66). In NICM, RV FWLS may provide additional predictive value for predicting appropriate ICD intervention. 2 TECHNICAL EFFICACY: Stage 5.

Short-term effects of foot surgery on walking-related pain, function, and satisfaction in patients with Charcot-Marie-Tooth disease: a prospective cohort study.

Patients with Charcot-Marie-Tooth disease (CMT) often suffer from walking-related pain (WRP), muscle weakness, foot deformities, and reduced ankle dorsiflexion (DF), which affects their ability to walk and daily activities. Functional surgery (FS) can restore foot deviations, affecting the loading ability during gait. We assessed the short-term effects of FS in patients with CMT on WRP, foot and ankle structure, and function, along with patients' perceived improvement. This is a prospective cohort study on CMT patients who had undergone FS and rehabilitation. We analyzed the changes after 1 month, focusing on WRP, DF, the center of pressure progression (COPP) during walking, and measures of walking ability. The non-parametric Wilcoxon test was used. Ten patients were included. One month after FS, WRP reduced from 5.5 (IQR = 3.5) to 2 (IQR = 3.5), p = 0.063, with an effect size of 0.615. The highest decrease was found in patients with very high pre-surgical pain levels. DF almost reached 10° for both active and passive movements (p < 0.05), and COPP improved from 44 to 60% (p = 0.009) of foot length. Gait speed, lower limb functioning, and balance did not change. More than half of the sample felt improved or much improved after FS. FS can be effective in reducing WRP and restoring foot posture in CMT patients in the short-term, which allows them to wear shoes, and leads to a perceived improvement and satisfaction. Lack of improvement in functional skills may be due to muscle weakness typical of CMT. Studies with longer follow-ups may confirm these hypotheses.

Blood loss quantification during major abdominal surgery: prospective observational cohort study

BackgroundBlood loss during major abdominal surgery is an essential parameter in the evaluation of strategies aimed at reducing perioperative bleeding. However, blood loss quantification remains unreliable and inaccurate. The aim of this study was to compare several methods of blood loss quantification—visual estimation by surgeon and anesthesiologist, the gravimetric method, the calculation method with spectrophotometric measurement. The spectrophotometric measurement is considered as the most accurate method.MethodsThe study was designed as a prospective observational cohort single-center study. We analyzed 61 patients who underwent elective liver or pancreatic resection. The anesthesiologists’ and surgeons' estimate of blood loss was based on a visual assessment. The gravimetric method was based on weighing the suction canister and surgical drapes before and after use. The basis of calculation method was anthropometric and hematological parameters, we used López-Picado's formula. The spectrophotometric method was based on the spectrophotometric determination of hemoglobin mass in the lost blood. We compared the methods using paired t-test, non-parametric Wilcoxon test and Bland–Altman analysis.ResultsVisual estimation by surgeons and anesthesiologists, gravimetric measurement, and calculation method were significantly different from spectrophotometric measurement at the significance level α = 0.05. All methods overestimated blood loss which was measured by spectrophotometric method. The estimate by surgeons was the closest to the spectrophotometric measurement, difference 68.7 ml (95% confidence interval [CI]: -129.3–-8.2).ConclusionsWe conclude that the estimate of blood loss by surgeons and anesthesiologists, as well as gravimetric method and calculation method are all significantly inaccurate in real surgical setting. We did not confirm the commonly accepted assumption that surgeons underestimate the blood loss.Trial registrationThe study was registered under the title " Blood Loss Quantification During Major Abdominal Surgery" at ClinicalTrials.gov with the registration number NCT05316649. Date of the first registration was 20/3/2022.