Nonparametric Research Articles

Bootstrapped Edge Count Tests for Nonparametric Two-Sample Inference Under Heterogeneity

Nonparametric two-sample testing is a classical problem in inferential statistics. While modern two-sample tests, such as the edge count test and its variants, can handle multivariate and non-Euclidean data, contemporary gargantuan datasets often exhibit heterogeneity due to the presence of latent subpopulations. Direct application of these tests, without regulating for such heterogeneity, may lead to incorrect statistical decisions. We develop a new nonparametric testing procedure that accurately detects differences between the two samples in the presence of unknown heterogeneity in the data generation process. Our framework handles this latent heterogeneity through a composite null that entertains the possibility that the two samples arise from a mixture distribution with identical component distributions but with possibly different mixing weights. In this regime, we study the asymptotic behavior of weighted edge count test statistic and show that it can be effectively recalibrated to detect arbitrary deviations from the composite null. For practical implementation we propose a Bootstrapped Weighted Edge Count test which involves a bootstrap-based calibration procedure that can be easily implemented across a wide range of heterogeneous regimes. A comprehensive simulation study and an application to detecting aberrant user behaviors in online games demonstrates the excellent non-asymptotic performance of the proposed test. Supplementary materials for this article are available online.

Permanent left bundle branch area pacing improves mitral regurgitation and cardiac function in patients with right bundle branch block

BackgroundPermanent left bundle branch area pacing (LBBAP) has been established as an effective means to correct left bundle branch block. Right bundle branch block (RBBB), emerge as a distinct form of cardiac conduction abnormality, can be seen in the context of LBBAP procedure. However, the correction potential of LBBAP in patients with RBBB remains largely unexplored.ObjectiveThe objective of this study was to evaluate the efficacy and safety of permanent LBBAP in patients with RBBB.MethodsNinety-two consecutive patients who underwent successful permanent LBBAP were recruited from May. 2019 to Dec. 2022 in Fuwai Central China Cardiovascular Hospital. Among them, 20 patients with RBBB were included in our analysis. These patients were followed up at 1, 3, 6 and 12 months post-LBBAP. The QRS duration (QRSd) on the V1 lead of the 12-lead elctrocardiogram was measured and compared before and after the LBBAP procedure. Additionally, mitral regurgitation, tricuspid regurgitation and cardiac function were assessed using transthoracic echocardiography, specifically focusing on left ventricular ejection fraction (LVEF) and mitral regurgitation severity. The acute pitfills and delayed complications associated with the LBBAP procedure were recorded to evaluate its safety. SPSS 23.0 was used to perform statistical analysis with Student’s t test or one way ANOVA or nonparametric tests (paired Wilcoxon test). A p value less than 0.05 was defined as significant.ResultsThe demographic breakdown of the RBBB cohort revealed a mean age of 66.35 ± 11.55 years, 60% being male. Comorbidities were prevalent, including severe atrioventricular block (AVB) in 75%, sick sinus syndrome (SSS) in 20%, heart failure in 25%, atrial fibrillation in 30%, coronary heart diseases in 45%, hypertension in 35%, and diabetes mellitus in 15%. Regarding the LBBAP procedure, the average operation time was 106.53 ± 2.72 min, with 45% of patients (9 individuals) requiring temporary cardiac pacing during the surgery. Notably, the LBBAP procedure significantly narrow the QRS duration in RBBB patients, from 132.60 ± 31.49ms to 119.55 ± 18.58 ms (P = 0.046). Additionally, at the 12-month follow-up, we observed a marked improvement in LVEF, which increased significantly from 55.15 ± 10.84% to 58.5 ± 10.55% (P = 0.018). Furthermore, mitral regurgitation severity improved, with a median reduction from 4.46 (0.9, 7.3) to 2.29 (0, 3.49) cm2 (P = 0.033). Importantly, no cases of ventricular septum perforation or pericardial effusion were reported during the LBBAP procedure or during the follow-up period.ConclusionLBBAP provides an immediate reduction in QRS duration for patients suffering from RBBB, accompanied by improvements in mitral regurgitation and cardiac function as evident in the 12-month follow-up period.

Impact of a Clinical Placement on Pre-Professional Health Students Perceived Knowledge, Skills, and Confidence in the Delivery of Behaviour Change and Physical Activity Support

Background: Clinical placements may provide an appropriate setting for health professional students to learn and apply skills for supporting clients to improve their physical activity. Methods: A mixed methods study was conducted with pre-professional health students completing clinical placement at one of two interprofessional community clinics. Surveys assessed student self-reported perceived skills, knowledge, and confidence for behaviour change and physical activity support pre- and post-placement (unmatched n=40). Interviews were conducted with students (n=18) and clinical educators (n=4). Change in student knowledge, skills, and confidence were assessed using non-parametric tests; qualitative data underwent inductive thematic analysis. Results: Post-placement, unmatched participants perceived knowledge and understanding (p = 0.017), skills (p = 0.001), and confidence (p = 0.004) in behaviour change significantly increased. Perceived confidence in providing physical activity behavior change support for low-risk (p = 0.022) and complex conditions (p = 0.009) significantly improved. Qualitative data emphasised the importance of clinical educators and direct clinical experiences in preparing students for future practice. Conclusion: Student-facilitated interprofessional clinical placements may be important for developing pre-professional knowledge, skills, and confidence in delivering behaviour change and physical activity support. Further exploration of clinical placement opportunities for strengthening pre-professional health students training in physical activity promotion and behaviour change is recommended.

Hispanic Cancer Survivors Exposed to Multiple Natural Disasters: Pre–Post-Disaster Changes in Anxiety, Depression, PTSD, Perceived Stress, and Physical Symptom Burden

Background: Studies evaluating the effects of natural disasters on cancer outcomes are scarce, especially among USA ethnic minority groups, and none have focused on the effects of concurrent natural disasters and the COVID-19 pandemic. The goal of this secondary data analysis is to explore the impact of concurrent exposure to COVID-19 and earthquakes on psychological distress and symptom burden among Puerto Rican cancer survivors. Methods: This secondary data analysis (n = 101) was part of a longitudinal case–control cohort study (n = 402) aimed at describing unmet psychological needs among Puerto Rican cancer patients and non-cancer subjects previously exposed to Hurricane María in 2017. The research team pooled data from participants (cancer survivors and non-cancer group) from their baseline assessments and from follow-up assessments conducted during January–July 2020 (earthquake and the lockdown period). A descriptive, paired t-test, non-parametric mean rank test, and two-sided Pearson correlation analyses were performed. Results: Psychological distress and cancer symptom burden diminished over time. Resilience was significantly correlated with all the psychological and symptom burden variables during both pre- and post-earthquake and COVID-19 assessment periods. Conclusions: The results support the role of resilience, social support, and post-traumatic growth as potential protective factors preventing psychological distress and diminishing cancer symptom burden among cancer survivors exposed to natural disasters and the COVID-19 pandemic.

Psychometric validation of the Chinese version of the dry eye-related quality-of-life score questionnaire.

To psychometrically validate the Chinese version of the dry eye-related quality-of-life score questionnaire (DEQS-CHN) among Chinese patients with dry eye. This study involved 231 participants, including 191 with dry eye disease (DED) comprising the dry eye disease group, and 40 healthy participants forming the control group. Participants were required to complete the DEQS-CHN, and Chinese dry eye questionnaire and undergo clinical tests including the fluorescein breakup time (FBUT), corneal fluorescein staining (CFS), and Schirmer I test. To assess the internal consistency and retest reliability, Cronbach's α and the intraclass correlation coefficient (ICC) were employed. Content validity was assessed by item-level content validity index (ICV) and an average scale-level content validity index (S-CVI/Ave). Construct validity was assessed by confirmatory factor analysis. The concurrent validity was assessed by calculating correlations between DEQS-CHN and Chinese dry eye questionnaire. Discriminative validity was evaluated through non-parametric tests, with receiver operating characteristic (ROC) curve serving as conclusive indicators of the questionnaire's distinguishing capability. The Cronbach's α coefficients for frequency and degree of ocular symptoms, impact on daily life, and summary score were 0.736, 0.704, 0.811, 0.818, 0.861, and 0.860, respectively, and the ICC were 0.611, 0.677, 0.715, 0.769, 0.711, and 0.779, respectively. All I-CVI scores ranged from 0.833 to 1.000, with an S-CVI/Ave of 0.956. Confirmatory factor analysis results exhibited a well-fitting model consistent with the original questionnaire [χ 2/df=2.653, incremental fit index (IFI)=0.924, comparative fit index (CFI)=0.924, Tucker-Lewis index (TLI)=0.909, and root mean square error of approximation (RMSEA)=0.065]. There was a moderate positive correlation between the DEQS-CHN and the Chinese dry eye questionnaire (r 2=0.588). The dry eye group demonstrated significantly higher scores compared to the control group, and the area under the curve (AUC) value was 0.8092. The DEQS-CHN has been demonstrated as a valid and reliable instrument for assessing the impact of dry eye disease on the quality of life among Chinese individuals with DED.

Effects of Physical Therapy Integrated with Dance/Movement Therapy on Heart Rate Variability and Fall-Related Variables: A Preliminary Controlled Trial

AbstractFalls among older adults are influenced by both physical and psychological risk factors. This pilot study specifically examined the impact of integrating Dance/Movement Therapy (DMT) into a regimen of physical therapy exercises (PTE) for fall prevention. The primary objectives included examining the effect of post-PTE+DMT intervention on heart rate variability (HRV), a psychophysiological marker, and fall risk factors. Additionally, this study aimed to examine correlations between HRV and levels of fall risk. Eight community-dwelling older adults (median = 83 [interquartile ranges: 80.5–85.75]) from a day center for senior citizens were randomly assigned to either a PTE+DMT group or a PTE group. A post intervention battery of HRV, physical and psychological fall risk assessments, was conducted. The results of nonparametric analysis demonstrated the potential impact of the PTE+DMT intervention in improving balance and self-efficacy measures related to falls when compared to participation in PTE alone. No statistically significant differences were observed between the groups in term of HRV and other physical and psychological fall risk factors. The emerging trends in the associations between HRV, fall risk, and balance levels suggest the potential utility of HRV as an objective psychophysiological marker for assessing fall risk levels. Moreover, the results underscore the potential advantages of interventions that integrate both physical and psychological components to mitigate fall risk in older adults, emphasizing the intricate mind–body connection.The ClinicalTrials.gov ID: NCT05948735, July 7, 2023.

Comparison of American Thyroid Association and Conventional Criteria in Diagnosing Hypothyroidism among Pregnant Ladies Attending a Tertiary Care Hospital

ABSTRACT Background: There is continuing debate regarding universal screening, the use of a thyroid-stimulating hormone (TSH) cutoff value, and levothyroxine replacement in frequently encountered issues like subclinical hypothyroidism in pregnancy. The study was intended to compare the American Thyroid Association (ATA)-2011 defined trimester-specific TSH with conventional TSH values in the diagnosis of newly detected hypothyroidism in pregnancy, as there are no trimester-specific reference ranges of TSH in Bangladesh. Methods: This cross-sectional, observational study enrolled 175 pregnant women recruited by convenient sampling from the Department of Obstetrics and Gynecology, BIRDEM General Hospital. As per the study protocol, investigations were advised. TSH, free thyroxine, and antithyroid antibodies were tested using the chemiluminescent technique. Data were analyzed by SPSS version 25. Nonparametric tests were chosen for statistical analysis. Results: The majority (53%) of the participants, were 30 years of age or younger. Using the ATA-2011 defined trimester-specific reference ranges of TSH, 32% had hypothyroidism. While using the conventional criteria (TSH – 0.4–4 mIU/L), hypothyroidism was diagnosed in 20.6% of cases. Conclusions: There is statistically significant discordance in diagnosing hypothyroidism in pregnancy between the two criteria.

An assessment of the efficacy of cognitive behavioral intervention for trauma in schools among student-residents at the Manila Boys’ Town Complex, Philippines

This study assessed the efficacy of the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) in mitigating the impact of trauma on the behavior and academic performance of student- residents at the Manila Boys’ Town Complex, Philippines. Utilizing a pretest-posttest control group design, trauma symptoms were evaluated using the Trauma Symptom Checklist for Children (TSCC). The study included 20 participants, divided equally into experimental and control groups. Statistical analysis was conducted using the Wilcoxon Signed-Rank Test, a non-parametric test used to compare two related samples, in this case, the pretest and posttest scores. The test revealed no statistically significant differences between pretest and posttest scores across six TSCC subscales: Anxiety, Depression, Anger, Posttraumatic Stress, Dissociation, and Sexual Concerns, at the .05 significance level. Despite the lack of significant statistical improvement, median posttest scores for the experimental group were lower than those of the control group, with scores of 61.5, 60, 51, 55.5, 58, and 64, compared to 64.5, 59.5, 52, 58.5, 61, and 74.5 for the control group across the respective subscales. These results suggest that while CBITS did not produce statistically significant outcomes, it may have a potentially positive effect on addressing trauma-related issues. The findings highlight the complexities involved in trauma intervention within educational settings and emphasize the need for culturally and contextually tailored approaches. Future research should consider increasing sample sizes and further adapting CBITS to enhance the reliability and applicability of the findings. This study contributes to a deeper understanding of trauma intervention strategies in public schools and underscores the necessity for ongoing exploration to optimize support for vulnerable student populations.

Exploring the Relationship Between Somatisation, Facial Pain and Psychological Distress in East Asian Temporomandibular Disorder Patients.

The relationship of somatisation with facial pain duration/intensity, pain-related interference/disability and psychological distress was investigated in East Asian temporomandibular disorder (TMD) patients. Correlations between somatisation, facial pain and psychological characteristics were also explored alongside the demographic/physical factors associated with moderate-to-severe depression and anxiety. Anonymised data were acquired from records of consecutive 'first-time' patients seeking TMD care at a tertiary oral medicine clinic. Axis I physical TMD diagnoses were established utilising the diagnostic criteria for TMDs (DC/TMD) protocol and patients with TMD pain were stratified into those with pain-related (PT) and combined (CT) conditions. Axis II measures administered encompassed the Patient Health Questionnaire-15 (PHQ-15), Graded Chronic Pain Scale (GCPS), Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder Scale-7 (GAD-7). Individuals with PT and CT were further categorised into those without (Pain - Som/Comb - Som) and with somatisation (Pain + Som/Comb + Som). Statistical evaluations were performed with nonparametric and logistic regression analyses (α = 0.05). The final sample comprised 473 patients (mean age 36.2 ± 14.8 years; 68.9% women), of which 52.0% had concomitant somatisation. Significant differences in pain duration (Comb + Som > Pain - Som), pain-related interference/disability (Comb + Som > Comb - Som) and depression/anxiety (Pain + Som, Comb + Som > Pain - Som, Comb - Som) were discerned. Depression/anxiety was moderately correlated with somatisation (rs = 0.64/0.52) but not facial pain characteristics. Multivariate modelling revealed that somatisation was significantly associated with the prospects of moderate-to-severe depression (OR 1.35) and anxiety (OR 1.24). Somatisation exhibited a strong association with psychological distress when contrasted with facial pain in East Asian TMD patients.

Cerebral white matter injury in hemodialysis patients: a cross-sectional tract-based spatial statistics and fixel-based analysis

Abstract Background End-stage renal disease (ESRD) patients with maintenance hemodialysis (HD) are often accompanied by damage to brain white matter (WM) and cognitive impairment. However, whether this damage is caused by maintenance HD or renal dysfunction is unclear. Purpose To investigate the natural progression of WM damage in patients with ESRD and the effects of HD on WM using Tract-based spatial statistics (TBSS) and fixel-based analysis (FBA). Population Eighty-one ESRD patients including 41 with no dialysis (ND) and 40 with HD and forty-six healthy controls (HCs) were enrolled in this study. Field Strength/Sequence A 3 T, single-shot spin–echo echo planar imaging (EPI). Assessment The difference of WM among the three groups (ESRD patients with HD, ESRD patients without HD and HCs) were analyzed using Tract-based spatial statistics (TBSS) and fixel-based analysis (FBA), pairwise comparison was then used to compare the difference of WM between two groups. Relationship between WM and neurocognitive assessments/clinical data were analyzed in ESRD patients with or without HD. Statistical Tests Group t-test, Chi-square Test, Kruskal–Wallis test, Mann–Whitney U-Test, Spearman’ correlation analysis, non-parametric permutation testing. Results The damage of WM in ESRD with ND and ESRD HD appeared around the lateral ventricles similarly used for TBSS while FBA reflected the changes had extended to adjacent WM in anterior hemisphere, with larger region in ESRD HD compared to ESRD ND and the brainstem was also widely affected in ESRD HD. The levels of MoCA score were lower in ESRD HD group. RD in body of corpus callosum (BCC) were negatively correlated with MoCA score in both groups. FDC in left Thalamo-prefrontal projection (T_PREFL), left and right cingulum (CGL and CGR) were positively correlated with MoCA score in both groups. Creatinine (Cr) was positively correlated with FDC in some frontal projection fibers in striatum and thalamus, CG and fronto-pontine tract (FPT), Cr was positively correlated with FD mainly in premotor projection fibers in striatum and thalamus in ESRD HD group. Cr was negatively correlated with MD and RD in regions of corona radiata ESRD ND group. Data Conclusion FBA is more sensitive in detecting differences between ESRD patients and HCs. When ESRD patients receive maintenance HD, the degree of WM damage may not be aggravated, however, the range of damaged WM can be expanded, especially in anterior hemisphere and brainstem, some of these changes in anterior hemisphere may contribute to cognitive decline.

Abstract B031: Alternate pain management strategies: targeting pancreatic cancer-related pain with Flavonoid

Abstract Purpose For up to 90% of cancer patients, pain is a substantial symptom, contributing to morbidity and, possibly, mortality. In this study we sought to test the hypothesis that a flavonoid, derived from Cannabis, and previously shown to suppress cancer cell growth in vitro and tumor progression in mice in vivo, could also reduce the pain caused by pancreatic tumors in vivo. Methods A subcutaneous tumor in the dorsum of C57BL/6 mouse was generated by sub- dermal injection of KPC mouse pancreatic cancer cell line (ATCC). All the mice were video recorded to observe and analyze their spontaneous pain-related behaviors, including facial washing, dorsal hunching, dorsal skin twitch, licking of dorsal skin and overall locomotion around the cage. Two five minute recording sessions were analyzed by a blinded observer during times before the cancer cell injection (Baseline), after tumor growth, to about 8mm diameter (30d and 37d post-injection) and just before and then 24h after intra-tumor injection of the flavonoid ( Group A: FBL-03G, 1 nmole in 100µL) or Vehicle(100µL; Group B). Pain-related behavioral changes were averaged from the two recording sessions and analyzed from Baseline, just before FBL-03G and 24h after and compared between test compound-and vehicle injected groups (n=7 in each), using non-parametric statistics. Results Facial washing (events/5min) was: reduced to 87% of Baseline in tumor-bearing mice, then increased by 150% at 24h post-injection in Group A (FBL-03G); reduced to 65% of Baseline in tumor-bearing mice of Group B, then reduced a further 9% by Vehicle. Dorsal hunching, which events occur only after tumor growth (Baseline =0), was reduced at 24h by 62% in Group A but increased by 75% in Group B. Dorsal twitch, also absent before tumor growth, was reduced by 64% in Group A, but increased by 19% in Group B. Dorsal skin licking was reduced from Baseline by 33% in tumor-bearing mice of Group A, then increased by 76% after FBL-03g injection whereas licking, reduced by 22% by tumors in Group B and then by an additional 4% by vehicle (Group B). Tumors reduced locomotion by 58% in Group A, which was reversed by 32% after FBL-03g (Group A); vehicle injection resulted in a 38% reduction in locomotion (Group B). Thus, in 4 of the 5 pain-related behaviors from tumors quantitated symptoms were reversed by FBL-03G and oppositely affected, or not at all, by Vehicle. Conclusions These results indicate a substantial relief of spontaneous pain-related pain in this mouse model of pancreatic cancer. Such an acute effect occurs much more rapidly than the previously published in vitro suppression of KPC cell growth (assayed after 9-12d of treatment) or the reduction of tumor size (1-7 weeks) in vivo and suggest that the anti-hyperalgesic affect is due to mechanisms that do not involve reduction in tumor mass. The findings, using a single dose and a small number of mice, appear promising for further studies that examine a range of doses or FBL-03G and its actions in intra-pancreatic tumors. Citation Format: Sayeda Yasmin-Karim, Suheera Haq, Mike Makrigiorgos, Gary Strichartz, Geraud Richards, Natasha Rayman. Alternate pain management strategies: targeting pancreatic cancer-related pain with Flavonoid [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pancreatic Cancer Research; 2024 Sep 15-18; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(17 Suppl_2):Abstract nr B031.

PSIX-8 A multistrain probiotic modifies fecal microbial populations of healthy adult cats

Abstract Probiotics can modulate the intestinal microbiota and benefit the host’s health, whereas environmental stressors can negatively impact the composition of the intestinal microbiota. Lactic acid bacteria (LAB), most commonly Lactobacillus and Bifidobacterium species, are well-known organisms with probiotic potential. The objective of this study was to determine the impact on the fecal microbial population of healthy Cats, after ingestion of a probiotic blend of Lactobacillus acidophilus-286, Bifidobacterium animalis subs. Lactis-689, and Enterococcus faecium-202. Thirty adult cats (15 male, 15 female; mean BW=3.39 kg; mean age=3.3 y) were enrolled in this placebo-controlled and blinded study. After a 7-d washout period, cats were allocated into two groups similar in terms of body weight, age, and sex. Cats were fed a complete dry extruded diet and at time 0 h on d-0 received orally 4 g of a placebo paste or probiotic paste corresponding to the target dose of 4x107 total CFU. Administration of the placebo or probiotic was repeated 12 h and 24 h after the first dose. Afterward, fecal scores were evaluated daily for 7 days. Fresh fecal samples were collected on days 0, 3, and 7 for microbial enumerations and fecal metabolite measurements. Fecal microbial count data did not conform to the assumptions of normality and homogeneity of variances, consequently, non-parametric tests were performed for comparisons. Fecal scores, dry matter, and metabolites were not different between groups. Fecal counts of Lactobacillus spp., Bifidobacterium spp., and Enterococcus spp. were greater on both d-3 and d-7 (P < 0.01) in cats that consumed probiotics. Fecal counts of both Escherichia coli and Clostridium perfringens were fewer (P < 0.05) in cats that consumed probiotics. In conclusion, the consumption by cats on d-0 of a probiotic blend of Lactobacillus acidophilus-286, Bifidobacterium animalis subs. Lactis-689, and Enterococcus faecium-202 modified the intestinal microbiota up to 7 days after consumption, as evidenced by the increase of lactic acid bacteria and the decrease of Escherichia coli and Clostridium perfringens in feces.

PSIX-7 A multi-strain probiotic modifies fecal microbial populations of healthy adult dogs

Abstract Probiotics can modulate the intestinal microbiota and benefit the health of the host, whereas environmental stressors can negatively impact the composition of the intestinal microbiota. Lactic acid bacteria (LAB), most commonly Lactobacillus and Bifidobacterium species, are well-known organisms with probiotic potential. The objective of this study was to determine the impact on the fecal microbial population of healthy dogs, after ingestion of a probiotic blend of Lactobacillus acidophilus-286, Bifidobacterium animalis subs. Lactis-689, and Enterococcus faecium-202. Adult dogs [n = 30; 15 male, 15 female; mean body weight (BW) = 14.7 kg; mean age = 3.3 yr) were enrolled in this placebo-controlled and blinded study. After a 7-d washout period, dogs were allocated into two groups similar in terms of breed, BW, age, and sex. Dogs were fed a complete dry extruded diet and at time 0 h on d 0 received orally 4 g of a placebo paste or probiotic paste corresponding to the target dose of 4x107 total CFU. Administration of the placebo or probiotic was repeated 12 h and 24 h after the first dose. Afterward, fecal scores were evaluated daily for 7 d. Fresh fecal samples were collected on d 0, 3, and 7 for microbial enumerations and fecal metabolite measurements. Fecal microbial count data did not conform to the assumptions of normality and homogeneity of variances, consequently, non-parametric tests were performed for comparisons. Fecal scores, dry matter, and metabolites were not different between groups. Fecal counts of Lactobacillus spp., Bifidobacterium spp., and Enterococcus spp. were greater on both d 3 and d 7 (P < 0.01) in dogs that consumed probiotics. Fecal counts of both Escherichia coli and Clostridium perfringens were fewer (P < 0.01) in dogs that consumed probiotics. In conclusion, the consumption by dogs on d 0 of a probiotic blend of Lactobacillus acidophilus-286, Bifidobacterium animalis subs. Lactis-689, and Enterococcus faecium-202 modified the intestinal microbiota up to 7 d after consumption, as evidenced by the increase of lactic acid bacteria and the decrease of Escherichia coli and Clostridium perfringens in feces.

PSI-30 Effects of high canola meal diet with acidifiers supplementation on cecal microbiota of nursery pigs

Abstract Inclusion of canola meal (CM) in swine diets is typically limited stemming from the presence of glucosinolates (Gls), which can reduce growth performance and cause thyroid dysfunction in nursery pigs. While certain members of hindgut bacterial communities are capable of degrading dietary Gls, which would mitigate their detrimental effects, they have yet to be identified. Moreover, lowering the pH in the hindgut of the pig can break down Gls into less toxic compounds, potentially reducing harm. Thus, this study aimed to characterize major bacterial species populating the hindgut of nursery pigs fed a high CM diet supplemented with acidifier and encapsulated butyrate. A total of 315 nursery pigs weaned at 21 d old, average body weight (BW) 6.0 ± 1.2 kg, were assigned to one of five dietary treatments with 9 replicate pens (7 pigs/pen) in a randomized complete block design. The dietary treatments included PC: a corn-soybean meal-based diet with 20% CM, NC: a corn-soybean meal-based diet with 40% CM, NC+A: NC diet supplemented with an acidifier at 1,500 ppm, NC+B: NC diet supplemented with encapsulated butyrate at 500 ppm, and NC+A+B: NC diet supplemented with both an acidifier and encapsulated butyrate. All diets were formulated to meet or exceed the nutrient requirements of NRC (2012). At the end of the feeding trial (6 wk), one pig from each pen was euthanized to collect fresh cecal digesta. Samples were analyzed using the 16S rRNA gene through PCR-amplification of the V1-V3 regions from microbial genomic DNA, followed by Illumina MiSeq 2X300 sequencing. A comparative analysis of the highly represented taxonomic groups and operational taxonomic units (OTU) using non-parametric Kruskal-Wallis sum-rank test and Wilcoxon pairwise test identified candidate bacterial groups or species enriched across different diets. Bacillota was the predominant phylum across all diets, ranging from 83.2% to 86.3%. At the genus level, Lachnospiracea incertae sedis was less abundant in the NC diets with acidifier (Acidifier effect, P < 0.05), whereas Dialister was less in the NC diets with encapsulated butyrate (Butyrate effect, P < 0.05). The OTU Ssd-00001 (Lactobacillus amylovorus, 99.6%) tended to be greater in the cecal microbiota of pigs fed the NC diets with acidifier (Acidifier effect, P = 0.09). Interestingly, OTU Ssd-00188 (Agathobacter rectalis, 99.2%) tended to be higher in PC diet than in NC diet (P = 0.06), while its abundance was less in the cecal microbiota of pigs fed the NC diets with acidifier (Acidifier effect, P = 0.09). In conclusion, these results provide valuable insights into the microbiome of pigs fed high CM diets. Understanding the interplay between microbial communities and high CM diet with acidifier supplementation is crucial for optimizing swine diets and mitigating challenges associated with the antinutritional effects of dietary Gls from CM.

PSXI-22 Effects of a palatability enhancer and olive bioactives on performance and physiological status of veal calves after farm reception

Abstract Veal calves have to deal with several stressors early in life, such as transport and commingling with animals of unknown health histories from multiple different origins; making the reception a possible critical period where animals should adapt to all these challenges. Previous studies in unweaned rosée calves have shown that the use of feed additives (FA) to enhance intake and immunity at farm arrival could be a strategy to minimize the negative effects of stress and feed restriction during transportation. The aim of this study was to evaluate the effects of a palatability enhancer (PE) and olive bioactives (OB) on performance and serum biomarkers in veal calves. Dairy beef calves [n = 252; BVD-free; body weight (BW) = 44.6 ± 3.63 kg] coming from auction market were distributed in 3 treatments (84 animals/tr) during 8 wk: i) calves fed concentrate and MR without FA (negative control, NC); ii) calves fed concentrate and MR with a PE based on sweeteners (PE); and iii) calves fed concentrate with PE and MR with PE and OB (PEOB). On farm arrival animals were housed individually until 5 wk of age, when animals were grouped in pens of 4 calves. Performance was monitored during the trial and serum samples were collected 48 h after the mixing (25 animals/tr) to analyze several biomarkers related to immune system (MILLIPLEX MAP Kit) and energy status (BHBA). Performance data were analyzed with a mixed-effects model and serum biomarkers by One-Way Anova with Fisher’s LSD correction for multiple comparisons (normally distributed data) or by non-parametric Kruskal-Wallis test with Dunn’s correction (data not normally distributed). Final BW was greater (P = 0.01) in PE and PEOB groups compared with NC (+2.2 kg and +2.6 kg, respectively). Concentrate feed intake (FI) during first 4 wk tended (P = 0.06) to be greater in PEOB compared with NC (+15%); however, after grouping (wk 5 to wk 8), PE showed a ldecreased FI compared with NC (-9.5%, P = 0.01). Forty-eight hours after animal grouping, PEOB showed reduced concentration of tumor necrosis factor (TNF) α than NC and PE (P = 0.03). Moreover, PEOB and PE had a greater concentration of interleukin (IL) 36Rα (P < 0.05) and IP10 (P < 0.01) compared with NC. Besides PEOB tended (P < 0.15) to have decreased concentrations of MIP1α, IL1α, and BHBA compared with PE. In conclusion, the addition of a PE and OB improved the adaptation of veal calves after reception, resulting in greater final BW. The improvement in early FI and the immunomodulatory effect in challenging situations displayed by the treatments may partially explain the observed benefits.

The clinical significance of pyogenic liver abscess after transarterial chemoembolization or microwave ablation on malignant liver tumors: A retrospective study.

Pyogenic liver abscess (PLA) is a rare but severe complication of interventional therapy that has been little studied. We aimed to find the risk factors for PLA after transarterial chemoembolization (TACE) or microwave ablation (MWA), further explore its clinical significance and summarize our experience with its treatment. Twenty-two patients with PLA and 118 randomly selected patients without PLA after TACE/MWA were enrolled. Logistic regression was used to analyze risk factors, a nonparametric test was used to compare recovery duration, the log-rank test was used to compare progression-free survival, and Spearman correlation coefficient was calculated between the time from fever to drainage and the total duration of fever. The disease process and treatment were summarized. Sphincter of Oddi manipulation increased the risk of PLA by 70.781-fold. The PLA group took longer to recover (36.56 ± 16.42 days) than the control group (5.54 ± 4.33 days), and had a shorter progression-free survival. Escherichia coli was the major pathogenic bacterium, and multidrug resistance was found in 8 patients with E coli or Enterococcus faecium. The time from fever to drainage was 15.89 ± 13.78 days, which was positively correlated with the total duration of fever (24.29 ± 18.24 days). Overall, 18 patients recovered, and 4 patients died of PLA, for a mortality rate of 18.18%. The fever of 10 patients (45.45%) was controlled by cefoperazone sodium and sulbactam sodium or piperacillin sodium and tazobactam sodium; the fever of 7 patients (31.81%) was controlled by imipenem and cilastatin sodium; and the fever of 3 patients (13.63%) was controlled by tigecycline. Sphincter of Oddi manipulation is a high-risk factor for PLA after TACE or MWA. PLA can accelerate cancer progression and even lead to death. E coli was the major pathogenic bacterium, and multidrug resistance was most common in E coli and E faecium. Timely drainage and appropriate antibiotics are the key primary measures for treating PLA. Cefoperazone sodium and sulbactam sodium or piperacillin sodium and tazobactam sodium is a good choice for the first treatment of PLA, especially before pathogenic bacteria are identified. With the emergence of drug resistance, imipenem and cilastatin sodium, and tigecycline can be used for posterior treatment.

Social needs and healthcare utilization in NICU graduates.

Unplanned healthcare utilization after neonatal intensive care unit (NICU) discharge challenges families and healthcare systems. The impact of social needs on post-NICU healthcare utilization is underexplored. Our objective was to identify social needs among NICU graduates and examine associations between social needs and post-NICU healthcare utilization. A prospective cohort design was used to screen for social needs and track healthcare utilization among 112 NICU graduates attending a NICU follow-up clinic (2021-2022). Associations between social needs and healthcare utilization were analyzed using non-parametric statistical tests. Of 112 patients screened, 20 (18%) had some social need. Infants with social needs experienced statistically significant higher rates of hospitalizations, overall encounters, and missed appointments. Social needs are associated with increased unplanned healthcare utilization and missed appointments. Addressing these needs during NICU follow-up may improve preventative care attendance and reduce unplanned healthcare use, leading to better outcomes for vulnerable infants and cost-savings for healthcare systems.

Temporal Statistical Analysis and Retrospective Assessment of Mortality Rate in the United States from 1999 to 2018

Objectives: To retrospectively examine the mortality trend in the USA from 1999 to 2018 using a basic statistical model while examining multiple variables. The inferential and descriptive statistical tools will be prioritized to elucidate the mortality of both years in simple terms. Methods: We conducted a retrospective observational descriptive analysis of data on the 10 leading causes of death in the United States by age, race, and sex over 2 decades (1999 to 2018). The data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia. The causes of death are classified by the International Classification of Diseases, 10th Revision (ICD–10), which is ranked according to the number of deaths (Cause-of-death statistics are based on the underlying cause of death). This report supplements “Deaths: Final Data for 2020,” the National Center for Health Statistics’ annual report of final mortality statistics. SPSS (statistical package for social sciences) version 29 Software in Excel sheet was used to analyze the generated datasets. Descriptive and inferential (parametric and non-parametric) analyses were used. The statistically significant relationships and assumptions were made using the chi-square/t-test, Kruskal-Wallis, and Fischer's exact tests with the significance level set at p ≤ 0.05. The analysis and determination of the level of agreement between the initial diagnosis and findings from the new analysis done. Results: The proportion of age-adjusted death rates of the heart (such as coronary artery disease) account for the highest proportion of 24%, while Malignant neoplasms (cancers) represent 23%, Chronic lower respiratory diseases contribute 6%, Unintentional injuries (accidents) also play a significant role, accounting for 5% of deaths. The regression analysis reveals a strong and statistically significant relationship between the number of causes in females and males. There was a high death rate of around 60 years in 1999 and a consistent decline over the years, reaching below 40 by 2018, with a 15/100,000 death fluctuation mark. Asian or Pacific Islander has the lowest age adjustment value of 8762.4, American Indian or Alaska Native, Hispanic, or Latino(11673.2), Black or African American, Hispanic, or Latino (12992.1), White, not Hispanic or Latino(15457.1), Black or African American (15708.2), Hispanic or Latino(19624.1), American Indian or Alaska Native, not Hispanic or Latino (16287.9).Asian or Pacific Islander, not Hispanic or Latino( 8791.3), and 99.2% of the variability in the dependent variable and standard error of 6.7240. Conclusions: Cardiovascular death remains the most common cause of death, with a significant decrease in the death rate from 1999 to 2018 due to improved health care and the provision of measures to improve health care. The regression analysis reveals a strong and statistically significant relationship between the number of causes in females and males. Therefore, based on the results, the number of causes in females strongly predicts the number of causes in males.

348 Repeat breeding syndrome: Dexamethasone decreases the prevalence of anti-sperm antibodies in dairy cows

Abstract Cows that require greater than two inseminations to conceive are diagnosed with repeat breeding syndrome (RBS). Anti-sperm antibodies (ASA) in serum are in greater abundance among individuals exhibiting fertility challenges. In humans, treatment with glucocorticoids has been shown to decrease the prevalence of ASA and improve fertility. Therefore, the purpose of this study was to determine the impact of dexamethasone on ASA and pregnancy outcomes in RBS cattle. Holstein multiparous cows (n = 18) diagnosed as having RBS were randomly allotted to one of three treatment groups: Control (C; n = 6), low dexamethasone (LD; n = 6) and high dexamethasone (HD; n = 6). Intramuscular injections of saline (C), 0.05 mg/kg of BW of dexamethasone (LD), or 0.10 mg/kg of BW of dexamethasone (HD) were administered daily starting 4 d prior to insemination (d 0) through insemination (d 4). All treatment volumes were standardized with saline to achieve the same treatment level. Blood was collected on d 0, 4, 8 and 18, with serum extracted on d 0 through 8. Additionally, milk weights were recorded until d 34. For breeding, cows were synchronized using the Double Ovsynch protocol and only one insemination was conducted at the time of breeding. The MIXED procedure in SAS was used to determine the relationship of treatment with the repeated measures of ASA abundance and milk yield. Additionally, a non-parametric chi-square analysis was conducted in SAS using PROC GENMOD to determine the relationship of treatment with immune cell count and pregnancy outcomes. Day, Treatment and Treatment × Day were designated as fixed effects, and a protected post hoc analysis was conducted to account for multiple comparisons. Anti-sperm antibodies tended to decrease (P ≤ 0.082) as dexamethasone increased compared with C, however, there was no Treatment × Day interaction. Daily milk yields for both LD and HD decreased (P < 0.002) compared with C cows, but there was no interaction with day. Though there was an effect for Treatment × Day (P ≤ 0.002) for white blood cell count, percentage lymphocytes, eosinophils, and neutrophils, there was no effect of treatment (P ≥ 0.181). Therefore, interaction differences were largely driven by day (P < 0.001). Surprisingly, there was a trend (P = 0.069) for an increase in pregnancy rates for C cows compared with LD and HD cows. In fact, one-half of the C cows achieved pregnancy compared with just one cow for LD and HD treatments. Overall, dosage of dexamethasone did not differ for ASA or pregnancy outcomes. However, dexamethasone did decrease ASA but did not increase pregnancy rates. Based on these results, we suggest that alternative treatment measures should be explored to improve pregnancy rates in RBS cows.

TRanscranial AlterNating current stimulation FOR patients with mild Alzheimer’s Disease (TRANSFORM-AD): a randomized controlled clinical trial

BackgroundThe mechanistic effects of gamma transcranial alternating current stimulation (tACS) on hippocampal gamma oscillation activity in Alzheimer’s Disease (AD) remains unclear. This study aimed to clarify beneficial effects of gamma tACS on cognitive functioning in AD and to elucidate effects on hippocampal gamma oscillation activity.MethodsThis is a double-blind, randomized controlled single-center trial. Participants with mild AD were randomized to tACS group or sham group, and underwent 30 one-hour sessions of either 40 Hz tACS or sham stimulation over consecutive 15 days. Cognitive functioning, structural magnetic resonance imaging (MRI), and simultaneous electroencephalography–functional MRI (EEG-fMRI) were evaluated at baseline, the end of the intervention and at 3-month follow-up from the randomization.ResultsA total of 46 patients were enrolled (23 in the tACS group, 23 in the sham group). There were no group differences in the change of the primary outcome, 11-item cognitive subscale of the Alzheimer’s Disease Assessment Scale (ADAS-Cog) score after intervention (group*time, p = 0.449). For secondary outcomes, compared to the control group, the intervention group showed significant improvement in MMSE (group*time, p = 0.041) and MoCA scores (non-parametric test, p = 0.025), which were not sustained at 3-month follow-up. We found an enhancement of theta-gamma coupling in the hippocampus, which was positively correlated with improvements of MMSE score and delayed recall. Additionally, fMRI revealed increase of the local neural activity in the hippocampus.ConclusionEffects on the enhancement of theta-gamma coupling and neural activity within the hippocampus suggest mechanistic models for potential therapeutic mechanisms of tACS.Trial registrationClinicalTrials.gov, NCT 03920826; Registration Date: 2019-04-19.