Paired Wilcoxon Rank Sum Test Research Articles

Evaluation of non-monoexponential diffusion models for hepatocellular carcinoma using b values up to 2000 s/mm2 : A short-term repeatability study.

Non-monoexponential diffusion models are being used increasingly for the characterization and curative effect evaluation of hepatocellular carcinoma (HCC). But the fitting quality of the models and the repeatability of their parameters have not been assessed for HCC. To evaluate kurtosis, stretched exponential, and statistical models for diffusion-weighted imaging (DWI) of HCC, using b-values up to 2000 s/mm2 , in terms of fitting quality and repeatability. Prospective. Eighteen patients with HCC. Conventional and DW images (b = 0, 200, 500, 1000, 1500, 2000 s/mm2 ) were acquired at 3.0T. The parameters of the kurtosis, stretched exponential, and statistical models were calculated on regions of interest (ROIs) of each lesion. The fitting quality was evaluated through comparing the fitting residuals produced on the average data of ROI between different models using a paired t-test or Wilcoxon rank-sum test. Repeatability of the fitted parameters at the median values on the voxelwise data of ROI was assessed using the within coefficient of variation (WCV), the intraclass correlation coefficient (ICC), and the 95% Bland-Altman limits of agreements (BA-LA). The repeatability was divided into four levels: excellent, good, acceptable, and poor, referring to the values of ICC and WCV. Among three models, the stretched exponential model provided the best fit to HCC (P < 0.05), whereas the statistical model produced the largest fitting residuals (P < 0.05). The repeatability of K from the kurtosis model was excellent (ICC 0.915; WCV 8.79%), while the distributed diffusion coefficient (DDC) from the stretched model was just acceptable (ICC 0.477; WCV 27.83%). The repeatability was good for other diffusion-related parameters. Considering the model fit and repeatability, the kurtosis and stretched exponential models are the preferred models for the description of the DW signals of HCC with respect to the statistical model. 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:297-304.

Effects of Increased Pharyngeal Tissue Mass Due to Fluid Accumulation in the Neck on the Acoustic Features of Snoring Sounds in Men.

Snoring sounds are generated by the vibration of pharyngeal tissue due to the upper airway narrowing. While recorded by a microphone placed over the neck, snoring can pass through the pharyngeal tissue surrounding the upper airway. Thus, changes in the pharyngeal tissue content may change the acoustic properties of the snoring sounds. Rostral fluid shift and the consequent increases in neck fluid volume (NFV) and neck circumference (NC) can increase pharyngeal tissue mass. Therefore, the goal of this study was to investigate the relationship between increases in pharyngeal tissue mass, as assessed by increased NFV and NC, and snoring sounds features. We obtained data from a previous study where 20 males who were not obese participated in a daytime polysomnography and their NC and NFV were measured before and after sleep. During sleep, snoring sounds were recorded with a microphone placed over the neck. Spectral centroid of the snoring sounds was estimated. Then, the first five snoring segments were selected from the first and last 30 minutes of stage N2 sleep. We found a significant decrease in the snoring spectral centroid from the beginning to end of sleep. We also found that spectral centroid from the end of sleep in frequency ranges below 200 Hz was inversely correlated with the increases in NFV and NC from before to after sleep. These results suggest that snoring spectral centroid can be used as a noninvasive and convenient method to assess variations in the pharyngeal tissue mass.

Cardio-pulmonary MRI for detection of treatment response after a single BPA treatment session in CTEPH patients

Chronic thromboembolic pulmonary hypertension (CTEPH) can be treated with balloon pulmonary angioplasty (BPA) in inoperable patients. Sensitive non-invasive imaging methods are missing to detect treatment response after a single BPA treatment session. Therefore, the aim of this study was to measure treatment response after a single BPA session using cardio-pulmonary MRI. Overall, 29 patients with CTEPH were examined with cardio-pulmonary MRI before and 62 days after their initial BPA session. Pulmonary blood flow (PBF), first-pass bolus kinetic parameters, and biventricular mass and function were determined. Multiple linear regression analysis was implemented to estimate the relationship of PBF change in the treated lobe with treatment change of full width at half maximum (FWHM), cardiac output (CO), ventricular mass index (VMI), pulmonary transit time (PTT) and PBF change in the non-treated lobes. Paired Wilcoxon rank sum test and Spearman rho correlation were used. After BPA regional PBF increased in the treated lobe (p < 0.0001) as well as in non-treated lobes (p = 0.015). PBF treatment changes in the treated lobe were significantly larger compared with the non-treated lobes (p = 0.0049). Change in NT proBNP, MRI-derived mean pulmonary artery pressure (mPAP), PTT, FWHM, right ventricular (RV) ejection fraction, RV stroke volume, CO, VMI and PBF in the non-treated lobes correlated with PBF change in the treated lobe (p < 0.05). PBF changes in the treated lobe were independently predicted by PTT as well as PBF change in the non-treated lobes. Cardio-pulmonary MRI detects and quantifies treatment response after a single BPA treatment session. • Two months after BPA regional parenchymal pulmonary perfusion (PBF) increased in the total lung parenchyma (p = 0.005), the treated lobes (p < 0.0001) and non-treated lobes (p = 0.015). • The PBF treatment changes in the treated lobe were significantly larger than in the non-treated lobes (p = 0.0049). • Change in NT proBNP, MRI-derived mean pulmonary artery pressure, pulmonary transit time, full width at half maximum, right ventricular (RV) ejection fraction, RV stroke volume, cardiac output, ventricular mass index and PBF in the non-treated lobes correlated with PBF change in the treated lobe (p < 0.05).

Prone liver phase MRA demonstrates improved intramuscular vascular detail compared to CTA in preoperative perforator mapping for free autologous abdominally-based breast reconstruction

Background: MRA and CTA are both used to evaluate perforator anatomy in preparation for autologous breast reconstruction. While CTA is most commonly performed, prone liver phase MRA (PLP-MRA) can be performed concomitantly with breast MRI to assess arterial and venous anatomy while providing superior discrimination of vascular anatomy. Methods: Consecutive patients with planned free autologous abdominally-based breast reconstruction were prospectively randomized to undergo preoperative perforator mapping with CTA or PLP-MRA. Imaging was used to predict whether a deep inferior epigastric artery perforator flap (DIEP) or muscle-sparing-2-TRAM (MS2-TRAM) would be performed. Paired radiographic and blinded intra-operative measurements of perforator location relative to the umbilicus, intramuscular pedicle length and pedicle position relative to the semilunar line were compared by paired Wilcoxon rank sum test. Results: The type of flap performed was accurately predicted in all cases from PLP-MRA or CTA. Both PLP-MRA and CTA accurately predicted perforator location (48 hemi-abdomens) and distance from semi-lunar line (30 hemi-abdomens). PLP-MRA was superior to CTA in accurately predicting intra-muscular pedicle length (P 2 mm in diameter. Conclusions: PLP-MRA offers superior accuracy in predicting intramuscular pedicle length compared to CTA while maintaining accuracy in determining perforator location and pedicle position to assist with flap design. This PLP-MRA protocol can be performed concomitantly with pre-operative breast MRI in select patients to avoid multiple imaging modalities and avoid radiation exposure.

2265 Effect of dietary approaches to stop hypertension (DASH) diet on hemodynamic markers in advanced heart failure patients

OBJECTIVES/SPECIFIC AIMS: The central aim of the study is to examine the effect of a Dietary Approaches to Stop Hypertension (DASH) diet on hemodynamic, cardiometabolic, and inflammatory markers in advanced heart failure patients with implanted hemodynamic monitoring devices. METHODS/STUDY POPULATION: This pilot study will employ a clinical feeding trial using a 1-group pre-post test design with an anticipated sample size of n=36 (n=20 plus 44% expected attrition). Heart failure patients 18+ years of age with English language literacy, classified as NYHA functional stage III, regardless of ventricular ejection fraction, who have undergone CardioMEMS™ hemodynamic monitoring device (St. Jude Medical, Atlanta, GA, USA) implantation and have received optimized heart failure therapy for 3+ months will be recruited at Piedmont Athens Regional Hospital in Athens, GA. The study is divided in (a) a calibration (self-selected diet) and (b) a DASH feeding intervention phase (each 21 days in length). The DASH meals will strictly follow meal planning guidelines published by the National Heart, Lung, and Blood Institute of the National Institutes of Health, and be prepared under the supervision of a registered dietitian at the University Health Center in Athens, GA. The DASH diet is a heart-healthy eating pattern that is focused on adequate consumption of fruits, vegetables, whole grains, low-fat dairy, fish, poultry, beans, nuts, and vegetables oils while emphasizing limited intake of foods containing saturated fat, such as fatty red meats, full-fat dairy products, and tropical oils, such as coconut, palm kernel, and palm oils, as well as sugar-sweetened beverages and sweets. Participants will visit the University of Georgia Clinical and Translational Research Unit on 3 occasions at baseline, upon completion of the calibration phase, and following completion of the intervention phase for repeated collection of anthropometric (height, weight, waist and hip circumference, percent body fatness), cardiometabolic (blood pressure, blood glucose, HbA1C, lipid panel, basic metabolic panel, BNP, NT-proBNP, troponin 1, MR-proADM, sST2), functional status (6-min walk test), inflammatory (IL-1a, IL-1b, IL-6, TNF-a), and self-reported measures (demographic and economic characteristics, health, chronic diseases, perceived stress, heart failure-related quality of life, social support, sleep quality, food insecurity, tobacco smoking status, healthcare utilization, medication adherence). Hemodynamic marker (pulmonary artery pressure, heart rate) and pharmacotherapy information (medication count, type, strength, and dosing) will be obtained from through retrospective assessment of EHR data. Descriptive statistics [percentage, mean (SD), median (IQR), mode, range] will be used to describe sample characteristics at each of the study visits, as well as characteristics of participants’ self-selected diets during the calibration phase. To measure changes in hemodynamic, cardiometabolic, and inflammatory markers pre-post DASH diet intervention, we will use paired Student t-tests (normal distribution) or Wilcoxon rank-sum tests (non-normal distribution), as appropriate. Data collection will be carried out between February and November 2018. RESULTS/ANTICIPATED RESULTS: The study builds upon previous studies showing improvement of ventricular function, arterial stiffness, oxidative stress, and blood pressure after short-term consumption of a sodium-restricted DASH diet in heart failure patients with preserved ejection fraction, and will provide new information on the cumulative effect of short-term adherence with a DASH diet on indicators of heart failure complications, including hemodynamic, cardiometabolic, and inflammatory markers. In addition, it will give better insight on heart failure patients’ habitual dietary intake in the context of other sociodemographic, economic, health, and social factors. DISCUSSION/SIGNIFICANCE OF IMPACT: Findings from the proposed study will provide key knowledge of dietary influences on ventricular function in order to define evidence-based diet therapy needed for the early prevention of HF complications in advanced heart failure patients.

A Dynamic Graph Cuts Method with Integrated Multiple Feature Maps for Segmenting Kidneys in 2D Ultrasound Images

Automatic segmentation of kidneys in ultrasound (US) images remains a challenging task because of high speckle noise, low contrast, and large appearance variations of kidneys in US images. Because texture features may improve the US image segmentation performance, we propose a novel graph cuts method to segment kidney in US images by integrating image intensity information and texture feature maps. We develop a new graph cuts-based method to segment kidney US images by integrating original image intensity information and texture feature maps extracted using Gabor filters. To handle large appearance variation within kidney images and improve computational efficiency, we build a graph of image pixels close to kidney boundary instead of building a graph of the whole image. To make the kidney segmentation robust to weak boundaries, we adopt localized regional information to measure similarity between image pixels for computing edge weights to build the graph of image pixels. The localized graph is dynamically updated and the graph cuts-based segmentation iteratively progresses until convergence. Our method has been evaluated based on kidney US images of 85 subjects. The imaging data of 20 randomly selected subjects were used as training data to tune parameters of the image segmentation method, and the remaining data were used as testing data for validation. Experiment results demonstrated that the proposed method obtained promising segmentation results for bilateral kidneys (average Dice index = 0.9446, average mean distance = 2.2551, average specificity = 0.9971, average accuracy = 0.9919), better than other methods under comparison (P < .05, paired Wilcoxon rank sum tests). The proposed method achieved promising performance for segmenting kidneys in two-dimensional US images, better than segmentation methods built on any single channel of image information. This method will facilitate extraction of kidney characteristics that may predict important clinical outcomes such as progression of chronic kidney disease.

Dynamic non-invasive ASL perfusion imaging of a normal pancreas with secretin augmented MR imaging.

To investigate prospectively the repeatability of pancreatic perfusion measurements using arterial spin labelling (ASL) and to determine the increase in perfusion due to secretin stimulation. An (FAIR)-TrueFISP ASL sequence was applied to determine the perfusion of the pancreatic head in a 3T MRI scanner. Ten healthy volunteers (four men, six women: mean age 28.5 ± 4.6 years; age range 25-40 years) were investigated twice within 1 week. The inter-individual variability was calculated using the standard deviation. Intra-individual agreement between the first and second scan was estimated using the Pearson correlation coefficient. A paired Wilcoxon rank-sum test was used to compare perfusion at baseline (BL) and during secretin stimulation. The mean BL perfusion of the pancreatic head was 285 ± 96 mL/100 g/min with an intra-individual correlation coefficient of 0.67 (strong) for repeated measurements. Secretin stimulation led to a significant increase (by 81%) in perfusion of the pancreatic head to 486 ±156 mL/100 g/min (p=0.002) with an intra-individual correlation of 0.29 (weak). A return to BL values was observed after 239 ± 92 s with a moderate intra-individual correlation coefficient of 0.42 for repeat measurements. Dynamic non-invasive ASL imaging of the pancreas permitted quantification of pancreatic perfusion in a clinically applicable setting. • ASL imaging of the pancreas permitted quantification of pancreatic perfusion • Secretin stimulation led to a significant increase in pancreatic perfusion • The intra-individual correlation coefficient for baseline perfusion was strong for repeated measurements.

Pharmacokinetic Effect of Anti-tumor Necrosis Factor-alpha Agents on Thiopurine Drug Metabolism in Inflammatory Bowel Diseases

Introduction: Thiopurines and anti-tumor necrosis factor-alpha (anti-TNF) drugs are commonly used in treatment of inflammatory bowel diseases (IBD). Studies have established that thiopurines, when used in combination with anti-TNF drugs, affect the metabolism of anti-TNF drugs, resulting in higher serum drug concentrations. However, the data on the effect of anti-TNF drugs on thiopurine metabolism is limited. Methods: All adult IBD patients followed at our IBD center who had thiopurine metabolite concentrations measured between 2000-2016 were eligible for inclusion if they had at least 1 level measured while on thiopurine monotherapy, and 1 level measured while on combination therapy with an anti-TNF and thiopurine drug with the same thiopurine drug dose. Thiopurine metabolite concentration, white blood cell (WBC) count, mean corpuscular volume (MCV) and serum alanine aminotransferase (ALT) levels were compared on monotherapy and combination therapy. Paired t-test and Wilcoxon rank sum test were used for analysis of variables with normal and non-normal distribution, respectively. Results: 30 patients met the inclusion criteria (Table 1). Mean 6TGN level (in pmol/8 x 108 RBCs) on monotherapy and combination therapy were 201 and 267 respectively (% increase 33%; 95% CI 30.1-105.8; p 0.0004). There was a corresponding decrease in mean WBC count (in x1000/mL) from 7.6 to 6.1 (% decrease 20%; 95% CI 0.49-2.85; p 0.01) (Figure 1). There was no significant difference in 6-MMP levels, MCV and ALT levels on monotherapy and combination therapy (Table 2). On subgroup analysis, patients with therapeutic 6TGN levels >230 (n=13) had a significant increase in 6TGN levels (301 vs 369; p 0.03), and a corresponding decrease in WBC count (8.0 vs 5.7; p 0.07) on combination therapy. One patient developed leukopenia (WBC 2.8) after starting infliximab with an increase in 6TGN levels from 425 to 516.Figure: Thiopurine metabolite concentration and WBC count on monotherapy and combination therapy.Table: Table. Baseline CharacteristicsTable: Table. Lab parameters on monotherapy and combination therapyConclusion: In patients with IBD on thiopurine monotherapy, the addition of an anti-TNF agent can lead to an increase in 6-TGN concentration, thereby increasing the risk of leukopenia. Hence, elective thiopurine dose reduction should be considered prior to starting an anti-TNF agent, particularly in patients with therapeutic 6TGN concentration on thiopurine monotherapy. Our findings also suggest that benefits of combination therapy may be, in part, due to increase in thiopurine metabolite concentration with addition of an anti-TNF agent.

Stabilization of Tumor-Associated Craniovertebral Junction Instability: Indications, Operative Variables, and Outcomes

Whether primary or metastatic, tumors of the craniovertebral junction (CVJ) are rare and challenging. To examine the surgical indications, operative variables, and outcomes in patients with tumors of the CVJ undergoing occipitocervical (OC) stabilization. A single-institution, retrospective case series was performed from a prospectively maintained spine database. Patients with primary or metastatic tumors of the CVJ who underwent OC stabilization were identified. Out of 46 patients who underwent OC fusion, 39 were for tumor. Paired t -tests and Wilcoxon rank-sum tests were performed to assess for postoperative changes. Ten patients (26%) harbored primary tumors, and the remaining 29 (74%) had metastatic disease. Of the metastatic patients, 14 had a neurological deficit, 10 had severe neck pain, and 5 were deemed mechanically unstable. Postoperative visual analog pain scores were significantly reduced at all 3 follow-up times ( P < .001, 95% confidence interval [CI; 3.2, 6.0]; P = .001, 95% CI [2.6, 7.7]; P = .020, 95% CI [0.6, 5.5]). The percentage of patients who were ambulatory and neurologically improved or intact remained stable postoperatively with no significant declines. There were 2 perioperative mortalities (5%), and 13 patients (33%) experienced a major complication. In patients with primary or metastatic tumor of the CVJ, OC stabilization using a cervical screw-rod system affixed to a midline-keel buttress plate, with or without posterior decompression, is a reliable method for CVJ stabilization in the oncologic setting. Improvement in pain and preservation of neurological function was seen.

The concept of a waiting period for preoperative patient consent: Prospective study of 51 shoulder arthroscopy cases

IntroductionThe French Code of Public Health (CSP) does not explicitly require that patients should be given a certain amount of time to think about a procedure, except for cosmetic surgery, where 15 days is required (Art. L 6322-2 CSP). We hypothesized that patients require a waiting period during their decision-making process for scheduled shoulder arthroscopy procedure. Materials and methodsThis prospective observational study of 51 patients analysed the concept of a waiting period based on a 10-item questionnaire. A comparative statistical approach was used and the P values were calculated using a paired Wilcoxon rank-sum test. ResultsOf the 51 patients, 42 (82%) rejected the concept of a waiting period before the procedure and 37 patients (73%) did not want a mandatory waiting period imposed by law. DiscussionThis study looked at the decision-making process during scheduled orthopaedic surgery and differentiated between the conscious and unconscious approach corresponding to an active and passive waiting period. A waiting period does not allow patients to make a conceptually deliberative decision that conforms to the criteria defined by the French Health Authority. This study rejects the need for a mandatory waiting period imposed on surgeons and patients as it does not integrate itself into the informative model of ethical decision-making for scheduled shoulder arthroscopy. Type of studyProspective, observational; level of evidence IV.

Immediate-term chemotherapy-related cognitive impairment (CRCI) following administration of intravenous (IV) chemotherapy.

10084 Background: The acute impact of chemotherapy on cognition is unknown. This study utilized performance on the psychomotor vigilance task (PVT) and trail-making test B (TMT) to assess CRCI immediately following chemotherapy administration. Methods: Patients aged 18-80 years receiving first-line IV chemotherapy for any stage of breast or colorectal cancer were eligible. Patients with brain metastases, neurologic disorders or allergic reactions to chemotherapy were excluded. Patient symptoms, peripheral neuropathy and Stanford Sleepiness Scale were assessed. A five-minute PVT and TMT were completed on a tablet computer pre-chemotherapy and immediately post-chemotherapy. Paired Wilcoxon Rank Sum tests were used to assess change in median PVT reaction time, TMT completion time, TMT errors and PVT lapses. A priori, an increase in median PVT reaction times by over 20 ms (approximating reaction time changes with blood alcohol concentrations of 0.04 to 0.05 g%) was considered a clinically relevant change. Results: 144 patients (74 breast, 70 colorectal, median age 55.5 years) were tested. Post-chemotherapy, median PVT reaction time slowed by an average of 12.4 ms ( p = 0.01). Post-chemotherapy median PVT times slowed by over 20 ms in 59 patients (40.9%). TMT completion post-chemotherapy was faster by an average of 6.1 seconds ( p &lt; 0.001). No differences were seen in TMT errors ( p = 0.417) or PVT lapses ( p = 0.845). Change in median PVT reaction time was not associated with age, gender, number of prior chemotherapy cycles, peripheral neuropathy grade, self-reported symptoms (anxiety, fatigue or depression). Change in median PVT reaction time was also not significantly associated with use of any specific chemotherapeutic drug or class, including paclitaxel (which includes ethanol as an excipient). Conclusions: Median PVT reaction time was significantly slower immediately after chemotherapy compared to a pre-chemotherapy baseline, and impairment correlating to effects of alcohol was seen in 41% of patients. This effect appears independent of age, self-reported symptoms or prior chemotherapy cycles. Further studies assessing functional impact of immediate-term CRCI are warranted.

Feasibility study of coronary CT angiography in single cardiac cycle in patients with high heart rate using 256-row detector CT

Objective To investigate the feasibility of coronary CT angiography in single cardiac cycle and to analyze the image quality and radiation dose in patients with high heart rate(HR) using 256-row detector CT. Methods Ninety-two consecutive patients between October and November 2015 who were suspected coronary artery disease underwent coronary CT angiography (CCTA) were enrolled, which was performed with a 256-row detector CT (Revolution CT, GE Healthcare) using prospective ECG-triggered volume CCTA within a single cardiac cycle with snapshot freeze (SSF) technique. The patients were grouped by HR during CT scans: group A (80—89 bpm, n=56), group B (90—99 bpm, n=20), and group C (≥100 bpm, n=16). Image quality was compared before and after using SSF technique reconstructions in seventy-four patients. The image quality of coronary artery was evaluated blindly by 2 experienced radiologists using a four-point scale based on the 18-segment model according to the Society of Cardiovascular Computed Tomography guidelines. The differences in age, body mass index, heart rate and CT dose index volume, effective dose(ED) among the three groups were compared by using ANOVA analysis or Kruskal-Wallis test, the image quality and interpretability using χ2 test. Comparisons of image quality between standard and SSF were performed with paired Wilcoxon rank sum test. Kappa coefficient was used to test inter-observer agreement. Results A total of 1 065 coronary artery segments, 98.97% (1 054/1 065) met the requirements for diagnosis. No significant difference was found (χ2=1.274, P=0.563) for the diagnostic image quality of coronary artery segments among the 3 groups with 98.64% (651/660), 99.57%(232/233), 99.42% (171/172), respectively. Significant difference (χ2=68.811, P 0.05). Conclusions Single cardiac cycle scan is feasibility for coronary CT angiography in patients with high heart rate using 256-row detector CT. This scan mode can maintain the diagnostic image quality with low radiation dose. SSF technique can improve the image quality. Key words: Heart rate; Coronary vessel; Tomography, X-ray computed; Radiation dosage

Immediate-term chemotherapy-related cognitive impairment (CRCI) following administration of intravenous (IV) chemotherapy.

146 Background: The acute impact of chemotherapy on cognition is unknown. This study utilized performance on the psychomotor vigilance task (PVT) and trail-making test B (TMT) to assess CRCI immediately following chemotherapy administration. Methods: Patients aged 18-80 years receiving first-line IV chemotherapy for any stage of breast or colorectal cancer were eligible. Patients with brain metastases, neurologic disorders or allergic reactions to chemotherapy were excluded. Patient symptoms, peripheral neuropathy and Stanford Sleepiness Scale were assessed. A five-minute PVT and TMT were completed on a tablet computer pre-chemotherapy and immediately post-chemotherapy. Paired Wilcoxon Rank Sum tests were used to assess changes in median PVT reaction time, TMT completion time, TMT errors and PVT lapses. A priori, increases of 20 ms or over in median PVT reaction times (approximating reaction time changes with blood alcohol concentrations of 0.04 to 0.05 g%) were considered clinically relevant. Results: 144 patients (74 breast, 70 colorectal, median age 55.5 years) were tested. Post-chemotherapy, median PVT reaction time slowed by an average of 12.4 ms (p = 0.01). Post-chemotherapy median PVT times slowed by over 20 ms in 59 patients (40.9%). TMT completion post-chemotherapy was faster by an average of 6.1 seconds (p &lt; 0.001). No differences were seen in TMT errors (p = 0.417) or PVT lapses (p = 0.845). Change in median PVT reaction time was not associated with age, gender, number of prior chemotherapy cycles, use of paclitaxel (which contains alcohol), peripheral neuropathy grade, or self-reported anxiety, fatigue or depression. Conclusions: Median PVT reaction time was significantly slower immediately after chemotherapy compared to a pre-chemotherapy baseline, and impairment correlating to effects of alcohol was seen in 41% of patients. This effect appears independent of age, self-reported symptoms or prior chemotherapy cycles. Further studies assessing the functional implications of immediate-term CRCI are warranted.

Comparison of the 18-month outcome after the treatment of osteoporotic insufficiency fractures by means of balloon sacroplasty (BSP) and radiofrequency sacroplasty (RFS) in comparison: a prospective randomised study

PurposeThe objective of this prospective, randomised study was to examine the feasibility and clinical outcome of balloon sacroplasty and radiofrequency sacroplasty.MethodsIn 40 patients with a total of 57 sacral fractures, CT-guided cement augmentation was performed by means of BSP or RFS. For BSP, the balloon catheter was inflated and deflated in the fracture zone, and the hollow space, thus, created was then filled with PMMA cement. For RFS, the spongious space in the fracture zone was initially extended using a flexible osteotome, and the highly viscous PMMA cement, activated by radiofrequency, was then inserted into the prepared fracture zone. Pain intensity was determined on a VAS before the intervention, on the second day, and 6, 12 and 18 months after the intervention. The results were tested for significance by means of paired Wilcoxon rank-sum tests and Mann–Whitney U tests.ResultsBSP and RFS were technically fully feasible in all patients. An average of 6.3 ml cement per fracture was inserted in the BSP group and an average of 6.1 ml per fracture in the RFS group. Leakage could be ruled out for both procedures. The mean pain score on the VAS before the intervention was 8.6 ± 0.55 in the BSP group and 8.8 ± 0.58 in the RFS group. On the second postoperative day, a significant pain reduction was seen (p < 0.001), with an average value of 2.5 (BSP ± 0.28, RFS ± 0.38) for both groups. After 6 (12; 18) months, these values were stable for the BSP group at 2.3 ± 0.27 (2.3 ± 0.24; 2.0 ± 0.34) and for the RFS group at 2.4 ± 0.34 (2.2 ± 0.26; 2.0 ± 0.31). With regard to pain, exceedance probability values of p = 0.86 (6 months), p = 0.94 (12 months) and p = 1 (18 months) were seen, so that neither treatment method leads to differences in results.ConclusionsBSP and RFS are interventional, minimally invasive procedures that enable reliable cement augmentation and achieve equally good clinical outcomes in the medium term.

Comparison of the diagnostic efficiency between digital breast tomosynthesis and full-field digital mammography

To explore the effect of digital breast tomosynthesis (DBT) on the classification of breast imaging-reporting and data system (BI-RADS) and its significance. Methods: A total of 832 patients with breast diseases, who came from Second Clinical College of Fujian Medical University from May 2013 to November 2013, were collected. The patients were examined by double position radiography (including craniocaudol and mediolateral oblique) and COMBO mode [including DBT and full-field digital mammography (FFDM)]. Meanwhile, the results of FFDM and DBT were classified. The number of glands, the characteristics of mass and other indirect signs were compared by COMBO and FFDM modes. Paired Wilcoxon rank sum text was adopted to investigate the differences between COMBO mode and FFDM mode in the 832 patients, and receiver operator characteristic curve (ROC) was applied to analyze the 79 patients with the pathological results. Results: The patients with large amount of glands (including Class c and Class d) accounted for 87.6% in the 832 patients, while the patients with small amounts of glands (including Class a and Class b) accounted for 11.7%. In estimating the content of glands, more details about the distribution of glands were found in the COMBO mode compared with those in the FFDM mode. According to the results of paired Wilcoxon rank sum test, there was significant statistical difference in BI-RADS classcification in breast masses between the COMBO mode and the FFDM mode (P<0.05), though the overall classification of the COMBO mode is higher than that of the FFDM mode. The pathology was served as a standard to estimate the diagnostic efficiency. The area under ROC curve was 0.805 in the FFDM mode, while that in the COMBO mode was 0.941. The optimal sensibility in the COMBO mode was 82.9%, which was higher than that in the FFDM mode. However, the specificity was 93.2% in both COMBO mode and the FFDM mode. Conclusion: DBT has a high clinical significance in BI-RADS classification for breast X-ray examination.

Normative values of retinal vessel oximetry in healthy children against adults

PurposeRetinal oximetry (RO) has been established as a non‐invasive method to analyze oxygen saturation in retinal vessels. The aim of our study was to compare metabolic (oxygen saturation) and anatomical (retinal vessel diameter) RO parameters of healthy children against adults.MethodsA total of 157 eyes of 79 healthy subjects were examined: 20 eyes of children (7–18 year) were compared to adults of different age groups [20–29 year (n = 16); 30–39 year (n = 46); 40–49 year (n = 38); 50–59 year (n = 25), 60–87 year (n = 12)]. RO was performed with the oxygen saturation measurement tool of the Retinal Vessel Analyser (RVA; IMEDOS Systems UG, Jena, Germany). The oxygen saturation in all four major peripapillary retinal arterioles (A‐SO2) and venules (V‐SO2) were measured and their difference (A‐V SO2) was calculated. In addition, we evaluated the corresponding diameter in retinal arterioles (D‐A) and venules (D‐V). For statistical evaluation non‐parametric tests (Friedman test for multiple comparisons, paired Wilcoxon rank sum test for pairwise comparisons) were performed.ResultsChildren showed statistically significant lower arterial oxygen saturation values (A‐SO2) compared to all adult subgroups (Friedman test, p = 0.0005). Although not statistically significant, the values of V‐SO2 (p = 0.06) and A‐V SO2 (p = 0.30) showed a trend to be lower in children. The D‐A (p = 0.49) and D‐V (p = 0.82) values were not significantly different between groups.ConclusionsThese data indicate that the retinal oxygen metabolism changes throughout lifetime. Therefore, normative data for different age groups are mandatory.

Immediate stress reduction effects of yoga during pregnancy: One group pre-post test.

Excessive stress during pregnancy may cause mental disorders in pregnant women and inhibit fetal growth. Yoga may alleviate stress during pregnancy. To verify the immediate effects of yoga on stress response during pregnancy. One group pre-post test was conducted at a hospital in Japan. We recruited 60 healthy primiparas without complications and asked them to attend yoga classes twice a month and to practice yoga at their homes using DVD 3 times a week from 20 gestational weeks until childbirth. Salivary cortisol and alpha-amylase concentration were measured before and after yoga classes at time 1 (27-32 gestational weeks) and time 2 (34-37 gestational weeks). Subjective mood was assessed using the profile of mood states. Saliva values and mood scores before and after each yoga class were compared using paired t-test and Wilcoxon rank-sum test, respectively. We analyzed 44 and 35 women at time 1 and time 2, respectively. The mean salivary cortisol concentration declined significantly after each yoga class [time 1: 0.36-0.26μg/dL (p<0.001), time 2: 0.32-0.26μg/dL (p=0.001)]. The mean salivary alpha-amylase concentration also decreased significantly following each class [time 1: 72.2-50.8kU/L (p=0.001), time 2: 70.6-52.7kU/L (p=0.006)]. The scores for negative dimensions of mood (Trait-Anxiety, Depression, Anger-Hostility, Fatigue, and Confusion) decreased significantly. The scores of Vigor for a positive dimension of mood significantly increased. This study indicated the immediate stress reduction effects of yoga during pregnancy.

Social Justice in Nursing Education: Leap into Action

Objective: Nursing students must be educated on their role in creating a social justice agenda in healthcare; therefore, academia must establish effective methods to teach these essential concepts. The purpose of this study is to explore the impact of an integrated approach to learning social justice. This research provides evidence of the potential efficacy and utility of interactive teaching strategies in the affective domain of nursing students. Methods: The intervention, select affective pedagogical strategies, was designed to integrate content into each semester of the undergraduate nursing curriculum, each were interactive in nature and enhanced the affective learning for the student. The approach aimed at integration of these strategies in a way that decreased further burden for faculty, yet created an environment that enhances the understanding of social justice. Using a pre/posttest design, this study administered the Social Justice Attitudes Scale (SJS), a 24-item questionnaire which is categorized into four sub-scales. A sample of 86 undergraduate nursing students completed the pre-test in the first semester of their nursing program and the post-test in the final semester of their nursing program. Results: The Paired Wilcoxon Rank Sum test was conducted to determine the difference between the pre-test median and the post-test median for each of the four subscales of the SJS; significance set at an alpha of 0.05, all four statistical analyses resulted in a p=<0.001. Conclusion: Reviewing pedagogy in nursing curriculum is an arduous task, but is necessary in order to understand instances in which courses may be lacking in socializing nursing students to the importance of professional nursing values, such as social justice. Integrating affective pedagogical strategies across the continuum of a baccalaureate nursing program has the potential to improve knowledge and intention to act regarding social justice.

Dual-input two-compartment pharmacokinetic model of dynamic contrast-enhanced magnetic resonance imaging in hepatocellular carcinoma.

To investigate the feasibility of a dual-input two-compartment tracer kinetic model for evaluating tumorous microvascular properties in advanced hepatocellular carcinoma (HCC). From January 2014 to April 2015, we prospectively measured and analyzed pharmacokinetic parameters [transfer constant (Ktrans), plasma flow (Fp), permeability surface area product (PS), efflux rate constant (kep), extravascular extracellular space volume ratio (ve), blood plasma volume ratio (vp), and hepatic perfusion index (HPI)] using dual-input two-compartment tracer kinetic models [a dual-input extended Tofts model and a dual-input 2-compartment exchange model (2CXM)] in 28 consecutive HCC patients. A well-known consensus that HCC is a hypervascular tumor supplied by the hepatic artery and the portal vein was used as a reference standard. A paired Student's t-test and a nonparametric paired Wilcoxon rank sum test were used to compare the equivalent pharmacokinetic parameters derived from the two models, and Pearson correlation analysis was also applied to observe the correlations among all equivalent parameters. The tumor size and pharmacokinetic parameters were tested by Pearson correlation analysis, while correlations among stage, tumor size and all pharmacokinetic parameters were assessed by Spearman correlation analysis. The Fp value was greater than the PS value (FP = 1.07 mL/mL per minute, PS = 0.19 mL/mL per minute) in the dual-input 2CXM; HPI was 0.66 and 0.63 in the dual-input extended Tofts model and the dual-input 2CXM, respectively. There were no significant differences in the kep, vp, or HPI between the dual-input extended Tofts model and the dual-input 2CXM (P = 0.524, 0.569, and 0.622, respectively). All equivalent pharmacokinetic parameters, except for ve, were correlated in the two dual-input two-compartment pharmacokinetic models; both Fp and PS in the dual-input 2CXM were correlated with Ktrans derived from the dual-input extended Tofts model (P = 0.002, r = 0.566; P = 0.002, r = 0.570); kep, vp, and HPI between the two kinetic models were positively correlated (P = 0.001, r = 0.594; P = 0.0001, r = 0.686; P = 0.04, r = 0.391, respectively). In the dual input extended Tofts model, ve was significantly less than that in the dual input 2CXM (P = 0.004), and no significant correlation was seen between the two tracer kinetic models (P = 0.156, r = 0.276). Neither tumor size nor tumor stage was significantly correlated with any of the pharmacokinetic parameters obtained from the two models (P > 0.05). A dual-input two-compartment pharmacokinetic model (a dual-input extended Tofts model and a dual-input 2CXM) can be used in assessing the microvascular physiopathological properties before the treatment of advanced HCC. The dual-input extended Tofts model may be more stable in measuring the ve; however, the dual-input 2CXM may be more detailed and accurate in measuring microvascular permeability.

MR Imaging-derived Regional Pulmonary Parenchymal Perfusion and Cardiac Function for Monitoring Patients with Chronic Thromboembolic Pulmonary Hypertension before and after Pulmonary Endarterectomy.

Purpose To evaluate surgical success after pulmonary endarterectomy (PEA) by means of cardiopulmonary magnetic resonance (MR) imaging. Materials and Methods In this institutional review board-approved study, 20 patients with chronic thromboembolic pulmonary hypertension were examined at 1.5 T with a dynamic contrast material-enhanced three-dimensional fast low-angle shot sequence before and 12 days after PEA (25th-75th percentile range, 11-16 days). Lung segments were evaluated visually before PEA for parenchymal hypoperfused segments. Pulmonary blood flow (PBF), first-pass bolus kinetic parameters, and biventricular mass and function were determined. Mean pulmonary artery pressure (mPAP) and 6-minute walking distance were measured before and after PEA. The Shapiro-Wilk test, paired two-sided Wilcoxon rank sum test, Spearman ρ correlation, and multiple linear regression analysis were performed. Results Two weeks after PEA, regional PBF increased 66% in the total lung from 32.7 to 54.2 mL/min/100 mL (P = .0002). However, after adjustment for cardiac output, this change was not evident anymore (increase of 7% from 7.03 to 7.54 mL/min/100 mL/L/min, P = .1). Only in the lower lobes, a significant increase in PBF after cardiac output adjustment remained: a 16% increase in the right lower lobe from 7.53 to 8.71 mL/min/100 mL (P = .01) and a 14% increase in the left lower lobe from 7.42 to 8.47 mL/min/100 mL/L/min (P < .05). Right ventricular mass and function also improved. mPAP decreased from 46 to 24 mm Hg (P < .0001). Six-minute walking distance increased from 390 to 467 m (P = .02) 5 months after PEA. Percentage change of mPAP and PBF in the lower lobe tended to be significant predictors of percentage change in 6-minute walking distance (β = -1.79 [P = .054] and β = 0.45 [P = .076], respectively) in multiple linear regression analysis. Conclusion Improvement of PBF after PEA was observed predominantly in the lower lungs, and the magnitude of improvement of PBF in the lower lobes correlated with the improvement in exercise capacity, reflecting surgical success. (©) RSNA, 2016.