Wilcoxon Paired Rank Test Research Articles

A Novel Scouring Method to Monitor Nocturnal Mammals Using Uncrewed Aerial Vehicles and Thermal Cameras—A Comparison to Line Transect Spotlight Counts

Wildlife abundance surveys are important tools for making decisions regarding nature conservation and management. Cryptic and nocturnal mammals can be difficult to monitor, and methods to obtain more accurate data on density and population trends of these species are needed. We propose a novel monitoring method using an aerial drone with a laser rangefinder and high zoom capabilities for thermal imagery. By manually operating the drone, the survey area can be initially scanned in a radius of several kilometers, and when a point of interest is observed, animals could be identified from up to one kilometer away by zooming in while the drone maintains an altitude of 120 m. With the laser rangefinder, a precise coordinate of the detected animal could be recorded instantly. Over ten surveys, the scouring drone method recorded significantly more hares than traditional transect spotlight count surveys, conducted by trained volunteers scanning the same farmland area within the same timeframe (p = 0.002, Wilcoxon paired rank test). The difference between the drone method and the transect spotlight method was hare density-dependent (R = 0.45, p = 0.19, Pearson’s product–moment correlation); the larger the density of hares, the larger the difference between the two methods to the benefit of the drone method. There was a linear relation between the records of deer by the drone and by spotlight (R = 0.69, p = 0.027), while no relation was found between the records of carnivores by drone and spotlight counts. This may be due to carnivores’ speed and vigilance or lack of data. Furthermore, the drone method could cover up to three times the area within the same timeframe as the transect spotlight counts.

Method assessment and observer variation in age estimation: A comparative analysis of the Suchey-Brooks and the İşcan methods on an archaeological medieval population

Age-at-death estimation methods have faced challenges in their applicability to past populations. This study aims to evaluate the assessment and observer variability of the Suchey-Brooks (SB) and İşcan methods within archaeological contexts. Our sample consisted of 400 individuals from the medieval cemetery of the Dunes Abbey in Koksijde, Belgium. The skeletal remains exhibited good preservation, especially for the İşcan methods, which showed higher sensitivity to preservation conditions.Intra- and inter-observer variation were investigated using Spearman correlation coefficients, Wilcoxon paired ranks test, and Cohen's kappa test. The Spearman coefficient revealed a strong positive correlation, with a moderate to almost excellent kappa coefficient for both intra- and inter-observer error. Overall, the SB method displayed better inter-observer agreement, while the İşcan method presented better intra-observer agreement. Applying these methods to younger individuals resulted in less variability. Certain descriptive phase categories, such as phase III for the SB method and phase 3 and 4 for the İşcan methods, seemed problematic.Only 188 sufficiently preserved individuals could be scored using both the SB and the İşcan methods. They were classified into age groups, and the methods assessment were evaluated using the same statistical approach. The Spearman correlation coefficient indicated consistent age group attribution between the two methods (rho = 0.92), with a moderate to almost excellent agreement (k = 0.45; wk = 0.91). Overall, the two methods mainly differ by only one age group, except for older adults. The SB method tended to assign older age groups compared to İşcan's method, leading to effective overestimation.

The QUALITY OF LIFE IN ADOLESCENT DURING COVID 19 PANDEMIC

Background : Assessment of quality of life in children is a useful indicator of overall health because it encompasses information about children's physical and mental health. Managing the existing environment and adhering to current constraints due to Covid-19 can be especially difficult for children and adolescents because these conditions can be regarded as incompatible with their developmental tasks. The Pediatric Quality of Life Inventory (PedsQL) is a tool designed to assess children's quality of life based on age, maturity, and cognitive development. While self-report is the gold standard for measuring perceived PedsQL, there may be occasions when the kid is too young, too sick, or too tired to complete PedsQL instrument, in which case a parent-proxy report may be required.
 Methods : An analytic observational study using a cross-sectional design involve three elementary schools in the Jimbaran area, Badung, Bali. The research was conducted at Udayana University Hospital in July 2022. Detailed explanations about the context and how to fill out the PedsQL form were given to students and their parents. The students and parents fill out PedsQL forms in separate rooms. The PedsQL questionnaire used was the Indonesian version. Concordance between self-report and parent-proxy was evaluated using the Wilcoxon paired sign rank test. Intraclass correlation coefficients (ICC) to assess parent and child agreement.
 Results : Amongst 189 children, median age was 11 years (range 11–13 years). There was no difference in PedsQL between self-report and parent-proxy in overall and subscales functioning domain. Physical, emotional, social, and school functioning all had intraclass correlation coefficients of 0.85, 0.83, 0.79, and 0.88, respectively. Low energy (physical functioning), feel afraid or scared and feel angry (emotional functioning), and can’t do things that children his age do (social functioning) were found different among factor loadings. School functioning factor loadings were found similar.
 Conclusion : This study shows a good agreement and no significant difference in overall and subscale scores between children's self-report and parent-proxy reports. Although significant differences were found when examining each factor loadings in each component.

Abstract CT196: A phase I clinical trial of oncolytic adenovirus mediated suicide and interleukin-12 gene therapy in patients with recurrent prostate cancer

Abstract Introduction: Men with locally recurrent prostate cancer, after definitive radiotherapy, have few therapeutic options. Oncolytic adenovirus-mediated cytotoxic gene therapy is an investigational cancer therapy. Delivery of the suicide gene to the tumor is by direct intratumoral or systemic injection of a viral vector containing the suicide gene. Our approach incorporates yeast cytosine deaminase (yCD) and herpes simplex virus thymidine kinase (HSV-1 TK), to confer sensitivity to 5-fluorocytosine (5-FC) and Valganciclovir (vGCV), respectively. The pro-drugs are converted into active drugs that inhibit DNA damage repair. Here we report the safety of oncolytic adenovirus-mediated suicide gene therapy that incorporates an interleukin-12 (IL12) gene for treatment of recurrent prostate cancer. Methods: In this phase I study, a replication-competent adenovirus (Ad5-yCD/mutTKSR39rep-hIL-12) expressing yCD/mutTKSR39 (yeast cytidine deaminase/mutant S39R HSV-1 thymidine kinase) and human IL-12 (IL12) was injected into tumors of 15 subjects with recurrent prostate cancer (T1c-T2) at escalating doses (1 × 1010, 3 × 1010, 1 × 1011, 3 × 1011, or 1 × 1012 viral particles). Subjects received 5-FC and vGCV for 7 days. The study endpoint was toxicity through day 30. Experimental endpoints included measurements of serum IL12, interferon gamma (IFNγ), and CXCL10 to assess immune system activation. Peripheral blood mononuclear cells (PBMC) and proliferation markers were analyzed by flow cytometry. Results and Conclusions: Fifteen patients received Ad5-yCD/mutTKSR39rep-hIL-12 and oral 5-FC and vGCV. Approximately 92% of the 115 adverse events observed were grade 1/2 requiring no medical intervention. Ad5-yCD/mutTKSR39rep-hIL-12 DNA was detected in the blood of only two patients. Elevated serum IL12, IFNγ, and CXCL10 levels were detected in 57%, 93%, and 79% of subjects, respectively. Serum cytokines demonstrated viral dose dependency, especially apparent in the highest-dose cohorts. Analysis of immune cell populations indicated activation after Ad5-yCD/mutTKSR39rep-hIL-12 administration in cohort 5. The study did not detect a significant difference in the PSA doubling time (PSADT) between pre and post treatment by paired Wilcoxon rank test (p=0.17). There was no correlation between adenoviral dose and PSADT in each cohort separately or pooled (cohorts1-3 and cohorts 4-5). The study maximum tolerated dose (MTD) was not reached indicating 1012 viral particles was safe. This trial confirmed that replication-competent Ad5-IL-12 adenovirus (Ad5-yCD/mutTKSR39 rep-hIL-12) was well tolerated when administered locally to prostate tumors. Citation Format: Shyam Nyati, Hans Stricker, Kenneth L. Barton, Piln Li, Mohamed Elshaikh, Haythem Ali, Stephen L. Brown, Clara Hwang, James Peabody, Svend O. Freytag, Benjamin Movsas, Farzan Siddiqui. A phase I clinical trial of oncolytic adenovirus mediated suicide and interleukin-12 gene therapy in patients with recurrent prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr CT196.

Unattended home sleep studies for the diagnosis of obstructive sleep apnea in a population of French children

BackgroundAmbulatory exams were preferred in children during the COVID-19 pandemic. Polysomnography (PSG), the gold standard for obstructive sleep apnea (OSA) diagnosis, requires several leads and sensors to be attached to the child's body. Children are more comfortable with respiratory polygraphic (RP) recording, which needs fewer sensors. ObjectiveTo compare respiratory parameters obtained by home RP with those obtained by home PSG with the device installed at the child's home by a trained sleep nurse from a national health care provider. MethodsData from home PSGs performed in children aged 2–19 years were retrospectively included. The obstructive apnea-hypopnea index (OAHI) was computed in PSG and then in RP after removing the sleep signals. The two indexes were compared using non-parametric paired Wilcoxon rank test, Bland-Altman analysis and sensitivity–specificity analysis. Results44 PSGs of 44 children were included with only 34 (77%) PSGs interpretable. Median (min-max) OAHI was significantly underestimated in RP than in PSG (2.2 (0–25) vs 4.0 (0.4–28), p < 0.0001), confirmed also by the Bland-Altman diagram, the magnitude of the difference being mean ± standard deviation −1.7 ± 1.7. The sensitivity and specificity of OAHI in RP to identify an OAHI ≥2/h in PSG was 0.91 for both. ConclusionUnattended ambulatory RP performed at child's house and installed under carefully controlled conditions is a useful exam for diagnosing OSA in children with or without comorbidities. However, RP must be installed in a supervised environment and interpreted with caution as it tends to underestimate OSA severity.

Relationship Between Daylight Saving Time and Traffic Crashes in Florida

The objective of this study was to examine the effect of transitions between daylight saving time (DST) and standard time (ST) on traffic crashes in Florida. The study was conducted using 37 years of crash data from Florida from 1983 to 2019. The analysis was based on crashes that occurred during the week before and the week following the time change. The paired Wilcoxon rank test implemented using a Bayesian approach was used to compare the difference in crash frequency following the clock shift to DST. The analysis showed that the time shift has a significant effect on traffic crashes. More specifically, the beginning of DST in the spring, when the clock moves forward by one hour, was associated with a higher frequency of fatal and nighttime crashes. The shift at the end of DST in the fall, when the clock moves back by one hour, resulted in a significant increase in all, no injury, morning peak hours, afternoon off-peak hours, two-vehicle, and multiple-vehicle crashes. Crashes during evening peak hours decreased in the week immediately following the time change. These findings were particularly significant on the Sunday when the shift occurred and the following Monday and Tuesday. It can be inferred from these findings that the impact of DST on safety may be attributed to the disruption of circadian rhythms as well as to the one-hour loss in the spring and one-hour gain in the fall. The study findings could assist researchers and practitioners in understanding the impacts of DST on roadway safety.

Combining an experiential learning model and interprofessional peer-mentoring to improve maternal and neonatal health: Lessons learned from Indonesia.

High maternal-neonatal mortality rate in the East Nusa Tenggara Timur Province, Indonesia, has raised a concern about improving quality health care and prevention. A task force team consisting of the district health office and the corresponding hospital implemented an interprofessional peer mentoring for improving maternal-neonatal health initiative involving various health professionals and community members. This study assesses the effectiveness of the interprofessional peer-mentoring program in improving health-care workers' capacity and community members' awareness of maternal-neonatal health in the primary care setting. A mixed-methods action research was conducted to measure the effectiveness of the peer-mentoring program. The task force appointed 15 personnel to be trained as peer mentors for 60 mentees from various professions. Peer mentors' perceptions of knowledge and skills improvement were measured before and after the training program. A reflective logbook was then developed to document mentoring activities. Surveys and logbook observations were performed to measure the effectiveness of the 8-month peer-mentoring program. Mentees' capacity and perception were measured before and after the mentoring program. Quantitative data were analyzed using the descriptive statistics and Wilcoxon's paired-rank test, whereas open-ended responses and log-book reflection were analyzed using the content analysis. The peer-mentor training program improved peer mentors' knowledge and readiness from 3.64/5.00 to 4.23/5.00 (P < 0.001). Moreover, mentees viewed the program as effective in improving self-confidence and working capacity in maternal-neonatal health services from 3.47/5.00 to 3.98/5.00 (P < 0.001). Open-ended responses and a reflective logbook revealed that both mentees and peer mentors gained positive learning experiences. Seniority might become an obstacle to the mentoring process since peer mentors reported barriers in engaging elderly mentees due to seniority issues. The interprofessional peer-mentoring program was effective in improving both mentors' and mentees' knowledge, self-confidence, and working capacity in maternal-neonatal primary health services and experiential learning. Further observation of the long-term outcomes of the program should be undertaken.

IL-6 blockade for prophylaxis and management of immune-related adverse events (irAEs) with anti-PD-1 based immunotherapy.

9553 Background: Immune checkpoint inhibitors (ICIs) have activity across many tumor types, but activation of the immune system may also lead to significant, often steroid-refractory irAEs. We sought to determine the activity of tocilizumab, an anti-IL6R monoclonal antibody (mAb), in treatment or prevention of auto-immune irAE in ICI-treated patients (pts). Methods: Institutional databases from 2 melanoma centers were reviewed for pts treated with ICIs and tocilizumab. Treatment and melanoma outcomes were prospectively assessed. Longitudinal assessment of c-reactive protein (CRP) and assessment of clinical improvement (defined as irAE resolution to grade ≤1 CTCAEv5) or prophylaxis (absence of flare, defined as ≥ grade 2) were utilized to evaluate the benefit of tocilizumab. Paired Wilcoxon rank test was used to compare CRP levels prior to ICI administration, at the onset of irAEs and after tocilizumab administration. Results: 22 pts were identified. 2 pts were treated prophylactically (pre-existing dermatomyositis [n = 1] and giant cell arteritis [GCA, n = 1]) before the administration of PD1. 20 pts were treated for management of irAEs due to PD1 +/-CTLA4 (multiple concurrent irAEs [n = 3], steroid refractory irAES [hepatitis &amp; pancreatitis, n = 2], steroid+anti-TNFα refractory colitis [n = 2], steroid+other immunosuppressive-refractory hepatitis [n = 1], cytokine release syndrome-related AEs [n = 6], musculoskeletal irAEs [n = 6]). 15 (68.2%) pts with irAEs required hospitalization and of those, 13 (86.7%) received tocilizumab whilst inpatient. Median time to irAE onset from ICI start was 48 days (range 8-786) and from irAE onset to tocilizumab administration 32 days (range 1-192). Median time to irAE resolution from tocilizumab administration was 7 days (range 1-799). Clinical improvement/benefit was demonstrated in 21/22 patients; one patient with ir-hepatitis did not respond. Median CRP prior to ICI administration was 32mg/L (range 0.3-99), at the onset of irAE 49.5mg/L (range 0.3-251, p = 0.055) and after the tocilizumab administration 18mg/L (range 0.3-18, p = 0.0015). Tocilizumab was well tolerated with self-limiting and transient toxicities in 17 (77.3%) patients. There were two grade 4 events; gastrointestinal tract perforation and Fournier gangrene, the latter unrelated to tocilizumab. Two (9%) patients died due to melanoma. From start of ICI, median progression-free survival (PFS) was 5.88 months and median overall survival (OS) was not reached. Conclusions: Tocilizumab was a well-tolerated and effective steroid-sparing treatment for both management of irAEs, as well as prevention of a flare of pre-existing auto-immune disorders during ICI administration. Prospective trials to evaluate its efficacy and impact on cancer outcomes compared with standard strategies are required.

Analysis of pancreatic segmentation algorithm based on deep learning to improve pancreatic critical region segmentation ability on dual-phase CT

Objective: To investigate the segmentation effects of the deep learning method on CT in the arterial phase and venous phase respectively by using subjective and objective evaluation system, and to investigate the factors that affect the difference between arterial phase and venous phase pancreas segmentation and the related factors affecting the venous pancreas segmentation. Method: A total of 218 cases of pancreatic CT scan data in the Department of Radiology of Peking Union Medical College Hospital from January to November 2019 were retrospectively collected. Each case contained images of arterial and venous phases, and the data were randomly divided into training set (139 cases), validation set (20 cases) and test set (59 cases) according to the ratio of the training and verification set to the test set of 7∶3. The two-stage global local progressive fusion network was trained on the training set, the model parameters of the optimal segmentation effect were found on the validation set, and the test set was predicted and the results were evaluated subjectively and objectively. The Likert 5-point scale was used for subjective evaluation based on the critical regions between pancreas and peripheral organs, while the Dice similarity coefficient (DSC) was used for objective evaluation. The paired t test or Wilcoxon paired rank test was used to compare the differences of subjective and objective scores of the arterial phase and venous phase. Results: For the critical regions of the pancreas at the duodenum, duodenal jejunal flexure, left adrenal gland, portal vein, superior mesenteric vein, splenic artery and splenic vein, the median number of subjective scores in arterial phase were 4(4, 5), 5(4, 5), 5(4, 5), 4(4, 5), 5(4, 5), 5(5, 5) and 4(3, 5)points respectively, the median number(first quartile, third quartile) of subjective scores in venous phase were 4(4, 4), 5(4, 5), 5(4, 5), 5(4, 5), 5(5, 5), 4(3, 4) and 5(5, 5) points respectively,there were statistically significant differences of the median number(first quartile, third quartile) of the subjective scores between the arterial and venous phase for the critical regions of the pancreas at the organs described above (all P<0.05). DSC in the venous phase was slightly higher than that in the arterial phase and the difference was not statistically significant (DSC: 0.932 vs 0.921, P=0.952). Subjective scores in venous phase of the pancreas and duodenal jejunum, stomach, and left adrenal gland with fat gaps were 4.64,4.68 and 4.63 points respectively, and those of the group without fat gaps were 4.56,4.62 and 4.56 points respectively, there were statistically significant differences of the subjective scores in venous phase of the groups with fat gaps or not between the pancreas and the organs described above (t=2.147, 2.112, 2.277, all P<0.05). Except the spleen, the density differences between the critical regions of the pancreas and other surrounding organs were statistically significant in arterial phase and venous phase segmentation (all P<0.05). Conclusion: Dual-phase CT was used to construct a deep learning automatic pancreas segmentation model, and the segmentation effect was evaluated subjectively and objectively. Subjective evaluation was helpful to improve the ability to segment the critical regions of the pancreas in the future.

Characterization of kinesthetic motor imagery compared with visual motor imageries

Motor imagery (MI) is the only way for disabled subjects to robustly use a robot arm with a brain-machine interface. There are two main types of MI. Kinesthetic motor imagery (KMI) is proprioceptive (OR somato-) sensory imagination and Visual motor imagery (VMI) represents a visualization of the corresponding movement incorporating the visual network. Because these imagery tactics may use different networks, we hypothesized that the connectivity measures could characterize the two imageries better than the local activity. Electroencephalography data were recorded. Subjects performed different conditions, including motor execution (ME), KMI, VMI, and visual observation (VO). We tried to classify the KMI and VMI by conventional power analysis and by the connectivity measures. The mean accuracies of the classification of the KMI and VMI were 98.5% and 99.29% by connectivity measures (alpha and beta, respectively), which were higher than those by the normalized power (p < 0.01, Wilcoxon paired rank test). Additionally, the connectivity patterns were correlated between the ME-KMI and between the VO-VMI. The degree centrality (DC) was significantly higher in the left-S1 at the alpha-band in the KMI than in the VMI. The MI could be well classified because the KMI recruits a similar network to the ME. These findings could contribute to MI training methods.

1021 Use of electromyography to determine quantitative effects of oxytocin during the 1st stage of labor

Electrical activity (EA) is the underlying basis of uterine contractility. The objective of this study is to assess the utility of electromyography (EMG) in measuring uterine EA after oxytocin treatments during the 1st stage of labor. EA was obtained from electrodes (n=4) placed on the abdominal surface near the navel of 61 parturients at a university-based hospital using PowerLab hardware and LabChart software (ADInstruments, New South Wales, Australia). Uterine muscle EA was evaluated by filtering signals from 0.3 to 1.0 Hz. Detailed EA characteristics of uterine activity were further quantified before oxytocin administration (an increase of 2 milliunits per minute) and immediately after treatment using RMS (a quantitative measure of signal magnitude) of EA and rectified EA (a measure of total positive and negative EA signals). Patient records (n=6) with oxytocin infusions (n=7) were analyzed. Data was analyzed using Wilcoxon paired ranks test with SPSS software. EMG records indicate that the onset, magnitude and duration of stimulatory effects of oxytocin are reflected as changes in RMS and rectified EA. There was a significant increase in median values (p=0.027, about 250% increase) in uterine RMS activity and an increase in median values (p=0.090, approaching significance, about 400% increase) in rectified EA following oxytocin administration. 1) This study demonstrates that EMG is an effective and valuable technique to evaluate the quantitative effects of oxytocin, including onset, duration and efficacy on uterine contractility during labor and delivery. 2) Understanding how oxytocin changes the EA of the uterus may improve clinicians’ ability to objectively titrate oxytocin and develop more accurate standardized protocols for its use in labor induction or augmentation. 3) EMG may be used to evaluate the effects of other medications and procedures which stimulate or inhibit labor.

Anatomical and functional outcomes after hysterectomy and bilateral sacrospinous ligament fixation for stage IV uterovaginal prolapse: a prospective case series

BackgroundAim of this study is to examine pelvic floor symptoms, anatomical results and patients’ satisfaction after sacrospinous vaginal fixation for stage 4 pelvic organ prolapse.MethodsAll patients with stage 4 pelvic organ prolapse were treated with vaginal hysterectomy, native tissue cystocele and rectocele repair and bilateral sacrospinous vaginal fixation. Anatomical and functional outcomes according to the POPq classification system and the German version of the Australian pelvic floor questionnaire were assessed. Changes between baseline, first follow-up and second follow-up were assessed by the paired Wilcoxon rank test using R, version 3.5.1.Results20 patients were included in the study. Scores in all four domains of the pelvic floor symptom questionnaire (bladder, bowel, prolapse, sexual function) were significantly improved at 6 and 12-months follow-up. One patient presented with a symptomatic stage 3 cystocele that needed a second surgical intervention and two patients needed surgery due to a de novo stress urinary incontinence. There were no perioperative adverse events and all patients reported full satisfaction after surgery.ConclusionsThe vaginal approach with hysterectomy, native tissue repair and bilateral sacrospinous vaginal fixation seems to be a safe and effective method for the treatment of advanced stage POP, offering excellent relief in all pelvic floor symptoms.Trial registrationClinicalTrials.gov (NCT 02998216), December 20th, 2016.Prospectively registered.

Low-dose cone-beam CT (LD-CBCT) reconstruction for image-guided radiation therapy (IGRT) by three-dimensional dual-dictionary learning

BackgroundTo develop a low-dose cone beam CT (LD-CBCT) reconstruction method named simultaneous algebraic reconstruction technique and dual-dictionary learning (SART-DDL) joint algorithm for image guided radiation therapy (IGRT) and evaluate its imaging quality and clinical application ability.MethodsIn this retrospective study, 62 CBCT image sets from February 2018 to July 2018 at west china hospital were randomly collected from 42 head and neck patients (mean [standard deviation] age, 49.7 [11.4] years, 12 females and 30 males). All image sets were retrospectively reconstructed by SART-DDL (resultant D-CBCT image sets) with 18% less clinical raw projections. Reconstruction quality was evaluated by quantitative parameters compared with SART and Total Variation minimization (SART-TV) joint reconstruction algorithm with paired t test. Five-grade subjective grading evaluations were done by two oncologists in a blind manner compared with clinically used Feldkamp-Davis-Kress algorithm CBCT images (resultant F-CBCT image sets) and the grading results were compared by paired Wilcoxon rank test. Registration results between D-CBCT and F-CBCT were compared. D-CBCT image geometry fidelity was tested.ResultsThe mean peak signal to noise ratio of D-CBCT was 1.7 dB higher than SART-TV reconstructions (P < .001, SART-DDL vs SART-TV, 36.36 ± 0.55 dB vs 34.68 ± 0.28 dB). All D-CBCT images were recognized as clinically acceptable without significant difference with F-CBCT in subjective grading (P > .05). In clinical registration, the maximum translational and rotational difference was 1.8 mm and 1.7 degree respectively. The horizontal, vertical and sagittal geometry fidelity of D-CBCT were acceptable.ConclusionsThe image quality, geometry fidelity and clinical application ability of D-CBCT are comparable to that of the F-CBCT for head-and-neck patients with 18% less projections by SART-DDL.

Impact of bowel preparation with Fleet's™ enema on prostate MRI quality.

To investigate the effects of cleansing Fleet's™ enema (FE) on rectal distention and image quality of diffusion-weighted imaging (DWI) in prostate magnetic resonance imaging (MRI). This study included 117 prospectively accrued active surveillance patients who underwent prostate MRI both without (prep-) and with bowel preparation consisting of FE (prep+) obtained within 12months of each other. The anterior-posterior (AP) diameter of the rectum, degree of perceived distention in the rectum and image quality scores were assessed by two independent readers for both (prep- and prep+) scans. DWI distortion was assessed quantitatively using the degree of anatomic mismatches between images obtained at different b values and the T2-weighted MRI. DWI artifact was qualitatively scored based on the presence of blurring, poor signal-to-noise, and artifact lines. The difference in rectal AP diameters between the two methods was tested by the paired Wilcoxon rank test. Stuart Maxell test was used in comparing rectal distention, DWI distortion, and artifact. Reader agreement was estimated by kappa statistics. p values < 0.05 were considered statistically significant. Mean rectal AP diameter was significantly larger in prep- compared with prep+ scans (p = 0.002). Subjective scores demonstrated inter-reader variability. For instance, the rectal distention score was significantly lower in prep+ for reader 2 (p < 0.001) whereas it was not significant for reader 1 (p = 0.09). Reader 2 also found significant improvement in DWI distortion (p = 0.02) in prep+ scans. There was no significant difference between prep- and prep+ in DWI distortion and artifacts for reader 1 (p = 0.17 and p = 0.49, respectively), or DWI artifacts for reader 2 (p = 0.55). Kappa scores were moderate for rectal distension, but weak for DWI distortion, and artifacts. Bowel preparation with enema prior to prostate MRI may diminish rectal gas but has modest effects on DWI distortion and overall image quality. The value of bowel prep is not conclusively validated in this study.

Synthesis, characterization, and aging resistance of the polyurethane dimethacrylate layer for dental restorations.

In this study, polyurethane dimethacrylate (PUDMA) was synthetized from different components and incorporated into a direct resin composite restoration system with the aim to buffer tooth-resin interfacial stresses and maintain the marginal adaptation. The tensile strength, elongation at fracture (ε), and thermal stability of the PUDMA layer were characterized, showing a tensile strength of 22MPa, an ε of 112%, and a thermal decomposition temperature of about 282°C. In addition, the degree of conversion, water sorption/solubility, hydrophobicity, microtensile bond strength (μTBS), marginal leakage, and cytotoxicity in vitro were evaluated for the PUDMA layer. The data were analyzed using one-way ANOVA, except for leakage depths (which were analyzed using the Wilcoxon paired-rank test). The level of significance was set at 0.05. Compared with dental adhesives, PUDMA displayed a higher degree of conversion, lower water sorption/solubility, and improved hydrophobicity and biocompatibility in vitro. After thermocycling, the μTBS of the restoration system containing PUDMA had increased compared with the μTBS at 24h. Restorations containing PUDMA showed lower leakage depths than those which did not contain PUDMA. In conclusion, because of its hydrophobic and elastic nature, the PUDMA layer, when used as an intermediate between tooth and resin restoratives, may buffer interfacial stresses, improve the stability and durability of the bonding interface, and reduce microleakage.

Increasing Water Intake Reduces High Copeptin in Healthy Adults

Plasma copeptin, a surrogate marker for vasopressin (AVP), is an independent risk factor for diabetes mellitus. Higher AVP and copeptin have also been observed in individuals with low water intake. In this study, we tested the effect of six weeks water supplementation (1.5 L·day−1) on fasting plasma copeptin (PCop) concentration and urinary hydration parameters in habitual low‐drinkers identified by screening for high copeptin (PCop ≥ 10.7 pmol·L−1 in men and ≥ 6.1 pmol·L−1 in women) in stored plasma samples originally collected in 2013–2015 as part of the population‐based Malmö Offspring Study (MOS).From the 24% of the MOS population who had high copeptin, we enrolled thirty‐one healthy adults who in addition had a 24h urine osmolality (UOsm) &gt; 600 mOsm·kg−1 at the baseline of the current study (i.e. 2.8±0.8 years after MOS). At baseline (Pre) and at the end of the six‐week water supplementation (Post), 24h urine collections for UOsm and urine volume (UVol), and fasting plasma samples for measurement of PCop and electrolytes (sodium, PNa) were obtained. In addition, a four‐day web‐based food and fluid record was completed Pre and Post intervention. Depending on distribution, Pre vs. Post differences were assessed with paired t‐test or Wilcoxon's paired rank test. Unless stated otherwise, data are presented as median [25th; 75th percentiles].The water intervention was effective in increasing mean (min; max) plain water intake from 427 (272; 582) to 1352 (997; 1707) g·day−1 (P &lt; 0.0001), with no other observed changes in diet. This was supported by a reduction in UOsm (Pre: 879 [705; 996]; Post: 384 [319; 502] mOsm·kg−1; P &lt; 0.001) and an increase in UVol (Pre: 1.06 [0.90; 1.20]; Post: 2.27 [1.52; 2.67] L·d−1; P &lt; 0.001). The intervention slightly reduced mean (min; max) PNa from 141 (137–145) to 140 (137–144) mmol·L−1 without inducing any cases of hyponatremia. At baseline, PCop was 12.9 [7.4; 21.9] pmol·L−1 and did not differ from the population screening in MOS nearly three years earlier (PCop 11.8 [10.1; 13.8] pmol·L−1; P = 0.367). Six weeks of increased water intake resulted in a significant reduction of PCop (Post: 7.8 [4.6; 11.3] pmol·L−1; P &lt; 0.001). Moreover, participants in the top tertile of baseline PCop (35.2 [21.0; 66.5] pmol·L−1) had a significantly greater reduction compared to the bottom two tertiles (−28.2 [−8.1; −58.6] vs. −1.6 [−0.3; −4.5] pmol·L−1; P &lt; 0.001) but were otherwise similar in clinical characteristics.In conclusion, water supplementation in subjects with high copeptin is effective in lowering copeptin and appears as a safe and promising intervention with potential of lowering risk of diabetes mellitus.Support or Funding InformationThis study was supported by grants from the Swedish National Research Council, The Wallenberg Foundation Clinical Scholar, The Swedish Heart and Lung Foundation, The Göran Gustafsson Foundation and funding from Danone Research.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Marginal Leakage of Class V Composite Resin Restorations

Introduction: Marginal leakage is one of the significant causes of restoration failure. This in-vitro study was conducted to compare cone beam computed tomography (CBCT) and dye-penetration methods for determining marginal leakage at gingival surface of class V resin composite restorations. Materials and Methods: Class V cavities were prepared on the buccal surfaces of nineteen caries-free extracted human molar teeth. Cavities were conditioned and filled. The teeth were immersed in a 50% w/w aqueous silver nitrate solution for 24 h and were taken out and rinsed with distilled water. Then, they were put into a developing solution. Whole specimens were first viewed with CBCT and were then sectioned and evaluated by stereomicroscope. Results: Measurement of agreement between CBCT and stereomicroscope revealed that 15 (78.9%) teeth had score 0, 1 (5.3%) tooth had score 1, and 1 (5.3%) tooth had score 2 in both techniques. Measurement of agreement between CBCT and stereomicroscope techniques, in the detection of marginal leakage, was 89.5% (Kappa coefficient = 0.627, P = 0.00). The Wilcoxon paired rank test revealed no significant difference between the results of CBCT and stereomicroscope in measuring the leakage at gingival margin (P = 0.157). Conclusion: Considering the limitations of the study, there was no significant difference between the results of CBCT and stereomicroscope in measuring the leakage at gingival margin of class V composite restorations. CBCT can be used noninvasively to detect the marginal leakage of gingival wall of class V composite restorations using aqueous silver nitrate solution as a tracer.

Abstract 9: Diffusion Tensor Tractography Correlates of Post-Stroke Spasticity &amp; Its Mitigation

Purpose: Anatomical localization of brain networks controlling post-stroke spasticity are not fully understood. The purpose of this study was to determine the relationship between the integrity of white matter tracts and severity of spasticity and how this relationship changes with mitigation of spasticity in response to motor learning therapy. Methods: Eleven stroke survivors (&gt;6 months post-stroke) with arm sensorimotor deficits had 12-week (5 d/week, 5 hr/day) motor learning therapy. Outcome measures included modified Ashworth Scale (mAS), Fugl-Meyer Upper limb (FM) and Diffusion Tensor Imaging (DTI). mAS was scored for 9 arm muscles and summated. Using Freesurfer software, DTI was analyzed via longitudinal processing stream and white matter tracts were reconstructed according to a global probabilistic tractography algorithm. Fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) were averaged along the center of the 8 bilateral and 2 interhemispheric white matter tracts. We performed partial Spearman correlation (Bonferonni correction for multiple comparisons) to evaluate the relationship between mAS and DTI measures while controlling for change in Fugl-Meyer. Wilcoxon paired sign rank test was used to compare pre vs post rehab scores for mAS and FM. Results: Subjects were 59±8.3 years old, 46±30 months after stroke and 54% were female. mAS improved from 5.95±3 to 3.95±2.6 (p=0.002, paired sign rank test) and FM improved from 25.9±12.4 to 37.6±13.9 (p=0.00097). At baseline, lower spasticity correlated with higher AD in the ipsilesional cingulum angular bundle (rho=.86; p=0.0007). Greater improvement in spasticity correlated with lower AD in the contralesional uncinate fasciculus (rho=.79;p=0.004) at baseline. Both tracts are part of limbic system. Furthermore, lower spasticity at baseline correlated with lower FA in the contralesional corticospinal tract (rho=.81; p=0.004) at baseline. Conclusion: The results show the complex nature of anatomical localization for spasticity and its mitigation. Structural integrity of the contralesional corticospinal tract as well as bi-hemispheric limbic system tracts may be involved in post-stroke spasticity.

Bladder augmentation in anuric/defunctioned microbladders and a novel antireflux mechanism for Mitrofanoff anastomosis to the ileal patch

Background/PurposeReconstruction of microbladders is a difficult surgical challenge: How can a neobladder be recreated when >90% of the new bladder is augmented patch, and how can a Mitrofanoff conduit be anastomosed when the native bladder is so tiny? This series describes microbladders secondary to anuria and/or diversion that required augmentation. This was done using a de-tubularized ileal segment, and because of the small size of the native bladder, Mitrofanoff anastomosis was performed to the bowel patch (using a novel “Keel Procedure”). MethodsOur surgical experience in reconstruction of microbladders was reviewed: pre and post augmentation capacity, compliance and maximum detrusor pressure were compared. The success of the Mitrofanoff anti-reflux technique is described. Data are given as median (interquartile range) and compared by Wilcoxon paired rank test. Results10 patients, median bladder capacity pre-op 10 (9–20) mls were reconstructed. The follow up time is 2.7years (2.2–4.2). Post-op bladder capacity increased 16-fold to 167 (114–281) mls, P<0.01. Compliance significantly improved from 1.7 (0.3–4.8) to 14.3 (4.1–66.3) mls/cmH2O, P<0.05. Maximum detrusor over-activity decreased from 27 (7–120) to 12.5 (8–26) cmH2O, (N.S. P=0.3).Videourodynamics confirmed a leak in 2 patients, leading to incorporation into the technique of a non-absorbable seromuscular suture to provide long-term robustness to the antireflux procedure. ConclusionBladder augmentation in microbladders is possible, and a functional Mitrofanoff procedure with a continent anti-reflux procedure can be created using the “Birmingham keel technique” implanting the Mitrofanoff into the augment patch, with 80% success (similar to published results for conventional anastomosis to native bladders). Level of evidenceLevel IV.

Diffusion weighted MRI of osteoid osteomas: Higher ADC values after radiofrequency ablation

PurposeFeasibility of diffusion weighted MRI (DWI) pre- and post-radiofrequency ablation (RFA) in patients with osteoid osteoma (OO). Material and methodsTen patients (1 female, 24±9years) received RFA of OO (mean size 8.7±3.2mm). Two OO recurred, in one of these a second RFA was performed. A 1.5T DWI (b=50, 400, and 800s/mm2) and a fat saturated DCE MRI were obtained the day before and after RFA. In DWI, the mean apparent diffusion coefficient (ADC) was recorded. With DCE MRI, signal-to-noise ratio, contrast-to-noise ratio, absolute signal intensity (SI), relative SI, and SI ratio were documented. All parameters were compared pre- and post-RFA using paired Wilcoxon rank test. ResultsADC values were significantly higher post-ablation, 1.6±0.5μm2/ms versus 1.3±0.6μm2/ms (p<0.05). Perfusion was significantly reduced after ablation [SNR, CNR, SI, %SI, and SI OO/SI muscle]; post-RFA: 55±13, 27±20, 757±534, 102±16, and 1.6±0.2; pre-RFA: 88±37, 65±22, 1038±755, 226±51, and 2.0±0.5 (p<0.05). DiscussionDWI is feasible in OO. ADC values increased and contrast enhancement decreased after RFA of OO. This may be explained by RFA-induced necrosis and devascularization.