Paired Test Research Articles

Mechanical evaluation of a novel resin infiltrated lithium-disilicate ceramic network versus resin infiltrated feldspathic ceramic network

Mechanical properties of polymer infiltrated ceramic network (PICN) fall in range between that of resin-based composites and glass ceramics. The aim of this study was to evaluate the mechanical properties of a newly fabricated polymer infiltrated lithium-disilicate network (PILN) and compare it with the commercially available PICN whose ceramic network is feldspathic ceramic (Vita Enamic, Vita Zahnfabrik, Bad Säckingen, Germany). Commercially available lithium disilicate based glass–ceramic CAD/CAM blocks (IPSe.max, Ivoclar, Schaan, Liechtenstien) were ground into a fine powder and used to produce a porous ceramic network (25% porosity). Resin was infiltrated and polymerized to form a dense PILN. Porosity percentage and microstructure were investigated. Single crowns were milled from the newly fabricated PILN blocks and from Vita Enamic then fracture load test was performed. Rectangular specimens were prepared from both materials, afterwards, flexural strength, fracture toughness, brittleness and Vickers’ hardness tests were investigated. Data were analyzed using independent sample-t test and paired sample-t test (n = 12, α = 0.05). Results showed that newly formulated PILN had significantly higher fracture resistance (1640 N) and superior fracture toughness (2.6 MPa m1/2) compared to the control which showed (1103 N) fracture load and (1.7 MPa m1/2) fracture toughness. PILN had lower brittleness index (0.89 μm1/2) than Vita Enamic (1.48 μm1/2) reflecting superior milling qualities. It was concluded that newly fabricated PILN material showed enhanced mechanical properties.

Preserflo-MicroShunt: Postoperative Effects on Endothelial Cell Density and Corneal Thickness

Background: The aim of this study was to evaluate the effects of Preserflo implantation on endothelial cell density (ECD), corneal thickness, intraocular pressure (IOP), and the use of antiglaucoma medications over a 12-month follow-up period. Methods: A total of 53 eyes from 53 patients undergoing Preserflo implantation were included in this prospective study. ECD, corneal thickness, IOP, and the number of antiglaucoma medications were measured at baseline, 3 months, and 12 months postoperatively. Statistical analysis was performed using paired t-tests and Wilcoxon signed-rank tests for non-normally distributed data. Results: There was no significant reduction in ECD at 3 months (p = 0.695) or 12 months (p = 0.229) compared to baseline. However, a significant reduction in corneal thickness was observed at 3 months (p = 0.008), with no significant change at 12 months (p = 0.118). A significant reduction in IOP was noted at both 3 months (from a preoperative median of 23.5 mmHg to 11.5 mmHg, p < 0.001) and 12 months (from 23.5 mmHg to 13.0 mmHg, p < 0.001). Additionally, there was a significant decrease in the use of antiglaucoma medications, from a preoperative median of 3.0 medication classes to 0.0 classes at both 3 months (p < 0.001) and 12 months (p < 0.001). Conclusions: Preserflo implantation resulted in a significant reduction in IOP and the need for antiglaucoma medications, with no significant impact on endothelial cell density and corneal thickness after 12 months. These findings suggest that Preserflo implantation is an effective procedure for IOP control and medication reduction, with favorable outcome for corneal health after one year.

Analisis Perbedaan Citra SPECT Non-AC dan CTAC pada Pemeriksaan Scintigrafi Perfusi Miokard

Background: Myocardial Perfusion Scan displays SPECT images, which is a non invasive imaging method for a quantitative view of myocardial ischemia which can’t be done with CT myocardial perfusion. The principle of myocardial perfusion scan is that the myocardial absorption of radiopharmaceuticals is proportional to coronary heart blood flow to the myocardium. The main problem with SPECT myocardial perfusion scan imaging is photon attenuation caused by soft tissue around the heart which causes inaccurate information and attenuation artifacts. One method to reduce attenuation artifacts is hybrid CT Scan imaging with SPECT tools. CT Scan images are used to correct attenuation in SPECT images. The purpose of this research is to analyze the differences between non-AC and CTAC SPECT images which will have an impact on myocardium perfusion values on myocardial perfusion scans.Methods: This research is a quantitative analysis with a direct observation approach. The research was undertaken at Nuclear Medicine and Molecular Theranostics Installation of Dr. Hasan Sadikin General Hospital in Bandung, starting November 2023 using a SPECT CT GE NM/CT 860 gamma camera. A total of 28 patients were examined for myocardial perfusion scans. Data processing is conducted by comparing the perfusion values of myocardium on non-AC and CTAC SPECT images for 28 samples by conducting hypothesis testing using paired test sample T-Test.Result: Based on the research results, non-AC, and CTAC SPECT image data showed a normal distribution using the Shapiro-Wilk test, allowing the analysis of differences using the Paired-Samples T-test. In general, the analysis results indicate a significant difference between non-AC and CTAC SPECT images, as the sig value is less than 0.05 in the RCA and LCx vascular segments, as well as in the septal, inferior, lateral, and apical wall segments. However, no significant differences were found in the LAD vascular segment and the anterior wall segment, as the sig value is greater than 0.05.Conclusions: There are differences between non-AC and CTAC SPECT images in the RCA and LCx blood vessel segments, as well as in the septal, inferior, lateral, and apical wall segments. However, no differences are observed in the LAD blood vessel segment and the anterior wall segment.

Real-world clinical experience with serum MOG and AQP4 antibody testing by live versus fixed cell-based assay.

To assess the real-world performance of a live (LCBA) versus a fixed (FCBA) cell-based assay for the detection of serum antibodies directed against myelin oligodendrocyte glycoprotein (MOG-IgG) and aquaporin-4 (AQP4-IgG). This was a retrospective study of patients evaluated at a single tertiary academic referral center, with serum testing performed clinically for AQP4-IgG and/or MOG-IgG by FCBA and LCBA on the same day. Additionally, frozen banked sera from the same day for patients tested only by one assay were retrieved and tested by the other assay. FCBA was performed by the Johns Hopkins Immunology Laboratory using Euroimmun kits with detection by indirect immunofluorescence (FCBA-IF), whereas LCBA was performed by the Mayo Clinic Neuroimmunology Laboratory with detection by flow cytometry (LCBA-FACS). Of 594 specimens with paired MOG-IgG testing, 500 were negative by both assays, 33 were positive by both assays, 56 were positive exclusively by LCBA-FACS, and 5 were only positive by FCBA-IF. Overall, MOG-IgG LCBA-FACS exhibited 95.1% sensitivity and 97.7% specificity, whereas MOG-IgG FCBA-IF had 45.7% sensitivity and 99.8% specificity. Of 577 specimens with paired AQP4-IgG testing, 503 were negative by both assays, 51 were positive by both assays, 21 were positive exclusively by LCBA-FACS, and 2 were only positive by FCBA-IF. Overall, AQP4-IgG LCBA-FACS exhibited 97.3% sensitivity and 100% specificity, whereas AQP4-IgG FCBA-IF had 71.6% sensitivity and 100% specificity. LCBA-FACS for both MOG-IgG and AQP4-IgG had markedly better sensitivity than FCBA-IF, with similar specificity. The use of FCBA-IF may result in underrecognition of both MOG antibody-associated disease (MOGAD) and AQP4-IgG seropositive neuromyelitis optica spectrum disorder (NMOSD).

Educating healthcare workers in snakebite management: A study to determine the effectiveness of the snake bite life support workshop.

Snakebite envenomation is a significant global health issue, with India bearing a substantial burden. Despite the development of guidelines, knowledge gaps and lack of training persist among healthcare workers (HCWs), contributing to high morbidity and mortality. This study aimed to evaluate the impact of the Snake Bite Life Support (SBLS) workshop on HCWs' knowledge, practices, self-efficacy, and advocacy skills in snakebite management. A pre-post interventional study was conducted during the SBLS workshop at a tertiary care center in May 2024. HCWs' knowledge, practical skills, self-efficacy, and advocacy skills were assessed using standardized questionnaires and a modified General Self-Efficacy (GSE) scale, both before and after the workshop. Data were analyzed using SPSS v25.0, employing paired t-tests and Wilcoxon signed-rank tests for comparison. Forty-one HCWs completed the pre- and post-workshop assessments. Significant improvements were observed in knowledge, particularly in avoiding false positive 20-min whole blood clotting test (20WBCT) results (p=0.020) and premedication for antivenom (p<0.001). Participants reported a marked increase in self-efficacy across all GSE parameters and demonstrated enhanced advocacy intent in resource management, policy influence, and educational outreach. The workshop influenced practice changes, notably reducing the administration of antivenom in confirmed hump-nosed pit viper bites. The SBLS workshop effectively enhanced HCWs' knowledge, management practices, self-efficacy, and advocacy intentions, emphasizing the need for integrating such training into healthcare education to drive systemic change in snakebite management and improve patient outcomes. Future studies should focus on long-term impacts and broader implementation.

Discordant Responses Between Imaging Examination and Surgical Pathology of Head and Heck Squamous Cell Carcinoma After Neoadjuvant Immunotherapy Combined With Chemotherapy.

We here investigated the value of imaging examination in evaluating tumor remission-based surgery in patients with head and neck squamous cell carcinoma (HNSCC), who had undergone neoadjuvant immunotherapy combined with chemotherapy (NICC). HNSCC patients who underwent NICC and surgery from May 2021 to September 2023 were retrospectively analyzed. All patients had to undergo imaging examination evaluation, including enhanced computed tomography (CT) and enhanced magnetic resonance (MR) imaging before and after NICC. Data related to clinical parameters, complete response of the primary site (PrCR), complete response of the primary site and the lymph node (PLCR), complete response of the lymph node (LCR), and tumor response (TR), were gathered. The paired Chi-square test and t-test were conducted to analyze the differences in responses between imaging examination and pathology. Binary logistic regression was applied to analyze the relevant clinical factors of differences in responses. In total, data of 41 patients were included in this study. Significant discordant responses were observed between enhanced CT, magnetic resonance imaging (MRI), and pathology in PrCR (4.9%, 7.3% vs. 41.5%), LCR (12.2%, 7.3% vs. 53.7%), PLCR (0%, 0% vs. 31.7%), and TR (severe 29.3%,17.1% vs. 25.61%) (P < 0.05). Patients with hypopharyngeal cancer (odds ratio (OR): 7.04), oral cancer (OR: 3.64), higher neutrophil to lymphocyte ratio (NLR) (OR: 2.05), and earlier T stage (OR: 0.71) exhibited a larger response difference between enhanced CT and pathology. Patients with younger age (OR: 0.79) hypopharyngeal cancer (OR: 22.81), oral cancer (OR: 2.65), higher NLR (OR: 19.47), and earlier T stage (OR: 0.29) exhibited a larger response difference between enhanced MR and pathology. Discordant responses were noted between the imaging examination and surgical pathology of HNSCC after NICC. Hypopharyngeal cancer, higher NLR, and earlier T stage may predict a higher response difference.

Germline pathogenic variants in a cohort of individuals with biliary tract cancer.

559 Background: Biliary tract cancers (BTC) are rare but have been implicated in hereditary cancer conditions such as Lynch syndrome (LS) and BRCA1 and BRCA2. Data from paired somatic and germline genetic testing on BTC have shown that ~5% may be related to germline pathogenic variants in BRCA1 and BRCA2. Identification of these germline pathogenic variants (PV) often provide patients with an opportunity for personalized treatment including platinum-based chemotherapies, PARP inhibitors and/or immunotherapy. Germline testing also provides crucial data to relatives regarding cancer risk and access to increased cancer surveillance and risk-reducing surgeries. Current guidelines recommend germline genetic testing when the likelihood of identifying a PV is &gt;5%. The contribution of germline PV in BTC has not been described in a diverse patient population. Methods: In this prospective clinic-based study, individuals with BTC were referred by their oncologist for genetic counselling and testing. The majority of individuals were enrolled based on participation in the Legresley Biliary Registry, which recruits all individuals with BTC. Blood was sent for germline multi-gene panel testing. Results: Germline genetic testing was performed for 139 individuals. Average age of diagnosis was 57.8 years (range 28-84). The majority of individuals were diagnosed with intrahepatic cholangiocarcinoma (CCA) (54.7%), followed by extrahepatic CCA (20.9%) and gallbladder cancer (10.1%). The majority of individuals were male (56.1%). The population was ethnically diverse with 55% European, 24% Asian, 9% Middle Eastern/North African and 6% African. A minority of individuals had a previous cancer (18%) and 24.5% met current provincial eligibility criteria. Germline testing was complete on 136 individuals. 25/136 (14.7%) PV were identified in 20 individuals. 8/136 (5.9%) of the cohort carried PV in genes known to increase the risk for BTC ( BRCA1, BRCA2 and LS genes), 9/136 (6.6%) carried PV in other genes with clinically actionability (e.g. PALB2, ATM ), and 8/136 (5.9%) carried heterozygous PV in genes for recessive diseases. Variants of uncertain significance were identified in 42/136 (30.9%) and negative results were identified in 74/136 (54.4%). Personal and/or family history was not suggestive of the associated cancer condition in 9/16 (56%) of the PV cohort. Tumor profiling by whole genome sequencing on some individuals with PV found corresponding somatic mutational signatures, consistent with variant pathogenicity. Conclusions: Detection rates for PV in a diverse BTC cohort was up to 14.7%, including 5.9% among genes known to increase the risk for BTC. The majority of PV were found in individuals lacking personal and/or family history suggestive of the associated hereditary cancer condition. These results suggest that guidelines should be updated to recommend universal germline genetic testing for individuals with BTC.

Immersive Virtual Reality as Computer-Assisted Cognitive–Motor Dual-Task Training in Patients with Parkinson’s Disease

Background and Objectives: The aim of this study was to determine the effect of immersive virtual reality used as a short-term multifaceted activity with a focus on motor and cognitive function in patients with Parkinson’s Disease. The sub-objective focused on quality of life in the study group of patients. Materials and Methods: Nineteen patients (64.2 ± 12.8 years) were included in this study. Inclusion criteria for this study: adult patients in Hoehn and Yahr’s stage 1–3, cooperative, with stable health status, independent and mobile. IVR therapy was performed twice a week for 20 min for one month. Input and output measurements were taken within 14 days of starting or ending therapy. The 10 Meter Walk test was used to examine and assess both comfortable and fast walking, and the Timed Up and Go (TUG) + s dual task was applied to quickly assess the highest possible level of functional mobility. The Berg Balance Scale test (BBS) was used to assess balance with a 14-item balance scale containing specific movement tasks. The standardized Parkinson’s Disease Questionnaire (PDQ-39) was used to assess quality of life. Data were processed in the PAST program using a nonparametric paired Wilcoxon test. The significance level was set at α = 0.05. The value of the r score was used to evaluate the effect size. Results: A significant reduction in the time in the fast walk 10MWT (p = 0.006; r = 0.63) and TUG (p &lt; 0.001; r = 0.80) parameter were found after therapy. Significant improvement in the BBS score was found after applied therapy (p = 0.016; r = 0.55). In the PDQ-39 questionnaire, significant improvements were found in the study group after therapy in the domains of mobility (p = 0.027; r = 0.51) and emotional well-being (p = 0.011; r = 0.58). Conclusions: The results of this study indicate a positive effect of virtual reality therapy on balance and gait, which is also good in terms of reducing the risk of falls in the study group. Therapy also promoted quality of life in the study group.

Comparing the Institution-based Supervision and Tele-based Supervision for Task-oriented Exercises on Upper Limb Motor Performance and Functional Ability among Stroke Patients: A Research Protocol

Introduction: Rehabilitation is a vital part of recovery for stroke patients, presenting a complex intervention that requires collaboration among patients, caregivers and the rehabilitation team. Telerehabilitation has emerged as a promising alternative to standard outpatient and home-care rehabilitation, offering advantages such as minimal travel barriers, flexible exercise schedules and the integration of skills into daily activities. Need of the study: The technologies that can be used for telerehabilitation range from inexpensive internet-based solutions, virtual reality, and robotic systems to more costly telephones and mobile phones, which are present in most homes. Physiotherapists have been suggested as being in the best position to help stroke victims transition from the hospital to their homes. However, there has been significant international professional resistance to using telerehabilitation-based services, based on the belief that the lack of in-person care may result in worse outcomes. Nevertheless, research on numerous chronic health disorders demonstrates that telerehabilitation strategies can effectively enhance results. There is a dearth of literature comparing tele-based supervision for task-oriented exercises with institution-based supervision for task-oriented exercises. Thus, the need for this study is to identify a cost-effective method for rehabilitation in stroke patients. Aim: To compare the effect of institution-based supervision and tele-based supervision for task-oriented exercises on upper limb motor performance and functional ability among stroke patients. Materials and Methods: A two-group pretest-post-test randomised clinical trial will be conducted in recognised hospitals in Mullana and Panipat, using purposive sampling from December 2022 to December 2024. A total of 62 male and female patients, aged 45-75 years, who have experienced their first ischaemic or haemorrhagic stroke within the last six months and have scores ranging from 26 to 56 on the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), mild to moderate spasticity (less than 2 on the Modified Ashworth Scale (MAS), &gt;24 on the Minimental State Examination (MMSE), and stages II and III of the Brunnstrom score will be included in the study. Group B will receive institution-based supervision for task-oriented exercises, whereas Group A will receive tele-based supervision for live sessions. Both groups will perform task-oriented exercises for 30 minutes, three days a week for eight weeks. There will be a 30-second break before switching tasks. Outcome measures, including the Fugl-Meyer Assessment for Upper Extremity (FMA UE) and the Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES), will be assessed at baseline, the 4th week, and the 8th week of intervention, respectively. Repeated measures of Analysis of Variance (ANOVA) or the Friedman test will be chosen based on normality to find differences within the groups at baseline, the 4th week, and the 8th week (completion). A paired t-test or Wilcoxon signed-rank test will be applied to identify differences between the groups for pre-post intervention changes in outcome measures. An Independent t-test or MannWhitney U-test will be applied based on normality to compare the changes in mean values of the outcome measures between Group A and Group B at baseline, the 4th week, and the 8th week of intervention. The level of statistical significance will be set at alpha=0.05.

Novel insights into estimating the postmortem interval: red cell distribution width - standard deviation.

Estimation of the postmortem interval (PMI) is highly significant, and many estimation methods have been developed. However, as no estimation method is determinate, several methods must be combined to achieve an accurate estimation. Therefore, the more methods available, the more accurate the estimation. To facilitate this, we examined whether red cell distribution width standard deviation (RDW-SD) was associated with PMI. We compared the RDW-SDs of blood samples from hospitals and autopsies in the same cadavers using a paired test. Additionally, we performed an unpaired test with multiple regression analysis to confirm the relationship between PMI and RDW-SD. Eighteen cases were included in the paired analysis, and a significant difference between hospital and autopsy RDW-SDs was confirmed. The 95% confidence interval for the difference was between 11.7 and 17.4. In the multiple regression analysis of the 756 cadavers, the 95% confidence interval of the regression coefficient of PMI for RDW-SD was 1.63-3.43. Our results suggest that RDW-SD may have a positive relationship with PMI. However, further research is required to determine the accuracy of this estimation method.

STRATEGI PENINGKATAN PENGETAHUAN PENDIDIDKAN AGAMA ISLAM MELALUI KONTEN YOUTUBE PADA MAHASISWA KEDOKTERAN UNIVERSITAS ABULYATAMA ACEH

Islamic Religious Education (PAI) plays a significant role in shaping the character of medical students who have a busy academic schedule. However, conventional learning often faces problems such as lack of student interest and limited time to attend classes optimally. This suggests the need for innovative strategies that can address the needs of the digital generation. This study aims to explore the effectiveness of YouTube media as an alternative to learning PAI that is interactive, flexible, and in accordance with the needs of medical students at Abulyatama University Aceh. The researcher used a mixed-method research method involving 120 students who were divided into two groups: experimental and control. Data were collected through pre-test and post-test and supported by surveys and interviews. The experimental group was given PAI learning using YouTube video content designed according to the curriculum while the control group used conventional methods. The research data were analysed using paired sample t-test statistical test to evaluate the difference in learning outcomes between the two groups. The results showed that the experimental group experienced a significant increase in post-test scores with an average of 83.14 compared to the pre-test of 66.11, while the control group only experienced a small increase from 65.05 to 70.22. The significant difference proved that YouTube media was able to improve the understanding of PAI concepts more effectively than conventional methods. Students also stated that YouTube media provides flexibility in learning time and is more interesting than traditional learning. Thus, this study illustrates that the integration of technology in PAI learning to answer educational problems, in addition, using YouTube as a learning media can be a strategic alternative in a more effective learning process for students with busy academic schedules.

Impact of blood pressure management on cardiac mechanics and vascular function in patients with resistant hypertension- a longitudinal study

Abstract Introduction Resistant hypertension (RH) has been associated with increased arterial stiffness, impaired endothelial function, and abnormalities in cardiac mechanics. However, the impact of intensified blood pressure (BP) management on improving arterial stiffness, endothelial function, and especially left ventricular (LV) and left atrial (LA) mechanics in patients with RH remains unknown. Purpose The aim of this study was to examine the effects of intensified BP management on LV and LA mechanics, arterial stiffness, and endothelial function in people living with RH. Methods A prospective longitudinal study in which 16 RH patients (mean age 61±12 years; 37.5% females) were followed up for eight weeks after the intensification of antihypertensive treatment was initiated in a specialised hypertension clinic. Participants underwent anthropometric assessment, office and central BP measurements, pulse wave analysis to assess arterial stiffness determined by aortic augmentation index (AIx), brachial artery flow-mediated dilatation (FMD) to assess endothelial function, transthoracic echocardiography, and two-dimensional speckle tracking echocardiography analysis to assess LV and LA mechanics. Paired t-test and Wilcoxon signed-rank test were utilised to compare parametric data and non-parametric data, respectively. Results Following 8-weeks of optimising antihypertensive treatment, patients with RH demonstrated a reduction in both office systolic and diastolic BP (change of -16/-12 mmHg, P&amp;lt;0.001) and central systolic and diastolic BP (change of -17/-6 mmHg, P=0.002). RH patients exhibited reduced AIx (Baseline: 24.7% [21.7 – 35.0] vs follow-up: 16.7% [14.0 – 22.5], P&amp;lt;0.001) as well as improved FMD response compared to baseline (Baseline: 3.1±1.7% vs follow-up: 5.1±1.9%, P&amp;lt;0.001). Improvements in LV peak systolic global longitudinal strain (Baseline: -16.6±1.9% vs follow-up: -18.6±2.2%, P&amp;lt;0.001), circumferential strain (Baseline: -18.1±3.7% vs follow-up: -19.8±3.4%, P=0.002), and radial strain (Baseline: 32.3±8.2% vs follow-up: 35.1±7.3%, P&amp;lt;0.001) were also observed. No differences were detected in LV twist (Baseline: 10.6±2.9° vs follow-up: 10.0±2.3°, P=0.24). For the LA longitudinal strain indices, notable enhancements only in the LA reservoir strain (Baseline: 24.5±6.4% vs follow-up: 28.6±6.6%, P&amp;lt;0.001) and conduit strain (Baseline: -12.7±5.2% vs follow-up: -15.3±5.9%, P=0.009) were evident, with no difference in the LA contractile strain, compared to baseline (Baseline: -11.9% [-13.5 – -8.5] vs follow-up: -12.5% [-15.2 – -10.5] P=0.12) (Table 1). Conclusion Intensive BP management in patients with RH was effective in improving LV and LA mechanics, arterial stiffness, and endothelial function. These novel data identify important mechanistic effects of intensive BP treatment but also highlight the need for future studies to determine whether their improvements are associated with better clinical outcomes.

Influence of Different Uses and Covers on the Chemical Characteristics of A Quartzarenic Neosol in the Maranhão Savannah

Objective: This study evaluated the effect of three different land uses and soil covers on the chemical characteristics of a QUARTZARENIC NEOSSOLO in the Maranhão Cerrado. The treatments studied were: conventional pasture (PC), open area (AD) and typical cerrado (CT). Theoretical Reference: The study is based on concepts of soil fertility, especially the impact of agricultural management practices, such as liming and fertilisation, on the chemical composition of the soil. The QUARTZARENIC NEOSSOLS, due to their sandy texture and low nutrient and water retention capacity, present limitations for agricultural cultivation, according to studies by Embrapa (2021). Method: Macronutrients (P, S, Ca and Mg), micronutrients (Zn, Mn, Fe and Cu), organic matter (OM) content and base saturation (V%) were analysed. Samples were collected according to the protocol suggested by Embrapa (2015) and were taken from three representative areas of the treatments mentioned. The data was analysed using statistical tests of variance (ANOVA) and paired mean tests (Tukey). Results and Discussion: The results showed that, for most of the chemical parameters analysed, the highest averages were obtained in the conventional pasture area (CP). This is due to the chemical residues from liming and fertilisation applied when the pasture was established and managed. On the other hand, the uncovered area (AD) and the typical cerrado (CT) showed lower concentrations of nutrients and organic matter. The analysis also revealed that the QUARTZARENIC NEOSSOLS in this region, despite their natural limitations, can be productive when well managed. Research Implications: The research highlights the importance of proper soil management, especially liming and fertilisation, to improve fertility and make agricultural production viable on QUARTZARENIC NEOSSOLS. Conventional grazing can be an effective strategy for improving the soil's chemical conditions, although it is also necessary to properly manage bare areas to avoid soil degradation. Originality/Value: This study contributes to the understanding of the effects of different land uses on the chemical properties of QUARTZ NEOSSOLS in the Maranhão Cerrado. The research offers insights into how to improve agricultural productivity and the sustainability of management in areas with natural limitations, highlighting the potential of areas apparently unsuitable for cultivation.

The impact of pre-treatment aneurysm angulation. What happens with WEB devices at follow-up?

WEB shape modification has been analyzed in relation to the aneurysm occlusion outcome and techniques have been presented with one-dimensional measurements of the device to quantify the change after implantation. In this work, we present an analysis of pre-treatment vascular morphology and hemodynamics of cases treated with WEB devices, which were three-dimensionally quantified in morphology and position to detect modifications. Seventeen WEB-treated aneurysms with pre-treatment, post-treatment and follow-up 3D flat-panel CT were included. Three-dimensional measurements of the WEB morphology and position were made at post-treatment and at follow-up. Differences between acquisitions of all measured variables were statistically evaluated (Wilcoxon signed-rank paired test, P-value = 0.05). Pre-treatment aneurysm angles were three-dimensionally measured and CFD simulations were performed to evaluate the influence of flow on WEB changes. WEB height and diameter presented statistically significant changes. Modification of the angle between the WEB axis and parent artery was significantly higher in the group with WEB shape modification (Mann-Whitney U test, P < 0.05). In this group, the median pre-treatment aneurysm angle was smaller than in the group without shape modification (8.16° vs. 13.14°, P = 0.06). Inflow ratio was higher in the WEB shape modification group. An association between the magnitude of morphological changes of the WEB with the direction of its axis within the aneurysm was found. The analysis of pre-treatment morphological and hemodynamic conditions would allow the detection of aneurysm cases in which the WEB will undergo a more pronounced modification.

Efficacy of sulfasalazine on recurrent acute anterior uveitis: a three-year follow-up.

To evaluate the efficacy of sulfasalazine (SSZ) for recurrent acute anterior uveitis (AAU). Retrospectivechartreview ofpatientsdiagnosed withrecurrent AAU treated with SSZfromJanuary2008 toSeptember 2023. Thegrading ofuveitisactivitywasdefined asper SUNworkinggroup. The primary outcome was thereductionin thenumber ofuveitisflare-upsover a one-year, two-year and three year-period,comparedto pre-treatment year.The response criteriato SSZwere defined as normal ophthalmologic examination. Paired samples Wilcoxon test and Kaplan-Meiersurvival curvewerecalculated using R-Commander statistical software (p < 0.05). Fifty-three patients were included. Mean time of follow up was 38.51 ± 38.45months.Nine patients developed adverse effects to SSZ (16.98%) most of them mild. Ankylosingspondylitis was the most frequent association(n = 28,52.83%), while HLA-B27 was positive in 69.23% of the patients (n = 36). The most frequent indication for SSZ was based on ocular activity in 52.83% (n = 28). The number of flare-ups dropped from 2.25 (± 1.34) in the pre-treatment year to, 0.81(± 0.99) at year 1 (p < 0.001), 0.61 (± 0.78) at year 2 (p < 0.001) and 0.65 (± 0.83) at year 3 (p = 0.005).The median time to flare-upof AAUafter SSZwas15.13months(CI 95, 7.97-27.40). Our data point to sulfasalazine as an effective treatmentto reduce flare-upsin patients with recurrentnon-infectious AAU.Itslow cost andgoodsafetyprofilemake it an interestingtherapeuticalternative,especially in women of childbearing age.

Baseline Imaging Derived Factors of Response Following [225Ac]Ac-J591 Therapy in Metastatic Castration-Resistant Prostate Cancer: A Lesion Level Analysis.

Actinium-225 labeled prostate-specific membrane antigen (PSMA) targeted radionuclide therapy has emerged as a potential treatment option in the management of men with metastatic castrate-resistant prostate cancer (mCRPC). This study investigated molecular imaging-derived parameters and compared imaging response of lesions categorized by tumor site. Men with mCRPC treated with [225Ac]Ac-J591 from 2017 to 2022 at our center on two prospective trials (NCT03276572 and NCT04506567) with pre- and post-treatment [68Ga]Ga-PSMA-11 Positron Emission Tomography (PET) imaging studies available were included. SUVpeak of the 3 most- and 3 least-avid lesions of the tumor sites were manually assessed. The median change of the SUVpeak from pre- to post-treatment per tumor site was evaluated using the paired Wilcox test. An objective response (OR) in the follow-up image was defined as complete or partial response using PET Response Criteria in Solid Tumors (PERCIST) 1.0. A total of 46 cases met the criteria for image review; most of them (n = 25, 54.3%) had more than one tumor site category. In total, 445 PSMA PET-positive lesions were assessed: 220 osseous, 163 nodal, 41 visceral, and 21 prostatic lesions. After treatment with [225Ac]Ac-J591, absolute SUVpeak values per tumor site declined significantly (p < 0.05) except for prostatic lesions (p = 1). The PERCIST-OR rate for osseous, nodal, visceral, and prostatic lesions was 53%, 28%, 56%, and 38%, respectively. [225Ac]Ac-J591 is an active treatment in men with mCRPC. Tumor distribution patterns may influence treatment response and potentially prognosis. Our findings warrant further validation in a larger cohort but may be considered in treatment planning and trial design.

P0757 Emulsifier restriction does not impair nutrient intake and improves food-related quality of life in active Crohn’s disease: dietary analysis of the ADDapt randomised controlled trial

Abstract Background Food additive emulsifiers are prevalent in the food supply1 and have been implicated in the development of intestinal inflammation2. A novel low-emulsifier diet (LED) has been tested for its effect in managing active Crohn’s disease (CD), however, it is crucial to consider the impact of dietary restrictions on nutrient intake and food-related quality of life (FRQoL). The aim of this study was to investigate whether dietary counselling can reduce emulsifier intake and whether this impacts dietary intake or FRQoL. Methods The ADDapt trial (NCT04046913) is a randomised, double-blind, placebo-controlled, re-supplementation trial in 154 patients with active CD, the clinical results of which are presented separately. Participants followed either a LED (LED group) or a LED with emulsifier re-supplementation (control). Both groups were provided dietary counselling from a dietitian as well as 25% of their foods from grocery deliveries and 3 daily trial snacks, which either did (control) or did not (LED) contain emulsifiers. Outcomes were measured at baseline and at week-8. Intake was measured using gold-standard 7-day food records which were coded using Nutritics software combined with an in-house emulsifier database1. FRQoL was measured using the validated FR-QoL-293. Outcomes at week-8 were compared between groups using unpaired tests and between baseline and week-8 in the LED group using paired tests. Results 113 participants completed the trial with 102 submitting both baseline and week-8 food records. Patients in the LED group reduced emulsifier intake from median 30.0 (IQR 33.0) to 2.5 (6.0) emulsifiers per week (p&amp;lt;0.001) (Figure 1). Patients in the control group consumed on average 2.5 g/d (±1.1) carrageenan, 3.6 g/d (±1.6) carboxymethyl cellulose and 0.8 g/d (±0.3) polysorbate-80 from re-supplemented trial snacks (all zero in the LED group). At week-8, energy and nutrient intakes were similar between groups, with only protein and calcium intake from trial snacks being different (Table 1). In the LED group, there were no major reductions in nutrient intake except for a small reduction in protein (Figure 1). FR-QoL-29 score significantly increased in the LED group (66.0 (IQR 20.0) to 76.0 (19.0), p=0.001) but not in the control group (67.0 (22.0) to 69.0 (15.3), p=0.09). Conclusion Dietary counselling significantly reduced emulsifier intake but did not result in major impairments in energy or nutrient intake. While the LED group had a reduction in protein, intake remained above the reference nutrient intake, indicating overall little negative impact of a LED on dietary intake. FRQoL improved on the LED. A LED is feasible and nutritionally safe in patients with active CD. Funding The Leona M. and Harry B. Helmsley Charitable Trust

P0571 Transmural healing, assessed through the combination of faecal calprotectin and intestinal ultrasound, is associated with a reduced risk of bowel damage progression in patients with Crohn's disease

Abstract Background Faecal calprotectin (Fcal) and intestinal ultrasound (IUS) could be used as non-invasive tools to monitor Crohn's disease (CD). We evaluated the agreement between Fcal and IUS in detecting active CD and to explore the complementarity of these tools in predicting long-term outcomes in CD. Methods In this prospective study, we consecutively included CD patients who underwent both IUS and Fcal testing within 7 days . IUS was performed by an experienced IBD sonographer, blinded from biological results. Patients were categorized into four groups: transmural healing (both normal), IUS healing (Fcal &amp;gt;100 μg/g but normal IUS), mucosal healing (Fcal &amp;lt;100 μg/g but abnormal IUS), and no healing (both Fcal and IUS abnormal). IUS was considered abnormal if at least one of the following CD-related findings was present: increased bowel wall thickness (&amp;gt;3 mm), abnormal vascular pattern (color Doppler signal &amp;gt;0), loss of intestinal wall layer stratification, mesenteric fat proliferation, enlarged lymph nodes, or CD-related complications (e.g., strictures, fistulas, or abscesses). Endpoints were the time to bowel damage progression and the time to relapse-related drug discontinuation. Agreement was expressed as a percentage and quantified using the κ coefficient. Survival analyses were conducted using the log-rank test (univariate) and Cox regression models (multivariate). 10-points acceptability numerical scale were compared using paired tests. Results Among 112 included patients, 44.6% (50/112), 12.5% (14/112), 16.1% (18/112), and 26.8% (30/112) achieved transmural healing, IUS healing, mucosal healing, and no healing, respectively. No significant differences were observed among the four groups. At baseline, 42% (47/112) of patients were symptomatic according to PRO-2. The agreement between IUS and Fcal for detecting active CD was low (71.4%, κ coefficient = 0.41 ± 0.09). Transmural healing was associated with a reduced risk of bowel damage progression compared to no healing (p &amp;lt;0.0001), unlike IUS healing (p = 0.15) or mucosal healing (p = 0.84) (Figure 1). Transmural healing was also associated with lower risk of relapse-related drug discontinuation compared to mucosal healing (HR = 0.09 [0.02-0.45], p = 0.003), IUS healing (HR = 0.10 [0.02-0.60], p = 0.001), or no healing (HR = 0.09 [0.018-0.04], p = 0.002). IUS was better accepted than stool collection for Fcal testing (10 points-acceptability numerical scale = 9.6 ± 0.8 vs. 7.9 ± 2.3; p &amp;lt;0.0001). Conclusion Transmural healing, assessed through a combination of non-invasive and well-accepted tools such as Fcal and IUS, is associated with improved long-term outcomes and could be used for monitoring patients with CD in daily practice.

The Effect of Smart Monitoring System on Attitudes and Adherences of Consuming Iron Supplement Tablets in Pregnant Women

Anemia is a condition of hemoglobin or red blood cells below 7gr/dl. The government's efforts to encourage pregnant women to consume 90 Fe tablets during pregnancy have not achieved national coverage due to the absence of a monitoring and evaluation program that is direct to low attitudes and adherence. Therefore, it is necessary to design an effective strategy with a smart monitoring system to observe the attitudes and adherence of pregnant women in consuming Fe tablets. The study aimed to determine the effect of a smart monitoring system on attitudes and adherence to the consumption of iron supplement tablets in pregnant women in the work area of Puskesmas Klego 1.The type of research adopted quantitative with the pre-experimental method using the one-group pre-test and post-test design research design. The sampling used a total sampling technique with 50 respondents. Data analysis utilized paired T-test and Wilcoxon test to determine the effect of a smart monitoring system on attitudes and adherence.The analysis of the Paired T-Test presented p value = 2.61 (p = 2.61-&gt;0.05). It indicated no effect of the smart monitoring system on attitudes. The results of the Wilcoxon test analysis obtained a p-value = 0.000 (p = 0.00-&lt;0.05. There are differences in the effect of using the smart monitoring system on the attitudes of pregnant women in the work area of Puskesmas Klego 1. Recommendations for further research are to enhance the application features.

Real-World-Evidence of Digital Health Applications (DiGAs) in Rheumatology: Insights from the DiGAReal Registry.

Prescribable digital health applications (DiGAs) present scalable solutions to improve patient self-management in rheumatology, however real-world evidence is scarce. Therefore, we aimed to assess the effectiveness, usage, and usability of DiGAs prescribed by rheumatologists, as well as patient satisfaction. The DiGAReal registry includes adult patients with rheumatic conditions who received a DiGA prescription. Data at baseline (T0) and the 3-month follow-up (T1) were collected through electronic questionnaires. Study outcomes included DiGA-specific outcome assessments as well as generic outcome assessments, including the Patient Global Impression of Change (PGIC), Patient Activation Measure (PAM®), and the German Telehealth Usability and Utility Short Questionnaire (TUUSQ). Changes between T0 and T1 were analyzed using descriptive statistics and paired tests. A total of 191 patients were included between June 2022 and April 2023. Of these, 127 completed the 3-month follow-up, and 114 reported using the prescribed DiGA, with 66% reporting weekly use and 15% completing the full DiGA program. The most commonly prescribed DiGAs targeted pain management (53%). Symptom improvement was reported by 51% of patients using a DiGA, with significant reductions in exhaustion levels (p = 0.03). Significant DiGA-specific improvements were observed for DiGAs addressing back pain (p = 0.05) and insomnia (p = 0.006). However, no overall significant changes were detected in patient activation, health literacy, pain, overall health, or disease activity. Back pain and weight management DiGAs were the most effective, frequently used, and best-rated DiGAs, with symptom improvements reported by 50% to 82% of patients. The findings suggest that DiGAs can improve symptom management in rheumatic patients, especially for conditions like back pain and weight control. Further real-world evidence is needed and may support value-based digital health efforts and reimbursement frameworks.