Repeated Measures Research Articles

Impact of Pilates Exercise on Quality of Life, Functional Capacity, Cancer-related Fatigue, Depression and Salivary Cortisol of Colorectal Cancer Survivors: A Quasi-Experimental Study.

This study aimed to investigate the effect of Pilates exercise on the quality of life, functional capacity, cancer-related fatigue, depression and salivary cortisol of colorectal cancer survivors. This is a quasi-experimental study which was conducted at Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia (UKM), and Hospital Al-Sultan Abdullah, Universiti Teknologi MARA (UiTM), Malaysia. The intervention group performed Pilates exercises with a certified Pilates instructor for eight weeks via online streaming from the participants' homes. Meanwhile, the control group participants received the usual care as stipulated by their oncologists. The primary outcome was the quality of life. The secondary outcomes were functional capacity, cancer-related fatigue, depression and salivary cortisol. Data was collected at baseline and eight weeks after the exercise intervention. The effects of the intervention were analyzed using Repeated Measures Analysis of Covariance (ANCOVA) statistical test. Thirty-six (36) colorectal cancer survivors were allocated into either a Pilates exercise intervention group (N= 18) or a control group (N= 18). Over eight weeks, the Pilates exercise group revealed significant group x time interactions in terms of quality of life (p = 0.003), role functioning (p = 0.012), functional capacity (p = 0.048), and stool frequency (p = 0.021). However, only the stool frequency symptom (p = 0.008) remained significant after controlling for the confounders of age, gender and stage of cancer. No significant changes in cancer-related fatigue, depression and salivary cortisol levels between the groups were observed after the intervention. Pilates exercise had positive impacts on role functioning, bowel function, and functional capacity among colorectal cancer survivors, ultimately contributing to an improvement in quality of life.

마음챙김 기반 교원 웰빙 증진 프로그램 개발 및 효과 분석

In this study, a mindfulness-based intervention program for teachers and empirically validated the effects on teachers’ stress and subjective well-being was developed. More specifically, based on the latest neuroscience and positive psychology research on mindfulness, we developed a mindfulness-based well-being program for teachers that incorporated mindfulness meditation and positive psychological factors such as compassion, loving-kindness, and gratitude. We implemented the program for eight weeks with the teachers in the experimental group. For the program effectiveness analysis, first, we compared between groups using Repeated Measure ANOVA to determine the treatment effect between the experimental and control groups. Second, Repeated Measure ANOVA and paired sample t-tests to examine the treatment effect within the experimental group were compared. In particular, we examined the persistence of the treatment effect, focusing on changes from pre- to 4-week follow up tests. The results showed that the mindfulness-based teacher well-being program was effective in increasing mindfulness and self-kindness, one of the components of compassion, and decreasing stress, such as anger and physical reactions. Furthermore, the effects on stress, which includes not only mindfulness and self-kindness but also depression, anger, and physical reactions as a result of these variables, were sustained up to four weeks after the program ended. On the other hand, self-criticism, life satisfaction, and negative affect showed significant treatment effects in the pre- and post-treatment periods, but the effects did not persist four weeks after the program ended. Based on the results of this study, we suggested ways to improve teachers' mental health and subjective well-being.

A single, maximal dose of celecoxib, ibuprofen, or flurbiprofen does not reduce the muscle signalling response to plyometric exercise in young healthy adults.

Non-steroidal anti-inflammatory drugs (NSAIDs) possess analgesic and anti-inflammatory properties by inhibiting cyclooxygenase (COX) enzymes. Conflicting evidence exists on whether NSAIDs influence signaling related to muscle adaptations and exercise with some research finding a reduction in muscle protein synthesis signaling via the AKT-mTOR pathway, changes in satellite cell signaling, reductions in muscle protein degradation, and reductions in cell proliferation. In this study, we determined if a single maximal dose of flurbiprofen (FLU), celecoxib (CEL), ibuprofen (IBU), or a placebo (PLA) affects the short-term muscle signaling responses to plyometric exercise. This was a block randomized, double-masked, crossover design, where 12 participants performed four plyometric exercise bouts consisting of 10 sets of 10 plyometric jumps at 40% 1RM. Two hours before exercise, participants consumed a single dose of celecoxib (CEL 200mg), IBU (800mg), FLU (100mg) or PLA with food. Muscle biopsy samples were collected before and 3-h after exercise from the vastus lateralis. Data were analyzed using a repeated measures (RM) ANOVA, ANOVA, or a Friedman test. Significance was considered at p < 0.05. We found no treatment effects on the mRNA expression of PTSG1, PTSG2, MYC, TBP, RPLOP, MYOD1, Pax7, MYOG, Atrogin-1, or MURF1 (all, p > 0.05). We also found no treatment effects on AKT-mTOR signaling or MAPK signaling measured through the phosphorylation status of mTORS2441, mTORS2448, RPS6 235/236, RPS 240/244, 4EBP1, ERK1/2, p38 T180/182 normalized to their respective total abundance (all, p > 0.05). However, we did find a significant difference between MNK1 T197/202 in PLA compared to FLU (p < .05). A single, maximal dose of IBU, CEL, or FLU taken prior to exercise did not affect the signaling of muscle protein synthesis, protein degradation, or ribosome biogenesis three hours after a plyometric training bout.

Population-wide eGFR percentiles in younger adults and clinical outcomes.

Identifying meaningful estimated glomerular filtration rate (eGFR) reductions in younger adults (<65 years) could guide prevention efforts. To aid in interpretation and identification of young adults at risk, we examined the association of population-level eGFR percentiles relative to the median by age and clinical outcomes. We conducted a retrospective cohort study of 8.7 million adults from Ontario, Canada from age 18 to 65 from 2008 to 2021 with an eGFR measure (both single outpatient value and repeat measures). We calculated median eGFR values by age and examined the association of reduced eGFR percentiles (≤10th, 5th, 2.5th and 1st) with outcomes using time to event models. Outcomes were a composite of all-cause mortality, major adverse cardiac outcomes (MACE) with/without heart failure (MACE+) and kidney failure as well as each component individually. From age 18 to 65, the median eGFR declined with age (range 128 to 90) and across percentiles [eGFR ranges 102 to 68 for ≤10th, 96 to 63 for ≤5th, 90 to 58 for ≤2.5th and 83 to 54 for 1st]. The adjusted rate for any adverse outcome was elevated at ≤ 10th percentile (HR 1.14 95%CI 1.10-1.18) and was consistent for all-cause mortality, MACE, MACE+ and predominant for kidney failure (HR 5.57 95%CI 3.79-8.19) compared to the median eGFR for age. Young adults with an eGFR in the lower percentiles were less likely to be referred to a specialist, have a repeat eGFR or albumin to creatinine ratio measure. eGFR values at the 10th percentile or lower based on a population-level distribution are associated with adverse clinical outcomes and in younger adults (18 to 39) this corresponds to a higher level of eGFR that may be underrecognized. Application of population-based eGFR percentiles may aid interpretation and improve identification of younger adults at risk.

Effect of cyclic meditation on anxiety and sleep quality in sailors on merchant ships-A quasi-experimental study.

Sailors undergo anxiety and sleep disturbances due to prolonged journeys and the nature of their work on ships. Earlier studies indicate Cyclic Meditation (CM) being beneficial for managing anxiety and improving sleep quality. Thus, the current study was designed to investigate the effect of CM on anxiety and sleep quality among sailors. Fifty sailors were assigned to experimental (n = 25) and control (n = 25) groups. The experimental group received 45 min of CM, 7 days a week for 3 weeks. Control group continued with their routine activities and were offered CM practice the following 3 weeks. Hamilton Anxiety Scale for anxiety (HAM-A) and the Pittsburg Sleep Quality Index (PSQI) for sleep along with blood pressure and pulse rate were taken at baseline and by the end of 3 weeks. Data were analyzed using Repeated Measures Analysis of Variance (RM ANOVA) for within and between group effects. Significant differences were found between the groups following 3 weeks for all the variables. Experimental group demonstrated reduced anxiety (p < 0.001) and improved sleep (p < 0.001) along with improvements in blood pressure and pulse rate. The control group did not show any significant changes following 3 weeks. CM could be incorporated as a routine for sailors to manage their anxiety and improve sleep quality during the period on board ships.

An open-labeled randomized non-comparative clinical trial on the efficacy of fairfoot ointment in Vipadika

In Ayurveda, cracked or fissured feet are often associated with an imbalance in the Vata dosha. An excess of Vata in the body can lead to various skin issues, including dry and cracked skin, not only on the feet but on other parts of the body. Fairfoot ointment, a proprietary product, is an antifungal and antiseptic combination of Jathyadi Grutham, Jeevanthyadi Yamakam and Karanja Thailam, intended for external application of cracked feet and other skin conditions like chapped lips, anal fissures etc. An open-labeled randomized non-comparative clinical trial study was conducted on 30 patients presenting with cracked feet, fissures, dry scaly skin, pain, and itching to prove the efficacy in Vipadika. The associated symptoms of pigmentation and skin elasticity were also evaluated as part of this trial. A visual analog scale (VAS) was used to quantify pain. On a Likert scale of 1 to 5, dryness, wrinkles, scaling, itching, and skin laxity were scored. At each point of examination, the amount of cracking and pigmentation were counted. The study involved four evaluations of the participants. Following pairwise analysis using the SPSS 16.0 program, data were examined using Repeated Measure ANOVA. The results of the study showed a considerable reduction in the symptoms of dryness, cracking, pain, and itching. Additionally, there was a statistically significant decline in the symptoms of skin laxity, wrinkles, sealing, and pigmentation. No adverse events were observed during the course of the experiment, suggesting that the medication is safe. Clinical findings indicate that Fairfoot ointment could be used for the improvement and treatment of patients with Vipadika.

UČINKI TELOVADBE NA GIBLJIVOST IN MOČ PRI OTROCIH

The aim of this study was to examine the effects of gymnastics training on flexibility and strength parameters of gymnasts. A total of 48 boys aged 5-7 years participated in this study voluntarily. Participants were randomly assigned to two groups (Experimental group n=24; age, height, weight and BMI 6.21±1.10 years, 114.18±19.98 cm, 22.38±4.09 kg, 15.85±1.59 kg/m², respectively; Control group n=24; age, height, weight and BMI (6.87±0.74 years, 114.18±19.98 cm, 22.38±4.09 kg, 15.90±2.72 kg/m², respectively). Standing Long Jump test (SLJ), Bent Arm Hang (BAH), Sit Ups in 30seconds Cruch (SUC), Sit and Reach Flexibility Test (SRF) and Static Flexibility (SF) tests were applied to the experimental and control groups. The training was applied to the experimental group three days a week for 12 weeks, each time for the duration of 90 minutes. A two-way Repeated Measure ANOVA (2×2) was used to test for interactions and main effects for time (pre-test vs. post-test) and group (experimental vs. control) on the dependent physical performance variables. Results showed that there was a statistically significant difference in the TSC and SR values of the experimental group from pre to post-tests (p&lt;0.01, d=0.95, p&lt;0.01, d=0.75, respectively). There were no significant differences in other parameters. According to post-test group difference results, experimental group participants performed better than those in the control group in terms of BAH, SUC, SLJ and SRF values (p&lt;0.02, d=0.780; p&lt;0.04, d=0.614; p&lt;0.00, d=2.11 respectively). As a conclusion, gymnastic training program significantly improved strength and flexibility of gymnasts aged 5-7 years.

Does caffeine improve team-based morning performances more than habituation?

Repeated sprint performance (≤6 s) has a 3-10% diurnal variation of an evening compared to a morning (17:00-19:00 vs. 06:00-10:00 h; Pullinger et al., 2019). Research distinguishing the effect of habit in comparison to other stimuli on morning performance is unestablished. Therefore, the present study investigates whether caffeine can improve team-based morning performance of 20 m repeated sprints, more than habituation. Eight team-based participants (age: 21 ± 1 years, body mass: 83 ± 9 kg, stature: 181 ± 5 cm) participated in this study. The participants retired at 22:30 h and raised at 06:30 h to be in the laboratory for 07:00 h throughout the study period. The participants completed with two familiarisations and were randomly allocated to two experimental conditions either 1) having taken caffeine on waking (300 mg at 06:30 h), then enter the laboratory at 07:00 h or, 2) The participant rose and retire as above but enter the laboratory at 07:00 h to sit on a cycle ergometer (60 mins) prior to the day of testing. They return the following day at 07:00 h. On entering the laboratory participants were seated, completed sleep questionnaires and mood was assessed using Perceived Onset Mood State (POMS) questionnaire. After 30-min Intra-aural temperature and fingertip blood glucose and lactate measured (as well as post warm-up and immediately after the RSP test). Thereafter, right- and left-hand grip strength (the best of 3 were recorded) and maximal repeated sprint performance measures were taken (RSP, 10 x 20m, 30s recovery period). Heart rate (HR), thermal comfort (TC), and rating of perceived exertion (RPE) were all recorded after each sprint. Data were analysed using a general-linear model.

How athletes’ biomechanical running characteristics effect running economy during the use of running shoes with and without carbon inserts

To maximise running economy (RE), shoe manufacturers placed carbon plates within the midsole of shoes. Shoe technology research is limited on understanding the variability of individual responses to carbon-plated shoes and how these responses vary across running velocities. Little research on same shoe characteristics with and without a stiff element has been completed. This study aimed to investigate how running shoes with carbon versus without a carbon composite stiff element alter individual running biomechanics and the metabolic cost of running. Ethical approval was gained from Cardiff Metropolitan University Ethics Committee. Ten male athletes (69 ± 9 kg; 174 ± 4 cm; 28 ± 9 years) completed two submaximal incremental treadmill runs. One test was completed in a shoe without carbon (C1), the other test was completed in carbon shoes (C2), the order of testing for each shoe were randomised. Running velocity started at 9 km/h and increased by 1 km/h every four mins, blood lactate samples were taken after every stage. Once 4 mmol·L−1 (OBLA; the second lactate turn point) had been reached one more stage was completed. Gas exchange was analysed throughout the whole test. The first 15 s of the final 2 minutes of each stage was recorded using Theia3D markerless motion capture software (Theia3Dv2022.1.0.2309, Theia Markerless, Inc., Kingston, ON, Canada). Data were analysed in 4 stages, the initial stage, pre-OBLA, OBLA and post-OBLA. Physiology data were averaged over the final two mins of each stage. Discrete joint angles were taken from each stage, and an average of the 15 s recording was taken for spatiotemporal measure. Data were analysed using a four-way repeat measures ANOVA, to show individual differences. Non-parametric data were analysed using Wilcoxon signed-rank test. Hedges g calculations were completed to calculate effect size (ES). Results showed significant increase in flight time (FT; P = 0.04, ES = 0.20) in the pre-OBLA stage when using C2. Metatarsophalangeal joint (MTP) dorsiflexion showed significant increase during the initial stage in C2 (P = 0.05, ES = 0.8), and ankle dorsiflexion had significant increase in the post-OBLA stage in C2 (P = 0.03, ES = 0.2). The were no significant differences present in the physiology data. Across the physiological, spatiotemporal and kinematics, high dispersions around the mean were exhibited. Findings suggest that to improve RE, mechanical and spatiotemporal changes need to be present when using C2. Further findings show carbon shoes elicit highly individual responses to both RE and mechanics of running.

Accuracy of Volumetric Bone Mineral Density Measurement in Weight Bearing, Cone Beam Computed Tomography

Background: Weight bearing computed tomography (WBCT) utilizes cone beam CT technology to provide assessments of lower limb joint structures while they are functionally loaded. Grey-scale values indicative of X-ray attenuation that are output from cone beam CT are challenging to calibrate, and their use for bone mineral density (BMD) measurement remains debatable. To determine whether WBCT can be reliably used for cortical and trabecular BMD assessment, we sought to establish the accuracy of BMD measurements at the knee using modern WBCT by comparing them to measurements from conventional CT.Methods: A hydroxyapatite phantom with three inserts of varying densities was used to systematically quantify signal uniformity and BMD accuracy across the acquisition volume. We evaluated BMD in vivo (n = 5, female) using synchronous and asynchronous calibration techniques in WBCT and CT. To account for variation in attenuation along the height (z-axis) of acquisition volumes, we tested a height-dependent calibration approach for both WBCT and CT images.Results: Phantom BMD measurement error in WBCT was as high as 15.3% and consistently larger than CT (up to 5.6%). Phantom BMD measures made under synchronous conditions in WBCT improved measurement accuracy by up to 3% but introduced more variability in measured BMD. We found strong correlations (R = 0.96) as well as wide limits of agreement (-324 mgHA/cm3 to 183 mgHA/cm3) from Bland-Altman analysis between WBCT and CT measures in vivo that were not improved by height-dependent calibration.Conclusion: Whilst BMD accuracy from WBCT was found to be dependent on apparent density, accuracy was independent of the calibration technique (synchronous or asynchronous) and the location of the measurement site within the field of view. Overall, we found strong correlations between BMD measures from WBCT and CT and in vivo measures to be more accurate in trabecular bone regions. Importantly, WBCT can be used to distinguish between anatomically relevant differences in BMD, however future work is necessary to determine the repeatability and sensitivity of BMD measures in WBCT.

Age-normed patient-reported outcome measures among cancer survivors.

11122 Background: Patient-reported outcome measures (PROMs) are instruments used to collect health-related outcomes that are derived completely from the patient without interpretation from healthcare providers. Monitoring and subsequent intervention based on PROMs collection has demonstrated efficacy in clinical trial settings. This has resulted in implementation of PROMs in routine clinical cancer practices throughout the nation. PROMs have been normed to the general population, but establishing the norms among cancer patients is essential to understanding how PROMs can be evaluated on an individual basis in routine clinical cancer care. This study aims to characterize age-normed PROMs scores among survivors of cancer using the National Institute of Health’s Patient-Reported Outcome Measures Information System (PROMIS) depression, fatigue, pain interference, and physical function domains. Methods: Routine collection of PROMs using 4 domains (depression, fatigue, pain interference, and physical function) of PROMIS were offered to all patients with a diagnosis of cancer of any disease site at visits with an oncologic provider using computer adaptive testing. All patients ≥18 years old with a completed PROM at least 2 years since their diagnosis of cancer were eligible for inclusion in the analysis. Only completed PROMs were included in the final analysis. Generalized estimating equation models were used to assess the relationship between age and the estimated mean T-score for each PROMs domain, considering repeat measures within a single patient. Results: A total of 3,636 patients were included in this retrospective cohort study with a total of 26,173 completed PROMs among all 4 domains. Mean age at diagnosis was 61.2 years (SD=12.44), 64% (n=2324) were female, 68% (n=2,461) identified as White, and 25% (n=893) identified as Black. For fatigue, mean T-score ranged from 48.4 points (SD=9.6) among 18-29 years olds to 56.5 points (SD=10.1) among 90-99 years olds, with no significant change with age (p=0.27). For depression, mean T-score ranged from 48.9 points (SD=9.0) among 60-69 year olds to 51.1 points (SD=8.8) among 80-89 year olds with a 0.3 point/decade decrease in T-score (p=0.01). Pain interference T-scores ranged from 48.6 points (SD=10.5) among 18-29 year olds to 55.0 points (SD=9.4) among 80-89 year olds with a 0.4 point/decade average increase (p&lt;0.001). The largest differences were observed in physical function, where scores ranged from 53.5 points (SD=11.0) among 18-29 year olds to 34.3 points (SD=9.2) among 90-99 year olds. There was a 2.1 point/decade decrease in T-score (p&lt;0.001). Conclusions: Among survivors of cancer, mean PROMIS scores differed by age in the depression, pain interference, and physical function domains but not fatigue. These age-normed PROMIS T-scores, which are required to understand individualized assessments of PROMs, are essential as PROMs are integrated into routine cancer care.

Integrating social drivers of health screening into ambulatory cancer care.

e13692 Background: Despite the known impact of social drivers of health (SDOH) on cancer related outcomes, the integration of SDOH screens into routine oncology clinical practice is scarce and suboptimal. Recent findings indicate feasibility of integrating these tools, yet data is limited in how to develop and implement the screens to address unmet SDOH related needs. This study aims to provide an overview of the development and integration of a SDOH screener and referral system into clinical workflow and describe the patients who completed and didn’t complete the survey. Methods: The 17-item Quality of Life and Support (QOLS) survey was based on evidence-based SDOH questionnaires, co-created with our community board, and built into the Mount Sinai Tisch Cancer Center EHR, Epic. The survey is sent out via the patient portal 7 days prior to patients’ second oncology appointment, with repeat measures every 90 days. Surveys are available in English and Spanish and evaluate SDOH needs such as transportation, food insecurity, employment, social support, financial strain, stress, and depression. If survey answers indicate need for additional support the case is ‘escalated’ to social work, chaplaincy, or family care coordinator depending on the area of need. We used descriptive statistics to describe patients who completed versus didn’t complete the survey. Of those completed, we also describe the SDOH trigger and frequency of ‘escalation’. Results: Between June 2022 - December 2023, 10,655 patients were assigned 25,353 surveys across 5 sites. 37% of the assigned surveys were completed.A total of 6,179 individuals completed at least one survey. The average number of surveys completed was 2. Of the completed surveys, 43% were completed before the appointment date. Of completed surveys, 21% were escalated to social work, 8.5% to chaplaincy, and 1.3% to family care with the most frequent reasons for escalation being distress, financial strain, and transportation. A significant relationship was found between Race (Pearson chi2 = 107.9 p &lt; .000) and Ethnicity (Pearson chi2 = 58.8, p&lt;.000) and survey completion with differences due primarily to White and non-Hispanic White completion vs non-completion. Notably, Black and Hispanic individuals are completing the survey in the same proportion as those receiving it. Conclusions: This study shows successful integration of a SDOH screen into ambulatory cancer care which allows for systematic referrals to SDOH resources. [Table: see text]

Comparison between total weight loss and other metrics after bariatric surgery using a multilevel mixed-effects linear regression model.

Several tools are used to assess postoperative weight loss after bariatric surgery, including the percentage of excess body weight loss (%EWL), percentage of total weight loss (%TWL), and percentage of excess body mass index (BMI) loss (%EBMIL). A repeated series of measurements should be considered to assess weight loss as accurately as possible. This study aimed to test weight loss metrics. Data were obtained from a prospective database of patients with obesity who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) between 2016 and 2017 in a French tertiary referral bariatric center. A multilevel mixed-effects linear regression model with repeated measures was used to analyze repeated weight measurements over time. A total of 435 patients underwent LRYGB (n = 266) or LSG (n = 169). At 2years, the average %EWL, %EBMIL, and %TWL were 56.8%, 61.3%, and 26.6%, respectively. Patients who underwent LSG experienced lower weight loss (β: -4233 in %TWL model, β: -6437 in %EWL model, and β: -6989 in %EBMIL model) than those who underwent LRYGB. In multivariate mixed analysis, preoperative BMI was not significantly associated with %TWL at 2years (β, -0.09 [-0.22-0.03] p = 0.1). Preoperative BMI was negatively associated with both %EWL (β, -1.61 [-1.84--1.38] p < 0.0001) and %EBMIL (β, -1.91 [-2.16--1.66] p < 0.0001). This is the first study to assess %TWL use for postoperative weight measurement, using a multilevel mixed-effects linear regression model %TWL is the measure of choice to assess weight loss following bariatric surgery.

An app-based ecological momentary assessment of undergraduate student mental Health during the COVID-19 pandemic in Canada (Smart Healthy Campus Version 2.0): Longitudinal study.

This paper presents results from the Smart Healthy Campus 2.0 study/smartphone app, developed and used to collect mental health-related lifestyle data from 86 Canadian undergraduates January-August 2021. Objectives of the study were to 1) address the absence of longitudinal mental health overview and lifestyle-related data from Canadian undergraduate students, and 2) to identify associations between these self-reported mental health overviews (questionnaires) and lifestyle-related measures (from smartphone digital measures). This was a longitudinal repeat measures study conducted over 40 weeks. A 9-item mental health questionnaire was accessible once daily in the app. Two variants of this mental health questionnaire existed; the first was a weekly variant, available each Monday or until a participant responded during the week. The second was a daily variant available after the weekly variant. 6518 digital measure samples and 1722 questionnaire responses were collected. Mixed models were fit for responses to the two questionnaire variants and 12 phone digital measures (e.g. GPS, step counts). The daily questionnaire had positive associations with floors walked, installed apps, and campus proximity, while having negative associations with uptime, and daily calendar events. Daily depression had a positive association with uptime. Daily resilience appeared to have a slight positive association with campus proximity. The weekly questionnaire variant had positive associations with device idling and installed apps, and negative associations with floors walked, calendar events, and campus proximity. Physical activity, weekly, had a negative association with uptime, and a positive association with calendar events and device idling. These lifestyle indicators that associated with student mental health during the COVID-19 pandemic suggest directions for new mental health-related interventions (digital or otherwise) and further efforts in mental health surveillance under comparable circumstances.

2D 1H sLASER Long-TE and 3D 31P Chemical Shift Imaging at 3 T for Monitoring Fasting-Induced Changes in Brain Tumor Tissue.

Emerging evidence suggests that fasting could play a key role in cancer treatment. Its metabolic effects on gliomas require further investigation. To design a multi-voxel 1H/31P MR-spectroscopic imaging (MRSI) protocol for noninvasive metabolic monitoring of cerebral, fasting-induced changes on an individual patient/tumor level, and to assess its technical reliability/reproducibility. Prospective. MRS phantom. Twenty-two patients (mean age = 61, 6 female) with suspected WHO grade II-IV glioma examined before and after 72-hour-fasting prior to biopsy/resection. 3-T, 1H decoupled 3D 31P MRSI, 2D 1H sLASER MRSI at an echo time of 144 msec, 2D 1H MRSI (as water reference), T1-weighted, T1-weighted contrast-enhanced, T2-weighted, and FLAIR. sLASER and PRESS sequences were used for phantom measurements. Phantom measurements and spectral simulations were performed with various echo-times for protocol optimization. In vivo spectral analyses were conducted using LCModel and AMARES, obtaining quality/fitting parameters (linewidth, signal-to-noise-ratio, and uncertainty measures of fitting) and metabolite intensities. The volume of glioma sub-regions was calculated and correlated with MRS findings. Ex-vivo spectra of necrotic tumor tissues were obtained using high-resolution magic-angle spinning (HR-MAS) technique. Wilcoxon signed-rank test, Bland-Altman plots, and coefficient of variation were used for repeatability analysis of quality/fitting parameters and metabolite concentrations. Spearman ρ correlation for the concentration of ketone bodies with volumes of glioma sub-regions was determined. A P-value <0.05 was considered statistically significant. 1H and 31P repeatability measures were highly consistent between the two sessions. β-hydroxybutyrate and acetoacetate were detectable (fitting-uncertainty <50%) in glioma sub-regions of all patients who completed the 72-hour-fasting cycle. β-hydroxybutyrate accumulation was significantly correlated with the necrotic/non-enhancing tumor core volume (ρ = 0.81) and validated using ex-vivo 1H HR-MAS. We propose a comprehensive MRS protocol that may be used for monitoring cerebral, fasting-induced changes in patients with glioma. 1 TECHNICAL EFFICACY: Stage 4.

Abstract PS02-02: Patient-reported outcomes from the Phase 3 CAPItello-291 trial investigating capivasertib and fulvestrant for patients with aromatase inhibitor-resistant HR-positive/HER2-negative advanced breast cancer

Abstract Background: In the Phase 3 CAPItello-291 trial, adding capivasertib (C), a pan-AKT inhibitor, to fulvestrant (F) in patients (pts) with aromatase inhibitor-resistant, HR+/HER2− (HER2− defined as IHC 0, or 1+ or IHC2+/ISH–) advanced breast cancer significantly improved PFS vs placebo (P) + F in the overall (HR 0.60, 95% CI 0.51, 0.71, p&amp;lt; 0.001) and AKT pathway-altered populations (HR 0.50, 95% CI 0.38, 0.65, p&amp;lt; 0.001). The safety profile of C-F was manageable; diarrhea (mostly grade 1) was the most frequent adverse event. Global health status (GHS)/health-related quality of life (HRQoL) was maintained from baseline in both arms; time to deterioration (TTD) favored C-F. We report results from additional patient-reported outcomes (PRO). Methods: Pts were randomized 1:1 to receive F (500 mg IM on days 1 and 15 of cycle 1 and day 1 of each subsequent 28-day cycle) with either P or C (400 mg BID; 4 days on, 3 days off). PRO measures assessed HRQoL, disease-related symptoms, functioning, and patient-reported treatment tolerability using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), EORTC QLQ Breast Cancer 23 items (EORTC QLQ-BR23), PRO version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE), and Patient Global Impression of Treatment Tolerability (PGI-TT). PROs were assessed at pre-specified timepoints. Change from baseline was assessed using Mixed Model Repeat Measures (on-treatment scores) for EORTC QLQ-C30 and summarized for EORTC QLQ-BR23; TTD was assessed using the stratified log-rank test for both. Results: Overall, 708 pts were randomized to C-F (n=355) or P-F (n=353). Overall compliance rates with EORTC QLQ-C30 and PGI-TT were 84.5% and 80.6% with C-F and 81.8% and 81.7% with P-F, respectively. Baseline compliance rates with the EORTC QLQ-C30 and PGI-TT were 88.2% and 82.8% with C-F and 87.3% and 83.1% with P-F, respectively. Mean changes from baseline in EORTC QLQ-C30 functional and symptom domain scores were maintained with C-F and P-F, except for diarrhea in the C-F arm, where scores worsened by &amp;gt;10 points (table). TTD analysis showed that HRs favored C-F vs P-F for all functional and symptom domains, except diarrhea (HR 2.75; 95% CI 2.01, 3.81), which favored P-F (table). Median TTD of diarrhea was shorter with C-F vs P-F in line with the C-F safety profile. Diarrhea with C-F was generally manageable, and discontinuations due to diarrhea were low (2.0%; n=7/355). For PGI-TT, most pts reported that they were ‘not at all’ or ‘a little bit’ bothered by the side effects of cancer therapy. Over the first 6 months, the proportion of pts reporting to be ‘somewhat’, ‘quite a bit’, or ‘very much’ bothered by side effects was higher for C-F vs P-F, with between-arm differences being highest in the first 2 cycles. Results from EORTC QLQ-BR23 domains will be presented at the meeting. Conclusions: Pts treated with C-F maintained HRQoL for longer than pts treated with P-F on all EORTC QLQ-C30 functional and symptom domain scores, except diarrhea. Worsening of diarrhea was observed with C-F, consistent with the safety profile of C, but events appeared tolerable and did not negatively impact GHS/HRQoL. Together with the clinical efficacy and manageable safety profile of C-F, the PRO results from the CAPItello-291 trial further support a positive benefit–risk profile of the combination in this population. https://clinicaltrials.gov/: NCT04305496. Funding: CAPItello-291 is sponsored by AstraZeneca. Editorial acknowledgment: AstraZeneca-funded medical writing support was provided by Suzanne Patel, Ph.D., from BOLDSCIENCE Inc. Capivasertib was discovered by AstraZeneca subsequent to a collaboration with Astex Therapeutics (and its collaboration with the Institute of Cancer Research and Cancer Research Technology Limited). Citation Format: Hope Rugo, Mafalda Oliveira, Sacha Howell, Florence Dalenc, Javier Cortés, Henry Gómez, Xichun Hu, Komal Jhaveri, Petr Krivorotko, Sibylle Loibl, Serafin Morales Murillo, Meena Okera, Yeon Park, Joo Hyuk Sohn, Eriko Tokunaga, Masakazu Toi, Samih Yousef, Lyudmila Zhukova, Marta Fulford, Haylee Andrews, Ian Wadsworth, Celina D’Cruz, Nicholas Turner. Patient-reported outcomes from the Phase 3 CAPItello-291 trial investigating capivasertib and fulvestrant for patients with aromatase inhibitor-resistant HR-positive/HER2-negative advanced breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PS02-02.

Acute versus non-acute targeted muscle reinnervation for pain control following major limb amputation: A comparative study

BackgroundTargeted muscle reinnervation (TMR) has been shown to reduce phantom limb pain (PLP) and residual limb pain (RLP) after major limb amputation. However, the effect of the timing of surgery on pain control and quality of life outcomes is controversial. We conducted a retrospective study to compare the outcomes of acute TMR for pain prevention with non-acute TMR for the treatment of established pain. MethodsAll patients treated with TMR in our institution between January 2018 and December 2021 were evaluated at 6, 12, 18 and 24 months post-operatively. Pain intensity and quality of life outcomes were assessed using the Brief Pain Inventory (Pain Severity and Pain Interference scales) and Pain Catastrophizing Scale. Outcomes were compared between acute and non-acute TMR using the Wilcoxon ranked-sum test or Fisher’s exact test as appropriate. Multilevel mixed-effects linear regression was used to account for repeat measures and potential pain confounders. ResultsThirty-two patients with 38 major limb amputations were included. Acute TMR patients reported significantly lower RLP and PLP scores, pain interference and pain catastrophisation at all time points (p < 0.05). Acute TMR was significantly associated with lower pain severity and pain interference in a linear mixed-effects model accounting for patient age, gender, amputation indication, amputation site, time post-TMR and repeated surveys (p < 0.05). There was no significant difference in the complication rate (p = 0.51). ConclusionAcute TMR was associated with clinically and statistically significant pain outcomes that were better than that in non-acute TMR. This suggests that TMR should be performed with preventative intent, when possible, as part of a multidisciplinary approach to pain management, rather than deferred until the development of chronic pain.

The Repeatability of Pharyngeal Opening Pressure Under Drug-Induced Sleep Endoscopy.

Pharyngeal opening pressure (PhOP) is a measure of upper airway collapsibility that can be obtained during drug-induced sleep endoscopy (DISE) using a continuous positive airway pressure (CPAP) titration. However, the stability of PhOP over the course of sedation during DISE remains unclear. This study aims to compare repeat measures of PhOP over the course of DISE. Single arm prospective study. Single tertiary care institution. Patients had 2 CPAP titrations while undergoing DISE. Collected data included patient demographics, PhOP, patient sedation index (PSI), and duration of and between CPAP titrations. t Tests, test-retest coefficient analysis, and repeated measures correlation were performed. Twenty-five patients completed the study between 2022 and 2023 with 22 patients having sedation depth (PSI) recording. Most were male (76%), obese (average body mass index: 30.24 kg/m2), with severe obstructive sleep apnea (average apnea-hypopnea index: 39.8 events/hr). Test-retest analysis showed good-excellent correlation between PhOP values (intraclass correlation coefficient = 0.892, P < .0001, n = 25). Average time between CPAP titrations was 15 minutes to 6 seconds. Over that time, PhOP increased by an average of 0.72 cmH2O (P = .06, n = 25) and PSI decreased by 9.5 units (P = .01, n = 22). Repeated measures correlation showed a weak negative correlation between PhOP and PSI (r = -.45, P = .03, n = 22). The results showed repeatability of PhOP values over the course of DISE. When adjusted for sedation depth (PSI), deeper sedation was weakly associated with greater PHOP. However, the magnitude of this change was small and we conclude that PhOP remains relatively stable over the course of DISE (Effects of Lung Volume on Upper Airway Patency During DISE [DISE-Pulm], NCT05350332, clinicaltrials.gov).

Translucency and Color Difference of Monolithic Zirconia Restorations: The Effect of Surface Finishing on Background Color

Aim: This study evaluates the effect of different surface finishing procedures on the color and translucency values of monolithic zirconia materials on three different colored composite backgrounds. Materials and Methods: Sixty monolithic zirconia blocks of three different translucency levels were prepared in vitro using computer-aided design/computer-aided manufacturing (CAD/CAM) systems. The correlation between repeat measurements was 0.5, resulting in a sample size of nine samples per group to detect a medium effect size, f = 0.25. Half of the zirconia blocks in each group were subjected to glazing, while the other half were polished ( n = 10). Composite blocks of three different colors were prepared to simulate dental substrates, and the zirconia specimens were placed on these composite backgrounds. The color parameters of the specimens were measured using a spectrophotometer on gray, black, and white backgrounds. Three-way repeated measure ANOVA was used to assess the interaction between the three independent variables (zirconia brand, surface finishing technique, and background color) and the effects of each tested variable on the changes in color and translucency. Results: The surface finishing techniques had a significant effect on the color and translucency of the monolithic zirconia materials. Glazing resulted in higher color differences and lower translucency values compared to polishing. For backgrounds of the same color, no significant differences were detected between the glazed zirconia groups for the same condition ( p &gt; .016). Conclusion: Overall, the study demonstrated the importance of selecting the appropriate surface finishing technique and translucency property of the monolithic zirconia materials to obtain the optimal esthetic results in dental restorations.

Establishing a reference focal plane using convolutional neural networks and beads for brightfield imaging

Repeatability of measurements from image analytics is difficult, due to the heterogeneity and complexity of cell samples, exact microscope stage positioning, and slide thickness. We present a method to define and use a reference focal plane that provides repeatable measurements with very high accuracy, by relying on control beads as reference material and a convolutional neural network focused on the control bead images. Previously we defined a reference effective focal plane (REFP) based on the image gradient of bead edges and three specific bead image features. This paper both generalizes and improves on this previous work. First, we refine the definition of the REFP by fitting a cubic spline to describe the relationship between the distance from a bead’s center and pixel intensity and by sharing information across experiments, exposures, and fields of view. Second, we remove our reliance on image features that behave differently from one instrument to another. Instead, we apply a convolutional regression neural network (ResNet 18) trained on cropped bead images that is generalizable to multiple microscopes. Our ResNet 18 network predicts the location of the REFP with only a single inferenced image acquisition that can be taken across a wide range of focal planes and exposure times. We illustrate the different strategies and hyperparameter optimization of the ResNet 18 to achieve a high prediction accuracy with an uncertainty for every image tested coming within the microscope repeatability measure of 7.5 µm from the desired focal plane. We demonstrate the generalizability of this methodology by applying it to two different optical systems and show that this level of accuracy can be achieved using only 6 beads per image.