Residual Signs Research Articles

K-depth tests for testing simultaneously independence and other model assumptions in time series

We consider the recently developed K-depth tests for testing simultaneously independence and other model assumptions for univariate time series with a potentially related d-dimensional process of explanatory variables. Since these tests are based only on signs of residuals, they are easy to comprehend. They can be used in a full version and in a simplified version. While former investigations already showed that the full version is appropriate for testing model assumptions, we concentrate here on either testing the independence assumption on its own or on simultaneously testing independence and model assumptions with both types of tests. In an extensive simulation study, we compare these tests with several known independence test such as the runs test, the Durbin-Watson test, and the Von-Neumann-Rank-Ratio test. Finally, we demonstrate how the K-depth tests can be used for improved modeling of crack width time series depending on temperature measurements in a bridge monitoring.

Photobiomodulation Therapy for Serous Pigment Epithelium Detachment in Chronic Central Serous Chorioretinopathy

PURPOSE: To report a case of giant pigment epithelium detachment (PED) secondary to chronic central serous chorioretinopathy (cCSC) successfully treated with photobiomodulation (PBM). METHODS: Case report. RESULTS: A 55-year-old man complained a worsening of vision in the left eye (LE) over the last 18 months. A complete ophthalmological evaluation encompassing best corrected visual acuity (BCVA) measurement, spectral-domain optical coherence tomography (SD-OCT), fundus autofluorescence (FAF), fluorescein angiography (FA) and microperimetry (MP) was performed. SD-OCT showed several small PEDs around the macula in the right eye and a giant macular serous PED with subretinal fluid (SRF) in the LE. FA disclosed multiple hyperfluorescent roundish areas in the posterior pole bilaterally, with a macular pooling in the LE. A diagnosis of cCSC was made, and patient underwent PBM with one session for week for four weeks, followed by one session bi-weekly for two months. SD-OCT of the LE showed a gradual flattening of the macular PED at 3 months, with a complete regression of the latter and of the SRF at 6- and 12-month follow up with no residual signs of chorioretinal atrophy on FAF. BCVA improved from 20/80 at baseline to 20/25 at the last follow up, and this functional improvement was further confirmed by MP. CONCLUSIONS: PBM can be considered a safe and effective treatment strategy for the management of cCSC with SRF and serous PED.

Diuretic Combination Therapy in Acute Heart Failure: An Updated Review.

Loop diuretics are the cornerstone of decongestive therapy in patients presenting with acute heart failure and have been extensively studied in randomized clinical trials. Therefore, in current guidelines, they are the only drug with a class I recommendation to treat signs and symptoms of congestion when present. However, the percentage of patients achieving successful decongestion is suboptimal, and diuretic resistance frequently develops. Patients with a poor response to loop diuretics and those discharged with residual signs of congestion are characterized by a worse prognosis over time. Recently, a renovated interest in different diuretic classes sprouted among heart failure researchers in order to improve decongestion strategies and ameliorate short- and long-term clinical outcomes. Randomized clinical trials investigating associations among diuretic classes and loop diuretics have been performed but yielded variable results. Therefore, despite initial evidence of a possible benefit from some of these compounds, a definite way to approach diuretic resistance via diuretic combination therapy is still missing. The aim of this review is to summarize current clinical evidence on the use of diuretic combination therapy in patients with acute heart failure and to suggest a possible approach to avoid or counteract diuretic resistance.

Chronic adaptive deep brain stimulation versus conventional stimulation in Parkinson's disease: a blinded randomized feasibility trial.

Deep brain stimulation (DBS) is a widely used therapy for Parkinson's disease (PD) but lacks dynamic responsiveness to changing clinical and neural states. Feedback control might improve therapeutic effectiveness, but the optimal control strategy and additional benefits of 'adaptive' neurostimulation are unclear. Here we present the results of a blinded randomized cross-over pilot trial aimed at determining the neural correlates of specific motor signs in individuals with PD and the feasibility of using these signals to drive adaptive DBS. Four male patients with PD were recruited from a population undergoing DBS implantation for motor fluctuations, with each patient receiving adaptive DBS and continuous DBS. We identified stimulation-entrained gamma oscillations in the subthalamic nucleus or motor cortex as optimal markers of high versus low dopaminergic states and their associated residual motor signs in all four patients. We then demonstrated improved motor symptoms and quality of life with adaptive compared to clinically optimized standard stimulation. The results of this pilot trial highlight the promise of personalized adaptive neurostimulation in PD based on data-driven selection of neural signals. Furthermore, these findings provide the foundation for further larger clinical trials to evaluate the efficacy of personalized adaptive neurostimulation in PD and other neurological disorders. ClinicalTrials.gov registration: NCT03582891 .

Sequential Blockade with Loop Diuretics and Acetazolamide: A Novel Strategy in Acute Heart Failure

Abstract Acute decompensated heart failure (HF) is the most common form of acute HF (AHF) and presents with systemic congestion due to left ventricular dysfunction with sodium and water retention. Diuretics are the mainstay of treatment for AHF, with loop diuretics being the first-line therapy. However, in some studies, patients who were given high doses of loop diuretics were discharged from the hospital with residual signs of volume overload. Combining acetazolamide, a carbonic anhydrase inhibitor, with loop diuretics has been shown to be beneficial as it increases the efficacy of loop diuretics and reduces the signs and symptoms of congestion. Further, it can be used for the prevention or treatment of diuretic resistance (DR). Sequential nephron blockade with acetazolamide has emerged as a novel strategy for the treatment of AHF to enhance the efficacy of loop diuretics and prevent DR. This review highlights the combination of acetazolamide with loop diuretics as an alternative and possibly more effective decongestive strategy option in AHF patients. Nevertheless, there is limited evidence to support this combination therapy, and further research is necessary to substantiate its use in AHF patients.

LMIC-24. ASSESSING THE TREATMENT OUTCOMES OF PEDIATRIC PATIENTS WITH MEDULLOBLASTOMA UNDER A U.S.-MEXICO CROSS-BORDER NEURO-ONCOLOGY PROGRAM

Abstract BACKGROUND Treating pediatric brain tumors in low-income countries is associated with worse outcomes, likely due to requiring a highly trained interdisciplinary team with ample resources. The Cross-Border Neuro-Oncology Program (CBNP) between Rady Children’s Hospital, San Diego (RCHSD), and Hospital General, Tijuana (HGT), was established to provide comprehensive care for children with brain tumors diagnosed at HGT. Given the most common malignant pediatric brain tumor is medulloblastoma, assessing treatment outcomes for this tumor is essential to establish this program’s validity. METHODS Pediatric patients with medulloblastoma were recruited from 2012-2021 as part of CBNP and risk-stratified into one of two treatment protocols (low - (K) versus high-risk (Y)). Patients underwent surgical resection and chemotherapy, which included cisplatin, etoposide, vincristine, and cyclophosphamide; patients with higher risk additionally received radiation therapy and higher-dose chemotherapy. Clinicopathologic profiles, extent of resection, methylation status and protocol type were analyzed and compared to known prognostic values for pediatric medulloblastoma. RESULTS Seventeen patients with medulloblastoma (age at diagnosis=6.8±5.0 years) were treated as part of CBNP during the study period. Patients were admitted to HGT, underwent resection at RCHSD, and returned to HGT for collaborative management. The mean symptom duration preceding diagnosis was 72.1±99.2 days. Gross total resection was achieved in 53% of cases and 5-year overall survival was 53% (9/17). Eight (47%) patients had residual post-treatment cerebellar signs. Survival data correlated with protocol type and methylation status will be presented. CONCLUSION Our cohort demonstrated a 5-year overall survival of 53%, moderately lower than the reported average 5-year overall survival of ~70% for pediatric medulloblastoma, with the majority of our cohort comprising of higher risk subtype and pathology. This indicates that this twinning model is a valid archetype for treating pediatric patients with brain tumors in low-income countries.

Improving electricity demand forecasting accuracy: a novel grey-genetic programming approach using GMC(1,N) and residual sign estimation

PurposeThis paper addresses the challenges associated with forecasting electricity consumption using limited data without making prior assumptions on normality. The study aims to enhance the predictive performance of grey models by proposing a novel grey multivariate convolution model incorporating residual modification and residual genetic programming sign estimation.Design/methodology/approachThe research begins by constructing a novel grey multivariate convolution model and demonstrates the utilization of genetic programming to enhance prediction accuracy by exploiting the signs of forecast residuals. Various statistical criteria are employed to assess the predictive performance of the proposed model. The validation process involves applying the model to real datasets spanning from 2001 to 2019 for forecasting annual electricity consumption in Cameroon.FindingsThe novel hybrid model outperforms both grey and non-grey models in forecasting annual electricity consumption. The model's performance is evaluated using MAE, MSD, RMSE, and R2, yielding values of 0.014, 101.01, 10.05, and 99% respectively. Results from validation cases and real-world scenarios demonstrate the feasibility and effectiveness of the proposed model. The combination of genetic programming and grey convolution model offers a significant improvement over competing models. Notably, the dynamic adaptability of genetic programming enhances the model's accuracy by mimicking expert systems' knowledge and decision-making, allowing for the identification of subtle changes in electricity demand patterns.Originality/valueThis paper introduces a novel grey multivariate convolution model that incorporates residual modification and genetic programming sign estimation. The application of genetic programming to enhance prediction accuracy by leveraging forecast residuals represents a unique approach. The study showcases the superiority of the proposed model over existing grey and non-grey models, emphasizing its adaptability and expert-like ability to learn and refine forecasting rules dynamically. The potential extension of the model to other forecasting fields is also highlighted, indicating its versatility and applicability beyond electricity consumption prediction in Cameroon.

Content validation of the defining characteristics of the nursing diagnosis "impaired swallowing" using the Delphi technique: A study with dysphagia nursing experts in Japan.

Nurses' clinical reasoning skills regarding impaired swallowing can help prevent patient complications and maintain quality of life. Clinical reasoning skills need content-validated defining characteristics (DCs). We aimed to validate the content of these DCs for nursing diagnosis "impaired swallowing." Content validation of the DCs was performed by 275 dysphagia nursing experts in Japan, using 3 rounds of the Delphi technique and Fehring's Diagnostic Content Validation (DCV) model. Three rounds of questionnaires on 84 DCs were completed via printed mail. The valid response rates for each round were as follows: round 1, 90.2%; round 2, 77.8%; and round 3, 71.3%. Of the 84 DCs, 77 that met the consensus criteria were categorized as major (n=18), minor (n=45), and excluded (n=14). There were four minor DCs other than the oral, pharyngeal, and esophageal phases. DCs listed from outside NANDA-I included 12 major, 16 minor, and 3 excluded characteristics. Of the NANDA-I DCs, 5 were no consensus and 11 were excluded. The total DCV score for the 63 major and minor DCs was 0.8. Our results recommend the addition of 28 DCs and the exclusion of 11 for the NANDA-I nursing diagnosis "impaired swallowing" (00103). Major DCs were prominent indicators of impaired swallowing and signs of aspiration or pharyngeal residuals. Minor DCs included not only the three phases but also other signs necessary for a comprehensive understanding of impaired swallowing. This validation study strengthens the clinical usefulness of the DCs for impaired swallowing, which can improve nurses' clinical reasoning skills. Major and minor DCs can increase the awareness of impaired swallowing and enable accurate intervention, thereby preventing patient complications and maintaining quality of life.

Outcome Measures in Adult Vulvar Lichen Sclerosus: A Case Series of Women Diagnosed as Juveniles.

Studies on the consequences of juvenile vulvar lichen sclerosus (JVLS) in adulthood are limited. A number of measuring tools are available for analyzing adult vulvar lichen sclerosus (VLS), but these have not been applied in studies on JVLS. The aim is to study physical findings, quality of life, sexual well-being, and self-image in adult women with a history of juvenile VLS. Adult women with a biopsy proven history of JVLS were recruited to be examined and surveyed using available standardized measurement tools. This took place in an outpatient setting by physicians who were not involved in the treatment of participants. Twenty-seven women (median age 29 years) with a history of JVLS and median time since biopsy of 19.5 years were recruited. Of these women, 59% currently had symptoms, 63% had signs of active disease, and 85% had moderate to severe architectural changes. Despite these residual signs, vulvar specific-quality of life and vulvar self-image scored favorably while generic health-related quality of life was somewhat effected. JVLS has consequences in adulthood involving physical findings and vulvar quality of life. The use of standardized outcome measures for clinical practice and research purposes facilitates a better understanding of the sequelae to JVLS.

Client's understanding of instructions for small animals in a veterinary neurological referral center.

It is not known how much information clients retrieve from discharge instructions. To investigate client's understanding of discharge instructions and influencing factors. Dogs and cats being hospitalized for neurological diseases. Clients were presented questionnaires regarding their pet's disease, diagnostics, treatments, prognosis and discharge instructions at time of discharge and 2 weeks later. The same questions were answered by discharging veterinarians at time of discharge. Clients answered additional questions regarding the subjective feelings during discharge conversation. Data collected included: data describing discharging veterinarian (age, gender, years of clinical experience, specialist status), data describing the client (age, gender, educational status). Raw percentage of agreement (RPA) between answers of clinicians and clients as well as factors potentially influencing the RPA were evaluated. Of 230 clients being approached 151 (65.7%) and 70 (30.4%) clients responded to the first and second questionnaire, respectively (130 dog and 30 cat owners). The general RPA between clinician's and client's responses over all questions together was 68.9% and 66.8% at the 2 time points. Questions regarding adverse effects of medication (29.0%), residual clinical signs (35.8%), and confinement instructions (36.8%) had the lowest RPAs at the first time point. The age of clients (P = .008) negatively influenced RPAs, with clients older than 50 years having lower RPA. Clients can only partially reproduce information provided at discharge. Only clients' increasing age influenced recall of information. Instructions deemed to be important should be specifically stressed during discharge.

The Course of Schizophrenia Spectrum Disorders With Episodes of Catatonic Depressions

Introduction Mood symptoms, especially depressive ones, occur in the majority of patients with schizophrenia spectrum disorders (SSD). Therefore, depression is often identified as one of the symptomatological dimensions of schizophrenia. Catatonia is also considered by some researchers as one of the dimensions of schizophrenia, or as an independent transnosological formation. Catatonia in SSD may be associated with affective dysregulation and is often accompanied by depression. Although the clinical course of SSD has been well studied previously, its relationship with psychopathological structure of episodes of SSD remains not entirely clear.ObjectivesTo determine the impact of episodes of catatonic depression on the course and prognosis of SSD.MethodsA sample of 60 patients with episodic course of SSD who met the criteria for catatonia according to the Bush-Francis Catatonia Screening Instrument (BFCSI) and for depression according to the Calgary depression schizophrenia scale (CDSS) was analyzed. An analysis of the clinical course of SSD was carried out on the basis of the medical history of all patients in the study sample and follow-up observation of 42 patients for 5 years. Global Assessment of Functioning Scale (GAF) was used to assess the prognosis of SSD.ResultsPatients were divided into two groups depending on the period of manifestation of catatonia in the clinical course of SSD: during the first episode or during subsequent episodes. The sample of patients with the first episode (n=43, 71.7 %) was divided into three subgroups. A relatively favorable course of SSD was observed only in 13 patients (30.2 %; 21.7 % of SSD sample). The course of disorder was characterized by similar episodes with a high proportion of affective symptoms, long-term remissions and minimally expressed negative symptoms (GAF score=75.2±5.82). A relatively unfavorable course of SSD was observed in 15 patients (34.9 %; 25.0 % of SSD sample). It was characterized by moderate negative and chronic subdepressive symptoms with low frequency of catatonic and psychotic relapses (GAF score=62.3). An unfavorable course of SSD was also observed in 15 patients (34.9 %; 25.0 % of SSD sample). It was characterized by a high frequency of relapses with a tendency to form a chronic conditions with residual catatonic signs and psychotic symptoms (GAF score=50.1). In the sample of patients with manifestation of catatonia in the second or subsequent episodes (n=17; 28.3 %), the clinical course of SSD was unfavorable. It was characterized by a rapid augmenting of negative symptoms with the formation of psychomotor poverty syndrome with residual catatonic symptoms (GAF score=52.7).ConclusionsOur study shows that the occurrence of catatonic depressive episodes in the clinical course of SSD in most cases is an unfavorable prognostic factor.Disclosure of InterestNone Declared

Robust Narrowest Significance Pursuit: Inference for Multiple Change-Points in the Median

We propose Robust Narrowest Significance Pursuit (RNSP), a methodology for detecting localized regions in data sequences which each must contain a change-point in the median, at a prescribed global significance level. RNSP works by fitting the postulated constant model over many regions of the data using a new sign-multiresolution sup-norm-type loss, and greedily identifying the shortest intervals on which the constancy is significantly violated. By working with the signs of the data around fitted model candidates, RNSP fulfils its coverage promises under minimal assumptions, requiring only sign-symmetry and serial independence of the signs of the true residuals. In particular, it permits their heterogeneity and arbitrarily heavy tails. The intervals of significance returned by RNSP have a finite-sample character, are unconditional in nature and do not rely on any assumptions on the true signal. Code implementing RNSP is available at https://github.com/pfryz/nsp.

Unveiling Modern Strategies for Diagnosing and Treating Grave Orbitopathy

Graves' Orbitopathy (GO), also known as thyroid eye disease or thyroid-associated orbitopathy is characterized by inflammation, ocular muscle hypertrophy, adipogenesis, and oedema (due to glycosaminoglycan accumulation). This condition leads to remodeling, tissue expansion, and/or fibrosis within the fibroadipose tissue or extraocular muscles of the orbit. GO manifests as an extrathyroidal aspect of autoimmune thyroid diseases in both Grave's disease (GD) and Hashimoto's thyroiditis.
 The pathophysiological foundation of GO entails the infiltration of B cells, T cells, and CD34+ fibroblasts in the orbit. B cells generate IGF (insulin-like growth factor), wherein IGF and TRab (Thyroid-Receptor antibodies) stimulate the IGF receptor complex and thyrotropin receptor (respectively) on the surface of CD34+ cells which triggers orbital tissue expansion, orbital protrusion, optic nerve compression, and eyeball displacement, resulting in exophthalmos.
 GO progress through an active phase (characterized by inflammation with visible manifestations), followed by a plateau phase (stabilization of GO manifestations), and a gradual resolution of distinctive residual signs and symptoms (inactive phase). This entire process spans between 18-24 months in untreated patients, where disease manifestations significantly depend on the phase during which the disease is identified.
 GO therapy is intended to shorten the active phase and supress its residual eye manifestations during the inactive phase. In general, GO therapy is categorized into general and disease severity-specific approaches.
 GO therapy often falls short of providing satisfactory results, prompting need of surgery to address lingering clinical manifestations. This review presents the latest insights into the pathogenesis and treatment of GO for better management and outcomes.

Magnetic resonance imaging in acute meningoencephalitis of viral and unknown origin: frequent findings and prognostic potential.

Magnetic resonance imaging (MRI) findings in meningoencephalitis have mainly been described in terms of their diagnostic value rather than their prognostic potential, except for herpes simplex virus (HSV) encephalitis. The aims of our study were to describe frequency and anatomic locations of MRI abnormalities specific to limbic, circadian and motor systems in a cohort of meningoencephalitis patients, as well as to investigate the prognostic value of these MRI findings. A secondary, selective analysis of a retrospective database including all meningitis, meningoencephalitis and encephalitis cases treated between 2016 and 2018 in the University hospital of Bern, Switzerland was performed. Patients with meningitis of any cause, bacterial or autoimmune causes of encephalitis were excluded. MRI scans and clinical data from 129 meningoencephalitis cases found that the most frequent causes were tick-borne encephalitis (TBE, 42%), unknown pathogens (40%), VZV (7%), and HSV1 (5%). At discharge, median modified Rankin Score (mRS) was 3 (interquartile range, IQR, 1), 88% of patients had persisting signs and symptoms. After a median of 17 months, median Glasgow Outcome Score (GOS) was 5 (IQR 1), 39% of patients still had residual signs or symptoms. All patients with HSV, 27% with TBE and 31% of those with meningoencephalitis of unknown etiology had fluid-attenuated inversion recovery (FLAIR) and to a lesser extent diffusion-weighted imaging (DWI) lesions in their initial MRI, with highly overlapping anatomical distribution. In one fifth of TBE patients the limbic system was affected. Worse outcome was associated with presence of DWI and/or FLAIR lesions and lower normalized apparent diffusion coefficient (ADC) signal intensities. Presence of FLAIR lesions, restricted diffusion as well as the extent of ADC hypointensity in initial MRI are parameters which might be of prognostic value regarding the longterm clinical outcome for patients with meningoencephalitis of viral and of unknown origin. Although not described before, affection of limbic structures by TBE is possible as shown by our results: A substantial proportion of our TBE patients had FLAIR signal abnormalities in these regions.

Severity of Postcovid Syndrome: A Systematic Review

Postcovid syndrome includes many conditions and symptoms, both those that arose directly during the acute period of infection and the appearance of new ones. The purpose of the systematic review is to determine the criteria for the severity of postcovid syndrome. Materials and methods. The following keywords were used to search for literary sources: “postcovid syndrome”, “severity of postcovid syndrome”, “severity of postcovid syndrome” and “symptoms of postcovid syndrome” in Russian and English. We used the search engines “eLibrary.RU — Scientific Electronic Library” and PubMed.gov. Articles were included that presented a study of patients with laboratory-confirmed coronavirus infection at least a month after recovery from COVID-19 with residual clinical signs and/or biochemical changes. The analysis included only publications from the last 3 years (2020– 2023). Results. A total of 2,913 publications were found by two search engines. After removing duplicates, literature reviews, clinical studies of medicines, studies conducted on animals, studies unsatisfactory for time after acute COVID-19, and studies performed on persons under the age of 18, 69 articles were selected for analysis that meet the criteria for inclusion in the analysis. Conclusion. An analysis of the literature of the last 3 years has allowed us to determine that the presence and severity of postcovid syndrome can probably be determined by the presence in a patient of at least one of the signs presented in the review that developed during or after a laboratory-verified COVID-19 infection and persisted for more than 4 weeks from the onset of the disease and that cannot be explained by other reasons.

실물옵션을 활용한 Olhson 모형 가치평가에 관한 연구

This study newly suggests investor’s psychological expectation values as ‘other information’ not yet clearly identified in the Ohlson model. These values are calculated through real option valuation. A total of 9,791 annual corporate stock prices and financial statements are investigated for KOSDAQ companies from 2011 to 2021. According to the classification criteria of the Korea Exchange, the entire sample was classified into a total of 8 panels: bluechip, midsize, venture, and technology companies, and each further classified into two sub-groups based on their respective residual income signs. We empirically find that the real option value, assessing investors’ expectations for future profits, significantly contribute to explaining stock values along with the book value per share and residual income per share comprising the established Ohlson model. In particular, for companies with negative residual incomes, the real option value demonstrates a higher explanatory power for stock prices compared to those with positive earnings. Furthermore, robustness test shows that the real option value’s explanatory power for stock prices remains significant even when accounting for previously recognized factors such as cash dividends per share, market price to book value ratio, total debt ratio, systematic risk, and market index.

1302. Impact of Insurance Coverage on the Route of Antibiotic Treatment for Forefoot Osteomyelitis

Abstract Background Recent studies suggest oral antibiotics can be a non-inferior alternative to intravenous antibiotics for treating bone and joint infections. In this study, we aimed to investigate whether insurance type affects the choice of antibiotic treatment routes and whether the route of antibiotic treatment influences the delivery of home health services. Methods We conducted a retrospective chart review of non-bacteremic patients who underwent amputations for forefoot osteomyelitis with residual signs of infection on proximal bone cultures and were discharged home from the hospital. Of 461 patients scheduled for hospital follow-up visits for bone and joint infections in our community practice infectious diseases clinic from January 2019 to December 2022, 40 met the inclusion criteria. Results were analyzed with multivariable logistic regression, selecting models with the lowest Akaike Information Criterion. Results The placement of PICC lines decreased significantly over time (OR 0.34, 95% CI: 0.14 - 0.71, p = 0.01), mirroring national trends favoring increased oral antibiotic use. After controlling for the year of treatment, we observed a trend towards patients with Medicaid insurance more frequently receiving IV antibiotics (OR 4.8, 95% CI: 1.0 - 29, p = 0.06). We found no evidence that the antibiotic administration route led to differences in the delivery of home health services at the time of discharge (p = 0.99). PICC Placement Percentage by Year and Insurance Percentage of PICC line Placement by year in patients with and without Medicaid Insurance during hospital encounter PICC Placement Frequency by Insurance and Home Nursing Frequency of PICC placement in patients during hospital encounters based on (A) if a patient has Medicaid insurance and (B) if home nursing is ordered at discharge Organisms Cultured by Year Frequency of organisms cultured on proximal bone cultures by year of study Conclusion Our findings suggest a trend towards patients with Medicaid insurance more frequently receiving IV antibiotics, despite the higher direct and indirect costs. It remains unclear whether this trend is due to differences in the severity of infections or microbiological resistance patterns. Future studies should assess the interaction of psychosocial and microbiological factors in influencing shared decisions regarding the route of antibiotic treatment outside of clinical trial settings. Organisms Cultured by Antibiotic Route, Insurance Type, and Home Nursing Orders Frequency of PICC line placement (A), Insurance coverage (B), and ordered for home nursing at discharge (C) by organisms cultured from proximal bone margins Disclosures All Authors: No reported disclosures

Clinical and epidemiological features of Lyme neuroborreliosis in adults and factors associated with polyradiculitis, facial palsy and encephalitis or myelitis

The clinical course of Lyme neuroborreliosis (LNB) is highly variable. Delayed diagnosis and treatment still remain actual challenges. Moreover, there is a lack of studies analyzing the factors associated with different LNB syndromes. We aimed to analyze clinical and epidemiological features of LNB in hospitalized adults in eastern Lithuania. A retrospective study was performed for patients presenting in the years 2010–2021. A total of 103 patients were included in the study, 100 with early, and three with late LNB. Patients with early LNB most often presented polyradiculitis [75/100, (75%)], which was also the most common initial neurological syndrome. Peripheral facial palsy was diagnosed in 53/100 (53%) patients, in 16/53 (30.2%) cases both facial nerves were affected. Encephalitis or myelitis was diagnosed in 14% of patients with LNB. A total of 76/103 (73.8%) patients were discharged with residual symptoms or signs. One patient presenting encephalomyelitis died because of bacterial complications. The absence of observed erythema migrans (EM) was the predictor of peripheral facial palsy, while female sex and EM untreated with antibiotics were predictors of isolated polyradiculitis. A fever of ≥ 38 ° °C and pleocytosis of ≥ 300 × 106/l were associated with the development of encephalitis or myelitis in patients with early LNB.

On the consistency of [formula omitted]-sign depth tests

The consistency of the so-called K-sign depth tests is considered. These tests are based on the K-sign depth, which originated from the simplicial regression depth, but is easier to compute. The K-sign depth tests use only the signs of residuals and are equivalent to the classical sign test for K=2. However, K-sign depth tests with K≥3 show a much better power than the classical sign tests in simulation studies. This property is attributed to the consistency of these tests for K=3. After deriving a general condition for consistency, it is shown that this condition is in particular satisfied for several relevant hypotheses in polynomial regression models.

Residual diffusion-weighted imaging hyperintense signal in primary central nervous system lymphoma can predict early recurrence.

The treatment response of primary central nervous system lymphomas (PCNSLs) is mainly evaluated using postcontrast T1-weighted imaging (T1WI). Because poorly enhanced lesions may contain residual tumors, the combination of evaluation methods will potentially improve the accuracy of determining treatment effectiveness. In this study, we evaluated the usefulness of diffusion-weighted imaging (DWI) in predicting recurrence among patients with PCNSL who achieved complete response (CR)/unconfirmed CR (CRu). Fifty-four patients newly diagnosed with PCNSL who were treated at our institution and achieved CR/CRu at the end of treatment were included in this study. The patients were divided into two groups according to the presence or absence of residual DWI hyperintense signal at the tumor site at the end of treatment. Kaplan-Meier analysis was performed to analyze the median overall survival (OS) and progression-free survival (PFS). The mean age of the 54 patients was 66.4 ± 13.3 years. The induction therapies were HD-MTX in 20 patients, R-MPV in 29 patients, and other chemotherapies in five patients. Radiotherapy was performed in 35 patients, high-dose cytarabine therapy in 14 patients, and autologous hematopoietic stem cell transplantation in one patient, and of the 54 patients, 10 had no consolidation therapy. The residual DWI hyperintense signal sign was observed in 18 patients. The R-MPV regimen was statistically associated with a lower rate of residual DWI hyperintense signal (p = 0.0453). The median PFS was statistically shorter in the residual DWI hyperintense signal group than in the non-residual DWI hyperintense signal group (14.0 months vs. 85.1 months) (p < 0.0001, log-rank test). A residual DWI hyperintense signal at the end of treatment was statistically associated with shorter PFS. Among patients who achieved CR/CRu evaluated based on postcontrast T1WI, DWI could be a valuable additional sequence to predict the early recurrence of PCNSL.