Sample Wilcoxon Signed Rank Test Research Articles

Impact of short-term dental dehydration on in-vivo dental color and whiteness

ObjectiveTo determine in-vivo chromatic and whiteness changes produced by short-term dental dehydration. MethodsSpectral reflectance of 452 upper incisors (226 centrals and 226 laterals) of 113 participants were measured using a spectroradiometer at baseline and after short-term dehydration (minutes 2, 4, 6, 8 and 10). CIE L*a*b* color coordinates (L*, a*, b*, C*ab and hab) and whiteness index for dentistry (WID) were calculated. Color differences (ΔE00, ΔEab*) and whiteness differences (ΔWID) were computed and interpreted based on their respective 50:50% perceptibility (PT) and acceptability thresholds (AT). Statistical analysis was performed using the related samples Wilcoxon signed-rank test. ResultsL* showed an increasing trend with dehydration, while a*, b*, C*ab and hab have a decreasing tendency. All chromatic coordinates showed statistically significant differences (p < 0.003) at each interval of dehydration compared with baseline, except a* for all teeth. For ΔE00 and ΔEab* values were higher than PT after 2 min of teeth dehydration and higher than AT after 6 and 8 min, respectively. The percentage of teeth exceeding corresponding PT was higher than 50% after 2 min. WID index increased with dehydration time, while whiteness differences were clinically perceptible after 4 min. Statistically significant differences were found for WID between all dehydration intervals (except 8−10 min). The percentage of teeth exceeding whiteness PT was higher than 50% after 6 min of teeth dehydration. ConclusionsShort-term dental dehydration produces clinically unacceptable changes in tooth color and clinically perceptible increase in tooth whiteness level. Clinical significanceClinical shade matching must be done within the first two minutes of any clinical procedure that requires precise chromatic determination but implies a risk of tooth dehydration.

Clinical feasibility of 2D dynamic sagittal HASTE flexion-extension imaging of the cervical spine for the assessment of spondylolisthesis and cervical cord impingement

Purpose: To assess the utility of a 2D dynamic HASTE sequence in assessment of cervical spine flexion-extension, specifically (1) comparing dynamic spondylolisthesis to radiographs and (2) assessing dynamic contact upon or deformity of the cord. Methods: Patients with a dynamic flexion-extension sagittal 2D HASTE sequence in addition to routine cervical spine sequences were identified. Static and dynamic listhesis was first determined on flexion-extension radiographs reviewed in consensus. Blinded assessment of the dynamic HASTE sequence was independently performed by 2 radiologists for (1) listhesis and translation during flexion-extension and (2) dynamic spinal cord impingement (cord contact or deformity between neutral, flexion and extension). Results32 scans in 32 patients (9 males, 23 females) met inclusion criteria acquired on 1.5 T (n = 15) and 3 T (n = 17) scanners. The mean acquisition time was 51.8 s (range 20–95 seconds). Dynamic translation was seen in 14 patients on flexion-extension radiographs compared to 12 (reader 1) and 13 (reader 2) patients on HASTE, with 90.6 % agreement (K = 0.83; p = 0.789). In all cases dynamic listhesis was ≤3 mm translation with one patient showing dynamic listhesis in the range 4−6 mm. Four cases (13 %) demonstrated deformity of the cord between flexion-extension, not present in the neutral position. For cord impingement there was strong inter-reader agreement (K = 0.93) and the paired sample Wilcoxon signed rank test found no significant difference between the impingement scores of the two readers (p = 0.787). Conclusions: A sagittal dynamic flexion-extension HASTE sequence provides a rapid addition to standard MRI cervical spine protocols, which may useful for assessment of dynamic spondylolisthesis and cord deformity.

Validation of a commercial deformable image registration for surface-guided radiotherapy using an ad hoc-developed deformable phantom.

The use of optical surface systems (OSSs) for patient setup verification in external radiation therapy is increasing. To manage potential deformations in a patient's anatomy, a novel deformable image registration (DIR) tool has been applied in a commercial OSS. In this study we investigate the accuracy of the DIR as compared to rigid image registration (RR). The positioning accuracy of the DIR and RR implemented in the OSS was investigated using an ad hoc-developed anthropomorphic deformable phantom, named Mary. The phantom consists of 33 slices of expanded polystyrene slabs shaped thus to simulate part of a female body. Anatomical details, simulating the ribs and spinal cord, together with 10 inner targets at different depths are included in thorax and abdominal parts. Mary is capable of realistic body movements and deformations, such as head and arm rotations, body torsion and moderate breast/abdomen swelling. The accuracy of DIR and RR was investigated for four internal targets after deliberately deforming the phantom nine times. Breast and abdomen enlargements and torsions around x, y, and z axes were applied. For reference purposes, rigid displacements (where Mary's anatomy was kept intact) were included. The phantom was positioned on the linac couch under the OSS guidance and for each target and displacement a CBCT was acquired. The accuracy of DIR and RR was assessed evaluating the difference in means of absolute values between CBCT and the OSS registration parameters (lateral, longitudinal, vertical, rot, pitch, and roll), using both a reference surface extracted from CT (CTr) or acquired with the OSS (OSSr). A comparison of the four different combinations, DIR+OSSr, DIR+CTr, RR+OSSr, and RR+CTr, was carried out to evaluate the position accuracy for the various combinations. Finally, the positioning accuracy of the different target positions using only OSSr was investigated for the DIR. A paired sample Wilcoxon signed-rank test (P<0.05) and a two-tailed Mann-Whitney test (P<0.05) were carried out. The DIR in combination with OSSr showed significantly (P<0.05) improved positioning accuracy in the lateral and longitudinal directions and in pitch, compared to RR, when deformations were applied to Mary. The positioning accuracy improved from 1.9±1.5mm, 1.1±0.8mm to 1.1±1.2mm, 0.6±0.5mm in lateral and longitudinal directions, respectively, and from 0.8±0.6° to 0.4±0.4° in pitch, using DIR compared to RR. Both the DIR and RR showed a similar positioning accuracy when rigid displacements of Mary were applied. For DIR, the OSSr generally showed improved calculation accuracy compared to CTr. Independent of the reference image used, the target position influenced the registration accuracy, and hence, one target could not be evaluated using RR due to its inability to calculate the correct position. Improved positioning accuracy was observed for DIR with respect to RR when deformations of Mary's anatomy were applied. For both DIR and RR, improved positioning accuracy was observed using OSSr as compared to CTr. The position of the target inside the phantom influenced the positioning accuracy for DIR.

Interest in Dialogic and Non-Dialogic Teacher Talk Situations in Middle School Science Classroom

Previous research has shown that dialogic teacher talk not only supports students’ understanding but also raises their interest. However, there is little, if any, research on the connection between dialogic talk and student interest in classroom situations. To investigate this connection, we collected video observations and experience sampling data. In total, 87 middle school students aged 14 to 16 participated in the study. Data were collected from the classes of six science teachers, and three lessons were video recorded in each teacher’s classroom. During the lessons, students were asked several times to express their interest in the situation through the experience sampling method (ESM). The measurements took place in situations where the teacher either talked with the students or talked to the whole group of students. The talk situations were categorised as dialogic or non-dialogic, based on the video recording. On a five-point scale of interest, the median value was 3.3 in non-dialogic talk situations and 3.5 in dialogic talk situations. We hypothesised that students’ interest would be higher in dialogic talk situations than in non-dialogic talk situations. The hypothesis was tested with a related samples Wilcoxon signed rank test, and the results supported the hypothesis (Z = − 2.62; p < 0.05). The results suggest that dialogic talk may trigger students’ interest in science learning.

Evaluation of [68Ga]Ga-DATA-TOC for imaging of neuroendocrine tumours: comparison with [68Ga]Ga-DOTA-NOC PET/CT.

Recently, the new hybrid chelator DATA (6-amino-1,4-diazepine-triacetate) has been introduced, which has the advantage of high yield and radiolabelling of DATA-based octreotide derivative (TOC) at room temperature in contrast to tetraazacyclododecane-1,4,7,10-tetraacetate (DOTA) that needs 95 °C for effective labelling. However, the diagnostic potential of DATA-TOC has not been studied with other chelators in humans. The aim of this study was to compare the diagnostic efficacy of [68Ga]Ga-DATA-TOC with [68Ga]Ga-DOTA-NOC (which is the current standard for imaging neuroendocrine tumours (NET)) in patients of gastroenteropancreatic neuroendocrine tumours (GEP-NETs). Fifty patients (thirty-one males and nineteen females) with biopsy-proven GEP-NETs were included in the study. Patients age ranged from 14 to 75 years (mean 46.11 years). All patients underwent two PET studies with [68Ga]Ga-DATA-TOC and [68Ga]Ga-DOTA-NOC. Images were evaluated visually and semi-quantitatively using maximum standardized uptake values (SUVmax) of tumour, mediastinum and liver. Tumour-to-liver (T/L) and tumour-to-mediastinum (T/M) SUVmax ratios were computed. For the purpose of comparison, patient-wise as well as lesion-wise analysis was carried out. The nonparametric-related samples Wilcoxon signed-rank test was used for comparison of the SUVmax values and ratios. On visual evaluation, the biodistribution and image quality of [68Ga]Ga-DATA-TOC was similar to [68Ga]Ga-DOTA-NOC. Physiological liver uptake was lower in [68Ga]Ga-DATA-TOC as compared with [68Ga]Ga-DOTA-NOC, 7.65 ± 5.37 vs 8.94 ± 5.95 (p = 0.009), respectively. On a patient-wise analysis, both [68Ga]Ga-DATA-TOC and [68Ga]Ga-DOTA-NOC were lesion-positive in the 44 patients (88%) and were negative in the 6 patients (12%). On a lesion-based analysis, [68Ga]Ga-DATA-TOC had 98.6% concordance with [68Ga]Ga-DOTA-NOC (232 out of 235 lesions detected). The target tumour SUVmax on [68Ga]Ga-DATA-TOC and [68Ga]Ga-DOTA-NOC were 36.63 ± 32.24 and 40.82 ± 36.89, respectively (p = 0.097). The T/L SUVmax ratios were not significantly different (5.99 ± 5.52 vs 5.67 ± 4.96, p = 0.77). [68Ga]Ga-DATA-TOC PET/CT imaging produced results that were comparable with [68Ga]Ga-DOTA-NOC. It, thus, has potential utility as an effective and safe alternative to 68Ga-DOTA-NOC with the added benefit of ease, cost-effective and improved yield of instant kit-type synthesis.

P035: Impact of EMS direct referral to community care on emergency department utilization

Introduction: The Community Referral by Emergency Medical Services (CREMS) program was implemented in January 2015 in Southwestern Ontario. The program allows Paramedics interacting with a patient to directly refer those in need of home care support to their local Community Care Access Centre (CCAC) for needs assessment. If indicated, subsequent referrals are made to specific services (e.g. nursing, physiotherapy and geriatrics) by CCAC. Ideally, CREMS connects patients with appropriate, timely care, supporting individual needs. Previous literature has indicated CREMS results in an increase of home care services provided to patients. Methods: The primary objective of this project is to evaluate the impact of the CREMS program on Emergency Department utilization. Data for all CCAC referrals from London-Middlesex EMS was collected for a thirteen month period (February 2015-February 2016). For all patients receiving a new or increased service from CCAC the number of Emergency Department visits 2 years before referral and 2 years after referral were calculated. A related samples Wilcoxon Signed Rank Test was performed to examine the difference in ED visits pre and post referral to CCAC. Results: There were 213 individuals who received a new or increased service during the study timeframe. Median [IQR] patient age was 77 [70-85.5]. 113/213 (53%) of patients were female. The majority of patients 135/213 (63.4%) were a new referral to CCAC. The median [IQR] number of hospital visits before referral was 3 [1-5] and after referral was 2 [0-4]. There was no significant difference in the overall number of ED visits before versus after referral (955 vs 756 visits, p = 0.051). Conclusion: Community based care can improve patient experience and health outcomes. Paramedics are in a unique position to assess patients in their home to determine who might benefit from home care services. CREMS referrals for this patient group showed a trend towards decreased ED visits after referral but the trend was not statistically significant.

Inverse Occlusion: A Binocularly Motivated Treatment for Amblyopia.

Recent laboratory findings suggest that short-term patching of the amblyopic eye (i.e., inverse occlusion) results in a larger and more sustained improvement in the binocular balance compared with normal controls. In this study, we investigate the cumulative effects of the short-term inverse occlusion in adults and old children with amblyopia. This is a prospective cohort study of 18 amblyopes (10-35 years old; 2 with strabismus) who have been subjected to 2 hours/day of inverse occlusion for 2 months. Patients who required refractive correction or whose refractive correction needed updating were given a 2-month period of refractive adaptation. The primary outcome measure was the binocular balance which was measured using a phase combination task; the secondary outcome measures were the best-corrected visual acuity which was measured with a Tumbling E acuity chart and converted to logMAR units and the stereoacuity which was measured with the Random-dot preschool stereogram test. The average binocular gain was 0.11 in terms of the effective contrast ratio (z = −2.344, p = 0.019, 2-tailed related samples Wilcoxon Signed Rank Test). The average acuity gain was 0.13 logMAR equivalent (t(17) = 4.76, p < 0.001, 2-tailed paired samples t-test). The average stereoacuity gain was 339 arc seconds (z = −2.533, p = 0.011). Based on more recent research concerning adult ocular dominance plasticity, we conclude that inverse occlusion in adults and old children with amblyopia does produce long-term gains to binocular balance and that acuity and stereopsis can improve in some subjects.

An integrative intervention program for college musicians and kinematics in cello playing

IntroductionCollege musicians preparing for performing careers must sustain physical-mental fitness as deficiencies can cause pain and injury and compound stress and anxiety. An integrative intervention program was embedded in a college music course. MethodsThe program included yoga, physical therapy exercises, and mental fitness & improvisation practices. Data were collected from a purposive sample of 34 over six semesters. We assessed the effects of the program by comparing pre-post data of (1) physical strength-flexibility-endurance tests and (2) psychometrics containing health-practice inventory (HPI), physical-musical efficacy (PME), and mental fitness and improvisation (MFI). Nonparametric Paired Sample Wilcoxon Signed Rank Tests were used to assess statistical significance of pre-post changes and Matched Pair Rank Biserial Correlation r was applied to demonstrate the effect size. (3) We observed kinematics of string players by plotting pre-post motion capture. ResultsPhysical strength showed significant changes with left pectoral minor length (p = .01, r = .64) and deep neck flexor strength/endurance (p < .001, r = .92). HPI revealed healthy practice habits and life style in our collegiate musicians. Survey results showed significant changes in all PME and MFI composite indices: physical awareness (p = .002, r = .66) and comfort (p = .004, r = .60), musical awareness (p = .01, r = .68) and comfort (p = .001, r = .74), calm mind (p = .043, r = .49), mental practice (p = .028, r = .51), calm recital (p = .002, r = .74), recall recital (p = .022, r = .53), comfort improvisation (p = .001, r = .78), in-the-moment improvisation (p = .004, r = .72), and satisfaction improvisation (p < .001, r = .85). Kinematics showed positive changes in range of motion and fluency. ConclusionCollege musicians’ integrative intervention program was effective with a modest postural change in our purposive sample (250).

Longitudinal study of medication use in caregivers of people with Alzheimer’s disease – Kuopio ALSOVA study

The longitudinal pattern of medication use among family caregivers of people with dementia is not well understood, despite the potential for medication over- or under-use. To investigate caregiver medication use over a five-year follow-up using data obtained via self-report and from a national prescription register, and compare agreement between medication data obtained from the two sources. Medication data for 222 family caregivers of people with Alzheimer's disease were obtained via self-report and from the Finnish Social Insurance Institution. Generalised estimating equations, Kappa statistics and related samples Wilcoxon signed rank test were used to analyse medication use over time. The mean number of medications used by caregivers increased from 3.4 to 4.1 (self-reported current regular medications) and 2.4 to 2.8 (reimbursed prescription medications during the past 90 days) over five years (p < 0.001). Significantly, more medications were identified via self-report (mean 3.6, SD = 3.3) than the national prescription register (mean 2.6, SD = 2.4, Z= -12.300, p < 0.001). Agreement between the two data sources was good for cardiovascular medications and anti-hypertensives (Kappa = 0.883-0.967, p < 0.001) and medications for acid-related disorders (Kappa = 0.508-0.092, p < 0.001). Agreement was moderate for analgesics (Kappa = 0.281-0.477, p < 0.001) and psychotropics (Kappa = 0.281-0.562, p < 0.002). The proportion of caregivers using five or more medications increased from 27.5% to 44.6% (self-report), and 16.7% to 27.7% (register) (p < 0.001). Caregivers use an increasing number of medications in the first five years of caring for persons with dementia, and self-report using a higher number of medications than data from the national prescription register suggest.

Changes in anterior chamber volume after implantation of posterior chamber phakic intraocular lens in high myopia

BackgroundThe present study aimed to assess changes in, and the factors that influence, anterior chamber volume (ACV) after implantable contact lens (ICL) implantation in high myopia eyes using a Pentacam.MethodsThe study sampled 26 high myopia patients (45 eyes) who were treated with ICL implantation. These patients were followed for an average of 4.28 months postoperatively. ACV was measured with a Pentacam preoperatively and at 3 months postoperatively. The data were analyzed by paired samples Wilcoxon signed-rank test. Generalized estimating equation (GEE) model adjusting within-patient intereye correlations in addition to Pearson’s and Spearman’s correlation tests were performed to determine associations.ResultsThe mean ACV was 198.33 ± 33.08 mm3 before surgery and 118.65 ± 17.70 mm3 after surgery. A significant decrease of 79.68 mm3 (40.18%) (Z = 5.841, P < 0.001) was detected. Positive correlations were found between ACV changes and ICL central vault (r = 0.528, P < 0.001) and preoperative anterior chamber depth (ACD) (r = 0.665, P < 0.001). There were positive correlations between postoperative ACV and postoperative anterior chamber angle (ACA) at 3:00 o’clock (r = 0.448, P = 0.002) and at 9:00 o’clock (r = 0.405, P = 0.006). GEE regression model showed that postoperative ACV significantly positively correlated with preoperative ACV (P = 0.002), ACD (P = 0.002) and horizontal ACA (P = 0.005) and negatively correlated with ICL central vault (P < 0.001).ConclusionComplementary to vault and ACD, ACV is a sensitive parameter with certain value of preoperative assessment and postoperative monitoring in ICL implantation.

Pregnancy-induced periodontal inflammation: Influence of salivary cytokines and antimicrobial proteins

The aim of this study was to evaluate the association between pregnancy-induced periodontal inflammation and levels of some salivary cytokines and antimicrobial proteins (AMPs). The study was a cohort longitudinal study that included pregnant women attending a secondary health facility. Consented participants had oral examination and saliva sampling during pregnancy and post-partum (three months after pregnancy). Saliva samples were used for the analysis of cytokines (TNF-α, IFN-gamma and IL-1β) and AMPs (Lactoferin, Lysozyme, and β defensin-1) using ELISA. Data are presented as median with interquartile range and compared using related sample Wilcoxon signed rank test. Correlations between levels of the salivary factors and indices of periodontal inflammation were determined using Spearman’s correlation test. Salivary flow rate, pH, levels of salivary IL-1β and IFN-gamma were significantly lower; while gingival index, periodontal index and level of salivary TNF-α were significantly higher during pregnancy compared with postpartum period. However, salivary lactoferin, lysozyme and β defensin-1 did not show significant difference comparing during pregnancy and postpartum period. Level of salivary IFN-gamma showed negative correlation with gingival index while level of salivary TNF-α showed positive correlation with gingival and periodontal indices. Lower levels of salivary IL-1β and IFN-gamma along with higher TNF-α concentration during pregnancy suggest their contributions to the pathophysiology of pregnancy-induced periodontal inflammation.

The Continental Divide: Anti-TNF Use in Pediatric IBD Is Different in North America Compared to Other Parts of the World.

Background and Aims Use of anti-TNF therapies varies internationally. As an initiative of the international Pediatric IBD Network (PIBDNet), we compared global pediatric IBD anti-TNF practice patterns. Methods Physicians were surveyed about anti-TNF use in Crohn's disease (CD) and ulcerative colitis (UC). Chi-squared, independent samples Mann–Whitney U, or related samples Wilcoxon signed rank tests were used to compare groups. Results 344 physicians treating pediatric IBD responded from 43 countries (54% North America, 29% Europe, 6% Oceania, 6% Asia, 3% Africa, and 2% South America). Respondents treated a median 40 IBD patients. CD was more commonly treated with anti-TNF than UC (40% vs. 10%, p<0.001). North Americans more often used anti-TNF (median 50% vs. 30%, p<0.001) and before immunomodulator (80% vs. 35% CD, p<0.001; 76% vs. 43% steroid-dependent UC, p<0.001). Anti-TNF monotherapy was more common in North America. Anti-TNF in combination with methotrexate, instead of thiopurine, characterized North American practices. North Americans more often continued immunomodulator indefinitely and less often adhered to standard infliximab induction dosing. Access limitations were more common outside North America and Europe for both CD (67% vs. 31%, p<0.001) and UC (62% vs. 33%, p<0.001). Conclusions Anti-TNF use in North America varies significantly from elsewhere.

Optimal safe implantation corridors in feline cervical vertebrae (C2-T1): CT study in 16 domestic shorthair cats.

The objective of this study was to define safe corridors for the optimal placement of bicortical implants in the feline cervical spine (C2-T1) using CT. CT images of feline cervical spines (n = 16) were reviewed retrospectively. Multiplanar reconstructions were used to define the optimal safe corridors. Safe corridors were defined by their angle of insertion, width and length. The insertion point within the vertebral body was also described. Vertebral measurements were compared between vertebrae using multilevel linear regression, and left and right measurements within vertebrae were compared with the paired samples Wilcoxon signed-rank test. A P value <0.05 was considered significant for all analyses. The safe corridor insertion points were located within the caudal third of the vertebral body in C2 (mean cranial vertebral ratio 0.73) and in the cranial third of the vertebral bodies from C3-T1 (mean cranial vertebral ratios 0.34-0.38). Mean safe corridor widths ranged from 1.04 mm in C2 to 2.30 mm in C7 and T1. The mean right and left optimal angles of implantation were, respectively, 21.79° and 21.49° for C2, 45.26° and 46.19° for C3, 51.48° and 51.04° for C4, 53.52° and 54.30° for C5, 56.36° and 56.65° for C6, 63.40° and 64.92° for C7, and 53.90° and 52.90° for T1. There were statistically significant differences between vertebrae in almost every measurement. Cervical vertebral safe corridors in cats are narrow and differ to those reported in dogs. Safe corridors are located in the caudal third of C2 and cranial third of the C3-T1 vertebral bodies. Current recommendations for implant sizes should be reviewed, as 1.5-2 mm implants would be oversized for bicortical implantation in most of the feline cervical vertebrae.

Exploring the impact of the care sport connector in the Netherlands

BackgroundRegular physical activity (PA) is deemed to contribute to the primary and secondary prevention of several chronic diseases, like diabetes mellitus, cancer, cardiovascular diseases, and osteoporosis. In 2012, Care Sport Connectors (CSC), to whom a broker has been ascribed, were introduced in the Netherlands to stimulate PA and guide primary care patients towards local sport facilities. The aim of this study was to explore which structural embedding is the most promising for CSCs’ work.MethodsIn three rounds of interviews, 13 CSCs were followed for 2 years in their work. In these interviews, a network survey was used to identify organisations in the CSCs’ network, whether they collaborated with these organisations, and the role of the organisations in the connection. Data from the network survey were analysed using the RE-AIM framework and disaggregated into how CSCs were structurally embedded (Type A: only PA sector; Type B: different sectors; Type C: partnership). A related samples Wilcoxon signed rank test was performed to study how the CSCs’ network developed between 2014 and 2016.ResultsAll CSCs established a connection between the primary care and the PA sector in which the average number of organisations with which CSCs collaborated increased significantly between 2014 (8.3) and 2016 (19.8) (p = 0.002). However, differences were identified in the way CSCs were structurally embedded and in the way they established the connection. Type A CSCs established the connection mostly around their own activities, supported PA organisations with their activities, and collaborated with primary care and welfare professionals around their own activities. Type B and Type C CSCs established the connection by organising, supporting, and implementing different kinds of activities targeting different kinds of audiences, and collaborated mostly with primary care professionals around the referral of professionals’ patients.ConclusionsThe results of this study suggest that adopting an integral approach (Type B and C) for the structural embedding of the CSC is more promising for reaching the desired outcomes. Whether CSCs really improve the target groups’ PA level and health needs to be further studied.Trial registrationDutch Trial Register NTR4986. Registered 14 December 2014.

Evaluating the outcome of an individual functional therapy program focused on children with cerebral palsy and cerebral visual impairment: a multiple case study

Background: To date, there is no evidence-based functional therapy programme available for children with both cerebral palsy (CP) and cerebral visual impairment (CVI). This study evaluates an individually targeted functional therapy programme adapted for these children experiencing difficulties with gross motor functioning and functional skills.Methods:Participants: Five children with CP and CVI, mean (SD) age 114 (52) months, participated in this study.Intervention: Participants were assigned to an 18-week functional therapy programme including nine weeks of individual functional therapy aimed at improving gross motor function followed by nine weeks of daily training of functional skills from the parents/caregivers.Analyses: The Related Samples Wilcoxon Signed Rank Test with a significance level of p < .05 was utilised to detect possible significant differences between the pre- and post-test.Results: According to the Goal Attainment Scaling (GAS), each child improved gross motor functioning. All the children also scored significantly higher in the section Functional Skills in the domains self-care and mobility as well as in the section Caregiver Assistance in the domain of self-care.Conclusion: This adapted individually functional therapy programme suggests improved gross motor functioning and functional skills in children with CP and CVI.

Abstract 4951: Dynamics of KIT exon 11 mutations in cell free plasma DNA of patients treated for advanced gastrointestinal stromal tumors: Results from the Dutch GIST bio-databank

Abstract Introduction Gastrointestinal stromal tumors (GISTs) are rare malignancies of the gastrointestinal tract. In the Netherlands, most patients with GIST are treated in five sarcoma expertise centers. GIST is known to have driver mutations in the tyrosine kinase receptors KIT and PDGFRα in respectively 80% and 10% of the patients. Mutations (single nucleotide variations, insertions and deletions) are mostly found in KIT exon 9 and 11. GIST patients with a primary KIT exon 11 mutation respond generally well to tyrosine kinase inhibitors (TKIs). The aim of this study was to evaluate treatment response by the detection of KIT exon 11 mutations in cell free DNA (cfDNA) of patients with GIST at multiple time points. Materials and methods Since Dec 2014, plasma samples of patients have been collected at every hospital visit and were put in a bio-databank for analysis of mutation detection in cfDNA. Eligibility criteria were histological diagnosis of GIST and treatment with a TKI. Patients with a known KIT exon 11 mutation, of which a baseline (before start of any TKI) sample or a recurrence/progression sample was available, were analyzed. A custom single-tube digital droplet PCR (ddPCR) drop-off assay, designed at the UMCG, was used. This assay detects 80% of the known KIT exon 11 mutations. Results Until Nov 2016, &amp;gt;620 samples of 175 patients have been collected. From 43 patients with a KIT exon 11 mutations in the pretreatment tumor biopsy, a baseline/progression sample was available. Mutations in exon 11 were detected in cfDNA from baseline plasma of 22/43 patients, 20 with metastasized and 2 with localized disease. Of the 21 patients without detectable mutations, 11 had localized and 10 metastatic disease. Three of these patients with metastatic disease had mutations that could not be detected by our probe. Two weeks after start of TKI, an increase in mutant allelic frequency was seen in 5 (of 9 available 2 week samples) patients, while 4 weeks later the mutant allelic frequency had decreased, in parallel with decrease in tumor load on radiological imaging. Eight patients developed radiological disease recurrence (2 patients, after 4 and 20 months) or progression (6 patients, median 10 (6-24) months). This was paralleled by an increase in mutant allelic frequency in cfDNA in 6 of them (baseline median 0% (0-0.9%); at progression median 3.5% (0-30%); p= 0.028; related samples Wilcoxon signed rank test). Summary and conclusion KIT exon 11 mutations in cfDNA could be detected in 74% of the patients with metastatic disease. Disease progression or recurrence, coincides with a rise of mutant alleles detected in the plasma. In conclusion, mutation detection in cfDNA of GIST patients with metastatic disease is feasible. Our study will be extended to include the monitoring of early progression based on cfDNA, which may guide early treatment adaptations. Citation Format: Pieter A. Boonstra, Arja ter Elst, Marco Tibbesma, Ron H. Mathijssen, Florence Atrafi, Frits van Coevorden, Sheima Farag, Neeltje Steeghs, Ingrid M. Desar, Winette T. van der Graaf, Hans Gelderblom, Boudewijn van Etten, Jelle Overbosch, Albert J. Suurmeijer, Jourik A. Gietema, Ed Schuuring, Anna K. Reyners. Dynamics of KIT exon 11 mutations in cell free plasma DNA of patients treated for advanced gastrointestinal stromal tumors: Results from the Dutch GIST bio-databank [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4951. doi:10.1158/1538-7445.AM2017-4951

Convergence Angles of Clinical Tooth Preparations for Metal Ceramic Restorations Among Dental Students and General Practitioners

Background: Numerous studies showed that the convergence angle (CA) of prepared teeth for fixed prosthodontics in the clinical practice is greater than the recommended values. Objectives: This cross-sectional study aimed to compare the total occlusal convergence (TOC) angles of metal ceramic fixed prosthodontics among dental students [final-year undergraduate (UG) and Master Prosthodontics (MS) students] and general practitioners (GP) in their private clinics with the recommended value (≤ 12 degrees). Methods: The buccolingual (BL) and mesiodistal (MD) TOC of 114, 90, and 111 stone dies referred to UG, MS, and GP, respectively, were measured. These dies included incisors, premolars, and molars. One sample Wilcoxon signed rank test, Mann-Whitney U test, Kruskal-Wallis, and Fisher exact test were used for statistical analysis. Results: Mean values of TOC for UG were 27.8 degrees BL and 20.9 degrees MD, whereas they were 30.6 degrees BL and 18.2 degrees MD for MS. GP had TOC of 35.5 degrees BL and 24 degrees MD. GP had significantly higher TOC values than the other groups (0.001 > P value ≤ 0.007). In each group, TOC did not differ when calculated for partial fixed prosthodontic and single crown abutments (0.117 ≤ P value ≤ 0.797). Molars in general had the highest TOC values. Only 0.9%, 3.3%, and 0.9% of UG, MS, and GP, respectively, respected the TOC ≤ 12 degrees. Conclusions: In all the groups, tooth preparations were inconsistent with the recommended TOC values, even among specialists in fixed prosthodontics. These results support the existing literature that the recommended values were rarely achieved and may require reconsideration. Clinical Significance: Clinically, the CA values of prepared teeth for fixed prosthodontics exceed the recommended values in most cases, not only among general practitioners, but also among students in academic institutes. Thus, the effects of teeth preparations with CA greater than the recommended values on the longevity of the prosthodontics should be further investigated.

The effects of a treatment combination of anti-VEGF injections, laser coagulation and cryotherapy on patients with type 3 Coat\u2019s disease

BackgroundTo examined the curative effect of vitreous injection with ranibizumab,laser coagulation and cryotherapy in treating stage 3 Coats’ disease with exudative retinal detachment.MethodsSeventeen patients with stage 3 Coats’ disease were enrolled in the study. All eyes were treated with vitreous injection of ranibizumab as initial treatment, and subsequent treatment depended on the absorption of subretinal fluid, Including cryotherapy and laser photocoagulation. Repeat treatment for the two treatment intervals occurred in ≥1 month. The mean follow-up time was 24.12 ± 5.99 months. The main data evaluation and outcome measurements included the patient’s vision, intraocular pressure(IOP), optical coherence tomography (OCT), slit lamp examination, indirect ophthalmoscopy, color Doppler imaging (CDI) and color fundus image analysis. The following variables were compared between groups: abnormal vascular changes, subretinal fluid and exudate absorption, retinal reattachment and complications. The final follow-up results were used to determine the effectiveness of treatment.ResultsOf the 17 patients included, 88.24% were male and 11.76% were female. Visual acuity was less than 0.02 in 12 eyes before surgery and 8 eyes after surgery. Visual acuity improved in 7 eyes, accounting for 41.18% of cases, and remained unchanged in 7 eyes, accounting for 41.18% of cases. Three patients were too young to undergo the operation, accounting for 17.65% of cases. The best vision was 0.1. Patients were treated 1 to 5 times for an average of 2.82 ± 0.95 times each. There was no statistically significant difference (t = 1.580, p = 0.135) between the preoperative and postoperative intraocular pressures. However, there was a statistically significant difference between the preoperative and postoperative retinal detachment height (2- related samples Wilcoxon signed rank test with z = 3.517, p = 0.000). The results further showed that all patients had different degrees of subretinal fluid absorption, and some of the new blood vessels subsided. All patients were successfully treated with laser and cryosurgery. No ocular or systemic complications were observed during follow-up.ConclusionsIntravitreal ranibizumab (IVR), laser coagulation and cryotherapy were effective in the treatment of Coats’ disease with exudative retinal detachment.Trial registration numberWe retrospectively registered our study, The trial registration number (TRN) is ChiCTR-ONC-17011161 and date of registration is April 16, 2017.

Patient Comprehension of Gestational Weight Gain Recommendations and Associated Pregnancy Outcomes [16I

INTRODUCTION: Gestational weight gain above the Institute of Medicine guidelines is associated with obstetric and fetal complications. American College of Obstetricians and Gynecologists recommends that weight management begin before conception and continue through the postpartum period. We assessed patients' knowledge of gestational weight gain recommendations and associated outcomes. METHODS: One-hundred-seventy-three women completed a survey at a prenatal visit after 20 weeks gestation. After delivery, a chart review obtained the patient’s starting and ending pregnancy weight and BMI. Pearson Chi-square testing and the Related Samples Wilcoxon Signed Rank test were used. RESULTS: Overall 44% of our studied population were overweight or obese. When assessing physician counseling of weight category, only 39% of women recalled being told their starting BMI (p=0.24). In addition, the majority (59%) reported receiving no counseling on pregnancy outcomes associated with starting BMI or excessive gestational weight gain (p=0.004). Less than one-third of overweight and obese women gained within guidelines (p=0.001), and most gained above guidelines (p=0.001). CONCLUSION: The majority of women gain in excess of guidelines. Excessive weight gain is associated with childhood and maternal health complications, including obesity. Our study shows that few women receive or retain information on weight recommendations and associated risks of excess gain. Not only are women unprepared for the immediate risks posed by excess gain, they are also more likely to retain weight which is a significant contributor to ill-health. Improved patient education could significantly reduce adverse outcomes in the United States related to excessive weight gain.

Abstract B20: Peritumoral CD3+ lymphocyte infiltration at the brain-brain metastasis interface is detectable by diffusion MRI and independently associated with prolonged survival

Abstract Brain metastases are an increasing clinical problem, causing significant morbidity and mortality in patients with solid organ cancer. Diffusion along white matter tracts can be assessed by diffusion tensor MRI (DTI) and disruption of white matter tract integrity generally indicates tumor invasion and inflammation in the brain. Matched preoperative DTI and image-guided neurosurgical sampling of the brain-brain metastasis interface was performed in 26 adult patients undergoing resection of a brain metastasis, uniquely yielding paired MRI and biological data from the same regions. Patients were followed prospectively from imaging diagnosis until death. In this surgical series patients were mostly of excellent performance status with no or stable primary disease. We consistently observed dense, activated macrophage infiltration at the brain-brain metastasis interface across tumors from different primaries. CD20-positive, B cell infiltration was sparse (with no significant difference from control white matter). CD3-positive lymphocytes were seen in the peritumoral region in all except 1 case (median 16 cells per high power field (HPF), significantly greater than control white matter, p&amp;lt;0.001). Peritumoral density of these cells, but not edge or core density and not peritumoral macrophage or B-cell infiltration, was associated with prolonged survival, even when controlling for confounders such as adjuvant whole brain radiotherapy (Cox proportional hazards analysis, HR = 0.96, 95% CI 0.93-0.99, p=0.021). When this CD3-positive lymphocyte response was further categorized into three groups (&amp;lt;5, 5-25 and &amp;gt;25 immunoreactive cells/HPF), those with moderate peritumoral infiltration were at no survival advantage compared to those with low infiltration, whereas those with the highest infiltrates lived over twice as long (median 11.7 months, vs. 5.1 and 5.2 months for moderate and low groups respectively, log rank test=10.06, p=0.007). Using image analysis of the paired MRI data, average fractional anisotropy (FA) readings in the peritumoral region were significantly lower than the unaffected, contralateral hemisphere indicating white matter disruption (related samples Wilcoxon-signed rank test, p&amp;lt;0.001). Those patients with a lower peritumoral FA (below median), indicating more white matter tract disruption, showed longer survival (median 9.9 months, 95% CI: 7.4-12.4 versus 5.3 months, 95% CI: 3.4-7.1) even if confounding variables were accounted for (HR = 0.21, 95% CI 0.06-0.96, p=0.044). The peritumoral density of CD3-positive lymphocytes was the only significant biological difference observed between the cases with high and low peritumoral FA i.e. metastases with less or more white matter tract disruption around them (Mann Whitney U, p=0.037). There were no differences in the presence of other immunoreactive cells, primary cancer type, growth pattern (invasive or pseudo-encapsulated), expression of matrix-metallo-proteinases, cellularity, Ki67 proliferative index, vascularity, necrosis or connective tissue density at the leading edge of the tumor or adjacent peritumoral region in those metastases with lower as opposed to higher peritumoral FA readings. Overall this unique data suggests that the cellular immune response to brain metastases is robust, may be a marker of subsequent overall survival and can be assayed non-invasively by measuring white matter tract disruption at DTI. Citation Format: Rasheed Zakaria, Michael D. Jenkinson, Philip S. Rudland. Peritumoral CD3+ lymphocyte infiltration at the brain-brain metastasis interface is detectable by diffusion MRI and independently associated with prolonged survival. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2016 Oct 20-23; Boston, MA. Philadelphia (PA): AACR; Cancer Immunol Res 2017;5(3 Suppl):Abstract nr B20.