Signficant Difference Research Articles

High Rates of Thrombotic Events in Newly Diagnosed Multiple Myeloma Patients Enrolled on the Maia Trial

Background. Patients with newly diagnosed multiple myeloma (NDMM) have a nine-fold increased risk of developing venous thromboembolism (VTE). Despite the availability of the IMWG and NCCN VTE prophylaxis guidelines and updated risk stratification models such as SAVED and IMPEDE, the optimal thromboprophylaxis strategy is unknown, especially in the age of modern daratumumab-containing regimens. To continue highlighting the importance of appropriate thromboprophylaxis for patients with NDMM, we performed a post-hoc analysis of the randomized phase 3 MAIA trial to identify rates of venous and arterial thromboembolism. Methods. This retrospective study, carried out under YODA Project #2021-4663, used data from the randomized phase 3 MAIA trial that investigated lenalidomide and dexamethasone (Rd) with or without daratumumab (DRd) in 733 transplant ineligible (TIE) patients obtained from the Yale University Open Data Access (YODA) Project, which has an agreement with JANSSEN RESEARCH & DEVELOPMENT, L.L.C.. Thrombotic events (TE), including both venous and arterial events (V/ATE) were examined with VTE events including deep vein thrombosis (DVT), pulmonary embolism (PE), and superficial thrombophlebitis (SVT). Arterial events (ATE) included cerebrovascular accidents (CVA) defined as hemorrhagic, ischemic, or verebrobasilar strokes. The incidence and time to event of V/ATE were calculated and graded using the CTCAE v4, with Grade 1 representing nonactionable venous thrombosis, Grades 2-4 representing TEs requiring increasing higher levels of medical intervention, and Grade 5 indicating death was a result of the TE. Rates and time to events were compared between the DRd and Rd arms. Results. Of the included patients, median age was 72 years (range 64-72) and 48% were female. There was no signficant difference between baseline characteristics of sex, race, myeloma subtype, presence of high-risk cytogenetics, or ISS staging between patients that experienced a V/ATE event and those that did not. All grade V/ATE events were 18% (66/363) and 19% (70/365) in the DRd and Rd arms, respectively. Of these, most were VTE events in both arms (16%), with G2-4 actionable VTE event rate of 14.9% vs 14.8% for the DRd and Rd arms, respectively. G5 VTE events were 0.2% in both arms (no G5 ATEs). ATE were 2.2% and 2.7% in the DRd and Rd group, respectively, overall constituting a minority of events. The overall PE rate was higher in the DRd than Rd arm, 6.3% vs 4.7%, DVT was more frequent in the Rd arm, 9.6% vs 7.7%, and rates of SVT rates were similar between both arms at 1.9% and 2.2% for the DRd vs Rd arms, respectively (Table 1). Median time to onset of cumulative TEs was longer in DRd vs Rd arm, 7.15 (0.27 - 63.0) vs 4.65 (0.03 - 58.0) months, respectively. Among these, median time to onset of VTE was similar among the groups [6.57 (0.27 - 63.0) vs 4.48 (0.03 - 52.9) months, respectively] while the median time to onset of ATEs was longer in DRd vs Rd arm, 19.8 (1.70 - 26.6) vs 8.3 (0.67 - 58.5) months. The incidence of VTE events persisted past 24 months and incidence of ATE events increased over time (Figure 1). Analysis regarding prophylactic anticoagulation use and rates of TE based on prophylactic regimen are ongoing. Conclusion. This retrospective study reveals the highest reported rates of VTE in any modern therapy dataset. In patients with transplant ineligible NDMM, we show that the TE risk persists past 24 months of treatment in patients on DRd or Rd therapy. Similar to observations in the GRIFFIN trial, the addition of daratumumab did not increase the risk of TE. Our report highlights the critical need for further investigation of optimal prophylactic strategies and their duration for patients with NDMM.

Dentin Loss and Surface Alteration Through Chemical and Chemomechanical Challenge after Initial Root Instrumentation.

To assess the root surface roughness and substance loss induced by chemical and chemomechanical challenges on root surfaces pretreated with ultrasonic instrumentation, a hand scaler, or erythritol airflow. One hundred twenty (120) bovine dentin specimens were used in this study. Specimens were divided into eight groups and treated as follows: groups 1 and 2: polished with 2000- and 4000-grit carborundum papers but not instrumented ('untreated'); groups 3 and 4: hand scaler; groups 5 and 6: ultrasonic instrumentation; groups 7 and 8: erythritol airflow. Samples from groups 1, 3, 5, and 7 then underwent a chemical challenge (5 x 2 min HCl [pH 2.7]), whereas samples from groups 2, 4, 6, and 8 were subjected to a chemomechanical challenge (5 x 2 min HCl [pH 2.7] + 2 min brushing). Surface roughness and substance loss were measured profilometrically. The least substance loss through chemomechanical challenge was noted after erythritol airflow treatment (4.65 ± 0.93 µm), followed by ultrasonic instrumentation (7.30 ± 1.42 µm) and the hand scaler (8.30 ± 1.38 µm); the last two (hand scaler and ultrasonic tip) did not differ statistically significantly. The highest roughness after chemomechanical challenge was observed on ultrasonically treated specimens (1.25 ± 0.85 µm), followed by hand-scaled specimens (0.24 ± 0.16 µm) and those subject to erythritol airflow (0.18 ± 0.09 µm); there was no statistically signficant difference between the latter two, but they both differed statistically significantly from the ultrasonically treated specimens. No statistically significant difference in substance loss through the chemical challenge was observed between specimens pretreated by the hand scaler (0.75 ± 0.15 µm), ultrasonic tip (0.65 ± 0.15 µm), and erythritol airflow (0.75 ± 0.15 µm). The chemical challenge smoothed the surfaces treated with the hand scaler, ultrasonic tip, and erythritol airflow. Dentin pretreatment with erythritol powder airflow resulted in a higher resistance to chemomechanical challenge than did dentin treated ultrasonically or with the hand scaler.

Risk of venous thromboembolism across the lifespan for individuals with cerebral palsy: A retrospective cohort study

IntroductionThe risk of venous thromboembolism (VTE) for individuals with cerebral palsy (CP) is understudied. The objectives were to characterize the incidence of VTE by age and sex for individuals with CP compared with those without CP at the population- and clinical-levels. Materials and methodsThis retrospective cohort study used commercial claims from 1 January, 2011 to 31 December, 2017 from individuals of any age with and without CP. Sex-stratified incidence rate (IR) per 1000 person-years and IR ratio (IRR) of VTE were assessed across the lifespan up to 2-years of follow-up. The IR, IRR, and hazard ratio (HR using Cox regression) of VTE were assessed within 30-days following placement of a central venous catheter (CVC) (in one analysis) and orthopedic surgery (in another analysis). ResultsThe 2-year IR of VTE for the full cohorts with (n = 20,486) and without (n = 22,161,726) CP was 19.1 and 9.7 for females (IRR = 1.97; 95%CI = 1.77–2.19) and 19.0 and 8.6 for males (IRR = 2.22; 95% CI = 2.01–2.45). The 30-day HR of VTE post-CVC (CP n = 1963; non-CP n = 558,150) was higher for adult males compared with those without CP (HR = 1.25 by 40 years to 1.80 by 80 years), but was not higher in pediatric males or females of any age compared with those without CP. The 30-day HR of VTE post-surgery (CP: n = 2634; non-CP: n = 1,066,136) was higher for pediatric patients and young adults compared with those without CP (HR = 2.58 to 2.79) There was no signficant difference between the groups among the older age groups. ConclusionsThe risk of VTE was elevated for individuals with CP across the lifespan, and some subgroups of CP had a greater 30-day risk of VTE following CVC placement and orthopedic surgery.

Periodontal status in male smokers visiting Hue University of Medicine and Pharmacy Hospital

Background: Many clinical studies, which were conducted to evaluate the association between smoking and periodontal diseases, have confirmed the harmful effects of smoking on oral health. Therefore, it is essential to properly assess the periodontal status and smoking habits to improve the effectiveness of interventions and disease prevention. Objective: This study aims to compare the prevalence and severity of periodontal disease in male smokers and male non-smokers visiting Hue University Hospital of Medicine and Pharmacy and to investigate the relationship between smoking and periodontal disease. Methods: A casecontrol study with 220 patients divided into two groups using a questionnaire to survey men aged 18-65 who have been smoking at the Department of Odonto-Stomatology - the Hue University Hospital of Medicine and Pharmacy. Factors related to smoking behavior and clinical examination of periodontal status were adopted. Results: In the smokers group, the mean gingival index “GI” (0.647 ± 0.316), plaque index “PlI” (2.045 ± 0.447), “PPD” periodontal pocket depth (1.955 ± 0.470mm), clinical adhesion loss “CAL” (1.883 ± 0.771mm), “BOP” bleeding index (4.898 ± 3.117) with 95% confidence interval “CI”. The percentage of patients without periodontitis accounts for the majority compared with the remaining levels of periodontitis with values of smokers 67.27% and 99.36% non-smokers. There is a signficant difference in gingivitis and periodontitis in both study groups with p<0.05. There is a correlation between periodontal indices and smoking indicators such as the number of cigarettes smoked per day, the number of years of smoking, and cumulative exposure p<0.05. Conclusion: The study shows that the heavier the smoking status, the worse the periodontal condition. However, the more cigarettes smoked, the less gingivitis and bleeding gums. Key words: Periodontal index, smoking, periodontal disease

Exploring Online Student Engagement Scaffolded by Teacher Management Communication Style

Prior studies of online student engagement generated insufficient information in longitudinal study and the scaffolding factors on the part of the teachers. To address this gap, this study proposed the approach of Teacher Management Communication Style and conducted the longitudinal quasi-experiment study for 8 weeks. A combination of 5-point Likert scale of Online Student Engagement (OSE), the self-designed Student Actual Online Learning Experience (SAOLE) and Student Perceived Offline Learning Experience (SPOLE) were administered in three stages (Week 1, Week 4 and Week 8) to a total amount of 117 learners from 3 intact classes in a prestigious research university in P.R.China.
 Statistical analysis, resulting from repeated measure ANOVA and Paired Samples t-tests, showed that there was a significant increase in Online Student Engagement in general and all the four factors of Skill, Emotion, Performance and Participation between stage 1 and stage 3. Further analysis showed the fluctuating yet increasing trend of Online Student Engagement in general and the three factors of Skill, Emotion and Participation between both stage 1 and stage 2, but no signficant difference between stage 2 and sage 3. The third factor of participation showed no signficant increase in both stage comparisons. In addition, the study resuls indicated that the learners’ perceptions towards online learning and their intention to share the learning experience was signficant higher than those towards perceived offline experience.
 The findings shed lights on the pedagogy scaffolded by Management Communication Style and delineate the picture at a fine-grained level of online learning engagement along the 8-week long and 3-stage process. Future efforts could direct to further examining the comparison of the learners in terms of gender, age, education background, and of different time duration of learning.

Can Artificial Intelligence Predict Good Eggs From Bad? Comparing Oocyte Assessment Tool Violet To Current Egg Freezing Predictors

BACKGROUND: Future Fertility’s Violet is an artificial intelligence image analysis egg assessment tool for patients seeking elective oocyte preservation. The technology is used to identify the relative viability of mature eggs to tailor a personalized treatment plan for each patient. The software detects patterns in oocytes in order to better understand egg quality. It may be particularly impactful for older patients who are known to have problems related to egg quality, especially given the fact that they may have less opportunities to undergo multiple cycles. While we currently have methods for assessing sperm quality and embryo quality, there are very limited guidelines for determining successful oocytes. Violet is currently the only objective assessment tool for predicting egg quality. Current research suggests Violet is superior to trained embryologists by more than 20%, with 100% reproducibility . More data is needed to assess the viability of Violet to better assess the value it provides in improving IVF outcomes. OBJECTIVE: We sought to compare predictions of live birth rate between Violet and a currently utilized egg freezing predictor, which takes into account age and number of mature oocytes. MATERIALS & METHODS: A retrospective chart review was performed at a private multi-site infertility center from March 2020 to April 2022. All patients undergoing elective egg vitrification who opted to get oocyte assessment results from Violet were included, for a total of 154 patients. Patients under the age of 24 or over the age of 44 were excluded as the calculator is not recommended in those age groups. All patients underwent controlled ovarian stimulation and subsequent retrieval and mature oocyte vitrification. Likelihood of one live birth was given as a percentage by the Violet report. These results were compared to the Brigham & Women’s Hospital Egg Freezing Counseling Tool (BWH EGCT) calculator per MDCalc. An unpaired t-test was performed to compare the mean percentages. Given differences in egg quality with relation to age, we also sought to determine if there was a difference in results by age (age groups: 27-32, 33-38, and 39-44 years old). RESULTS: The probability of one live birth was assessed using Violet as well as the BWH EGCT for 154 patients. Mean AMH of patients included was 2.42. Mean age at retrieval was 36, with a range of 27-44. The mean likelihood of one live birth rate using Violet as an assessment tool was 47.60%, while the conventional method gave a mean likelihood of one live birth of 49.14% (p=0.6079). There was no significant difference in predictions by Violet versus the conventional method by age, though the results did approach signficance (p=.12 for 27-32, p=.24 for 33-38, and p=.13 for 39-44). CONCLUSIONS: This is the largest study to our knowledge assessing the viability of Violet compared to conventional methods for assessing egg quality. Our results suggest there is no significant difference between the AI oocyte assessment tool Violet and conventional methods for prediction using age and number of mature oocytes. Additionally, there is no signficant difference when comparing results by age group. This suggests that Violet is able to individually visually assess oocytes for quality and likelihood of success. Violet provides a non-invasive approach and a comprehensive breakdown of the quality of each oocyte. Though these results suggest Violet is similar to existing predictors, it adds value by determining the individual quality of each oocyte. This allows for stratification that can guide fertility decision-making. A limitation of the study is the fairly low number of patients given this is a new technology. As more patients utilize the Violet assessment tool, there will be greater numbers of oocytes that undergo thaw, insemination, and transfer. This will provider greater data regarding fertilization, blastocyst development, and ultimately live birth rate. Though this technology is still in its relative infancy, there is an exciting future ahead for artificial intelligence in assessing oocyte quality and predicting IVF success.

Effect of resource-based instructions on pre-service biology teachers’ motivation toward learning biology

Linking motivation and learning is central to understanding students’ motivation toward learning and learning itself as complex cognitive phenomena. Some studies focused on students’ motivation toward learning biology in general; however, the shortage of studies on the effect of animation-based instruction and small-group laboratory activities as Resource-based Instructions (RBIs) on pre-service biology teachers was realized. The present study aimed to determine the effect of resource-based Instructions on pre-service biology teachers’ academic motivation toward learning biology at private and public Universities in Rwanda. Pre-service biology teachers were grouped into three groups at a public teacher traning University and received a pre-and post-assessment. Quasi-experimental, pre and post-test control group design was used at a public university, while a repeated measures design was used at a private university. The standard academic motivation scale for learning biology (AMSLB) yielded a Cronbach alpha coefficient of 0.71 before use. The t-Test was computed to measure the statistically significant difference between the pre-and post-assessment scores and group of RBI interventions. Multivariate analysis (MANOVA) was computed to measure the effect of RBIs vis à vis the AMSLB factors. Findings revealed no statistically significant difference (df=18, p=.458) in the motivation of learning biology of pre-service teachers before and after learning via traditional instruction at a public university. However, a statistically signficant difference was found with animation instruction (df=18, p=.002) and lab instruction (df=18, p=.014). The motivation of learning biology increased at a public university than at a private university. However, animations and small-group lab activities increased pre-service biology teachers’ intrinsic and extrinsic—career motivation of learning biology at both universities. Therefore, the study recommends using RBIs to improve pre-service biology teachers’ motivation toward learning biology.

Positive Synergistic Effect of Adhesives and Resin Cements Containing an Iodonium Salt on Bonding of Fiber Posts.

To evaluate the push-out bond strength (PBS) of glass-fiber posts (GFP) in different root canal zones (cervical, middle, and apical), bonded with experimental simplified adhesives (ESAs) containing different initiator systems (camphorquinone [CQ] or phenylpropanodione [PPD]) with or without diphenyl iodonium hexafluorophosphate (DPI), in combination with a DPI-containing composite cement. ESA blends were prepared with bisphenol glycidyl methacrylate (bis-GMA), triethylene glycol dimethacrylate (TEG-DMA), 1,3-glycerol dimethacrylate (GDMA), 2-hydroxyethyl methacrylate (HEMA), and ethanol, then divided into 12 experimental groups (n = 10) according to the initiator systems (CQ, PPD, or CQ + PPD) and the presence or absence of DPI. The roots of 120 extracted bovine incisors were prepared with #5 Largo drills and the GFP were cemented with each ESA and experimental composite cements containing 0.05 mol% of DPI. The push-out bond strength (PBS) test was performed after 24 h of storage. Failure patterns were analyzed under a stereomicroscope. Data were analyzed with split-plot two-way ANOVA and Tukey's test (α = 0.05). PBS was significantly higher for DPI-containing ESAs in all regions evaluated, with the group containing 0.5 CQ + 1 PPD + 0.5 DPI exhibiting the highest PBS. There was no statistically signficant difference among groups without DPI. Most failures were classified as adhesive at the cement-dentin interface. The combination of an adhesive and a composite cement containing DPI salt can improve GFP bonding to root dentin, even in the apical region.

The Effect of Different Monitor Use on Radiography Interpretation in Emergency Medicine

Aim Although it is recommended to use a medical monitor in radiology guides, it is rare to use a medical monitor in non-radiology departments. In this study, the effect of using LED, tablet and medical monitor in the radiography evaluation of inexperienced physicians in the emergency room was investigated. Materials and Methods Fifty medical intern from the medical school were included in the study. Participants were asked to diagnose pre-prepared radiography sets on LEDs, tablets and medical monitors and to request a radiology consultation for radiographs they could not decide. The diagnoses of medical interns and cases of requesting radiology consultation were recorded. Results The median values of the correct diagnosis of the participants according to the monitors; 13.5 on led monitor, 13 on tablet monitor and 16 on medical monitor. The median value of the desired radiology consultation numbers; 6 on led monitor, 7 on tablet monitor and 4 on medical monitor. The medical monitor has statistically signficant difference to the other two monitors, in the correct diagnosis and number of consultations desired. Conclusion The use of medical monitors by inexperienced physicians in the emergency room where workload is extreme and time is valuable, will increase the diagnosis accuracy and decrease the rate of request for consultation.

The cognitive load of listening activities of a cognitive-based listening instruction

The aim of this study was to investigate the cognitive load (henceforth, CL) of listening activities of a cognitive-based listening instruction of a recently changed EFL curriculum. 126 K-11 students (male=62, female=64) participated in the study. The quantitative and qualtivative data were collected and analyzed in two phases. In phase 1, the participants were asked to judge the CL of listening activities of their textbook based on the CL measure immediately after completeling the tasks. The scale has 10 items that measure three components of CL including Intrinsic Load (IL), Extraneous Load (EL), and Germane Load (GL). The data were analyzed by Multivariate Analysis of Variance (MANOVA). The result primarily revealed that the general cognitive load of listening activities was rather high and when three kinds of CLs were compared, the GL was found to be higher than IL and EL. Comparing the CL of male and female students revealed that there is a signficant difference between the two groups regarding general CL and both IL and EL; and as the GL of both groups was high, no signficant difference was observed between their GL. In pahse 2 of the study, 14 students participated in a structured interview to express their opinions about the difficulty of listening comprehension. The rate of speech and unintelligibility of the speakers’ pronunciation, insufficient technological infrastructures, lack of interest in and negative attitudes towards listening, and limited multidmodal input were among the factors that students felt to contribute to the difficulty of listening comprehension.

Identification Using Border Approaches and IVs

We document that recent quasi-experimental strategies for identifying advertising effects can be derived from a model in which ad decisions are made at a more aggregate level than conversion is measured. Next, we show that the identifying variation in one of these strategies, the Border Approach, is conceptually similar to what are commonly known as Waldfogel IVs. We compare these, as well as supply-side instruments and fixed effects, in a data set on advertising in US presidential elections. Both border approaches and IVs are known to sacrifice statistical power and they do, but not by enough to affect statistical significance, in this application. The Waldfogel IVs are much more powerful than the supply-side IVs and, when combined, the standard errors are substantially reduced. Each IV estimator has the potential to produce a local average treatment effect that weights aggregate markets differently. Estimates suggest differences may exist, but they are not significant. When both IVs are combined, the point estimate is identical to a fixed effect estimate that is likely to be unbiased. The Border Approach can produce local effects at the disaggregate level when border and non-border regions differ. We find evidence of a statistically signficant difference when analysis is restricted to those counties where identifying assumptions are more plausible. The point estimate drops to nearly zero and becomes insignificant despite a standard error that is as small as the lowest IV standard error. We suspect local estimate concerns are greater for the Border Approach because it identifies advertising effects that exclude the high population counties in all markets, whereas IVs may weight each market differently but include counties of all types within each market.

Effect of Surface Treatment and Cement on Fracture Load of Traditional Zirconia (3Y), Translucent Zirconia (5Y), and Lithium Disilicate Crowns.

To determine if surface treatment and cement selection for traditional 3 mol% yttria partially stabilized zirconia (3Y-PSZ), "translucent" 5 mol% yttria-stabilized zirconia (5Y-Z), or lithium disilicate crowns affected their fracture load. Crowns with 0.8 mm uniform thickness (96, n = 8/group) were milled of 3Y-PSZ (Lava Plus), 5Y-Z (Lava Esthetic), or lithium disilicate (e.max CAD) and sintered/crystallized. Half the crowns were either particle-abraded with 30 µm alumina (zirconias) or etched with 5% hydrofluoric acid (lithium disilicate), and the other half received no surface treatment. Half the crowns from each group were luted with resin-modified glass ionomer (RMGI, RelyX Luting Plus) and half were luted with a resin cement (RelyX Unicem 2) to resin composite dies. Crowns were load cycled (100,000 cycles, 100 N force, 24°C water) and then loaded with a steel indenter until failure. A three-way ANOVA examined the effects of material, cement, and surface treatment on fracture load. Post-hoc comparisons were performed with the Tukey-Krammer method. Fracture load was signficiantly different for materials and cements (p<0.0001) but not surface treatments (p = 0.77). All lithium disilicate crowns luted with RMGI failed in fatigue loading cycling; 3Y-PSZ and 5Y-Z crowns luted with resin showed a higher fracture load compared with RMGI (p<0.001). With resin cement, there was no signficant difference in fracture load between 5Y-Z and lithium disiliciate (p = 1) whereas 3Y-PSZ had a higher fracture load (p < 0.0001). Cement type affected fracture load of crowns but surface treatment did not. The 0.8 mm uniform thick crowns tested benefited from using resin cement regardless of type of ceramic material. Crowns fabricated from 5Y-Z may be particle-abraded if luted with resin cement.

The value of rapid semi-automated morphometric analysis system in predicting malignancy in thyroid follicular neoplasm

Aims: To constuct and evaluate a rapid semiautomated system in discriminating malignant from benign follicular thyroid neoplasms. Methods: Sixty formalin fixed paraffin embeded blocks of follicular thyroidneoplasms were retreived and slides were prepared and H and E stained. A morphometric system was constructed to be as rapid as possible and was tested.Results: No signficant difference was found in ratio of largest nuclear to smallest nuclear diameter between follicualr adenoma and follicualr carcinoma groups.Conclusion: Rapid semiautomated morphometric analysis is of no help in predicting malignancy in follicular thyroid neoplasm.

The value of multi-modal guiding in transrectal ultrasound-guided prostate targeted biopsies in the biopsy naive patients

Objective To estimate the value of multi-modal guiding in transrectal ultrasound-guided prostate targeted biopsies(TB) in the biopsy naive patients. Methods From June 2016 to December 2017, 178 patients with suspicious prostate cancer were retrospectively evaluated. The age of patients was 54-87 years(median 70 yesrs). Serum PSA level before biopsy was 1.5-95.0 ng/ml(median 13.2 ng/ml), in which 70 cases with PSA 20 ng/ml.All patients underwent transrectal ultrasound(TRUS), real-time tissue elastography (RTE) and contrast-enhanced ultrasonography(CEUS). All positive sites on imaging undergoing two-core TB and 10 core-systematic biopsy (SB). The detection rates and positive rates of biopsy for any cancer(PCa) and clinically significant prostate cancer (CsPCa) were compared between TB and SB. Pathological findings of each biopsy core was analyzed for Gleason grade and the single-core length of prostate cancer. Results The total detection rate for PCa was 48.8%(87/178). The diagnostic accuracy of PCa did not significantly differ between TB 35.5%(63/178) and SB 42.8%(76/178) groups. There was no significant difference between the proportion of CsPCa in TB group and SB group [80%(50/63) vs. 66%(50/76), P=0.21]. TB had an obvious higher single-core positive rate for prostate cancer 60.6%(449/740)and an obvious higher single-core positive rate for high-risk prostate cancer[10.3%(76/740)] than SB [29.7%(530/1 780) and 5.5%(98/1 780) ], with statistically signficant difference (P<0.001, P=0.002). TB also had a higher single-core length of prostate cancer than SB [6.80(0.20-15.00)mm vs. 5.50(0.06-18.00)mm, P<0.05]. Conclusions This study revealed a similar rate of prostate cancer detection between multi-modal guiding in transrectal ultrasound-guided prostate targeted biopsies(TB) and 10 core-systematic biopsy (SB). TB maybe tend to detect higher proportion of high-risk PCa. Key words: Prostatic neoplasms; Targeted biopsies; Contrast-enhanced ultrasonography; Elastography

The value of rapid semi-automated morphometric analysis system in predicting malignancy in thyroid follicular neoplasm

To constuct and evaluate a rapid semiautomated system in discriminating malignant from benign follicular thyroid neoplasms.Sixty formalin fixed paraffin embeded blocksof follicular thyroid neoplasms were retreived and slides were prepared and H and E stained. A morphometric system was constructed to be as rapid as possible and was tested. No signficant difference was found in ratio of largest nuclear to smallest nuclear diameter between follicualr adenoma and follicualr carcinoma groups. Rapid semiautomated morphometric analysis is of no help in predicting malignancy in follicular thyroid neoplasm.

Validity of automated threshold audiometry in school aged children

BackgroundAutomated hearing tests have the potential to reduce the burden of disease amongst learners by introducing such services within the school context. MethodsThe aim of the study was to conduct a validation study on normal and hearing impaired learners, comparing air and bone conduction automated test results to conventional test results in 50 school aged learners (n = 100 ears) within a noise controlled school environment using a cross sectional comparative study design. The KuduWave 5000 (Emoyo.net) was used in this study. Data analysisThe spearman's correlation coefficient was calculated to determine test-retest reliability. The mean and standard deviation (SD) was measured for each frequency. The absolute mean difference (AMD) and SD was calculated for both air and bone conduction testing at each frequency for automated testing. A paired sampled t-test and a one way ANOVA was used to identify any significant differences. Alpha was set as 0.05. ResultsThere was significant correlation between thresholds obtained for automated test one and test two for normal hearing and hearing impaired group. The spearmans correlation coefficient was high (close to +1) for majority of the results for both groups across the frequency range. Both air and bone conduction testing across the frequency range of 250 Hz–2000 Hz and at 8000 Hz were not statistically signfiicant (p < .005) for both groups, however at 4000 Hz for bone conduction testing in the hearing impaired group, there was a statisticially signficant difference (p = .003). This was attirubted to the variaibilty in bone conduction test results often due to force and placement of the bone vibrator. ConclusionThe findings indicate that automated audiometry can yield relaible results that are comparable to conventional test results. Key clinical considerations include extending the response time, regular rest periods, improving instructions and comfort levels.

The Comfort Measures Order Set at a Tertiary Care Academic Hospital: Is There a Comparable Difference in End-of-Life Care Between Patients Dying in Acute Care When CMOS Is Utilized?

Standardized protocols have been previously shown to be helpful in managing end-of-life (EOL) care in hospital. The comfort measures order set (CMOS), a standardized framework for assessing imminently dying patients' symptoms and needs, was implemented at a tertiary academic hospital. We assessed whether there were comparable differences in the care of a dying patient when the CMOS was utilized and when it was not. A retrospective chart review was completed on patients admitted under oncology and general internal medicine, who were referred to the inpatient palliative care team for "EOL care" between February 2015 and March 2016. Of 83 patients, 56 (67%) received intiation of the CMOS and 27 (33%) did not for EOL care. There was significant involvement of spiritual care with the CMOS (66%), as compared to the group without CMOS (19%), P < .05. The use of CMOS resulted in 1.7 adjustments to symptom management per patient by palliative care, which was significantly less than the number of symptom management adjustments per patient when CMOS was not used (3.3), P < .05. However, initiating CMOS did not result in a signficant difference in patient distress around the time of death ( P = .11). Dyspnea was the most frequently identified symptom causing distress in actively dying patients. Implementation of the CMOS is helpful in providing a foundation to a comfort approach in imminently dying patients. However, more education on its utility as a framework for EOL care and assessment across the organization is still required.

Effect of acetabular tilt angle on acetabular version in adults with developmental dysplasia of the hip

To investigate the difference in acetabular tilt angle (ATA) between adults with deve-lopmental dysplasia of the hip (DDH) and normal adults and the effect of ATA on acetabular version. Between February 2009 and October 2015, 31 adult female patients with DDH (39 hips) (DDH group) and 31 female patients with osteoarthritis of the knee (31 hips) who had no history of hip disease (control group) were included in this study. The average age was 39 years (range, 18-59 years) in the DDH group, and was 69 years (range, 52-79 years) in control group. The morphometric parameters of the acetabulum including ATA, acetabular anteversion angle (AAA), acetabular inclination angle (AIA), acetabular cranial anteversion angle (ACAA), and acetabular sector angle (ASA) were mea- sured by CT reconstruction; The ASA was used as an index for acetabular coverage of the femoral head. The correlation between ATA and other parameters was analyzed using Pearson correlation analysis. The values of ATA, AAA, and AIA of the DDH group were significantly larger than those of the control group ( P<0.05). The ASA in all directions was significantly decreased in the DDH group when compared with the values in the control group ( P<0.05). There was no significant difference in ACAA between two groups ( t=1.918, P=0.523). The ATA was positively correlated with AAA and ACAA in the DDH group ( r=0.439, P=0.001; r=0.436, P=0.002), but there was no correlation between ATA and AIA ( r=0.123, P=0.308). In the control group, the ATA was not correlated with AAA, ACAA, and AIA ( r=-0.004, P=0.724; r=-0.079, P=0.626; r=-0.058, P=0.724). Regarding acetabular coverage of the femoral head, the ATA and AAA were correlated negatively with anterior ASA ( P<0.05) and positively with posterior ASA ( P<0.05), but had no correlation with superior ASA ( P>0.05) in the DDH group; AIA was correlated negatively with anterior ASA and superior ASA ( P<0.05) and had no correlation with posterior ASA ( r=-0.092, P=0.440). In the control group, there was no correlation between ATA and ASA in any direction ( P>0.05). In the DDH group, defects of the acetabular anterior wall, lateral wall, and posterior wall were observed in 18 hips (46.2%), 15 hips (38.5%), and 6 hips (15.3%), respectively. ATA value of the posterior wall defect [(15.70±10.00)°] was significantly smaller than those of the acetabular anterior wall and lateral wall defects [(22.91±5.06)° and (21.59±3.81) °] ( P<0.05), but no signficant difference was found between anterior wall and lateral wall defects ( P>0.05). ATA will influence acetabular version in DDH. The anterior rotation of the acetabular fragment during periacetabular osteotomies is an anatomically reasonable maneuver for hips with anterolateral acetabular defect, while the maneuver should be avoided in hips with posterior acetabular defect.

Increased blood flow in keloids and adjacent skin revealed by laser speckle contrast imaging.

Keloids are fibroproliferative lesions of unknown origin that are characterized by increased collagen deposition. Vascularization may play a role in the pathogenesis of keloids, but existing reports are contradictory. Thus, we assessed perfusion within keloids and surrounding skin using laser speckle contrast imaging (LSCI). Twenty-one patients with 61 untreated keloids were enrolled into this study. LSCI was used to evaluate blood flow in the keloids and surrounding skin. Three regions of interest were manually defined: keloids (K), skin adjacent to keloids (A), and nonadjacent skin separated by at least 0.3 cm from the edge of the keloids (N). Mean perfusion in each of these regions was determined and ratios (K/N, A/N) were calculated. Significantly higher perfusion was noted in keloids and adjacent skin compared with nonadjacent skin (P < 0.05). The mean values (95% confidence intervals) of the ratios were: K/N = 2.41 (2.28-2.54) and A/N = 1.33 (1.28-1.37). A heterogeneous perfusion map was frequently observed. Mean perfusion in keloids and nonadjacent skin in the chest region was significantly higher than that on the back (P < 0.05). There was no statistical signficant difference in K/N at different locations (P > 0.05). Perfusion values in keloids and adjacent skin were significantly higher than those in nonadjacent skin. LSCI may be a suitable and useful way of assessing perfusion in keloids.

209 Optimizing vitamin D levels through the winter months in children with cystic fibrosis

Objectives Vitamin D plays a role not only in bone health but also in innate immunity and other biological pathways. Maintenance of adequate vitamin D levels in cystic fibrosis (CF) is challenging, indicating that routine supplementation is often suboptimal. We implemented a protocol using single supra-physiological doses of vitamin D3 – therapy – aiming to attenuate the winter nadir of in vitamin D3. Methods Children with CF were included if they underwent both pre- (May, June) and end-of-winter (August, September) 2013 assessment of vitamin D levels (by chemiluminescent immunoassay) as part of the newly-instituted protocol. Demographic and clinical characteristics were assessed. Vitamin D deficiency was defined as levels Results Eighty-four patients (age: 2 months to 19 yrs) met the inclusion criteria of whom 41 (48.8%) were vitamin D 3 deficient pre-winter (stoss group) and 43 (51.2%) had sufficient levels (no stoss group). Clinical and demographic characteristics were similar between the two groups. Vitamin D 3 levels increased significanlty in those treated by stoss (pre-winter mean±SEM: 53.9±2.1 nmol/L; post-winter: 74.1±3.9 nmol/L; p 75 nmol/L obtained in 16 (39.0%). Vitamin D3 levels did not change significantly in those not treated by stoss (p = 0.197). There was no signficant difference in vitamin D 3 levels between the two groups post-winter (p = 0.6815). Conclusion Stoss vitamin D3 therapy given in addition to routine supplementation attenuates the winter nadir in children with CF.