Significant Statistical Difference Research Articles

Analysis of the Wear Parameters and Microstructure of High-Carbon Steel in Order to Identify Its Tribological Properties

Alloyed high-carbon steels are materials primarily intended for components operating under conditions of intense tribological wear. The carbides present in the microstructure of these materials significantly contribute to improving the wear resistance of such alloys. However, changes in the morphology of these precipitates can considerably alter the wear rate, leading to a deterioration in the properties of the materials. Therefore, this study aims to analyze the influence of several factors on the tribological wear of alloyed high-carbon steel. The research included friction tests under various load conditions and different sliding paths. Additionally, the samples were subjected to heat treatment to change the morphology of the observed precipitates. The tribological tests were conducted in a block-on-ring configuration under dry friction conditions. The tribological tests were analyzed statistically using analysis of variance (ANOVA). The results of the statistical analysis indicated that the primary factor influencing the observed differences between the samples was the heat treatment time of the material. Additionally, there were no significant statistical differences when pressure and friction path were varied. These findings, in conjunction with the SEM studies, allowed for the evaluation of the wear mechanism. The results demonstrated that, within the adopted tribological system, no alterations in the wear mechanism were observed with changes in test parameters. The observed differences in wear properties between the samples were found to be related to their heat treatment. The heat treatment resulted in alterations to the particle size distribution, with the annealing of the material at an elevated temperature leading to the dissolution of finer particles within the material. An increase in the average diameter of the carbide present in the material was observed to improve the wear resistance of the alloy tested.

Electrodiagnostic Findings of Median Nerve Motor and Sensory Conduction in Neurological Asymptomatic Newly Diagnosed Patients with Hypothyroidism

BACKGROUND: The influence/impact of thyroid hormones on peripheral nervous system has still not been thoroughly/substantially studied/examined. Neurographic studies, which measure motor and sensory nerve conduction along with F-wave, have an important role in diagnosing diseases of the peripheral nerves since electrophysiological sings of neuropathy can be detected even in subclinical state/cases. AIM: The aims of this study were to assess the neurophysiological parameters of the median nerve by electrodiagnostic measurements using electromyoneurogaphy (EMNG) in the region of radiocarpal joint in patients with newly diagnosed and medically untreated primary hypothyroidism who had no symptoms and signs of peripheral nerve damage/injury/lesion. Furthermore, it was our aim to make an insight of the possible early detection of the latent damage of peripheral nervous system in untreated hypothyroidism. MATERIAL AND METHODS: This was a prospective clinical study that comprised 78 subjects/patients according to inclusion criteria, divided into two groups: one with primary hypothyroidism and the other group involving euthyroid subjects. Thyroid status was examined in each subject; anthropometric parameters were analyzed, and electromyoneurographic imaging (EMNG) of hand median nerve was realized. RESULTS: Of the total number of 78 subjects included in the study, 58 (74.36%) had hypothyroidism and 20 were euthyroid subjects (25.64%). The calculated mean levels of thyroid status parameters in hypothyroid patients, TSH, aTPO and FT4, were 6.19±1.85 mIU/L, 872.22±296.66 U/mL and 0.78±0.11 ng/dL, respectively. In euthyroid patients, the mean levels of TSH, aTPO and FT4 were 0.27±0.08 mIU/L, 31.2071±5.65 U/mL and 1.31±0.25 ng/dL, respectively. Statistically significant differences were obtained between hypothyroid and euthyroid subjects regarding: age (p=0.0147, r=0.3239), body weight (p=0.0441, r= -0.531), body mass index (p=0.0050, r= -0.301), WHO classification for BMI (p=0.0032, r= -0.250), TSH (p<0.0001, r=-0.309), aTPO (p<0.0001, r=0.5554) and FT4 (p<0.0001, r= -0.317). In the group of 58 hypothyroid subjects, 38 (65.52%) were women and 20 (34.48%) were men. A strong correlation and significant statistical difference were registered in EMNG pathological findings in patients with pathologic BMI and with mild predilection for the sensory part of the median nerve. Of the 58 hypothyroid patients, EMNG pathologic findings were present in 18 that, in terms of their features, indicated a distal lesion of the median nerve. These 18 subjects had an increased body mass index (30.83±5.65 kg/m2). CONCLUSIONS: Discovery, definition and explanation of etiopathogenic nodes in peripheral nervous system diseases will require extensive and multidisciplinary strategies in the next decades. These complex conditions, in our opinion, will claim a steady/a step-by-step/ approach to the problems, as well as consistency and symmetry in the design and methodology of the research procedures.

Evaluating the Effects of Prostate Radiotherapy Intensified with Pelvic Nodal Radiotherapy and Androgen Deprivation Therapy on Myelosuppression: Single-Institution Experience.

Prostate cancer (PCa) management commonly involves the utilization of prostate radiotherapy (PRT), pelvic nodal radiotherapy (PNRT), and androgen deprivation therapy (ADT). However, the potential association of these treatment modalities with bone marrow (BM) suppression remains inadequately reported in the existing literature. This study is designed to comprehensively evaluate the risk of myelosuppression associated with PRT, shedding light on an aspect that has been underrepresented in prior research. We conducted a retrospective analysis of 600 patients with prostate cancer (PCa) treated with prostate radiotherapy (PRT) at a single oncology center between 2007 and 2017. Patients were categorized into four cohorts: PRT alone (n = 149), PRT + ADT, (n = 91), PRT + PNRT (n = 39), and PRT + PNRT + ADT (n = 321). To assess the risk of myelosuppression, we scrutinized specific blood parameters, such as hemoglobin (HGB), white blood cells (WBCs), neutrophils (NEUT), lymphocytes (LYM), and platelets (PLT) at baseline, mid-treatment (mRT), immediately post-RT (pRT), 1 month post-RT (1M-pRT), and 1 year post-RT (1Y-pRT). The inter-cohort statistical significance was evaluated with further stratification based on the utilized RT technique {3D conformal radiotherapy (3D-CRT), and intensity-modulated radiation therapy (IMRT)}. Significant statistical differences at baseline were observed in HGB and LYM values among all cohorts (p < 0.05). Patients in the PRT + PNRT + ADT cohort had significantly lower HGB at baseline and 1M-pRT. In patients undergoing ADT, BMS had a significant impact at 1M-pRT {odds ratio (OR) 9.1; 95% Confidence Interval (CI) 4.8-17.1} and at 1Y-pRT (OR 2.84; CI 1.14-7.08). The use of 3D-CRT was linked to reduced HGB levels in the PRT + PNRT + ADT group at 1 month pRT (p = 0.015). Similarly, PNRT significantly impacted BMS at 1M-pRT (OR 6.7; CI 2.6-17.2). PNRT increased the odds of decreased WBC counts at 1Y-pRT (OR 6.83; CI: 1.02-45.82). Treatment with any RT techniques (3D-CRT or IMRT), particularly in the PRT + PNRT and PRT + PNRT + ADT groups, significantly increased the odds of low LYM counts at all time points except immediately pRT (p < 0.05). Furthermore, NEUT counts were considerably lower at 1M-pRT (p < 0.05) in the PRT + PNRT + ADT group. PLT counts were significantly decreased by PRT + PNRT + ADT at mRT (OR 2.57; 95% CI: 1.42-4.66) but were not significantly impacted by the RT technique. Treatment with PRT, ADT, PNRT, and 3D-CRT is associated with BMS. Despite this statistically significant risk, no patient required additional interventions to manage the outcome. While its clinical impact appears limited, its importance cannot be underestimated in the context of increased integration of novel systemic agents with myelosuppressive properties. Longer follow-up should be considered in future studies.

New perspective, more rational decoupling: A case study of China

Scholars usually unconsciously employ the Tapio decoupling model with a static perspective and results-oriented philosophy, which often leads to errors. Therefore, we propose an improved Tapio decoupling model that adopts a dynamic perspective and process-oriented philosophy. Taking China, the world's largest carbon emitter, as a case study, we investigate the decoupling of its provincial industrial carbon emissions (ICE) from industrial value-added (IVA) during 2005–2020 using both the conventional and improved decoupling model, followed by a comparative analysis of their results. Our findings are as follows: (1) Both China's ICE and IVA exhibited a general upward trend during the study period, with non-linear annual ICE and IVA variations observed across all provinces. (2) Overall, China's provincial IVA increasingly decoupled from ICE, with some provinces achieving a strong decoupling state during 2015–2020; however, from the long-term perspective spanning the entire study period, most provinces remained in a weak decoupling state. (3) The conventional decoupling model tends to yield overly optimistic results in empirical study of China, with the decoupling indices during the periods of 2005–2010 and 2005–2020 determined by the conventional model even had significant statistical difference between those determined by the improved model. (4) To ensure equity, differentiated carbon reduction policies should be tailored to each province, considering factors such as absolute carbon emissions, short-term decoupling states, and long-term decoupling states. The improved Tapio decoupling model is proposed as a valuable framework for researchers engaged in related studies.

Cone beam computed tomography analysis of the root and canal morphology of the maxillary second molars in a Syrian subpopulation

AimTo investigate the root number and morphology of the maxillary second molars in the Syrian population besides bilateral symmetry, and the effect of gender.Methods250 Cone Beam Computed Tomography (CBCT) images (140 females, 110 males) were examined by two endodontists. The detailed analysis included the number of roots, the number of canals and their configurations, bilateral symmetry, and relation to gender. The evaluation was made according to Vertucci classification by analyzing the CBCT images at all levels (Axial, Coronal, Sagittal, Oblique, and 3D). The Chi-square statistical analysis was performed to compare the canals’ morphologies and bilateral symmetry in both genders via SPSS.ResultThe most common shape of the upper second molars is three roots (90.4%). There were significant differences between males and females regarding the symmetry of the number of roots (P < 0.05). The root canal configuration was mainly Vertucci type I classification in the Distobuccally (93.4%) and palatal root (99.6%). The most common type in the mesial root was type I (29.5%), showing all varieties of Vertucci classifications (except VII, and VIII) percentage of MB2 of 70.5%. The ratio of symmetry was (59.6%) with no significant statistical difference between the genders (P = 0.708).ConclusionMost maxillary second molars in the examined Syrian population were types (II) (associated with MB2 cases with three roots and four canals). In terms of symmetry, the number of roots surpassed the canal configuration. Males had a greater symmetrical tendency in the number of roots than females.

Analysis of Blood Lipids, Blood Glucose, Blood Uric Acid, and Blood Routine Test Results in Retired Employees of a Unit in the Civil Aviation System

Objective: To investigate and analyze the annual physical examination results of retired employees from a unit in the civil aviation system, focusing on blood lipids, blood glucose, blood uric acid, and blood routine results. The study aims to provide relevant references for formulating reasonable disease management measures for preventing and controlling hyperlipidemia, hyperuricemia, and other conditions in retired employees. Methods: The examination results of 231 participants were collected and analyzed. The participants were divided into four groups based on age: middle-aged group, young-old group, middle-old group, and old-old group. The blood test results were compared across these groups, and an assessment of atherosclerotic cardiovascular disease (ASCVD) risk levels was completed in conjunction with medical history. Blood test results were also compared by gender. Results: There were no significant statistical differences in blood test results when grouped by age. However, the prevalence of hyperuricemia was higher in males than in females, while the prevalence of hypercholesterolemia was higher in females than in males. The LDL-C target achievement rate was lower in the moderate-and-high-risk group as well as the very high-risk group as defined by ASCVD risk levels. Conclusion: Management of hyperuricemia and hyperlipidemia in retired employees (elderly patients) should be strengthened to reduce the risk of ASCVD events and alleviate the potential medical burden associated with disease progression.

Electrochemical Sensor Based on Glassy Carbon Electrode Modified with Carbon Nanohorns (SWCNH) for Determination of Cr(VI) via Adsorptive Cathodic Stripping Voltammetry (AdCSV) in Tap Water

In this study, a new and simple glassy carbon electrode modified with carbon nanohorns (SWCNH/GCE) was used for the determination of Cr(VI) in aqueous matrices via adsorptive cathodic stripping voltammetry (AdCSV). The modified electrode was characterized via field emission scanning electron microscopy and cyclic voltammetry, which revealed a homogeneous distribution of spherical agglomerates of SWCNH on the electrode surface. The modification increased the electrochemically active area from 0.10 cm2 ± 0.01 (GCE) to 0.16 cm2 ± 0.01 (SWCNH/GCE). The optimized analytical conditions were as follows: a supporting electrolyte (0.15 mol L−1 HCl), an accumulation potential of 0.8 V versus Ag/AgCl, and an accumulation time of 240 s. Validation of the analytical methodology was performed, obtaining a linear range between 20 and 100 µg L−1, a limit of detection of 3.5 µg L−1, and a limit of quantification of 11.6 µg L−1 with good accuracy and precision. The method was applied to the analysis of spiked tap water samples, and the results were compared using a flame atomic absorption spectrophotometer (FAAS) with no significant statistical differences.

The Effect of Age on Human Immunodeficiency Virus Risk Related Behaviors among Undergraduate Students at a Historically Black College and University in the United States of America

Objective: HIV infections have taken a heavy toll on young adults in the USA. Most undergraduate students fall within the age group who are at high risk of HIV infections. The effect of age on HIV risk related behaviors among African American undergraduate students has never been investigated before. Thus, this study assessed the effect of age on HIV risk related behaviors among African American undergraduate students at a Historically Black College and University. Methods: A total of 400 respondents were randomly selected from Jackson State University of the USA, a Historically Black College and University. A cross-sectional study design was utilized from January to September, 2016. Data were collected using a validated self-administered standardized questionnaire. Chi-square test was used to see the association between age and HIV risk related behaviors. Results: Over seventy five percent of the study participants have had at least one risk behavior related to HIV infection transmission and there was significant statistical difference between students aged 18-24 years and students aged 25 years and above (p&lt;0.05). The students aged 18-24 years were more likely to participate in risk behaviors that could predispose them to HIV infections (P = 0.02). Conclusions: As the HIV related risk behaviors was higher among students aged 18-24 years old, age appropriate HIV preventive programs that are appealing to young people will be required to effectively prevent HIV infection among this vulnerable population.

Association of MCP-4, NRTN, and PD-L1 with the risk of hepatic fibrosis: A Mendelian randomization study.

Previous studies have confirmed the affiliation between specific inflammatory cytokines and Hepatic fibrosis (HF); however, contradictions remain in the causality. The study implemented a bidirectional two-sample Mendelian randomization (MR) analysis with published statistics derived from Genome-wide Association Studies (GWAS) to investigate casualties between inflammatory cytokines and HF. Additionally, MR analysis was also introduced to consider if 1400 blood metabolites act as the key mediators in this process. Single nucleotide polymorphisms (SNPs) with strong correlations to inflammatory factors were selected for multiple MR analyses in this study. The inverse variance weighted method (IVW) was chosen as the principal analysis, and the others as the supportive. Besides, sensitivity tests were involved to identify potential heterogeneity and pleiotropic level. IVW methods revealed that a relatively high level of prediction-based monocyte chemoattractant protein-4 (MCP-4) (95% CI: 1.014-3.336, P = .045), along with neurturin (NRTN) (95% CI: 1.204-4.004, P = .010), may increase the risk of HF; while programmed cell death 1 ligand 1 (PD-L1) (95% CI: 0.223-0.928, P = .030), showed a protective effect on HF. No significant statistical differences were detected on any other inflammatory cytokines, nor did the impact of HF genetic predisposition on the 91 circulating inflammatory cytokines-related characteristics.

Short-term outcomes of totally robotic versus robotic-assisted distal gastrectomy for gastric cancer: a single-center retrospective study

BackgroundTotally robotic distal gastrectomy (TRDG) is being used more and more in gastric cancer (GC) patients. The study aims to evaluate the short-term efficacy of TRDG and robotic-assisted distal gastrectomy (RADG) in the treatment of GC.MethodsWe retrospectively collected the clinical data of patients who underwent TRDG or RADG, of which 60 patients were included in the study: 30 cases of totally robotic and 30 cases of robotic-assisted. The short-term efficacy of the two groups was compared.ResultsThere was no significant difference in the clinicopathological data between the two groups. Compared to RADG, TRDG had less intraoperative blood loss(P = 0.019), less postoperative abdominal drainage(P = 0.031), shorter time of exhaust( P = 0.001) and liquid diet(P = 0.001), shorter length of incision(P<0.01), shorter postoperative hospital stays(P = 0.033), lower postoperative C-reactive protein(CRP)(P = 0.024) and lower postoperative Visual Analogue Scale(VAS) scores(P = 0.048). However, no significant statistical differences were found in terms of total operation time(P = 0.108), number of lymph nodes retrieved(P = 0.307), time for anastomosis(P = 0.450), proximal resection margin(P = 0.210), distal resection margin(P = 0.202), postoperative complication(P = 0.506), total hospital cost(P = 0.286) and postoperative white blood cell(WBC)(P = 0.113).ConclusionsIn terms of security and technology, TRDG could serve as a better treatment method for GC.

Assessment of household solid waste characteristics, quantity, and management practices in Dangila Town, Ethiopia.

Solid waste refers to the material that is discarded because of human activity. In developing countries like Ethiopia, rapid urbanization leads to the production of large amounts of solid waste in towns. As a consequence, it causes severe problems to human health, aesthetics, and the environment, particularly in Dangila Town. Therefore, this study aimed to assess household solid waste characteristics, quantity, and management practices. Data was collected for seven days in January 2020 from 73 households, which were divided into three income groups. Observations, interviews, field measurements, sorting, and open-ended questionnaires were used as data collection tools. The research showed that food waste and ash and dust were the most dominant fractions, comprising 41.04% and 26.18%, respectively. It was also revealed that 77.88%, 12.74%, and 9.38% of household solid waste was decomposable, recyclable, and disposable waste, respectively. Furthermore, the waste components showed a significant statistical difference among income groups, except for the metal and miscellaneous groups. The quantification result indicated that the per capita household generation rate was 0.26kg/day. The management practice assessment found that most households did not practice integrated solid waste management options. They disposed of waste indiscriminately, leading to environmental pollution. The results of this study suggest that the municipality needs to create awareness among households regarding proper solid waste management practices. It is crucial to apply appropriate solid waste management mechanisms and establish a well-organized institution that will collect solid waste in the town and achieve a circular economy.

Assessing Placental Shear Wave Elastography as a Tool for Evaluating Preeclampsia.

Background Hypertensive disorders of pregnancy, especially its dreaded complication preeclampsia, remain a major cause of morbidity and mortality for both the mother and the fetus. Existing tools for the prediction of preeclampsia remain inadequate in their sensitivity and specificity. Hence, there is an urgent need for a reliable, economically feasible, and objective marker for its diagnosis/early prediction. In this regard, shear wave elastography has shown great promise. Shear wave elastography is a novel method to quantify tissue stiffness, which is objective and has significantly lower inter-observer variability. Objectives We aim to quantify the tissue elasticity using point shear wave elastography (pSWE) in the placentas of diagnosed cases of preeclampsia and to compare them with the placentas of healthy controls in order to evaluate if there is a significant statistical difference between the two. Materials and methods This comparative study was conducted at the Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India, from August 2022 to July 2024. The study included 60 participants, divided into two groups: 30 patients with preeclampsia and 30 healthy pregnancies. Placental stiffness was measured using a Samsung HS70A ultrasound machine (Samsung Electronics Pvt. Ltd., Seoul, South Korea), and pSWE was performed with a curvilinear probe. Data was analyzed using IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States), and the significance of differences between the two groups was assessed using an independent t-test with a p-value of <0.05, considered statistically significant. Results The mean placental stiffness, measured in kilopascals (kPa), was significantly higher in the preeclampsia group (11.71 ± 1.52 kPa) in comparison to the healthy group (3.36 ± 0.66 kPa) (p = 0.001). Patients suffering from preeclampsia were found to have significantly higher levels of placental stiffness. Conclusion Early diagnosis remains key to managing preeclampsia so that adequate monitoring and treatment could be provided to the patients. Our study showed that there is a significant statistical difference in the placental stiffness in patients with preeclampsia in comparison to a healthy placenta. Hence, shear wave elastography can be used as a supplementary tool to aid in the diagnosis/prediction of preeclampsia.

Superior Measurement Accuracy of Digital Thickness Gauge Versus Digital Vernier Caliper in Determining Venous Tissue Thickness.

Background In determining mechanical characteristics, the accuracy of the thickness of the specimens can influence the biomechanical behavior, especially in the case of human tissues, where there is an important variability. This study aims to compare the accuracy of two routine measuring instruments, i.e., the digital vernier caliper and the digital thickness gauge, when measuring the thickness of venous specimens multiple times. Methodology In this study, we used 12 tubular vena cava specimens obtained from common breed pigs aged 18-24 weeks at the time of sacrifice from a local slaughterhouse. The measurements were performed using a digital vernier caliper (Multicomp PRO MP012475) for the first four protocols and a digital thickness gauge (Mitutoyo 547-500S) for the fifth protocol. In the first protocol, three measurements were taken on the same side, and their average was recorded as the sample thickness. The second protocol involved taking measurements on two opposite sides, and the average of these measurements was recorded as the sample thickness. In the third protocol, the thickness of each side was measured at its midpoint, and the average of the four measurements was recorded as the sample thickness. In the last protocol using a digital vernier caliper, the thickness of the vernier specimens was calculated as the average of the measurements taken at each corner of the square sample. Finally, for the fifth protocol, three consecutive measurements were taken using the digital thickness gauge, and their average was recorded as the final thickness of the sample. Results In the first protocol, we observed lower values during the first measurement in comparison to the second (0.409 ± 0.063 vs. 0.536 ± 0.064, p < 0.0001) and the third (0.409 ± 0.063 vs. 0.528 ± 0.055, p = 0.0001). Moreover, with the second protocol, we observed lower values during the first two measurements in comparison to the third measurement (p = 0.0279 and p = 0.0054). Regarding protocols three and four, we recorded higher values for the second and third measurements than the first one, with higher values for the third measurement than the second one. In the fifth protocol, there were no significant statistical differences between the three consecutive measurements (p = 0.953, p = 0.742, and p = 0.897). Further, we examined the variations in sample thickness determined using each of the protocols proposed for the digital vernier caliper, as well as the values obtained with the digital thickness gauge protocol. As a result, during the first and second measurements, we observed lower thickness values for the venous wall samples using the first four protocols compared to the fifth protocol (for all p < 0.05). However, no differences were noted between the five protocols during the third measurement. Conclusions The digital thickness gauge Mitutoyo 547-500S provided superior accuracy with no difference between three successive measurements of venous wall thickness, regardless of the examiner's experience. Accurately determining the thickness of venous specimens is crucial for calculating the tissue's biomechanical properties.

Fuchs’ Endothelial Corneal Dystrophy evaluation using a high-resolution wavefront sensor

This study aims to evaluate the applicability of the high-resolution WaveFront Phase Imaging Sensor (WFPI) in eyes with Fuchs’ Endothelial Corneal Dystrophy (FECD) through qualitative and quantitative analysis using a custom-designed Automatic Guttae Detection Method (AGDM). The ocular phase was measured using the t·\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\cdot$$\\end{document}eyede aberrometer and then was processed to obtain its High-Pass Filter Map (HPFM). The subjects were pathological and healthy patients from the Fundación Jiménez-Díaz Hospital (Madrid, Spain). The AGDM was developed and applied in pupils with 3 and 5 mm of diameter. A set of metrics were extracted and evaluated like the Root-Mean-Square error (RMS), Number of guttae, Guttae Area, and Area of Delaunay Triangulation (DT). Finally, a Support Vector Machine (SVM) model was trained to classify between pathological and healthy eyes. Quantitatively, the HPFM reveals a dark spots pattern according to the ophthalmologist’s description of the slit-lamp examination of guttae distribution. There were significant statistical differences in all the metrics when FECD and Healthy groups were compared using the same pupil size; but comparing both pupil sizes for the same group there were significant differences in most of the variables. This sensor is a value tool to objectively diagnose and monitor this pathology through wavefront phase changes.

Impact of Isotretinoin on Blood Lipids and Liver Enzymes: A Retrospective Cohort Study in Saudi Arabia.

Isotretinoin is an effective treatment for acne but can cause side effects such as changes in blood lipids and liver enzymes. Laboratory monitoring is essential during treatment, but there is variation in monitoring practices. This study aims to investigate the relationship between isotretinoin therapy and its effects on complete blood count in Saudi Arabia to improve patient outcomes. The study was a retrospective cohort study conducted at King Khalid University Hospital in Riyadh, Saudi Arabia, between January 2016 and December 2020. Following the inclusion and exclusion criteria, 515 patients were randomly selected for the study. The data was analyzed using SPSS, and descriptive statistics and paired samples t-tests were employed to analyze the data. In this study, 515 patients were enrolled. Of these participants, 76.7% (n=395) were females and 23.3% (n=120) were males. The mean age of the study participants was 23.98±7.4 years and ranged between 16 and 65 years. The mean dose of Isotretinoin administered was 27.65±9.6 mg/day, with a range of 10-60 mg/day. The mean BMI of the study participants was 24.3±4.1 kg/m2, ranging from 14.3 to 44.8 kg/m2. Regarding the effect of Isotretinoin on laboratory measures, significant statistical differences were found in hemoglobin measurements (t=-3.379, p=0.001), platelets (t=-3.169, p=0.002), neutrophils (%) (t=3.107, p=0.002), total cholesterol (t=-13.017, p=0.000), AST (t=-6.353, p=0.000), ALT (t=-4.352, p=0.000), HDL (t=2.446, p=0.015), and LDL (t=-12.943, p=0.000). However, there were no significant statistical differences in the measurements of WBC, neutrophils (count), or triglycerides. In the Chi-square analysis and Fisher's Exact test to identify the interaction between BMI, dose, and gender on abnormal lab results, significant interaction was found between participants' BMI and abnormal HDL measurements (p=0.006). Furthermore, there were significant interactions between Isotretinoin dose (either less than 30 mg/day or 30 mg/day or more) and abnormal neutrophil count (p=0.04), abnormal HDL measurements (p=0.010), and abnormal triglycerides measurements (p=0.020). Moreover, a statistically significant interaction was found between participants' gender and abnormal hemoglobin measurements (p=0.006), abnormal total cholesterol (p=0.016), abnormal AST measurements (p=0.001), abnormal ALT measurements (p=0.000), abnormal HDL measurements (p=0.000), and abnormal triglycerides measurements (p=0.007). In conclusion, the study found that isotretinoin therapy has significant effects on several laboratory measures, including hemoglobin, platelets, neutrophils, total cholesterol, AST, ALT, HDL, and LDL. The study also revealed significant interactions between BMI, dose, gender, and abnormal lab results.

Team-based Learning (TBL) in Medical Education: Fostering Collaboration and Enhancing Learning Outcomes

ABSTRACT Background and Aim: Team-based learning (TBL) is an instructional strategy that has gained popularity in various educational settings, including anatomy courses. It is an active learning approach that encourages students to work collaboratively in small teams to solve problems, discuss concepts, and apply their knowledge. Therefore, the purpose of this study was to assess how well students engaged with and learned about anatomy through the medium of TBL. Materials and Methods: The current study was carried out for phase I MBBS students in the Department of Anatomy at KAHER’s J N Medical College, Belagavi. TBL sessions included 65 students. One week prior, students were provided pertinent reading materials for the gross anatomy topics that were chosen. The Pre-TBL test, which was composed of five MCQs based on case scenarios, was administered before the start of the session. Students completed the Individual Readiness Assurance Test (IRAT), which had ten multiple-choice questions (MCQs) at the start of the class. The students were then put into groups where they collaborated on the same MCQs, talked about the topics, and provided identical answers. This is called the Group Readiness Assurance Test (GRAT). A post-TBL test was given after the case scenario discussion to wrap up the session. This test’s questions were the same as those on the Pre-TBL. Results: The effect sizes provide insights into the magnitude of change observed between pre-TBL and post-TBL test scores. In this study, significant statistical differences were found between pre and post-TBL tests across all sessions [Table 1, P &lt; 0.001], indicating larger effect sizes associated with more significant improvements in learning outcomes attributed to TBL. This aids in interpreting the statistical significance of the results. Conclusion: TBL can help students achieve academic success through teamwork. Study revealed that TBL is one of the most effective ways to teach anatomy and can complement traditional didactic lectures.

Recognizing red flags for alternative diagnoses in pediatric chorea beyond Sydenham's

BackgroundChorea is a common movement disorder in children, requiring thorough clinical assessment and appropriate tests for etiological diagnosis. Early identification of treatable conditions can lead to effective treatment, reducing morbidity and improving quality of life. ObjectiveTo describe the clinical, demographic, and epidemiological characteristics of children and adolescents diagnosed with chorea. MethodsA retrospective cross-sectional study of pediatric patients treated in a fourth-level hospital in Bogotá, Colombia, from January 2008 to January 2022. Results81 patients with chorea were found. The most frequent etiologies were rheumatic fever (50.6 %), vascular chorea (29.3 %), and chorea secondary to lupus (11.1 %). Patients with chorea secondary to rheumatic fever (Sydenham's chorea) were older compared to other etiologies, 10.36 ± 3.41 years vs 8.29 ± 5.16, p = 0.037. The presence of another movement disorder or abnormalities during the physical examination suggests a different etiology from rheumatic fever. Moreover, the presence of psychiatric symptoms was similar in all etiologies. However, a correlation between age and psychiatric symptoms was observed with an odds ratio of 1.14 95 % CI 1.02–1.29 per year. ConclusionsRed flags in Sydenham's chorea suggesting an alternate etiology are younger age, the presence of other abnormal movements or other findings in the neurological exam or in the magnetic resonance imaging. No significant statistical differences were found between the etiologies with the presence of neuro-psychiatric manifestations. Nevertheless, these manifestations are very frequent in abnormal movements. This study evidenced the positive correlation between age and the presence of psychiatric symptoms.

Comparison of Proliferating Cell Nuclear Antigen (PCNA) Expression among Nasal Polyp and Chronic Rhinosinusitis

Background and objectiveChronic rhinosinusitis is a common inflammatory disorder in sinonasal mucosa that could be developed with or without nasal polyps. Cellular proliferation is suggested as a possible mechanism of nasal polyp development. However, conducted studies in this context are limited. So, the present study's aim is the comparison of proliferating cell nuclear antigen (PCNA) expression in nasal polyps and chronic rhinosinusitis. Materials and methodsIn this cross-sectional study, 70 nasal polyp and 60 chronic rhinosinusitis samples from patients referred to Mostafa Khomeini Hospital, Tehran from 2017 to 2022 were immunohistochemically stained by PCNA marker. The percentage of PCNA nuclear expression was determined in two groups and its association with the type of pathological lesion and the patient's age and sex was analyzed by SPSS statistic software version 24 statistical software (IBM Statistics, USA). ResultsThe mean percentage expression of PCNA in nasal polyp and chronic rhinosinusitis samples was 16.55 ± 13.66 and 17.58 ± 12.68 respectively (ranging from 0 to 57 in both groups) however, there was no significant statistical difference between the two groups (p = 0.479). No relationship was found between PCNA expression with age and sex in none of the chronic rhinosinusitis and nasal polyp groups. ConclusionProliferative activity of the nasal epithelial cell is similar in chronic rhinosinusitis with and without nasal polyps and it is considered that the increase of epithelial cell proliferative activity probably has no role in nasal polyp development in patients with chronic rhinosinusitis.

No difference between 5 and 6 weeks of non-weight bearing after osteochondral grafts for medial osteochondral defects of the talus with medial malleolar osteotomy.

The present study aimed to compare the clinical outcomes and safety at a 1-year follow-up after 5 or 6 weeks of non-weight bearing after a Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for a medial osteochondral lesion of the talus (OLT). A retrospective comparative case-control analysis of prospectively followed patients who underwent a TOPIC procedure with medial malleolus osteotomy was performed. Patients were matched in two groups with either 5 or 6 weeks of non-weight bearing. Clinical outcomes were evaluated using the Numeric Rating Scale (NRS) during walking, rest, running, and stairclimbing. Additionally, the Foot and Ankle Outcome Score (FAOS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were assessed. Moreover, radiology and complications were assessed. Elevenpatients were included in the 5-week non-weight bearing group and 22 in the 6-week non-weight bearing group. No significant differences were found in any of the baseline variables. The NRS during walking in the 5-week group improved by 3.5 points and 4 points for the 6-week group (p = 0.58 at 1-year post-operatively). In addition, all other NRS scores, FAOS subscalesand the AOFAS scores improved (all n.s. at 1 year follow-up). No significant differences in radiological (osteotomy union and cyst presence in the graft) were found. Moreover, no significant differences were found in terms of complications and reoperations. No statistical significant differences were found in terms of clinical, radiologicaland safety outcomes between 5 or 6 weeks of non-weight bearing following a TOPIC for a medial OLT. Level III, Therapeutic.

How Effective is Deep Inspiration Breath Hold in Minimizing Cardiac Doses During Hybrid Radiotherapy Treatment for Left-Sided Breast Cancer with Comprehensive Regional Nodes?

In the context of left breast cancer radiotherapy, long term cardiopulmonary toxicity has been well-documented, significant efforts have been undertaken to mitigate such toxicity by using 4D gating, deep inspiration breath-hold(DIBH) and active breath control(ABC) techniques. To evaluate and compare the cardio-pulmonary radiation doses incurred during postmastectomy radiotherapy (PMRT) in two distinct breathing conditions such as DIBH and Free Breathing (FB), with a specific focus on the left chest wall with comprehensive regional nodal irradiation. A prospective dosimetric study was conducted on 15 patients who received adjuvant loco-regional radiotherapy of chest-wall (CW), supraclavicular fossa(SCF), and internal mammary region(IMC), with or without axilla. Two sets of planning CT scans were taken in DIBH and FB conditions. The dosimetric difference between DIBH CT and FB CT plans analyzed using Wilcoxon signed-rank test, employing SPSS software version 21.0. Comparison of DIBH and FB parameters for target coverage revealed a statistically significant advantage with DIBH in SCF(D95, V90, p<0.017) and IMC(D98, V90 & V95, p<0.03). Dosimetric characteristics of heart and LAD exhibited statistically significant lower doses with DIBH (V20, V25, and Dmean, p<0.001) compared to FB plans. Lung doses were similar with no discernible advantage of one technique over the other. Other OARs such as contralateral breast (p=0.027) and esophagus (p=0.001) received lower doses with the DIBH technique while the spinal cord (p=0.691) and thyroid(p=0.496) showed no significant difference. Maximum heart distance (p= 0.001), central lung distance (p= 0.011) and Haller index (p= 0.001) exhibited statistical significance between the two techniques, whereas chest wall separation showed no significant statistical difference (p=0.629). DIBH demonstrates a substantial reduction in cardiac and LAD doses compared to the FB technique. This study underscores the efficacy of DIBH as a viable strategy for mitigating cardiac and LAD radiation doses in left-sided breast cancer patients undergoing PMRT of chest wall with comprehensive regional nodes.